This is a really good article, and the contrast in the outcomes between Philadelphia and St. Louis is such a clear example why aggressive social distancing is so crucial right now. Thanks for sharing!
Yes, realistically the world will be playing whack-a-mole over the coming months as city after city experiences an outbreak that saturates its health care facilities and has to lock down. It will seem endless.
But with each outbreak more people will acquire immunity, and eventually the peaks will be lower than capacity.
But it's going to be a rough road to get there, and we'll all suffer on some level. This isn't going to be "over" for quite some time.
That would be the good scenario because then we can move the critical ICU equipment from outbreak to outbreak. The bad scenario is if it becomes too much.
China sending equipment to Italy now is a good sign.
right, as I understand the information from Italy right now emergency services are basically shut down because system overburdened. So as a healthy 30 year old, don't go do any of those healthy sports you like because you might get an injury and that's it then.
Also patient 1 in Italy was a healthy marathon runner who at least ended up in intensive care, not sure if dead yet or not.
In Lombardy, the only region where the situation is critical at the moment, emergency service have NOT shut down. Non urgent procedures are suspended, both to spare doctors and nurses and to avoid creating new emergencies in case those procedures go wrong. ERs are not overwhelmed, ICUs are.
You basically get in real trouble if you need a respirator - they're pretty much out of those and they have to assess your chance of survival to decide if they can tube you.
Interestingly ERs are seeing much less load because people have stopped going there for stupid reasons, because they are afraid of catching COVID-19. All medical stuff is still busting their ass if course, a lot of them have been lended to ICUs, rooms have been repurposed, etc.
This is not to say that the situation isn't bad. It's really bad. And if you think that your country has such a good health care system that it will hold better, you should know that Lombardy hospitals are top notch.
Whatever your age, stop traveling. If there's been a single case in your region, stop risky behaviors now: don't go shopping, have it delivered. Work from home. Don't use public transit. Teach your parents how to shop online and force them to stay home. Don't shake hands and wash them often.
> stop risky behaviors now: don't go shopping, have it delivered.
As someone living in Milano, I'm afraid that if the panic in the government (as opposed to the population) keeps on going on, this won't be possible when they shut down almost everything (given that the rules change every 24h and no one knows how to properly follow them, let alone evaluate the effect of them).
Just to clarify, my advice is for people living in barely affected zones. If your are in the middle of the emergency, things obviously change. It might not be possible to have food delivered within a reasonable time.
The mortality rate of COVID-19 is estimated to be around ~0.1% for young people, which is five times higher than seasonal flu.
> the risk of death among young adults would be smaller than that of older adults, e.g., at most 0.1%–0.2%. Whether to perceive this estimate as severe or moderate is a matter for discussion, but we consider 0.1%–0.2% among young adults to be unusually high.
But measles wasn't a pandemic! Everyone keeps thinking this is about individual risk and trying to downplay things, and it's not like that.
Our grandparents went to measles parties because they knew that they'd eventually be exposed and wanted to do it under controlled conditions where they knew treatment was available and had a plan for early detection of symptoms.
The situation with COVID-19 is that people who get sick are going to do so in an environment where they and their government are surprised as "how fast it grew" and where all the hospital beds (and oxygen masks, and ventilators, and intubation kits, and doctors, and nurses, and...) are going to be filled by other sick people.
And a lot of them are going to die, who didn't need to if we had just taken this seriously and not told people "it's just like measles".
Im 34 so I'll be fine, and I probably won't lose any friends. But I may lose a parent and I'll definitely have a friend who loses a parent. And that seems pretty awful especially considering how preventable this all was.
I'm sorry, but that's a stupid assumption to make.
I'm "only" 29 and last year I managed to catch a parvovirus B19 from someone - it's a virus that's relatively common in children, but has very mild symptoms - it's almost unheard of in adults, mostly because you either already have immunity, or there are no symptoms/the symptoms are no worse than a mild cold/flu. Well, except that in about 10% of adults it causes severe response with a high fever that last weeks, with arthretic swelling of joints - and in 10% of those the joint issues don't go away for years. Well, it's been nearly a year now and my knees and other joints are still fucked from the virus, I'm constantly on steroids just to control the inflammation.
