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Open letter from Italy to the international scientific community (left.it)
1095 points by magoghm on March 14, 2020 | hide | past | favorite | 693 comments



Chris Martenson likes to say "If the facts scare you, the problem isn't with the facts". (also check out his COVID-19 updates, I think they are very well done! [0])

You may think "it's not here yet". It is.

You may think "the numbers are low". They aren't. We are failing miserably in our testing, our numbers are easily off by a factor of 10 (for infections).

You might not want to be "weird" and not want to practice social distancing. You need to.

You need to act when it feels too early and honestly, in the US, that was a week+ ago so at least act now.

I don't say these things to whip people up in a panic, I say them because we are about to get hit hard here in the US. If you know a nurse maybe send them a text and ask how they feel. I can tell you the nurses I know are freaking out because they know we are not prepared. A have a friend who works at a big hospital. They have 2 cases (at least as of a day ago) and they almost buckled under it. They don't have many masks, they don't have training, and the hospital itself has no plans in place. When asked "How many masks do we have?" the answer (on Thursday of this week) was "I don't know" from the head of infections diseases. Let that sink in. March 12th.

I can understand not knowing the count off the top of your head in November 2019, I can understand it in December 2019, I can still wrap my head around not knowing it in January 2020 but damn it... It's March, you are in a meeting to discuss COVID-19 and you don't know how many masks you have on hand?

The world has been warning us for months now and they had no plans for how to handle visitors. The nurses have not done n95 mask fit tests. They are not getting clear direction on how handle mask reuse. We are not prepared for this. If this hospital (which I would trust for any major procedure) is feeling the strain with 2 patients what happens when there are 4? 8? 16? 32?

[0] https://www.youtube.com/playlist?list=PLRgTUN1zz_oeQpnJxpeaE...


> I don't say these things to whip people up in a panic, I say them because we are about to get hit hard here in the US.

The average person in the US rightly did not have much reason to be concerned a few weeks ago, but that's not the case anymore. It's important to understand that the situation has evolved rapidly for the worse here, and our response ("panic level" if you will) must escalate accordingly.

In particular:

- Each one of us is now at much higher risk of infection, possibly orders of magnitude higher than the official numbers suggest. The bungled testing rollout, the high level of community spread and the number of deaths together suggest the official numbers are grossly under-counting. [1] This is very different from a few weeks ago when the cases where mostly imported or had known transmission routes.

- A few weeks ago, the CDC was still hoping to contain the epidemic by tracing and quarantining cases. But that has changed. Whereas China, Hong Kong, Taiwan etc have succeeded in containing the disease so far, the US has already failed and the CDC now expects it to eventually spread to most of the US population. [2] Its strategy is now to slow it down enough to avoid what's happening in Italy.

- The situation in Italy has shown us the magnitude of human suffering that will result from people "under-panicking" and going about their daily lives at a similar stage of the epidemic. There will be a rapid explosion in cases, leading to a meltdown of the health care system. Many of us will lose our loved ones, and many of us will die unnecessary deaths from hospitals being overrun. Not to mention the impact on the economy, which we can't measure yet in Italy but could well be greater than the cost of locking down early.

So stop thinking "it's fine". It was a few weeks ago. It's not anymore.

[1] https://medium.com/@tomaspueyo/coronavirus-act-today-or-peop...

[2] https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/summ... or https://www.youtube.com/watch?v=9cfYC4YLsu4


100% agree with what you are saying. I really meant more so that I don't want to encourage hoarding or panic buying to the level where other people can't get what they need. You should be worried, you should be preparing in anyway you can (2 weeks+ food, isolate yourself as much as possible, discourage gatherings of any size).


Yep, 100% agree. No reason to go rob-a-hand-sanitizer-factory crazy. But as you said, everyone one of us should be worried enough to go prep and do our part to slow the spread (WFH if possible etc).


> they don't have training, and the hospital itself has no plans in place

I have a difficult time grasping this part. It’s not like it’s something completely new. We encounter virus infections every year during flu season. The SARS outbreak was 18 years ago and MERS was 8 years ago. Did we not learn anything from it?

Sure, it was not as severe as SARS-CoV-2, but we should know how to handle it. I agree we should take precautions to stop spreading. But from seeing what is going on around here in EU, I am thinking that the panic is over-inflated and is doing more harm than good. Maybe it takes panic and fear to scare the majority of people into taking all precautions to stop the virus from spreading?


> The SARS outbreak was 18 years ago and MERS was 8 years ago. Did we not learn anything from it?

> Sure, it was not as severe as SARS-CoV-2, but we should know how to handle it.

The answer appears to be no, we didn't. Remember neither of those really hit here in the US.

CDC SARS FAQ [0]

> How many people contracted SARS in the United States during the 2003 outbreak? How many people died of SARS in the United States?

> In the United States, only eight persons were laboratory-confirmed as SARS cases. There were no SARS-related deaths in the United States. All of the eight persons with laboratory-confirmed SARS had traveled to areas where SARS-CoV transmission was occurring.

CDC MERS FAQ [1]

> Q: Has anyone in the United States gotten infected?

