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Covid-19 update and guidance to limit spread (flattenthecurve.com)
510 points by tectonic 19 days ago | hide | past | web | favorite | 358 comments



This graph showing how many days other countries are behind Italy's infection rate is quite alarming [1]. Especially the close alignment of most of the countries.

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

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

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

[3] https://www.dailymail.co.uk/health/article-8095299/Man-under...


The bit of good news which isn't entirely clear from a log-scale chart of total number of cases, is that today's number of new cases in Italy is down significantly.

New Cases: [1]

   March 6  - 640
   March 7  - 1145
   March 8  - 2314
   March 9  - 1797
   March 10 - 977
Alternative Data Source: [2]

   March 6  - 640
   March 7  - 1145
   March 8  - 1326
   March 9  - 1598
   March 10 - 529
In perhaps two more days we can say definitively that growth rate has peaked in Italy.

[1] - Direct from daily government reports - e.g. http://www.salute.gov.it/portale/news/p3_2_1_1_1.jsp?lingua=...

[2] - http://opendatadpc.maps.arcgis.com/apps/opsdashboard/index.h...



This shows at least some increase from Lombardy...?

http://www.salute.gov.it/imgs/C_17_pagineAree_5351_4_file.pd...

vs. yesterday

http://www.salute.gov.it/imgs/C_17_pagineAree_5351_2_file.pd...

And the day before...

http://www.salute.gov.it/imgs/C_17_pagineAree_5351_0_file.pd...

The drop in new Lombardy cases is precipitous, I agree, we'll know for sure in a couple days.


The comments I quoted say that today's Lombardy update is partial - deaths are counted in, but total cases not yet. That's apparently as of 3-4 hours ago, told in the Italian TV just after the numbers report.

I.e. the first PDF you link doesn't have complete numbers per official government admission.


Meanwhile, back in the real world where data can be noisy:

https://www.worldometers.info/coronavirus/country/italy/


There is another page that shows the case numbers by country.

https://mackuba.eu/corona/

A few countries look like they have reached an inflection point (see number of daily new cases going back for example) but that could be a problem of testing (or lack thereof).


If I'm to believe random comments on /r/CoronaVirus by people claiming to be working in healthcare (or related to such people), in Italy, they're not testing everyone in ICUs anymore, as there's little point or time (high prevalence of disease, completely saturated medical system). This implies the number of cases there is going to be underreported.

Also note RE today's Italy stats - they're only partial, Lombardy (i.e. the region with most cases) isn't counted in yet.


Anaesthetist Jason van Schoor from UCL tweeted a rather long chain [1] from his friend in Italy and the situation seems to be indeed very, very bad.

The pressure on the healthcare system from the virus seems to be simply massive and the system cannot keep up nor maintain a level of care for everyone who enters the system.

[1] https://twitter.com/jasonvanschoor/status/123714289107769753...


For those who haven't seen it and don't want to read the whole thread (though they should!), the IMO most salient part:

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.

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


Please update Morocco, as it should be 3 cases and 1 death.


The website is run by someone else. It looks like it was not updated at all today.


They updated it now.


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


Technically it is like a flu but I don't think people realize how bad flus can be. The 1918 one killed about 2.7% of the population which would be 200 million with the present population. Hopefully covid19 won't be that bad.


I totally understand the reaction is totally different from the flu.

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


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


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

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

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

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

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

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

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

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

[5] -https://www.reliasmedia.com/articles/136827-the-next-pandemi...


Life Care Center in Washington had 120 residents a week ago. Now 19 of them are dead.[1] Does that sound like "just the flu?"

There's plenty of evidence that this is much worse than the flu. R0 is >2, compared to 1.3. Mortality rate seems to be at least 5x higher. And those are low bounds. And this is all adding to the regular load on hospitals. It has observably overloaded hospital capacity in China and Italy.

[1]: https://www.chron.com/news/education/article/Washington-viru...


You're right but it could be people are getting over-reacting and thus causing more panic and more buying. It is more worry some economically speaking than medically.


That's true, but it doesn't take into account the relative population of the various countries.

Also, I'd love to see it broken down by city. I figure my city is at least a week ahead of Seattle.


Relative population doesn't matter at this stage. Relative population density might matter, a little.


Relative population only becomes important once a significant portion of the population is infected. Until that time you'd expect a roughly exponential increases from the original outbreak.


Testing is very limited in many countries. In Switzerland for example, testing is only done for very limited groups of persons with severe and for some medical staff. Broad testing never took place.


Testing in the US is just coming online after everyone started going around the CDC and developed their own tests.

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

Scroll down to the table showing testing rates per million.

   Guangdong China: 2820
   South Korea: 3692
   Italy: 826
   US: 5


Maybe a better metric would be % of ICU utilization.


Do you have a source for this image/the data in this image? It's a great plot, but would like to confirm the veracity.


Here is an ugly chart I made using Johns Hopkins data: https://mobile.twitter.com/fagiolinux/status/123705989830484...

I used logarithmic scale and normalized per million people, so despite the ugliness the exponential growth is quite clear, even in countries with relatively few cases.


It's clear, right there in the data.

https://github.com/CSSEGISandData/COVID-19

I've been plotting this data myself for a few countries in EU over the past days, and the trend is plainly visible.

Steps to reproduce the effect:

1) Load https://github.com/CSSEGISandData/COVID-19/blob/master/csse_... into your favourite data processing package (mine is Excel, here's the PowerQuery for data mangling I did, valid up to yesterday's cases: https://gist.github.com/TeMPOraL/2a26d3a1da551fb818efce87493...),

2) Select Italy and other countries of interest, and plot on a log scale.


Excellently informative graph! I had been meaning to plot something just like it but got distracted by other things. Do you have a source for the data and/or the graph?


Here's the data provided by Johns Hopkins University; they collect WHO and CSSE reports. That's what you see on the popular JHU coronavirus map (though the repository is often few hours behind the map).

https://github.com/CSSEGISandData/COVID-19


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


I am facing a similar issue with my aging parents. They are both 70+. They both get respiratory issues every year. My Mom in particular is convinced she is healthy and doesn't need to worry about it. I understand why she is resistant towards the notion that she is vulnerable (I have similar issues confronting my own aging, and I am roughly 40 years younger), but it still pains me to discuss this with them. I lose my patience, which isn't helpful. I am growing more and more fearful that they will put themselves at risk, become infected, and then not survive when the hospitals are overwhelmed.

If anyone has any ideas about how to communicate about this with them, I am all ears.


I went through this today. In German there‘s a really great Podcast „Coronavirus-Update“: https://www.ndr.de/nachrichten/info/podcast4684.html

30 min/weekday a science journalist talks to Christian Drosten, a world-renowned expert on Coronaviruses, who explains things in a very concise manner. Yesterdays episode was „We have to protect the elderly“, where Drosten talked about the high risk for the sick and elderly and trying to fully get this point across to his own father over the weekend. He also mentioned that we should work on hopefully achieving a broader societal awareness of this over the next week or two.

I talked to my mother and father a bit first, sent my mother a link to this episode and told her to put me on speakerphone. We then listened to it together and discussed it a bit afterwards. I found this to be really helpful.

My mother was in denial until 2 weeks ago, when she went a bit hysterical for a day and has been concerned (but okay) since. My father was mostly in denial until today. He also bailed out soon after the podcast ended, because it was a bit much for him. But overall he took it quite well and is taking it more seriously now.

Overall I am very happy with the way this went. Sorry, this isn‘t very helpful if you don‘t speak German. But maybe you are able to find a similar thing in your native language.


It's a good podcast. Since some may have a limited command of the german language, they made a full transcript: https://www.ndr.de/nachrichten/info/Coronavirus-Update-Die-P...