So no, this has changed my "I'm young so I'll be fine" outlook on this - the chances are not always in your favour.
Sorry to hear that. I wish the insight you have could spread further (what a sorrowful irony) but it seems wisdom is rarely won without painful experience, the blasé attitude of some is not helping right now.
I'm not so sure that this was "preventable" in a meaningful way. We may well find out (and I suspect) that there was no obvious, sensible moment for radical containment measures to be enacted that wouldn't have been far worse than the outbreak.
Note that assumes that such containment measures would have been enacted many more times over the last decade, incurring inconveniences [which you can model as "life energy and time lost", even if few lives are lost from them] if the containment criteria were tight enough to stop the initial outbreak of a virus that has relatively high transmissibility, many infected who feel relatively mild symptoms, those symptoms mimic other common diseases, and a week or more incubation period before serious symptoms show up.
The problem, from a non-medical expert layman, is that the "sensible" measures only appear so in hindsight.
It would have been sensible to close our borders and halt international travel 8-12 weeks ago, and begin widespread screening of suspect individuals. But at the time everyone said that was nuts, you want to tank our economy over some virus that's barely even outside Wuhan!?
Right now we could still contain it with radical isolation measures like Italy is doing. Nobody leaves their house without a good reason, everything comes to a halt, we perform mass testing on everybody and if you're infected you get an even stronger quarantine. But you want to shut down our economy over just a few hundred "isolated cases"!?
By the time people are dying en masse and hospitals are overwhelmed, it's too late. There's nothing you can really do at that point.
The basic problem is that people don't understand quadratic or exponential curves. If you have a pond that starts with one lily pad and they double in number each day, and it takes one month to fill the pond completely, then when is the pond 50% full? The answer is the day before. And the lesson is - exponential growth requires extrapolating from "who cares, it's just a few cases" to what could happen if it's allowed to grow unchecked. Which humans are incredibly bad at doing.
> It would have been sensible to close our borders and halt international travel 8-12 weeks ago, and begin widespread screening of suspect individuals.
Types easy; is hard.
11 weeks ago was Christmas. How many Americans were overseas on holidays for Christmas? How many Americans with Chinese relatives were in China? How many Chinese students of American universities were home on break? Is flying Boston to Seattle meaningfully different than flying Boston to Toronto? If you halt international travel and close the borders, where do the stranded travelers now live? For how long? Who pays for it? Do they lose their jobs/have to quit college? On average, nearly half of international travelers are on their way home, not out. These are real people.
> But at the time everyone said that was nuts, you want to tank our economy over some virus that's barely even outside Wuhan!?
If you set the system parameters tightly enough to prevent the virus from leaving Wuhan, I think you're basically closing travel all the time. How many people get sick and die of random, novel things? How many of those have the theoretical potential to be silently but exponentially transmissible? How can you set a system tight enough to prevent all of them while having travel and commerce?
It seems quite possible that such a tight system would be a cure that's worse than the disease. I'm not suggesting that we're doing all that we can or that we shouldn't have taken some of today's steps last week, but I am saying that I think it's completely unrealistic to think we could prevent this entirely in any sane way.
No one said it was going to be easy, or convenient. But most estimates say 70% of the population could become infected and with Italy's mortality rate of 6% that's 13.7 million deaths in the U.S. alone.
We had 6 weeks to prepare for this, and we did nothing, and we're still not doing nearly enough.
With due respect, telling Americans that they can't come back home from Christmas holidays is quite a bit more than "well, it won't be easy or convenient."
I got the initial wake up call after it became clear this is much more contagious than SARS/MERS. (Reused parameters and initial data for contagion simulation.)
That was a month ago. Managed to get done most of the preparations designed for a quarantine of about a month length as predicated by Chinese data. And a few extras. Not exactly hoarding food levels.