> A: Yes, two patients in the U.S. tested positive for MERS-CoV infection, both in May 2014.

The hospitals (nurses at them) that I've heard from say they don't have the masks on hand and they have received no training for how to deal with something like this on this scale. In fact they are being told things contrary to their training like having them wipe down the disposable shield of a CAPR [2] with bleach to re-use it (they are supposed to be single use).

They have limited (10 in the case of the CAPR shields in one hospital) because it's only required for specific diseases that they see few to no cases of per year. They don't have stockpiles of n95 masks because they could alway just order more if they needed them (same with CAPR). They are having to use the CAPR's temporarily because you need to pass a n95 mask fit test [3] (to insure nothing can get in) but the nurses haven't done that. At one hospital they just so happened (dumb luck) to have someone working that day that knew how to administer it and so they have been rushing to have nurses complete it.

> But from seeing what is going on around here in EU

What do you mean by this?

[0] https://www.cdc.gov/sars/about/faq.html

[1] https://www.cdc.gov/coronavirus/mers/faq.html

[2] http://www.lbs-biotech.com/products/personal-protection/max-...

[3] https://www.osha.gov/video/respiratory_protection/fittesting...


As an Italian, I raise my eyebrows every time China is mentioned as an example for the successful containment of this virus.

It could do that because it could afford to take the economical hit and because it is an authoritarian state, which means you can get almost everyone to obey, in one way or another. Also, the Chinese Party is what caused this mess to begin with, by allowing this virus to spread all around the world.

Why on Earth is this a good model?

Undoubtedly for the safety of citizens, but even with all the people shouting about a "fascist revolution" going on with the previous government, it only took three orders to strip everyone of most of their freedoms without anyone batting an eye (especially since no one knows for how long, the April 3rd date is a joke).

Quarantining is probably inevitable (although it won't help the overloaded ICUs until two weeks from now, so more capacity will always be needed), but following rules in place in an outbreak does not mean one should not question their principles.

And this letter should be sent to the media and the government, since both can't even understand an exponential, or basic statistics (even with the so-called "peak" reached, cases will keep on increasing until recoveries are due).

Personally I'd like fast-tracking of anti-SARS-CoV-2 drugs instead (those are the ones which will get out of this mess, quarantining is just flattening the curve, although immensely beneficial), along with setting up place for non-intensive care COVID-19 patients. Every ICU bed freed is a victory.


> As an Italian, I raise my eyebrows every time China is mentioned as an example for the successful containment of this virus.

China dropped the ball for a full 10 days back when the disease was nicely contained to a small part of Wuhan, and then largely to Wuhan itself and Hubei - they didn't let the population know about the danger, so for quite some time no one was thinking about protecting themselves by wearing masks, social distancing etc. But the trouble is, Italy then made the exact same mistake by being late with containment measures, and now the UK and US are doing the same. So there's nothing to roll one's eyes or raise eyebrows about.


The full danger was unknown in the initial stages. Provincial officials were downplaying it for various reasons, and until the very end of December it wasn't known to even transmit person-to-person.

Once the threat was clear, the government of China acted much more alacrity and decisiveness than any Western country, which have had months of advance notice.


"The very end of December" was 20+ days prior to the Wuhan lockdown, which was was essentially the only instance where China officially acknowledged the disease - before then, the local government was having police caution their doctors and scientists not to talk or "spread untrue rumors" about it. In the meantime, people in Wuhan and elsewhere were just hanging out as usual with no social distancing behaviors whatsoever. Not even wearing protective masks, which is a common habit there unlike the West.


People are very quick to blame Chinese officials, but I think they were correct in avoiding panic before knowing for sure the true dimensions of the problem they had at hand. The government has its credibility at stake: if you start using harsh measures without evidence, you lose credibility for the next time it is really needed.


You have to be kidding.

They were correct in threatening a doctor who reported what he saw (facts) to retract his statements as being _false_?

The local government didn't want to believe in the threat and wanted very much to keep any negative news hushed out of fear of looking bad to the central government.

So there you have it, a country governed by fear where people prefer to hide issues instead of quickly seeking help.

They could have done it through internal channels, without the public knowing but no, they crushed the messengers and tried to hide the facts until it was too late.

The central government admitted it itself: https://news.rthk.hk/rthk/en/component/k2/1506445-20200203.h...


> People are very quick to blame Chinese officials, but I think they were correct in avoiding panic

That's for sure but there's a useful middle ground between mindless panic and total complacency, and these Chinese officials were way too far on the complacency side for quite some time.


[flagged]


A quite black-and-white view to take when it's shown pretty well in this letter how the containment strategy they adopted apparently cut down the transmission a lot and potentially prevented many deaths. Would an alternative government that you propose do better in China? Very debatable. The world is not a good vs. evil story you know.


Most countries would not intentionally cover up serious outbreaks like this, much less do it twice (as previously with SARS).

They wouldn't threaten and silence numerous doctors that tried to warn everyone.

They wouldn't blockade access to one of the world's largest cities, to prevent outside health inspectors from assessing what was really going on. It wasn't until the first week of February that they were willing to let a major contingent of outside experts in, including from the US. That was two months into the outbreak and a point where things had already gotten very bad.