Your self-awareness, self-accountability, and emotional IQ to ascertain the likely source of her resistance are all extremely admirable.

It sounds like you need to convince her of two things: (1) she is vulnerable; and (2) she must change.

How about focusing on #2?

Instead of asking her to change for herself, perhaps suggest this could protect friends and others around her who may be more vulnerable. An appropriate analogy may be secondhand smoke. Maybe her lungs are resilient enough to withstand the toxic effects of smoking, but what about the lungs of all her loved ones?

Hopefully others can chime in with better ideas. I hope you and your family, and we all, can remain safe and healthy during this crisis.


"If anyone has any ideas about how to communicate about this with them, I am all ears. "

First of all, respect them. Even if they might be wrong, they are adults, who have the right, to make their own decisions. You can stress the point, how worried you are and provide them with a good article etc., that in this case some caution is advised, but try not to push them.

Also, eventually everybody has to die. When you are 70+ it can happen any moment. I can understand to not want my last years to live in fear of every disease there is. And there are plenty of them, which are especially dangerous for old people, because .. they are older and weaker.


By appealing to pathos aka emotions. Most intelligent people resent this style of persuasion.

Your parents are on death's doorstep as is everyone in their later years. It may be more meaningful to figure out what experiences you'd like to share with them in the limited time you have left instead of trying to prolong their existence at the cost of straining the relationship.

In other words don't put off whatever you might potentially regret not having done if they were to pass away suddenly - with each passing day, the inevitable conclusion every human being shares only draws closer.


I think the most important thing is to ask CLEARLY for what you want. Do you have a specific list of social distancing practices you would like them to implement? Do you want them to stockpile supplies? How many supplies? What is on your shopping list?

"Please take this seriously" is not a request. It's barely even english. It also contains an out of context judgement which you should also try to avoid. Use objective observations instead. So rather than saying "I think you're irresponsible", tell them the actual concrete things they said or did, that led you to that assessment. Something like "I notice you rode the bus during peak hours five times last week." is an example of an objective observation, devoid of judgement or criticism.


Many thanks to everyone for their thoughts. It will take me some time to digest it all.


What medical authorities are saying (in the EU) is that while widespread contagion is inevitable, we don't want everybody to get infected at the same time, because that would overwhelm medical resources and prevent serious cases from getting treated properly. Therefore it seems that the idea is not so much to stop the virus but to just slow it down.


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


Regardless of the merits from an individually selfish standpoint, this kind of behavior would be extremely anti-social.

The overriding public health concern is slowing the spread as much as possible. Even if in the asymptote the same number of people are infected, spreading that burden out over a protracted time period minimizes overloading on the healthcare system.

If even a small percent of the population became "bug-chasers", it would supercharge the rate of transmission. Especially because the incubation period is so long. The same unhygienic behavior of trying to acquire the disease, would very likely also spread the disease by the asymptomatic.

If you put any ethical weight on the consideration of other human beings, then the very minor plausible individuals benefits are more than outweighed by the massive social harm.


It may be too late for that, in the same sense that all the folks who chase the hot startup idea that just appeared in the news are too late. There's about a 3-week lag time between contracting the virus and needing serious medical care. The folks in the ICU now generally contracted it in early February. With a doubling time of roughly 4 days, there'll be 5 doublings = 32x increase of cases in that time frame. It's very likely that if you contract it now, by the time you need ICU support so will everyone else, and you'll be left to fend for yourself in a hallway while in serious respiratory distress.


OK so you think the early "slots" are better. Maybe they are. If you manage to get in slot n anyone you infect will be forced to take n+1 (perhaps not as good) and the exponentially increasing set of people _they_ infect will be forced to take n+2, n+3, ...

Now there are a lot more people in those time slots all competing for the same doctors and hospital beds, etc.

Congratulations, you made the curve a little less flat :(


If anything, experience from China has shown that the early slots are not better. The mortality % has gotten better over time as they've figured out what works, what doesn't, and how to properly manage the disease. For example, there's some retrovirals being given now that appear to be successful to some degree. That wasn't known in the early progression of the illness.

Odds are decent an even more effective treatment will be found in the coming months, and if you can stave off your infection date till then you'll be better off (which of course presumes that you will get the virus at all, which is far from a given).


You're assuming you would get it no matter what: you might not, especially given the precautions that are being taken. And there's a non-zero chance of dying. Assuming you're in a low risk age group from 20-50, you have, at minimum, between a 1 in 500 to a 1 in 250 chance of dying. Sure, you're much less likely to die than not die, but those still aren't odds I'd play willingly.


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

[1] https://www.businessinsider.com/wuhan-coronavirus-risk-of-re...


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

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

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


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


According to top health officials in Norway (as seen on a TV program last night), reinfection is not likely, at least in the short run. And the Japanese case apparently is based on a misunderstanding, not an actual reinfection.

Over the long haul, reinfection is quite possible, since immunity wears off with time. It is not considered unlikely that this disease will be with us forever. In that case, vaccination will perhaps be our best tool to manage it.



That's actually not a bad strategy in a selfish sense, assuming that the virus grows otherwise normally. Obviously, the problem is that if everyone did it we'd be looking at the apocalyptic worst case extreme! Everyone would be sick simultaneously and have to endure the virus with no health care resources at all.

The more practical problem is that the growth is exponential, so the window between "no one has it, it's safe to get it now" and "everyone has it, mass quarantine" is just a few weeks. Add to that that the virus has a 5-6 day incubation period and it basically doesn't work. Statistically, by the time you know someone sick from whom you can infect yourself, the number of people with still-incubating cases (who are AHEAD of you in the "queue"!) is probably enough to overwhelm health care facilities anyway.

Don't do this.


I want to get it late - ideally I can hold off long enough for an effective vaccine and never get it. Lacking that, maybe at least someone will discover a better treatment. Maybe in a few months we will discover some existing rabies drug also helps this treatment, or some other such thing. There are also some other anti-virals in development, maybe one of them will turn out to be somewhat useful. However it will take time for doctors to figure that out. I'd rather they learn on someone else.


Chloroquine is looking quite promising eg see the linked article here https://www.reddit.com/r/COVID19/comments/ffztou/expert_chlo...

Even with that there seem bureaucratic type delays till it gets used. I just took some as a prophylactic which is totally unproven but as a clinical treatment it seems to work well in trials.


There are some points in the article: https://www.flattenthecurve.com/#DO_NOT_BE_CARELESS

> Don’t be that person. It might not be about you but it is everyone’s problem. Don’t be careless in the hopes you get sick when you can “avoid the rush.” There is zero benefit to individuals or the population to getting sick early in the pandemic. You would be putting the lives of others at risk. It is not just that people are dying, but how they are dying. To say nothing of the physical trauma, emotionally speaking this is the opposite of a “good death”. People are dying alone, quarantined from those they love.

> Early reports are that people who recover develop antibodies that provide immunity if they are infected with the same strain again. However, this is great news for vaccine development, so flatten the curve and wait it out.

> This can get very serious; one person described the pain as feeling like her lungs were being put through a pasta maker. 10% of cases require ICU care and mechanical ventilation. Even if autopsy reports from China have been misrepresented or overstated, there is a possibility of long term or permanent lung damage if you do get sick and recover. There are lot of gaps in the information about lung damage, mostly because everyone qualified to let the public know exactly what is going on is already very busy saving lives and putting their own at risk.


If you get infected, you put others at risk of getting infected, no matter how perfectly you may think you've isolated yourself. Unless you have a clean room level setup somewhere, you're making yourself a reservoir of viral load for others to catch.


There are also two strains, one more aggressive than the other. I would imagine that getting the weaker strain out there ahead of the bad strain may be useful.