What I didn't consider was how strict and well executed were the containment measures applied by China. Without these, we'll probably get much longer, three month run. The measures I've taken definitely will help but potentially are not enough.
Italy's patient 1 is 38 and was in excellent health before catching the virus (he ran two half marathons in a week just before getting sick). Then he spent 20 days in an ICU attached to a ventilator.
Uggh, that reminds me that I better take it easy when the weather breaks. I like to take LONG bike rides (typically 80-100 km) when the weather is nice. Yes, exercise is good for me, but inadvertently overtaxing myself would not be good.
- it will kill some number of younger people, even healthy ones.
- it’s also worth considering that we don’t (AFAIK) have a clear picture about potential long-term complications (eg lung damage). We should not simply assume there won’t be these.
I’m saying this to emphasize the seriousness of the situation.
But you'll need to hope that you don't need a hospital for anything at all for a while - so avoid accidents, keep living with that little surgical problem, etc. You may be relatively safe from COVID-19 but it's in addition to all of the other medical conditions that trouble our species, and you may need to just cope with them.
An otherwise healthy thirtysomething in Minnesota is in critical condition right now - it's not time to panic but you probably want to avoid getting this if you can.
Not completely true. It can apparently spread to a lower respiratory problem in ANYONE (where it is VERY deadly, 50% mortality rate) it just tends not to do it very often in persons 10-30 yrs old.
I've never seen this 50% figure, looking at people in critical condition data, even that's not 50%, more like 20% mortality. Please provide a source, or delete your comment.
Generally speaking, all vaccines are low dosage. Everyone having the vaccine would be better, starting with those most at risk. If we had a vaccine, we would give it to 80 year olds first, then go down the chain.
We have a ways to go before a vaccine is available.
iirc he reiterated this to congress this morning before hearings were terminated to allow Trump to hold a press conference. Witnesses were told to stop their testimony and leave immediately.
> “This morning we were informed that President Trump and Vice President Pence have called our witnesses to an emergency meeting at the White House,” Maloney said. “We don't know the details, just that it is extremely urgent.”
> At about 11:30 a.m., she ended questioning from lawmakers, saying she received notice from the White House that the witnesses needed to leave “now.”
The current goal is to create any vaccine that is safe and effective.
If you have that, you give it to everybody you can.
I guess deciding what safe enough is can be a problem (for many people the bar will be "getting the vaccine has better odds for a good outcome than getting the infection", but that is sort of a minimum).
yeah, I agree that this is no problem if hospitals stop taking anyone over 40 with respiratory issues and leave them to die at home. Letality might approach 10-20% then (from all we know), but hey, we are young!
> But with each outbreak more people will acquire immunity, and eventually the peaks will be lower than capacity.
Last time I checked there are at least 3 or 4 different strains circulating now. That's why some folks who got cured got it again. So don't have such naive hopes that all will be rosy on its own soon.
If the story will be similar to flu, we're pretty much fucked - every year the strain is so different that prior vaccinations/immunity doesn't work on them. I certainly hope that's not the case, too early to tell.
Realistically it's more than that, though. Viruses mutate rapidly and this one is into the hundreds of thousands of human transmissions now and still picking up steam. We just don't have the PCR bandwith available to sequence them as fast as they're spreading. Pretty much any direct pronouncement on the "kinds" of SARS-CoV-2 is going to be speculation, so it's all "rumors".
But strains don't correlate perfectly to immune respnse, so the upthread point about reinfection risk remains speculation. We just don't know yet. But all endemic viruses eventually reach equilibrium with the population immune response (and vaccination regime), even if it requires regular updates a-la the yearly change in flu shots.
In other words it's following a logistics curve. This is what every pandemic does: the problem is that we can't know when the inflection point is. Sometimes it's quite early on, and sometimes it isn't. Plan for the latter, hope for the former.
Unless Chinese officials are still lying about their cases, and international observers are being fooled despite now knowing to look carefully, it seems (only tentatively, not saying it's the case at this point) that China is already reaching an inflection point. The number of new cases has dropped heavily and the death count is shrinking too apparently. That this is possibly already happening in such a densely populated region could bode well for the rest of the world for the initial surge in cases leveling off sooner than some are predicting.