If this had started in France and the US asked to send experts in to help, France would not deny that request, they wouldn't blockade Paris off from all foreign access to hide what was really happening (how bad it was, and what they were doing to people).


[flagged]


I live in Austin where people are still lamenting SXSW being canceled and the Democrat Mayor was still encouraging people to go out to concerts after he canceled SXSW.

And the tech press mocked "no handshakes" until less than a month ago.

Stupid knows no political party.


The only way I see the mocking change is when they see their close ones being infected. We haven't seen anything like this (at-least in our lifetime) where the entire world was in semi-lockdown.

Sure our president is really downplaying it, but how do you even fight something that makes some people sick, and not others. There could be 1000s of carriers of COVID-19 who don't even know it.


Stupid knows no political party.

It's a spectrum of stupid. Moscow Mitch is holding up financial relief because it's a good opportunity to stick it to Planned Parenthood.


Your anti-Russia, nationalist rhetoric is not welcome here.


You're conflating self-determination with nationalism, and the upvotes I got would suggest that HN is generally OK with calling out foreign election interference.


Looks like lots of people consider them the same.

"Nationalism is an ideology and movement that promotes the interests of a particular nation (as in a group of people) especially with the aim of gaining and maintaining the nation's sovereignty (self-governance) over its homeland. Nationalism holds that each nation should govern itself, free from outside interference (self-determination), that a nation is a natural and ideal basis for a polity,[2] and that the nation is the only rightful source of political power (popular sovereignty)."

Ref: https://en.wikipedia.org/wiki/Nationalism


The local police imprisoned a doctor for speaking out about a fast-growing pneumonia disease. They didn't just ignore it, they actively quashed discussion of it


They did not imprison him.

They did squash discussion of it.

Once the national government found out, they fired the local officials and lauded the doctor as a hero.


The fact that there wasn't a credible free press to report responsibly on an emerging illness or a free vote to hold officials accountable are not at all unrelated to the authoritarian system that allowed them to build a hospital fast or close a city or whatever they did well on.

I'll admit, though, that I wouldn't trade my right to vote for a cure for the common cold, coronavirus, or anything else.


> authoritarian system that allowed them to build a hospital fast or close a city or whatever they did well on.

Look, this is a dangerous meme in more ways than one. Italy and Spain managed to lock down entire cities, and those are countries with a strong tradition of democracy. Emergency powers, martial law etc. are a thing, and there's even quite a bit of precedent for using them to deal w/ disease outbreaks. Even in the US.


Anglo-American law was strongly influenced by the repeated waves of bubonic plague in England during the middle ages. Though the powers have been rarely used to their full extent, they continue to exist.


well, Spain is still a monarchy (and has been since the caliphate was pushed back), had a Civil war, where fascists won and then ruled for 40 years... Then the king declared that he would like democracy more than autoritarian rule (without him). So much to a strong tradition of democracy...


Spain has a _constitutional monarch_ the same approach as the United Kingdom. This is actually a more stable choice than America's.

In constitutional monarchy the monarch is Head of State, a figurehead role with no real personal power. Because monarchs are born not elected this figurehead has no semblance of democratic legitimacy, it's obvious to everyone that they shouldn't get any power, yet as a symbol they are long-lived and emphasise continuity even as political change happens around them.

Elected Politicians on the other hand actually run the legislature and executive government.

That is, the laws you obey are made by people you elected to make them, but at times of crisis the living symbol of your country isn't some politician roughly half the country doesn't like.

This works so much better than the US system that Americans charged with trying to make new countries or fix broken ones (after "regime change" for example) do not follow the US model for many decades. If you're an optimist, the US model worked once and maybe they got lucky. If you're a pessimist we're just waiting for the cracks to get bad enough that it falls apart.


> This is actually a more stable choice than America's.

You can't support that claim. Historically - all of recorded history - there are less than half a dozen examples that can be argued to be comparable to or to have systems that are more stable than the US over two centuries of time.

Go ahead and list all the constitutional + democratic systems that have lasted for more than two centuries. The European region barely had any democracies as recently as WW1. Here is what that looks like:

https://i.imgur.com/fnJNjIn.png

Now go back to 1850 or 1900. How many were there? So where do you plan to get your data from, to support your premise on stability?

There is long-term instability inherent in all functioning monarchy systems: the source of that instability is that people frequently don't like them, which is why nations have spent the last few hundred years gradually abandoning or neutering monarchy systems. Most of what remains is a cultural trinket. It's why the monarchy in the UK is little more than a facade, a figurehead; it has no real governing power or position, it is of relatively little political consequence and probably never will be again. Even including the UK in this, is a questionable data point because of that. What does the Queen do? Answer: not much, she is nothing more than a quaint cultural nod to the past at this point.

In fact the US has the opposite problem. Its system of government tends to produce too much stability and not enough dynamism (which is what the argument for many political parties is arguing in favor of). That stability often means the US moves slower on reforms and its system is highly resistant to change. Those are the trade-offs inherent in having greater stability.


So what you've done there is a very common mistake. The US was not the only country built with this approach, it's just the only time it has worked (so far).