That wasn’t completely confirmed and may result from drawing conclusions from biased data. Also it doesn’t matter unless you can reliably get infected with the weaker strain.


I thought about that yesterday... It probably wont help you as an immunization. But it might help to reduce symptoms?


How old are you?

If you're under 60 or so, it's quite likely you won't need any medical attention at all after contraction.

This is why it's spreading -- most middle-aged and younger people feel like they have the common cold.


> This is why it's spreading -- most middle-aged and younger people feel like they have the common cold.

Is that actually the case? Don't the details look like a low grade flu? It's not sore throat or sniffles, it's still a cough and a fever.


About half of exposures have no symptoms at all, about half of the remaining ones have mild cold symptoms (fever, sore throat, dry cough), and then a further 30% of the remainder might have nasty symptoms (deep cough, walking pneumonia) that don't require hospitalization. The remaining 20% of symptomatic cases (10% of total) get pneumonia that's bad enough to require hospitalization, and half of those require ventilators and ICU beds. With good medical care and no pre-existing conditions about 90% of those patients recover, without medical care virtually all of them die.

Untreated, it's basically like playing Russian Roulette. 5 out of 6 times, nothing bad happens. 1 out of 6, you die. The disparity in outcomes is probably what makes this so insidious: a lot of folks look at the numeric outcomes for healthy people in the presence of ventilators and ICUs and reasonably think "Oh, I have a 1 in 500 chance of dying, it's no big deal". Medical professionals look at the exponential infection curve, the capacity to overwhelm health care systems, and the number of patients requiring hospitalization and think "this is the scariest disease I've ever seen".


One thing missing from your analysis is that the group you end up in is greatly impacted by age and current health.


Right, although the news out of Italy is that young healthy adults are ending up in the "bad pneumonia, need hospitalization" bucket nearly (but not quite) as much as older patients. They just have a much better prognosis with hospital interventions, because once they're ventilated or on oxygen for a while their immune system can reliably clear the virus, while with 80+ year olds or folks with pre-existing conditions it starts running amuck and causes ARDS or multiple organ failure. Overload the hospital system and the death rate jumps for healthy young adults as well - this happened in Wuhan and is now happening in Italy and Iran, and is why you see videos on the Internet of middle-aged adults dead in their bed from coronavirus.


Your analysis is suffering from survivorship bias -- Italy still has no idea how many infections they actually have.

South Korea is a better dataset because they have tested so many people.


Could you share the source for this? It's very useful for understanding the situation.


Some reports are showing that a little under half of those infected get no symptoms at all. Otherwise it can be anything from mild cold symptoms all the way to deadly pneumonia. That's from what I've been reading in the UK anyway.


Can someone be tested after recovery to see if they had it? Would that person be a possible carrier?


Data from Italy shows that currently 8% of the patients in ICU are 20-49 years old.


See section 2.8.2.11 of the article


Also nice that the appropriate domain wasn't squatted by some jerk.


Haha. I guess I’m that jerk.

Basically, I saw that this domain was available and saw the increasing talk of “flattening the curve” on Twitter. I grabbed it and wanted to do something helpful, like post just the pic of the tall and flat graph that was making the rounds, because I loved how simple the visual was, and how powerful the point it made. I thought at least people could share the concept easily.

But then someone shared Julie’s post, which was living on a gdoc at the time, and even that was struggling with the amount of readers... and was very much not an easily shareable link.

So I reached out and asked if she’d like to have it live at flattenthecurve.com, and promised to give her a login to update and add more info etc.

She said yes and I got the site live in half a day mostly spent reformatting the gdoc into WP.

I’m thrilled that the domain is really living up to its best use!


Nice work! Glad to see strangers come together and work on this in such a short timeline.


Good on ya!

I hope you have something like cloudflare behind it -- or at least static HTML. That sucker is "going viral", no pun intended.


You are a good human!


Thanks!


[flagged]


So this person who not only provides their prior work history but also links to primary source material in multiple places through the whole list, AND includes comments about where things are still unsure or developing, somehow _doesn't_ meet your criteria?

I'd think that compared to the vast majority of material posted anywhere, this discussion is of much higher quality and veracity.


"My comment is a response to the wording of parent comment, not the article itself."


... how do you judge the nice explanation? Why wouldn't you want to hear from someone who studied/works in something over someone who is a random observer?


I am saying trusting someone blindly because they are an expert is bad.

A nice explanation is one that is backed by science in this case.


And who determines what a "nice explanation" is, and what is or isn't backed by science? Another expert that you then have to trust?

When dealing with technical topics that require deep study, unless you're some kind of genius with an abundance of free time, it is impossible to judge the quality of someones argument without you yourself also being a mini-expert in the same field.


Specifically, for things like medical advice I look to the experts because medicine has been around for a few centuries and is backed with science.

New concepts such as cryptocurrency I just walk away.

My comments are about how a lot of people tend to put the person ( + credentials) before the soundness of their arguments.

(edit: The scientific method is well documented. This is a good place to start if one wants to learn about it, https://books.google.com/books/about/The_Scientific_Outlook....)


>My comments are about how a lot of people tend to put the person ( + credentials) before the soundness of their arguments.

Ok fair enough. So what is the argument that you feel was not sound? And who said that they believed the argument was sound because of 'credentialism'?

>(edit: The scientific method is well documented. This is a good place to start if one wants to learn about it, https://books.google.com/books/about/The_Scientific_Outlook....)

I don't know what a "well documented" philosophy book has to do with anything. That doesn't get you anywhere close to understanding deeply technical topics. Today's cutting edge science is deeply technical and you cannot gain knowledge simply by reasoning about it. You have to be an expert yourself to even begin to comprehend complex topics. A good educator can simplify a topic and make it approachable - like I suppose what Neil deGrasse Tyson does, but you are no closer to actually grasping the math or other details without going to grad school ... or putting in an equal amount of work at home using the library and self-study.


okay, but what do you do when you need an explanation but aren't knowledgeable enough to verify the reasoning?


An expert with good communication skills.


So you'd like to see "someone who has the qualifications explain so clearly" the issue?

Because that's what your original reply was taking issue with.


In general, trusting based on the letters behind a person's name is bad.

I am cultivating the habit of weighing the validity of the argument instead of implied trust based on a person's name or degrees.


But you said you wanted to hear from an expert. How do you imagine a non-expert can select an expert without indulging in something that could easily be called credentialism by a cranky internet commenter?


A good explanation not something from someone who claims to be an expert.


There are all sorts of people giving good explanations on almost any topic. Only some of them know what they're talking about. And there are plenty of experts who aren't very good at explaining, as they have spent their time and energy on gaining expertise.

So your heuristic easily leads to believing all sorts of nonsense. Antivaxxers, for example, frequently point to glib people with plausible-sounding explanations whose flaws are not at all obvious to the casual observer.


Unfortunately, the medical field is one place where credentialism is mandated and good for society. I would never let a "self-trained" doctor anywhere near me the way we accept bootcamp developers.


And for what it's worth, I'm incredibly wary of bootcamp developers too. I've seen too many terrible ones to not assume the worst without good proof otherwise.


The medical field relies on "training" more than just a degree. Fortunately, it's not a credentials based industry.

My comment is a response to the wording of parent comment, not the article itself.


Yes, but the training ends up converting to a license or title if you've completed it properly, and we judge whether or not a person is competent in that field based on whether or not they hold that title or license. For example, when quoting experts they're qualified as,"so-and-so is a board certified X," which is credentialism. But we have belief that the credential required training and knowledge, and that it was accredited by a board/panel of trained experts. But we trust those experts to be adjudicators of expertise because of their credentials. It's turtles all the way down.