I've seen a surprising amount of panic and unfounded assumptions towards the worst from many commentators here on HN and though it's perhaps to be expected from a crowd with a notable number of visible hypochondriacs, it's disappointing to see too. This isn't to say that concerns about the virus should be neglected or that people shouldn't take practical precautionary measures seriously but someone leaping to cataclysmic conclusions based on early figures is no more substantive than another person dismissing the whole thing as nothing major. Both are based on notions without backing and impossible foreknowledge.
>> Unless Chinese officials are still lying about their cases
Is/was there a whole lot of evidence of this? Was it a local problem in some parts of China? Or was it unfounded? It seems to me there's been just as much of this going on in the west + we're doing a much worse job of handling the epidemic than China has done. I don't have any personal opinion on China generally but the amount of China bashing + hypocrisy in the last few weeks has been astonishing. Supposedly they are even at the point where they are shipping supplies they no longer need to Italy (masks + other equipment) and considering sending people to help too.
I in no way intended my comment to be seen as China bashing for its own sake, but in the early days of the epidemic in Wuhan, there were noted incidents of at least local officials claiming false information about how contagious COVID was and how far it had spread. It's difficult to generally trust any authoritarian regime that has a vested interest in downplaying things which in part worsened because of its own bad initial response but no, nothing right now gives a solid reason to doubt the current numbers on cases, fatalities, recoveries from China and if indeed they are true as they likely are, the reduction in new cases is visible, and even if that's being achieved through strict measures, it's heartening to see, because it shows that COVID spread can indeed be mitigated to some extent through social measures while medical resources brace themselves
There's almost zero chance you see peak virus before end of March in the US. From what I hear, most people are predicting peaks in Europe in late April / early May and peaks in the US a week or two after.
I'm not sure how much faster you think we'll see peak than that.
Maybe you mean the tail will be shorter? Most people I see are predicting Coronavirus will impact consumer behavior until end of year. I don't have the first clue how likely that is.
I agree with you on what you say about zero chance for those dates, but there have been predictions (many repeated right here on HN) about a level of spread that in months infects dozens to hundreds of millions and results in several million fatalities worldwide. So far, none of these extreme prediction figures have a genuinely concrete footing (and a number of similar figures were predicted for how much it would have spread even by now, which obviously haven't come to pass)
"someone leaping to cataclysmic conclusions based on early figures is no more substantive than another person dismissing the whole thing as nothing major"
The potential downsides for "dismissing the whole thing as nothing major" are a lot higher than "leaping to cataclysmic conclusions". Better safe than sorry. Better to be prepared than unprepared.
While that may be true, it is in no case at all a reason for panic and panicked behavior such as rampant hoarding of things one won't even conceivably need for the length of time this is reasonably expected to last. I have seen a large number of rather hysterical comments on this site that have openly proposed that yes, people should outright panic. It's absurd.
It inflected early in China because of the lockdown. People are hardly allowed to leave their house. Not even for work unless you're essential personnel.
The US is not prepared for those methods. Not culturally or legally. For better or for worse, it's the sort of thing that can only happen in an authoritarian dictatorship.
I fully expect the US to inflect much, much later than China did.
It seems to me that there’s also a wave effect at play. For instance, China’s largest source of new infections is now imported cases. China can’t exactly drop its guard until the virus is on the decline across the world. The same will apply to other countries who are hit early. This might be with us for a while.
It'll inflect when the measures we take reduce the R0 enough that (1-1/R0) goes below the fraction of people already infected, hopefully but getting R0 below 1. But yeah, it's hard to tell when that'll happen.
Early can mean "at a low percentage" (which would be good) and not just "reached fast" (which would be very bad, unless also at low percentage). The percentage is directly depending on R0 (which apparently isn't easy to get below 1 even with China-grade measures).