Plenty of countries especially in Latin America copied this choice and it didn't work for them. I think the evidence supports the conclusion that's because it's a bad choice.


Thry silenced doctors, faked numbers to the medical community and eventually the lockdown was to save the Chinese economy & people not to stop the spread overseas, however, I’m sure the communist party will claim that.


> The full danger was unknown in the initial stages.

The danger was sufficiently known, sufficiently early.

Those sounding the alarm were silenced.


The containment situation in Wuhan in the early stages cannot be compared to the situation in European countries or the US now, or even the situation in Wuhan now

In the early stages in Wuhan the virus only existed in Wuhan. A severe lockdown that eliminated the virus there would have eliminated it completely. Full stop. It would have been gone forever.

A draconian lockdown right now in e.g. the UK, or even a few weeks ago, might have eliminated the virus in the UK, but then it would just come back in again. We can’t seal the entire country permanently.

Even in Wuhan, they are easing the lockdown so soon the virus will get back into Wuhan again. It’s just a matter of time before they have another outbreak. It’s simply impossible that it won’t happen.

Lockdowns are important tools to slow the spread of the virus, they are a vital part of our response, but they can only slow it down. They cannot stop it or eliminate it. Also lockdowns are most effective the first time you do them, and then they’re the most effective in the first few weeks.

Impose a heavy lockdown too soon, and it’s like using up your most powerful ammunition before the enemy is in effective range of your weapons. Letting the enemy get closer might mean accepting casualties early on, but fewer casualties overall and a better chance of victory. It’s a hard, painful choice to have to take.


I am not a huge defender of China, but it is disingenuous to claim that not realizing the import of the virus in the first 10 days is anywhere near the magnitude of the Italian government's failure.


The Italian government as the first Western country facing an outbreak was dealing with the prisoner's paradox. If you are the only one instituting strong lockdown measures you are the only one paying the economic price. It was wrong, but it's understandable that the government hoped that the infection could be contained to two clusters. The other European governments and the US on the other hand have absolutely no excuse.


So you're arbitrarily suggesting that being the first western country is special. China's economy was already affected at that point. In our global world, why doesn't that count? By your logic, I could also say the US doesn't do enough for obvious reasons: They're the first western non-European country affected. They don't want to be the only ones (after China and Italy) paying the economic price.


It's special in that the Western world and their economies are much more interconnected and fragile than China or Iran, and South Korea was considered special due to the sect. It's also special in that they didn't have any experience with SARS.

Besides Italy did start to apply lockdown measures to specific towns, and closed schools when they had 20 cases. It was insufficient but at least it was an attempt. The US has had clusters out of control in Washington state for almost as long and the federal agencies were actually trying to silence them. And another in NYC, which is basically the economic powerhouse of the United States.


> It was insufficient but at least it was an attempt.

And it should've been clear with all the data we had that it would be. Don't get me wrong, I don't think any of the other western countries does it right. Italy got unlucky because it was the first country where shit hit the fan. Might as well have been Germany if they wouldn't have gotten lucky in stopping the spread from their Bavaria case. But I fully stand by my point anyways that no country in the west did a good job, and points like yours are weak excuses at best, since it basically boils down to "well we're delaying taking down our economy a bit and make sure the rest of Europe suffers too, so we're not as ducked in comparison to them." There's certainly some logic to that, but it shows how shallow our advanced civilized world really is.


> But I fully stand by my point anyways that no country in the west did a good job

FWIW I totally agree.

> Might as well have been Germany if they wouldn't have gotten lucky in stopping the spread from their Bavaria case.

Yes, that's what Italy was hoping to do. They didn't realize how contagious this thing is.


It's interesting that the encouragement for self isolation in Washington came from companies like Microsoft about 10 days ago. That raised awareness quite a bit.


> China dropped the ball for a full 10 days back when the disease was nicely contained to a small part of Wuhan...

Uh, China dropped the ball for a full 3 months since the first reports of a novel respiratory disease started back in November. First denying it, then jailing the doctors who tried to raise the alarm. Not to mention not enforcing their own laws regarding food hygiene put in place after SARS which would have prevented the transmission in the first place.

Yeah, they're now showing containment measures that work. But they could have stopped this in its tracks before going global, or prevented it entirely.

Too little, too late.


New viruses come out all the time. This viruses wasn't isolated as different till the end of December.

The Doctor wasn't jailed ...

The virus was spread at the market. It didn't start at the market.

Until we know where it started we don't know if it would have stopped the virus or not.


The doctors were not jailed, because luckily CCP need them to work to fight the virus. Some of them died for it already, mostly due to the hard work, insufficient protection CCP provided to the doctors, and in one case at least, intentionally punish the doc by delay his treatment.

Talking about the origin of this virus, this paper of 2015 is quite interesting: https://www.nature.com/articles/nm.3985 . In this paper, the wuhan P4 institute people basically described how they produced a prototype of the 2019 wuhan virus.


He was brought in to sign a confession/apology on the 3rd before things were out of control.

He is/was also a member of the CCP.


"the people who sign this letter are not aware that they're being manipulated by CCP, in the meantime, let me push conspiracy theories".