I didn't call a "Board certified Physician" as credentialism. The previous commenter did. I never brought medicine to support my case against credentialism.


Credentialism is rejecting a sound argument or explanation because the author is perceived to lack credentials.

What you're doing here is the opposite.


I was right.

You seem confused.

https://en.wiktionary.org/wiki/credentialism

"belief in or reliance on academic or other formal qualifications as the best measure of a person's intelligence or ability to do a particular job."


It's also accepting a weak argument because of the credentials of the author. I thought that was trivially understood, but I guess not.

Which is also not what you're doing; your case appears to be that credentials are a reason to reject a sound explanation or argument, which is absurd.


Now you are bringing in your own narrative to a dictionary definition. My case is that the parent comment seems to put credentials before a valid argument, which is what I am against. Credentials are not a proxy for a sound argument.


Dictionaries aren't weapons.


Dictionaries are references to look up words before opening mouths.


You have both on that page.


Listen, if you're going to cut off quotes to make up an imagined problem then you're not contributing. The very next words are "so clearly" which hits your "nice explanation" part.

Listen, I'm going to tell you this because feedback is important and this is for your benefit: low brow dismissals are easy. You can always make up an imagined way to disagree with someone and it is almost always useless.

Here's an example of one of these lowbrow dismissals with your comment:

> "nice explanation"

> Why does the explanation have to be nice? I'd rather have someone tell me the truth rudely rather than tell me lies kindly.

Behold the incredible worthlessness of that response! It is fucking idiotic. People who interpret things literally are not talented, they are crippled.


The original comment first addresses the credentials of the author before giving any valid feedback on the points in the article.

People do this a lot subconsciously and it affects the way we consume information.

Instead I prefer to first understand how valid the argument is before looking at who said it.

Unfortunately most people are wired to "like" based on who says a thing more than how valid their arguments are...


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

> Zero universal guaranteed paid sick leave [1]

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

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

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

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

[1] https://www.worldpolicycenter.org/policies/for-how-long-are-...

[2] https://ourworldindata.org/uploads/2020/03/Coronavirus-Sympt...


> Zero universal guaranteed paid sick leave

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

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

[1] https://www.ncsl.org/research/labor-and-employment/paid-sick... [2] https://www.opm.gov/policy-data-oversight/pay-leave/leave-ad... [3] https://www.bls.gov/ncs/ebs/benefits/2009/ownership/private/...


It is a literally true statement. Universal means covering everybody. That some slices of the population have it in no way contradicts that. Indeed, most of your numbers prove that sick leave in the US is not universal.


Oddly, in this instance, "Zero" seems like the wrong description for something that is binary.


Being charitable, it's not actually binary, because sick leave has both a quantity axis and an accessibility access. The "universal" qualifier makes the accessibility axis binary. There's still a big difference between universal 1-day-per-year paid sick leave and universal 30-day-per-year paid sick leave or what have you.


I read it as relating to the quantity of leave. E.g., a country could have "7 days per year of universal guaranteed paid sick leave".


It's not "oddly", it's deliberately deceptive and trying to exaggerate the problem to advance a political narrative.


>Universal means covering everybody.

Wouldn't this mean it is an impossible goal since unemployed people don't have it. This might sound a bit snarky, but I am being serious because unemployed does account for people who are working under the radar, often through illegal means. An illegal sex worker, panhandler, or someone doing odd jobs and taking straight cash payments are likely not covered even in places that would be said to have universal paid sick leave.


Definitely not impossible. Plenty of countries give money to unemployed people: https://en.wikipedia.org/wiki/Unemployment_benefits


But that doesn't covered the sick leave portion of the claim, and in general unemployment benefits do not cover everyone who is unemployed (such as children, which is another group who may be working under the radar). It would effectively require a UBI, and even then it wouldn't qualify as being sick leave.

This is the problem with reducing it to a fully binary clarification where everything but fully true is false. 99.999% is so much easier to hit than 100%.


I'm afraid I don't understand what "sick leave" for children or people already receiving benefits would mean.

Are you trying to make an actual point about real-world responses to pandemics? Or is this just some sort of language-is-imperfect cul-de-sac you're in? If the latter, please leave me out of it.


Children work. Be it mowing a yard, working on a farm, or illegally violating labor laws and having an actual job. In some places, even in first world countries, there are children who are working under the radar (children of undocumented immigrants or children who are undocumented immigrants being an example). These children do not get paid sick leave, and thus if the standard for 'universal paid sick leave' is 'everyone gets it', then nowhere meets that standard. If you make your definition require perfection to meet it, then it won't be met. You set the standard on being literally universal a few comments ago, and I'm just showing that nowhere meets that standard.

> Or is this just some sort of language-is-imperfect cul-de-sac you're in?

Come now, have you forgotten when you said the following?

>It is a literally true statement. Universal means covering everybody. That some slices of the population have it in no way contradicts that.

Please do not suggest me being in some language-is-imperfect cul-de-sac when you were the one driving.


Or even just someone that is self employed. There's no federal law requiring them to have an agreement with themselves about what they do on days that they don't feel well.

I realize that this sounds like a really stupid comment to make.


I think it is a great counter example given the word play people are engaging in. It is a silly example, but if a silly example fits, then it suffices to show the standard itself is also silly.

It seems a variant of reductio ad absurdum but I'm not fully certain it qualifies.


Actually my point was that focusing on situations where there is not an employee-employer relationship is a tedious digression. Of course only employed people get sick time from their employer, that is what it is.


>employee-employer relationship

This seems a bit difficult to define to begin with (look at the cases with countries deciding differently for gig workers at places like Uber), and it doesn't seem to have been a qualified exception to the universal that the original comment called out.

It also achieves much the same effect as the very original article in that it allows a sort of propaganda by being able to say no countries in Europe have universal sick leave. And being able to technically make such statements, be their reasoning extremely tedious or not, is the topic at hand.


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

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

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

[1] https://www.bls.gov/opub/ted/2018/higher-wage-workers-more-l...

[2] https://www.bls.gov/opub/ted/2019/private-industry-workers-w...

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


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

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

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


Yep.

Paid sick leave except for the people who, y'know, prepare food, handle groceries at checkout, and move packages around warehouses.

Better than nothing... but is it though? Like really?


> Also, the average paid sick leave varies between 6-10 (working) days. Suggested quarantine is 14 days.

All the more reason to treat coronavirus as an exception that needs to be considered, as-needed, business by business. Or state-by-state, or county-by-county. Just because something like coronavirus happens every so often doesn't mean we need a 1-size fits all policy for every year and occasion.

I think businesses should be encouraged to play a role in helping limit the spread of the virus, but if everyone just decides they need to take 2 weeks off because of the cold, that's going to cause some economic troubles. Maybe something like that is needed this year, but for every year, that would be excessive and not help.


There's plenty of reasons to believe that businesses will take precautions themselves to limit the spread of the virus internally

It's not even on their radar. Not too long ago, a major university hospital in the Southern US held a town hall on the coming plague. It was an embarrassment. Several times, members of the audience asked about sick leave, in case they are under quarantine or have to care for dependents. Crickets from the leadership.

What is going to happen is that hourly support staff will drag themselves to work sick - that actually happened at an Atlanta school, a substitute teacher collapsed at work with Coronavirus and had to be taken away in an ambulance - and will spread disease to those lucky enough to enjoy better benefits.

Where is political discussion about this threat to public health?


So 22% don't have any vaccation.That is insane.

If the sick leave is limited, it isn't worth much.

38% without any sick leave is already pretty bad. How many of the rest can take 14-21 days of payed sick leave?


Yes, a dry cough, sore throat, and a temperature over 101°F are the most common symptoms of the virus. It shouldn't affect the sinuses too much.