The inflection point here means that the speed of the spreading of virus gets slower, so less people get infected then previous day. If this point is earlier in time, this means that the virus won't infect so many people after a time. I think the big question is the cause of the inflection point. Is it because of the nature of the virus or because of the different action like quarantine
It will be difficult to convince the 40% of the population that measures need to be taken when that 40% thinks everything of consequence is a hoax, fake news, etc - being incited and reinforced by their Dear Leader. It's the result of a decades long undervaluing, underfunded, ignored education system.
Does this mean it is better to get it very early before the health system stresses out (might be too late for that and this is a selfish sort of thing anyway), or medium early before you are so old that your immune system is crap, or very late when they have effective vaccines. Anytime but right now, basically.
If you are part of a high mortality rate demographic, you are better to get it first in your demographic to have a better access to resources (or very late when the resources are back under control). The issue is not really the virus per se, but its effect on the healthcare systems. That is something health systems work with _every year_ with flu season, nothing new under the sun. What's different is _nobody_ has immunity to this virus, and a lot of people initially dismissed the virus, or are still dismissing the risks.
I think it is like with everything else - it depends. If you are in the high mortality rate demographic and your recovery is not fast enough then you may still have the risk of being "phased out" when the medical system comes crashing down with the load of new cases happening during your recovery.
About the grandparents caring for the children: it's true that this could pose a risk, however it also keeps the risk confined to a single family circle, which wouldn't be the case with a nanny who could then potentially spread the infection to her own family or other families kids.
For a fascinating, in-depth look at the Spanish flu of 1918 check out John Barry’s “The Great Influenza” [1]. The book was amazing and gives you a real sense of what one of the worst pandemics in history must have been like.
FWIW, I recently ordered a Spanish Flu book by Gina Kolata, and it took more than a week to arrive instead of the normal two days. Kindle version might be a better bet.
If it spreads to infect a large proportion of the world's population, it way be beneficial to get it now, before the healthcare services are overwhelmed.
might've been an option a month and a half ago. but: exponential growth. most western countries are _days_ behind italy. if you're destined to downturn, it'll take you a week or more to need the ventilator, and you'd be on it for some time.
Only for the first few people who do it and it will come at a great cost to everyone else. Classic collective action problem at work and down right dangerous thinking. If even a fraction of the population acts on this idea the rate of transmission will increase and the overall outcome of the event will be worse.
Flatten the curve. Reduce the rate of spread. Buy time to keep the strain on the health care industry as low as possible. Increase the probability that vaccinations can be produced in time to assist. And stop spreading this ridiculous idea.
> In the face of highly variable responses from public officials, the media served as an essential ally of the public health community in fighting the pandemic.
However, the difference between private media outlets, such as WSJ, and the public health administration is that the latter is being paid for by taxes. Your taxes.
The only "free" media are public media such as public broadcasters. Even so, those aren't "free" as in "free beer", they are part of a fiscal budget and the only reason why you can consume them with little restrictions is because that's foundational to public policy.
It's perfectly acceptable for private ventures, such as WSJ, NYT or WaPo, to put their articles behind a paywall. Put differently, even during the 1918 pandemic, you would still pay the paperboy on the corner of the street a few nickles to get a copy of the daily.
If you think that the WSJ or NYT are mere outlets for public health administration, you're very much mistaken. The "independence" of the Press serves one goal in particular: to critically assert public governance. That independence is a constitutional right, but it's not a guarantee nor an entitlement.
Good journalism needs to be paid for. The digital age didn't suddenly deprecate the expense associated with doing research and writing a good piece.
So, the statement needs to be amended:
> the media served as an essential ally of the public health community in fighting the pandemic, but it can only do so if the audience is willing to pay for the efforts.
Yes, I understand that in modern economics, particular outlets are part of larger corporations. A newspaper can be a losing proposition if the costs can be covered through other income channels.
The downside of that is the reduction of quality as media channels devolve in sheer revenue machines (ads, subscriptions,...) or heavily biased outlets. Hence why I feel that supporting journalist organisations, who aren't "brands" bought by larger corporations, is where audiences can really make a difference if we hope to let a true "free and independent" press survive.