I said in my comment clearly it is a hypothesis. While it is important and useful to think logically the Euclidean way, it is also important to find clues and make hypothesis, that is how people discover things in the real world.

Without information about how this letter was prepared and signed among these people in detail, my hypothesis stands.


> The virus was spread at the market. It didn't start at the market.

The virus came from bats. The "wildlife market" in question sold raw bat meat. How else would it have gotten there?


Is this known for a fact? I thought the bat angle was more a most likely scenario but not proven.


No, Chinese markets generally don't sell bat meat or eat bats.

They eat lots of animals but bats are not one of them. (I'm sure there is a village in China where they do eat bats. It is a big country.)

The photos you see online of Chinese people eating bats are Tourist in the Pacific.


Correct, Chinese markets generally don't sell such things. I know, I'm Chinese ;)

But this particular part of China does. It's more a subculture derived from one of the minority groups in that province, but it's there.


Never heard about such a thing. Sounds like some sort of conspiracy theory unless you have concrete proof of that.

The original hypothesis was that some other animal sold at the market acted as an intermediate host between bat and human, just like the case in 2003 SARS, but this is also not proven.


Conspiracy theory has a specific meaning. Their claim might be false but even if this is the case they are not implying the existence of any conspiracy.


Chinese containment measures gave other countries a head start of at least two months. Too bad that no government took the challenge seriously.


Taiwan started acting on 31st December. Taiwan were prepared because they predicted an event like this could happen. Taiwan hasn’t been hit by a sledgehammer even though they have huge flows of Chinese people travelling.

Any delays by other 1st world countries after 31st Dec are largely their own fault.


I don't think you've followed this argument to its logical conclusion. Taiwan started acting on the 31st of December because they didn't believe a word coming out the Chinese government's mouth. They haven't been hit like a sledgehammer even though they usually have huge flows of Chinese people travelling because they promptly rounded up and quarantined travellers from the affected regions and their close contacts back when China was falsely claiming it was a small outbreak with no evidence of person-to-person transmission, and then locked down travel entirely over the objections of China and the WHO which insisted doing so was racist and counterproductive. Any delays by other 1st world countries after 31st Dec are therefore largely their own fault for believing a word coming from of a totalitarian dictatorship with a long history of cover-ups and their parrots over at the WHO.


None of that is really the point though. The point is that so many other countries are dropping the ball in the same (or worse!) ways than China did after having the luxury of seeing what happened in China.

If you have 3 people and one slips on a patch of ice and falls you could argue they should understand how ice works and should have been more careful, but if you have 2 other people see that person fall and they blithely walk across the ice and also fall, who should you judge more harshly?

For me personally, I'm going with the people who saw the result of the first event and then followed the same path.


Maybe the best solution would be to get rid of the patch of ice instead of finding someone to blame, while people keep slipping over it.


They traced the virus back to November, but at the time it was not a serious threat. They just didn’t have enough data then.

Let’s put it this way, other countries have had a full 2 months of warning and preparation time and they are also dropping the ball.


[flagged]


Not sure if this is a parody or not. So in your logic anything good being said about CCP is surely their propaganda, and they can do nothing else but being evil and destroying the world? Well I have bad news for you: the world is probably not as black-and-white, good vs. evil as you think. They do some stuffs wrong or at least controversial, and also some others right, or effective, just like every other political entity. Otherwise China would definitely not be where it is today, economically. Even the WHO recommended a lot the actions by China. Memeing them like Kim Jong-Un doesn't get you anywhere.


WHO? Italy lockdown its cities on Mar 9, and WHO declares wuhan virus pandemic on Mar 11. Before that, WHO discourages country to take effective measures and cut out traffic with China. Luckily, not all countries are fooled by this idiotic org and take its own measures. Taiwan, who is not even a member of WHO, took good measures and protected itself. Unfortunately Italy and other European countries are fooled and cut out traffic too late. That is the result of they trusted CCP and WHO too much.

Chinese Economy? Is the gain worth all the environmental damage and pollution everywhere?

If CCP gov is like the other political entity, would it when having a SARS outbreak in 2003, make an even bigger one like wuhan virus outbreak and do even worse cover up to spread it around the world?


Italy was one of the first countries to cut down traffic from China months ago. Didn't do any good.


Where you got that info? Any link?


https://www.voanews.com/science-health/coronavirus-outbreak/...

It happened on the 31st of Jan. I think that was before Taiwan stop, but I'm not 100% sure.


> As an Italian, I raise my eyebrows every time China is mentioned as an example for the successful containment of this virus. It could do that because it could afford to take the economical hit and because it is an authoritarian state,

You know what is MUCH more effective than an authoritarian response? An _earlier response_.

An earlier response, even if it weaker, is much more potent than a stronger later response.

The intensity of china's response would not be necessary where the response is faster.

> but following rules in place in an outbreak does not mean one should not question their principles.

The best way to preserve civil rights and not have to bend them to protect against loss of life is to respond as early as you can reasonable justify.

In the US the fact that our principles (and laws!) tie our hands somewhat is all the more reason that it's important that we act aggressively within the space that our society allows.