Sore throat is not a known common symptom to COVID-19. The standard list being propagated by public health organizations[1] is: fever (nothing about 101F specifically that I'm aware of), cough, and breathing trouble (e.g. shortness of breath, pneumonia, chest tightness). Upper respiratory symptoms like sore throat are significantly less common with COVID-19 than they are with most viral infections, though obviously the instance isn't going to be zero.

Obviously to some extent this is just pedantry, but at times like this it's really important that we get these things right consistently. If all you have is a sore throat you are very unlikely to have COVID-19 given what we know right now.

[1] Here's the Mayo clinic's: https://www.mayoclinic.org/diseases-conditions/coronavirus/s...


The WHO report has sort throat listed in about 13% of cases, so yes not very common.

As of 20 February 2020 and based on 55924 laboratory confirmed cases, typical signs and symptoms include:fever (87.9%), dry cough (67.7%), fatigue (38.1%), sputum production (33.4%), shortness of breath (18.6%), sore throat (13.9%), headache (13.6%), myalgiaor arthralgia (14.8%), chills(11.4%), nausea or vomiting (5.0%), nasal congestion (4.8%), diarrhea (3.7%), and hemoptysis (0.9%), and conjunctival congestion (0.8%)

Page 12

https://www.who.int/docs/default-source/coronaviruse/who-chi...


FYI I work for UHG. They're currently spending tens of millions on infrastructure so that their entire workforce can be remote if this gets any worse. If people self-quarantine, they won't lose sick or vacation days and can work remotely.

Several states are proposing bills to protect people who are in hourly or contract roles where if they do self-quarantine, their jobs are covered and they will still be paid.

I feel like companies and the states are able to do more for their people than the government can. I've never been a huge fan of UHG, but they're putting their money where their mouth is this time and protecting their employees and working to contain the spread of the virus within the company.


That's great to hear! At times like these, it makes sense that we society protect the weak from dying. Its also we as society who carry the burden of a less prosperous economy (on the short term).

Today I read in the news that 4% of all employees of hospitals in North Brabant, The Netherlands have COVID-19.


I’m a little skeptical of that sick leave data source, since it claims that Australia offers 6 months or more “paid leave for personal health needs through employers and the social security system,” while Australian unions are campaigning for government support for 3.3 million casual workers with no sick leave: https://www.sbs.com.au/news/unions-call-for-quarantined-casu...


Keyword is casual workers which I suppose is the same as interim and flex workers. These have different rights [1] than people who have a contract. Same with self-employed.

[1] This has its pros and cons but that is beyond the scope of the point.


That's right. It's not beyond the point because in both countries, these millions of casual retail and hospitality workers are the source of the risk discussed in the article (they won't self-quarantine because it would cost them their income). It would be wrong to look at the chart you linked, which shows Australia and Western Europe as green and the USA as orange, and conclude that the USA is unique among developed economies in having a casualised workforce and "zero universal guaranteed paid sick leave."


Lies, damn lies, and...

What I meant with "beyond the scope of the point" is that the discussion of the pros and cons of such system (of casual workers / interim) i a tangent I'm not going on about.

In this context it'd be proper to include an amount/percentage of people who have such a job versus those who have a normal job (with permanent contract). I'm also interested in differentiation between different states, but then again there might also be differences in say Germany's provinces.

On another note, the USA is not unique among developed economies in this context; South Korea is also a developed economy.


> One thing I wish I knew way earlier is that COVID-19 victims rarely suffer from a runny nose

Definitely worth knowing, especially with hay fever season just about to kick off.


>Also, some people are in quarantine.

A day late and a dollar short, breaking news in the last half-hour or so suggests a one-mile containment zone is being setup in New York (New Rochelle), National Guard troops have been sent.

https://www.bbc.com/news/world-us-canada-51826317


Damn it. I intellectually knew it was only a matter of time before it hits hard in the US, but it's different seeing it happen. Next, it will be my city...


[flagged]


Maybe I'm naive or overly optimistic, but I suspect that COVID-19 presents a big enough scare to motivate legislators and voters to fix these problems in the near future.


Not with reports like this on the air it won’t

https://twitter.com/ndrew_lawrence/status/123717484635584102...


I've interacted with 4-5 potential voters (people) in the US in the last 2 days, talking about this topic. 100% of them think the virus is a hoax, since the president and media said so, and that it's meant to "distract" the population.

These are just random people in 7-eleven or whatever. At least for now, the 'scare' that people talk about is how controlling the media is and how "this whole virus-thing" is a hoax.

It seems many legislators and those in the executive branch share this view, are calling it a hoax and suggesting that the virus is a political creation meant to hurt the stock markets and prevent the president from being re-elected.


When that many people think it's a hoax, that's a symptom you're observing of people crying wolf too often.

We have a mainstream media credibility crisis because clickbait journalism presents far too many issues as needlessly apocalyptic and journalists are too wrapped up in advocacy instead of just presenting unfiltered facts.


This is exactly my thought as well.


considering most legislators are in a high risk group i would think so.


In a zero-based budgetting system, maybe. But given that any opponents will just present such a change as a huge additional expense and very much big government, do you really expect it to get much support?


Some incarnation of "paid sick leave" is likely to emerge [1], though I'm a little pessimistic -- probably would have a sunset clause.

POTUS tiptoed around this yesterday: "We're also going to be talking about hourly wage earners getting help so that they can be in a position where they're not going to ever miss a paycheck." IIUC "Paid sick leave" maybe via tax credit or some other subsidy.

[1] https://www.nytimes.com/2020/03/10/upshot/coronavirus-paid-s...


When the first of the 535 members of Congress succumb to the virus, I think it will be pretty motivational for the survivors to enact policy change. The median age of serving Senators is ~66, so if a non-trivial proportion are infected I think we can expect a lot of deaths.


Only if the right politicians are directly affected. The infected individual at CPAC could end up being the unsung hero of pandemic preparedness in the United States.


In the United States, we have these entities called "states" that are often larger than other nations. According to our constitutional system, these "states" are supposed to, and frequently do, legislate on such matters.


Yes, for example:

California has 3 day universal sick leave

Compensation for sick individuals who can not work

Compensation for business impacted by the virus

A sizable stockpile of masks

I wish we had developed an independent test method from the CDC.


> We are.

We are? Who is “we”? I don’t care for specific laws/legislators/etc but I can’t possibly imagine feeling shame for the emergent properties of such a complex system, especially at the federal level.

Do you hold the Italian people accountable for the actions of their government, or even the Eurozone? Do you think they should walk around in a cloud of self shame?


Nope.


What proportion of our population actually works without paid sick leave?

What proportion in countries with guaranteed sick leave is pressured into coming to work anyway by social stigma?

Not everything needs to be legislated. Especially not at a federal level.


At the risk of being confrontational, I have to question whether you have ever had a low-paying job in the USA or if you have even taken the time to look at the typical "benefits" and work requirements attached to such jobs. The absolute and unquestionable reality for millions of workers in the USA (food industry, customer service, transportation, and many others) is that they have zero paid sick leave and are also subject to work requirements that allow for their termination with little to no warning for any form of work absence. It follows logically that there is a great deal of people who work while sick and are afraid of missing work for any reason - they have minimal rights, live paycheck to paycheck, can barely afford healthcare, and have almost zero job security.

This is the environment that rabidly pro-business regulation and the erosion of worker protections has created; assertions that the hideously benighted situation of low-paid workers in the USA will magically "self-resolve" without strong legislation go against the entire history of the labor rights movement and basic common sense.