TL;DR: The "free" in "free press" doesn't mean free lunch.
> You don't need to be for-profit to be independent
When I stated "private", I implicitly referred to for-profit and non-profit organizations a-like.
I could go on a tangent about the merits and differences between public and private legal entities, non-profit and profit based organizations. I could even dive into the rabbit hole of private organizations who receive grants from public endowments and such.
It's an interesting discussion. But that would be splitting hairs.
It should be clear that organizing any media outlet implies incurring costs and expenses, regardless. Those need to be covered somehow. And the strategic choices made in picking sources of revenue are going to affect independence in subtle and less subtle ways regardless.
> and you don't need a paywall to get paid - see Guardian
I didn't say news outlets "need" a paywall. I said that there is no such thing as a free lunch and someone always pays for putting the news out.
The last paragraph in that op-ed explicitly states how necessary it is to pay for content:
> In the last three years, more than one million people around the world have chosen to support The Guardian financially. Thank you to all of you who have supported us and we hope more of you will consider joining us on this mission — you can do this through voluntary contributions, subscriptions to the Guardian, the Observer and Guardian Weekly, or as part of our patrons programme. As we approach the Guardian’s 200th anniversary in 2021, your support will help ensure we can keep holding the powerful to account, with purpose, for many generations to come.
I was also well aware of the choice made by the Guardian. I omitted the example because their choice entails taking a calculated but huge risk: politely asking their audience to pay for free content could have gone horribly wrong. The audience of the Guardian was willing to follow suit, but another audience might simply indulge in freeloading without limits.
Thanks for elaborating! I think we mostly agree. Perhaps the biggest question is whether it's ok to profit from the pandemia? I would say in general it's ok as long as your prices are reasonable and there is no surge pricing, but media outlets can have a conflict of interest between reliable reporting and attention-seeking. For WSJ, the middle ground might be to fund their pandemia coverage from their profits elsewhere, and to profit indirectly via new readership.
Exactly! News doesn't "happen", it is "made". Hence the phrase "that made the headlines!". Reporting is mirroring events as they happen, and in doing so creating a narrative that explains why things happen and how they unfold.
This is where context matters and Marshall McLuhan's "The medium is the message" starts to make sense.
> He said that a medium affects the society in which it plays a role not only by the content delivered over the medium, but also by the characteristics of the medium itself.
> Perhaps the biggest question is whether it's ok to profit from the pandemia?
I think it's hard question to answer because you're implicitly asking "can we find a universal standard that provides a consistent answer in different contexts?" and the answer is "no" because ethical and moral standards are always based on a collective consensus emerging from the interplay between many individual, contradicting beliefs. This is why moral standards can also shift and change over time.
It's worth observing that there will always be unscrupulous outlets ready to profit from a good crisis ("don't let a good crisis go to waste!").
This is where it's up to society to define their own moral standards and give individuals the leverage through education to critically assert the value of the news. Is this item truly informative or is it clear fearmongering and not worth the paper it was printed on? And how much do we value voicing our own dissent or disagreement with what was printed?
I've been extremely pessimistic since early January when I started following this obsessively - and I still think it's going to get far worse before it gets better.
But there is a silver lining here. This is probably the first time in history that a disease will have this much attention from so many researchers. There's a good chance someone will find a cure or prophylactic relatively soon, even if a vaccine is unlikely.
Also any potential drug will be put on rush evaluation so things should move quickly - there's Hope yet.
It's my anecdotal observation that there are more people hysterical over the hysteria than there are people legitimately hysterical over the virus. But that's probably not representative. I hope.
Honestly surprised to see star voodoo like this on HN.
There's literally always something happening to people on a planet with hundreds of millions to billions of people. The correlations are spurious because at any alignment you can say "oh, look at all these bad things happening".
That's why astrology and the like have zero predictive value.
That..... and the fact that he's spouting off astrological nonsense in the first place. You know, regardless of what planet, planetoid, dwarf planet, asteroid, giant alien mothership definitions you choose.