> Personally I'd like fast-tracking of anti-SARS-CoV-2 drugs instead

Responding earlier keeps people alive longer for those drugs to become available.


> You know what is MUCH more effective than an authoritarian response? An _earlier response_.

Absolutely. If this were Kerbal Space Program just about everybody would be able to tell you that the best moment to deflect an orbit is early on when you only need a little push for a giant effect later on. With exponential developments timing is everything.


Agreed. And where is Trump's response? We don't even have enough testing kits. We had 2 months to ramp things up.


Relying solely on the federal government for a response is a single point of failure. Regardless of who is in control of the FDA and CDC, neither agency should have had the ability to block testing. Not having a breakglass feature is downright stupid.


At least he closed the borders. Russia as well. EU can't even do that.


Several EU countries have already closed or will be closing their sovereign borders in the next 24 hours. They can do that. They are doing it.


He did it in an ineffective way. US nationals were returning from the EU without any screening. And it was way too late. All a bunch of xenophobia theater.


Though I agree with your criticism in broad strokes, this is also a numbers game. If it reduced the number of infected people entering then it was useful. It doesn't have to completely eliminate it to be worth doing.

There are legal and logistical challenges in preventing US residents from entering or imposing quarantine.

Would strong or (more importantly) earlier responses have been good? Absolutely! But a weak and late response is much better than an even later response (even if the later response is stronger).

By the numbers we should prefer a non-US-resident ban-- even without screening/quarantine-- on day 20 than a everyone-ban on day 40.


The China travel ban went into effect 6 weeks ago. Italy, South Korea, and Japan followed not too long after.

He was even called a dictator for that.

Correction: South Korea & Japan were "do not travel" not specific travel bans.


Wait, I hope you are joking because you are spreading misinformation. Japan and Korea were NEVER banned. China was and Italy was just a few days ago.

Japan: level 2 (exercise caution) https://travel.state.gov/content/travel/en/traveladvisories/...

Korea:level 3 (reconsider) https://travel.state.gov/content/travel/en/traveladvisories/...


My mistake. You are correct. They weren't travel bans but "don't go there" recommendations.

Regardless, they're still a response which refutes your original point.


> could do that because it could afford to take the economical hit and because it is an authoritarian state, which means you can get almost everyone to obey, in one way or another. Also, the Chinese Party is what caused this mess to begin with, by allowing this virus to spread all around the world.

I don't understand this logic. Because China made a mess at the beginning of the pandemic, so we shouldn't copy the model they employed at later stage that is proven to be working?

Or because China is an authoritarian state, so everything it does is bad and nothing we can learn from them? Well China has been copying and learning from any countries for a while now and that's what makes it stronger by day. Just keep blaming China and do nothing. That will surely make China less powerful and less influential.

You know what's scary? All major democracies failed to manage the pandemic while China becomes the most powerful country after all this.


Nah scratch that. At this point it's hard to tell who are the baddies[1].

1. https://www.bangkokpost.com/world/1879190/us-germany-battle-...


Drugs are not a solution in the next 2-3 months. There's no way a drug can be tested and ensure safe and scaled up to the tens/hundreds of millions of doses you would need. It's impossible so don't even bother considering it.

Quarantining is the only thing that will help in this situation. There's no other solution we have as a society to slow down the pace of infections. People who normally wouldn't die will die because of the lack of medical care.

The problem we face in the US is lack of testing, which makes it impossible to do anything except a quarantine.


> Quarantining is the only thing that will help in this situation.

The question is, for how long? Until the infection curve goes down? Until there is not a single infected cases in the whole country?

While you can't know when this will happen (especially the former, most models are inaccurate because too little is still known about this virus), I don't believe it is sustainable to keep an extended lockdown on a whole country (as opposed to "just" Hubei, which however has almost the entire population of Italy) more than a few months.


The purpose now of social distancing and quarantine is to spread out the infections so that the hospitals are not overrun by everyone being sick at once.

A significant proportion of infected need hospitalization to survive. If we all get sick at once, there simply aren't enough hospital beds to go around, not to mention other supplies. If the hospitals go far beyond capacity, the fatality rate will be _far_ higher than otherwise.

As to how long, I haven't seen good models. In the US we don't have very good data either, because we're testing basically noone.


The press reports several models which say between next week and the end of April for the so called "peak" (I don't think the press understands what it means, however), but at least to me they're useless because the confidence intervals are not given (I can't expect a newspaper to do so, but providing a source to consult in such cases would be beneficial).

Some of these models are also different in nature, which adds to the uncertainty: some are epidemiological models, some are economical (used to evaluate the impact of the measures on the long term).

Lastly, a lot of qualified people speak and try to give estimates. I'd love if they don't, because currently the best answer is "we do not know yet".

That said, I think that going over two months of lockdown will be probably ruinous for the country as whole.


The purpose now of social distancing and quarantine is to spread out the infections so that the hospitals are not overrun by everyone being sick at once.


Until we have a vaccine or enough people have been infected to build up natural herd immunity. At least a year is my guess.


I don't know if the country can hold economically and socially being completely locked up for one year. Probably not.

And I'm not sure if people can hold psychologically being locked up for one year.