>The absolute and unquestionable reality for millions of workers in the USA (food industry, customer service, transportation, and many others) is that they have zero paid sick leave and are also subject to work requirements

I don't doubt that - but I'm asking for numbers because I also know that some proportion of supervisors even in shitty jobs are understanding enough to offer sick days. And just as in this current system some people are understanding enough to give people time off, under legislation there will also be some proportion of people who ostensibly are doing nothing illegal but indirectly pressure employees not to take time off - the same way people often accumulate vacation time from the same pressures!

That's why I'm legitimately asking for numbers. Because neither case is going to be black or white. Laws are hard do undo and frequently have unintended consequences. Some things are better solved through social reform, if they are necessary at all.

It's like the oft quoted idea that millions of Americans are struggling working multiple jobs to make ends meet and this requires some form of price floor - but if you look at official BLS reports, less than a couple percent (can't remember exactly) are actually in this state. For decisions which affect millions of people, numbers are everything.


The idea that the number of employers who might pressure their employees into not using legally-enshrined sick leave could be comparable to the number of employers who, through the goodness of their hearts, currently offer sick leave to their low-wage employees in the absence of a requirement to do so doesn't hold water. Furthermore, the (quite real) threat that employers will attempt to violate the spirit of a worker protection law should not be justification for society to not implement such laws. History clearly shows us that the goal of improving the lives of American citizens cannot rely upon charitable behavior from corporations.

I agree that neither case may be black or white; however, one is dark, dark gray and the other is eggshell.


Research how many states have pushed hard to break up unions of nearly every type. Wisconsin's governor made the news repeatedly pulling through "right to work" laws (I don't know details but I was shocked at how little pushback I heard about at all).

Here in IL and IA we've been "right to work" for a good while. Most purposefully misleading euphemism ever.

I'd vote for anyone who had a reasonable shot at forcing those laws to be rescinded and basic worker termination protection restored.


> Wisconsin's governor made the news repeatedly pulling through "right to work" laws (I don't know details but I was shocked at how little pushback I heard about at all).

Wisconsinite here: We really love to screw ourselves over. It's our state pastime. Scott Walker went to blue collar neighborhoods and said "I'm going to take away your right to organized negotiation!" and we said "Yes, I LOVE that!" We put his signs in our yards. Then as a joke we voted to remove, and then changed our minds.

When our some of our legislatures refused to go to work because some silly people stood outside the capital with signs, we decided to unelect the ones that stayed in the capital throughout the protests, and reward the ones that left the state entirely. We just love it :)


There's another side to that argument ("the right to make it damn hard to get hired") but maybe this thread isn't the place for meta social/political discussions.

The immediate problem needs the best fix possible and I do have to say the response from the federal government so far has been underwhelming at best.


I think asking vague questions and mouthing hazy principles is a very bad response to a specific, acute situation. If you want to argue against sick leave, fine, take a swing at it. But please do it with specifics and enough data that you have an argument worth taking seriously.


There are places where people are pressured to work while sick? Not because they can’t afford to be home, but due to pressure from peers and/or management?

Where is that? And why? A five year old would realize that sick people hurt productivity by infecting others?


How about a startup, for starters? Where people spend years burning themselves out?

How about when you have a big project coming up for a client and your team is depending on your contributions?

I'm not advocating for this sort of pressure, but I'm saying that even a law requiring paid sick leave is not going to guarantee that people go home when they're sick. Even in low paying jobs, managers still have to cover shifts. There's always pressure to work. Laws aren't magic.


Both of those are examples where it’s typically possible to work from home while ill. That I realize can be a pressure everywhere. There’s a difference between being pressured to work and being pressured to come to work.

It’s the second that is counterproductive.

If it’s the deadline day and you can afford three people to be off next week so long as the one sick person comes in this week, then it’s a conscious tradeoff at least. But in general it’s short sighted and counterproductive, not to mention rude to coworkers.


The pandemic hasn't even officially started yet; you're making a lot of assumptions about how the situation will unfold that are nowhere near justified. Pieces of paper saying that everything should be alright are one of many things that do not have an impact on the virus. The US has officially done better than most countries with a sick leave policy, although the real state of affairs we won't know for a while and is likely to be horrible.

From afar, the biggest problem looks like the CDCs iron clad grip on test kit certification slowing the response by a month. This compounds a general view of mine that the American healthcare system is crippled by existing regulation that links insurance to employment. Linking emergency response funding to employment is another terrible idea that will hardly assist the situation.

What everyone needed was a disaster preparedness plan. Forcing companies to pay money that they are probably not going to have in a pandemic is a great way to obscure from people how much planning they need to do. Companies don't have magically deep pockets.


> The US has officially done better than most countries with a sick leave policy

This isn't true though. We're simply behind them on the infection timeline, thanks solely to geographical proximity and luck. We're several weeks behind Italy, Korea, Japan, and Iran in terms of how long the virus has been spreading here, and months behind China. You can't compare us now to them now.


We're behind them on the timeline because the president restricted travel from the epicenter back at the end of January [1], and the US is the best prepared country in the world for an epidemic [2]. Italy got its 3rd coronavirus case on Feb. 6 [3], and now its totals are at 10k.

Take a look at the cases/country chart on [4] and sort by cases/population. The US is many orders of magnitude better than European countries. It's absolutely worth comparing for specifically the reasons mentioning in OP's post, that being ahead of this makes all the difference in the world.

[1] https://www.nytimes.com/2020/01/31/business/china-travel-cor... [2] https://www.statista.com/chart/20629/ability-to-respond-to-a... [3] https://www.reuters.com/article/us-china-health-italy/third-... [4] https://www.worldometers.info/coronavirus/


And then we proceeded to waste all of that lead time and did nothing with it. We didn't even have a working test until recently.

Meanwhile, we're gonna be at 1,000 confirmed cases in the US in another day or so and the exponential increase is continuing. We're not doing better than European countries by any stretch; what's happening there is going to be happening here in a month's time.

And being "best prepared for an epidemic" may have been true back in 2016, but it's certainly not true under Trump. He fired the highly successful crack epidemiologist team that was initially assembled to fight ebola, and the administration's response to the crisis so far has been largely incoherent, focusing more on the stock market than actually preventing the spread of the disease, and with officials continually contradicting each other and downplaying the serious of the pandemic. Pence, the man in charge of the response, is notable for having presided over an HIV epidemic in his home state. We simply don't have the right people at all in charge to manage this, and that matters greatly. And we still have way too many people not making a livable wage, who aren't guaranteed paid sick days and can't afford to not work.


The US is not testing sufficiently to make any claim about having less cases than European countries.


I'm not a Trump fan, but he made the right choice by shutting down China travel. However, preparedness -- what does that mean? Does that mean we can usually successfully contain illnesses before they break out? That's great, but it's not going to help us anymore. It's already here.

What we need are hospital beds and ventilators. Are we doing ANYTHING to prepare those? Anything at all? Or will we wake up when people are literally dying in the streets, like as is certainly happening in other places in the world?


This column by a conservative columnist does a good job of explaining how the extra time gained by that decision was unfortunately completely wasted: https://www.nytimes.com/2020/03/07/opinion/coronavirus-trump...


Also, the low rate of recorded infections in the US just might have something to do with the regulation-imposed shortages of tests.


The US is one plane flight from China and Italy is one plane flight from China. And their testing has reportedly been weak compared to many countries; they might be in a more advanced state of trouble than it appears.

But the major point here I am happy to concede; it is far to early to start comparing how the US is doing with how everyone else is doing.


The flights don't matter anymore. It's already here, and it's clear we won't start doing anything about it until the hospitals start overflowing, so whether that point is in a month or three doesn't seem that much different to me.

I hate to sound so bleak, but I believe it is mostly accurate.


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


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

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

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

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

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

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


> bottles of clean water. Old milk jugs of tap h20 will do

This only works if there enough chlorine in your tap water. In my country, the tap water starts to taste foul after a few days left in a clean bottle.

You can add a few drops of unscented bleach, and the water should be good for months or years:

https://getthru.govt.nz/how-to-store-water


> dry goods like beans and rice

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

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


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

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


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

[0] https://www.fda.gov/downloads/Food/FoodborneIllnessContamina...


It's not a culinary requirement, it just means you don't have to boil them for absolutely ever. A pressure cooker is quite effective if one happens to have one.

My experience with most beans-qua-beans is that a pre-soak or pressure is needed or they'll still be somewhat chalky even after 90+ minutes at a boil. Lentils and peas don't have this limitation.


For dried beans, I recommend Bittman's quick-soak approach. Basically you throw the beans in a lot of water, get them to boiling, and then let them sit for a couple hours. It's equivalent to soaking them overnight. Then cook as normal. Details here: https://www.markbittman.com/recipes-1/cooked-beans-the-quick...


You can soak them for 24 hours at room temperature before you intend to cook them normally. You can even re-use the soaking water if you need to.


Red lentils cook much quicker.


spoonful of minced garlic and crock pot on high for 2-3 hours, easy and tasty.


try adding a couple of spoonfuls of basic spaghetti sauce. Takes it to another level.


Dried beans only need 45 minutes in a pressure cooker.


On my small camping gas stove that is forever. Couscous is the best.


Just curious: Why water? Do we expect treatment facilities to suddenly stop working?


They're talking about "for general disaster preparedness" in this comment. The OP specifically mentions not worrying about water in the case of COVID specifically.


My guess is GP is suggesting water for disasters, such as earthquakes, floods, or other situations where water supplies will often be compromised. I say that because GP differentiated between pandemics, and natural disasters, and specifically mentioned his/her experience working disasters in the national guard. I believe the distinction being drawn here is that, as far as we know, infrastructure hasn't been compromised by COVID-19


I'm not an expert, but I'd imagine they require maintenance and staffing.


Yeah, but most people won't be sick. They can keep those facilities staffed.


I'm sorry but what you are saying makes no sense. You can't compare a (localized?) natural disaster to a potential worldwide pandemic. We most likely haven't even seen the beginning of it given the exponential rise of cases in many countries around the world.


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

Given our propensity towards liquid versions (at least in my circles and from what I can see culturally) I wonder if solid soap will be easier to acquire over liquid soap and hand sanitizer...


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

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

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

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

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


Totally agree. Wife has a small business. She's lost $20k in contracts in 2ks. Gonna affect her 45 employees. She gets no sympathy, yet she has to pay the business expenses regardless, taxes, unemployment... Politics will turn people away.


Loans and tax breaks for small businesses are exactly one of the POLITICAL recommendations being considered right now.

If one party is against them, should experts (in this case economic) not weigh in?


The political discussion should happen separately from a brilliant piece of writing that has the ability to encourage many people to act in a way that will save lives.

Muddying that message with political and partisan discussion is not helpful. Your comments are not constructive to this discussion and the messaging around healthcare and artists is not constructive to the messaging in the document.

The fact that you cannot see that only highlights my point.


I'm against partisanship, as stated above.

But this idea of yours that by disagreeing with you, it means you're right, is absurd. If we agreed, would that mean you were wrong?


A similarly pithy but purely scientific resource is the paper referenced here: https://news.ycombinator.com/item?id=22531962

US Coronavirus team referenced this (very short, very clear) paper with short, concrete guides for school, work and home. It's completely apolitical.


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

and regardless of what one thinks about the issue, there is no way the US is passing sweeping legislation overhauling the whole system, and getting it implemented, in time to do any good at all in the current situation.


You don't need sweeping reform to bolster confidence in the healthcare system, a targeted emergency appropriation can go a long way.

Congress saying they are going to pass a bill to pay for testing and then doing it would not be difficult, and it would reduce qualms about getting tests.


Who is going to pay the bill for the massive run on hospitals that is going to take place in early May, if Italy is any guide? Unless the major health insurers have adequate reinsurance in place, they are going to go belly-up. Same with hospital providers, they are going to have to provide surge capacity, yet in the last 30 years they have been run by economists who have been trained in the just-in-time mindset.

There will have to be a bailout, and the aftermath should mean nationalization. Public health has been neglected for far too long.


> Who is going to pay the bill

The people that have the money to do so.


I agree. When I read something like this, I have a hard time trusting that the rest of an article isn't aimed at pushing a political agenda rather than spreading information directly related to containment. I'd rather not have to be suspicious and just focus on consuming & evaluating the scientific information.


I have the same feeling about WHO after seeing their treatment of Taiwan at the beginning of the epidemic.


> Healthcare is a politically charged issue

Which is kind of amazing in itself given it's a basic human right in so many countries and taken for granted.


Agreed, I saw that political/moralizing comments and stopped reading. Most of this is common sense, but when I see the political talk I'm much more suspicious of the actual message.


Rather than criticize public health messaging for being at odds with popular political positions, shouldn't we put the onus on popular politicians and parties to embrace whatever health policy is best suited to public health needs?


Obviously, the best health policies are debatable. Saying “our system isn’t prepared for this, therefore we need single-payer!” is moronic and insulting to the reader’s intelligence.


Or we can do both.


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


I think he is referencing this line in particular.

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

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


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


Not discussing the healthcare system because it's "politically charged" is only good for those who advocate for status quo.

In addition, artist are indeed a small fraction of the population, but this offending sentence is also a very small fraction of the writeup..


This is what I posted last night on my Instagram: “Opinions aside, this is affecting everything indefinitely”

Unless you have real property, reserves or a salary to ride, the only option is to try and adapt.


The assertions in the article are factually true.


I think the author would get more credibility if they didn't just link to several other twitter posts - and actually linked to proper data from the WHO etc.


Tons of links are to scientific publications, some through the tweets, some direct.


The only critique I have as well. Other than that, top notch!


Maybe those readers who can't filter out the "politically charged information" wouldn't be especially helped by lists like this anyway.


No. The support artists is part of the theme of support eachother that is omnipresent in the writing.

Apart from this in the age of streaming the only spurce of income for eg bands are live gigs, so the advice is good, and not just now; do support your favourite bands, painters, musicians, etc., and do it directly. If the gig is out, buy merch.


Partisanship I'd argue is bad. Politics, however, is not.

The idea that we should ignore the state of our healthcare system because we find politics icky is counter-productive to building an effective system for dealing with public health systems. We can't avoid facts because they're uncomfortable and the public needs to be engaged with political leadership for problems to be solved. That's politics.

You don't "save lives" by saying discussion of the healthcare system is off-limits. The two things are quite related to one another!


You're missing the point, the problem that is if you're trying to offer credible expert opinion on how to deal with a crisis, you undermine those opinions by introducing a highly charged political wedge issue that offers no solutions to the problem at hand.

Sure, you can argue that single-payer healthcare would have been good to solve this crisis and others would certainly argue that it would make things worse, but the debate is totally fruitless because implementing such a system will take years--well after coronavirus is either endemic or wiped out. Thus, even bringing it up makes me question whether you, as an expert, are capable of divorcing your personal bias from your scientific objectivity. I immediately think, "is this person speaking from their objective expertise, or do they look for the data that satisfies their political arguments, and ignoring the rest?"

Scientists should tell people the facts as objectively as possible because that is the purpose of the field and discipline. Leave activism to others, who will use the facts to come to whatever conclusions they can.


How far should scientists take this principle? If a political party decided to take the view that this whole thing was no big deal and that big events in key geographies shouldn't be cancelled, should public health experts stay out of it because it could make people ignore their other recommendations? Experts should offer their views and the burden is on us to be open-minded, regardless of our ideologies.