Drugs are a solution for mitigation. They already have a preliminary trial result in China that says Chloroquine works. South Korea agrees and I believe is combining it with Zinc. South Korea has the lowest fatality rate of any country.


This has a lot to do with their age distribution. Their fatality rate by age is similar to elsewhere. A large fraction of the infected cult members were young.

Korea also hasn’t had any hospital breakdown related increase in the death rate.

Chloroquine may indeed work, but the Korean stats are misleading if you don’t adjust for ages.


China’s fatality rate is also way down. Partly of course from less stress on the medical system, but they’ve also just learned a lot about how to treat it, particularly what drugs to use. I believe Chloroquine + Liponavir/Ritanovir + Interferon or Ribavirin is state of the art.


Chloroquine + Liponavir/Ritanovir may cause fatal arrithmias, in the case anyone out there is self medicating. It's one or the other.


Can you cite a source? Current Chinese treatment guidelines allow it.

Also very important to quantify side effect risks, even if it's a rough estimate. For example, if a 70 year old patient has already progressed to dyspena, they might have something like a 20% mortality rate from COVID. Even if there is a side effect profile for the treatment that normally would be considered very dangerous, it may be well worth it to administer it.

We see the same thing with chemotherapy or radiation treatment. The side effects are terrible and fairly often fatal, but they are safer than the disease. This is the situation in which we find ourselves.


I can't find the original source, but you can easily verify that both drugs increase the QT/QTC and PR interval, which is a high-risk interaction AFAIK (I'm not a doctor). Some doctors recommend doing an EKG before administering Chloroquine.

https://www.sciencedirect.com/science/article/pii/S088394412...

What you're saying is true, but you're assuming that Chloroquine + Kaletra is better than Chloroquine by itself, and we don't have the data for that yet.

Do you have a source for the Chinese recommendations?


Thanks for the link. Current Chinese treatment guidelines are: https://www.chinalawtranslate.com/en/coronavirus-treatment-p...

They state:

4. Antiviral therapies: Interferon-alpha (adult: 5 million units or equivalent can be added to 2ml sterile injection water and delivered with a nebulizer twice daily), lopinavir/ritonavir (adult: 200mg/50mg/tablet, 2 tablets twice daily; the length of treatment should not exceed 10 days), ribavirin (recommended in combination with interferon or lopinavir/ritonavir, adult: 500mg twice or three times daily via IV, the length of treatment should not exceed 10 days), chloroquine phosphate (adult 18-65 years old weighing more than 50kg: 500mg twice daily for 7 days; bodyweight less than 50kg: 500mg twice daily for day 1 and 2, 500mg once daily for day 3 through 7); umifenovir (adult: 200mg three times daily; the length of treatment should not exceed 10 days).

Pay attention to issues such as adverse drug reactions, contraindications (for example, chloroquine should not be given to patients with heart diseases), and drug interactions. Further evaluate the efficacy of current treatment regimens in clinical applications. Using 3 or more antiviral drugs is not recommended. Corresponding medication should be discontinued should intolerable side effects appear.


Same for many EU guidelines

Source as I posted on other submissions

Chloroquine is mostly admitted as a valid treatment now

https://news.ycombinator.com/item?id=22582374


I thought that remdesivir was the drug showing the most promise? What happened with that one? And my big questions are how soon can they spool up world supplying levels of batches?


It's being tested in a few trials, the earliest one should have data in April, IIRC.


> They already have a preliminary trial result in China that says Chloroquine works

Chloroquine has a long history with many diseases of "sorta, but not really" working when subjected to actual test.

Please don't spread unsubstantiated info.


This is not unsubstantiated. It is proven in vitro, and this came out the other day: http://news.southcn.com/nfplus/gdjktt/content/2020-03/09/con...

I haven’t found the source paper if there is one yet — I can’t read Chinese except with google translate


Drugs shown to be effective in vitro routinely fail to show similar effects in vivo.

Chloroquines have a long history of this in viral studies.


The point is that according to what the official Chinese medical line is, it works in vivo. This is apparently confirmed by Korean experience. I understand the skepticism, but you go to war with the data you have, and the data we have indicates Chloroquine works.


The “data” is anecdotal, not even close to the standards of an effectiveness trial.

That said, it’s an approved drug, so it will be applied and we’ll see how it goes. But don’t spread rumors about its effectiveness, because the truth is, we don’t know.


Bleach or a handgun also work "in vitro".

Relevant XKCD: https://www.xkcd.com/1217/

Chloroquines will be tried since they already pass the "safe" bar.

However, I suspect that if they worked "in vivo", we would have compelling data on that from China already. The fact that we don't have such data suggests that they don't.

We seem to have much better data about the effectiveness of standard anti-virals already.


They can fast track drugs if that drug has been tested for other things. It happens all the time. I mean like all the time doctors do it for other cases, there's not reason it couldn't happen for cov19


There are some existing drugs that help with the treatment but they don't really stop the infection spreading. Chloroquine / hydroxychloroquine are maybe the most useful.

Probably if they handed some out and told people to take a few as soon as they got a cough + some temperature it would help things. (http://news.southcn.com/nfplus/gdjktt/content/2020-03/09/con...)