There's a separate point you make about what things can and cannot be done in this moment. But that's not the original point made. Most of the "politics" recommendations could in fact be done during this time. Some are even being discussed, short-term.


khawkins said (emphasis mine):

> by introducing a highly charged political wedge issue that offers no solutions to the problem at hand

which seems to be their core issue.

Some proposed solutions may become political as you describe, but that doesn't change their utility as proposed solutions to the problem. Whereas it seems like the entire section "Relative to Other Countries, US Labor and Healthcare Policies are a Perfect Storm for Pandemics" could have been omitted entirely without losing any value related to slowing the spread of COVID-19.


What's your argument that none of the items listed in that section would slow the spread of COVID-19? Some of them are being considered on a short-term basis by political officials right now on the very basis that it could slow that spread.


Actually, you do save lives because more people will listen. Pushing to change the healthcare in the U.S. is a very partisan thing.


If one of our two political parties was calling for everybody to lick doorknobs in areas where there have been coronavirus outbreaks, does arguing against that suddenly become partisan?

How about experts talk about what's in their experience and then it's the job of open-minded citizens to evaluate it, hopefully with good political leadership from elected officials? Now, it's fair to weigh different public health experts advice, and it's fair to also weigh what experts on economics have to say, so that we can evaluate pros and cons.

But this idea that experts shouldn't talk about healthcare systems that need to be changed in order to better meet the moment because talking about it is "politics"... Sorry, but I don't think it makes sense. You don't solve problems by running away from them. Experts can do more than say that we should wash our hands. In fact, we need them to!


All of the experts who are qualified to speak on this topic and everyone else writing about it should probably be focusing solely on the ongoing pandemic because there is literally nothing we can realistically do about the partisan stuff until that is resolved. Even if we all came together in a Kumbaya moment right now, between legilastive procedure, court challenges, bureaucratic inertia, and the chaos caused by said ongoing pandemic nothing productive would happen anyway. We won't bring pricing transparency and trust busting to healthcare or medicare for all or whatever anyone's ideology calls for until the dust has settled. Until that happens, it's just going to keep pushing us apart while the best opportunity since the 2000s to work past the partisan divide is staring us right in the face.


Paid sick leave (including caring for family members) is one item that can absolutely be dealt with in the moment during this ongoing pandemic, and MUST be dealt with to have an effective response. Same for how we deal with a lack of hospital beds. Same for the problem of financial support for those trying to self-quarantine. Same for issues related to how uninsured folks can get care. All of these things are politics.

There's legislation being discussed as we speak that may deal with many of these things, even if only on a temporary basis. It's simply false that the only things we can do, we must do as individuals and cannot do through government and with political leadership.

If you're making a narrower point about Medicare for All, I'd put that in a different category than most of these political recommendations simply because it would take years to implement. But that's different from arguing that we should ignore the merits of sound public health recommendations on the basis that some people have an ideological aversion to hearing it.


> Paid sick leave (including caring for family members) is one item that can absolutely be dealt with in the moment during this ongoing pandemic, and MUST be dealt with to have an effective response. Same for how we deal with a lack of hospital beds. Same for the problem of financial support for those trying to self-quarantine. Same for issues related to how uninsured folks can get care. All of these things are politics.

> There's legislation being discussed as we speak that may deal with many of these things, even if only on a temporary basis. It's simply false that the only things we can do, we must do as individuals and cannot do through government and with political leadership.

I'm arguing that any such attempt is doomed to failure if it so much as even stirs the beast of partisanship because of how far gone our civic discourse is. I believe most or all of the things you listed can be done quickly by the executive branches of local, state, and federal governments within the bounds of existing legislation. At this point, anything but the most bipartisan bills are impossible to do on a short time frame. The place to be is lobbying governors, political appointees that lead state and federal agencies, and civil servants on the ground. They have unilateral power to actually do something about the situation because emergency powers are very broad (Lincoln used his to suspend habeas corpus!) and justices will be even more hesitant to reign in executive power during a pandemic than whatever immigration state of emergency enabled the travel bans. That way, even judicial branch challenges will slow down partisan interference instead of obstructing the intended goal.

I hope I'm wrong and our legislature does pull it together under threat of an emergency. After all, if JFK getting shut down was enough to end the government shutdown, maybe a pandemic cratering the global economy is more than enough to bring us together, at least for a little bit. However if the goal is to get something done instead of arguing over what to do, I'd look to the executive branch, not legislative. The former is meant to do, the latter is meant to argue.

Edit: I wasn't trying to make a point with medicare for all, just trying to pick out some examples from different sides of the isle (single payer on the left, free market reforms on the right). I'll admit I don't know enough about either group of ideologies to predict which relevant bills would be bipartisan enough to pass quickly but based on how antagonistic partisans have become, I don't think it'd be much since we don't have much time for the normal pork barreling process to work.


I don't think public health experts should be taking partisan views of the public into consideration, or need to be experts on what can and cannot pass legislatively, personally. They should be objectively speaking from experience as health professionals and/or scientists.


If an obese person has a heart attack, do you really want the doctors discussing weight loss when they acutely need to be dealing with cardiac arrest?


This author has "a masters degree in public health from the University of London School of Hygiene and Tropical Medicine as well as a background in infectious diseases and vaccine development." They are not literally at somebody's deathbed trying to prevent them from dying at this moment.

So really, here's the comparison: 647,000 Americans die from heart disease each year. Do I think doctors should be afraid to talk about obesity because it might turn people off listening to their other recommendations?

No, listen to experts.


Honestly there are people who just do not care. Article has interesting content. But political stuff is just like ads, you ignore it, or go away if it becomes too annoying.

I am not even from US, we have universal healthcare, but it is even more broken than yours.


Except it's not. Improving health care in the US is actually very centrist and polls show majority supported among independents, democrats, and republicans. Albeit slight more on the left than the right. Pretending it's partisan is just a way to quell progress on something that most people are in favor of.


“Improving health care” != “single-payer system now!”


Well actually I was thinking about Medicare for All specifically, eg: https://thehill.com/hilltv/what-americas-thinking/412552-maj...


Nobody cares what you were thinking about. This whole thread is based on the author's decision to insert a push for single-payer healthcare into an article about the outbreak. And the point is that a general agreement that healthcare should be improved doesn't justify pushing a particular, partisan solution in this context. That applies whether you would push for single-payer, medicare for all, or a true free market.


"Pushing to change the healthcare in the U.S. is a very partisan thing."

Which is outrageous. The manner in which basic societal discussion get short-circuited into being partisan is grotesque.

Though recall that Donald J. Trump promised universal healthcare (several times). Seems like it isn't partisan at all.


I wholeheartedly agree...”Never has there been a clearer case for single-payer health care as a public good. The voting public in the US need to care as much about “keeping their doctor” as they do about keeping their doctor alive.”

Regardless of your political point of view, when you see political statements like this, it should raise serious doubts about the veracity of everything else in the article, regardless of how factual it may be. Even if every fact in it is true, the clearly political motives of the author indicate that they likely cherry picked facts to support their viewpoint. One only need tune into CNN or Fox News to see how political propaganda masquerading as “news” is toxic for society and how “facts” can be warped to support any point of view.


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


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

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


Fair enough! Thanks for the clarification.


Discussion: https://news.ycombinator.com/item?id=22535650

Editing in response to the comments below ...

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

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

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

Further edit ...

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


That discussion revolves around a wholly different resource.


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

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

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

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


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


Now moot ...


I think you needed to give more context, which you might be able to do if you can still edit it. “Discussion” could mean anything.


Edited, but the downvotes continue, and it's all moot ... I'll not bother to muddy the threads further. Thanks for the feedback.


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