> Why on Earth is this a good model?

Pretty much all countries have mechanisms for emergency powers. China being authoritarian has nothing to do with it. I'm not familiar with Italy's constitution or laws, but I assume it has similar provisions?

> Also, the Chinese Party is what caused this mess to begin with, by allowing this virus to spread all around the world.

Huh? On the one hand you're arguing China was too draconian (and Italy shouldn't copy), then a sentence later you're complaining it wasn't enough and this is all China's fault?

What exactly do you suggest China ought to have done to prevent it from spreading outside of China? I haven't heard any reputable source suggest there was any practical way of containing it perfectly.

Your comment comes across as knee-jerk anti-China rather than anything based in science or public policy.


> I haven't heard any reputable source suggest there was any practical way of containing it perfectly.

Of course there was. If they somehow magically divined the true danger of the virus the day they identified it.

But they didn't, it took time and observation, and they shut down the affected areas as soon as the extent of danger was realized and processed by their bureaucracy. There's plenty of things here that could've been done better, but it's asinine to blame them for the virus taking hold everywhere else. Doubly so given that most of the world had a month+ warning before they registered their first cases.


>> processed by their bureaucracy

That is the issue here. They completely ignored it until people were dying in the hallways of hospitals and then implemented a draconian policy.

And now they're locking up anyone who criticizes them. See this article about "Gratitude education", a term that tops Orwell in its dystopian implications:

https://www.theguardian.com/world/2020/mar/09/gratitude-educ...


Where did you read that people were "dying in the hallways of hospitals"?


Italian doctors have been writing about this since ~Tuesday. There's loads of reports and newspaper articles about it. They're in full-on triage mode, and there isn't time or manpower to give people even palliative care.


So, It seems that China did some things very wrong in the beginning, but then took some big actions to turn things around. There was a long form piece in the Wall Street Journal last weekend that looked at the timeline. It seems that in the early phases, authorities didn’t want to have bad news leading up to the end of year / New Years period. There was suppression of information coming out about there being a novel virus — to the extent the doctor had to offer a public apology for ‘spreading rumors’ — dots weren’t connected, etc. The Wuhan banquet wasn’t cancelled, number of cases exploded shortly after.

And, look — I’m sitting here in the US where I’ve been horrified at our own response over the last month. But the question was, could it have been contained? Looking at that timeline, it certainly seems possible that it could have been. Of course, we’ll never know.

https://www.wsj.com/articles/how-it-all-started-chinas-early...


> What exactly do you suggest China ought to have done to prevent it from spreading outside of China?

Well, at the very least, take it seriously when there were the first reports of "new viral pneumonia" in Wuhan, instead of locking up or censoring people who reported that.

Yes, this doesn't mean that other countries did not take it as seriously as they should have, and perhaps containment might have failed nevertheless. Still, it was a spectacular failure with long-lasting consequences on every other country in the world.

That, IMO, deserves blame, no matter if other governments are doing the same errors.


Not sure why this is greyed out. I might not agree with all of it, but you're not out of line.


Just like China, there was a time when Italy had 1 case, then 2 cases, then 4, etc. Italy was unable to stop the spread before reaching a huge level and spreading to other countries.

Why blame China for "allowing this virus to spread all around the world" when Italy allowed the same?

(Italy even had a warning that it was coming!)


Doctors and civilians tried to sound the alarm that something was going on, and were silenced until it was too late. To their credit, the CCP fired the Wuhan officials who presumably silenced those people, but it is still their responsibility for fostering a culture where towing the line and hiding problems until they cannot be hidden is acceptable for leadership positions.


There's nothing to credit. Everyone was in on the silencing, the CCP only used those officials as scapegoats. Everyone on all levels of politics was keeping this a secret and hoping it would go away.


You raise a high bar for China but if the virus appeared in many other countries the global outcome would have been much worse.


There are several articles about he CDC being silenced in various ways on early measures because they would hurt the economy.


you're missing that China initially suppressed info abt this virus, which caused it to spread. had they reacted immediately, we might be in a much better situation rn


That's a very important point if we're discussing the upsides and downsides of censorship, or whether China is a bad country and should feel bad about itself.

But if we're looking for an example of how to solve the pandemic, when people point to China as an example, they aren't saying "we should spend a few weeks pretending the virus doesn't exist, threaten doctors who talk about it, order our labs not to study it, and THEN take decisive action". They're saying we should do the stuff that China did, starting from the decisive action part.


Which is why I honestly don't understand why the mainstream media isn't saying "do what Korea/Japan did". Other countries have handled this admirably (e.g. Taiwan and Singapore), but Korea and Japan are larger and had very sudden upward trajectories in infection rates. Both countries acted decisively and they got this under control incredibly quick and with minimal loss of life, all without resorting to extreme authoritarian measures.

What China did is not something that other countries may want to replicate, but we should all be replicating the Korean and Japanese measures. Actually we should have been doing it weeks ago instead of pretending that if we didn't test then there would be no cases.


From what I learn, Japan is acting like UK. Nothing like China and Korea at all. They don't want to cancel 2020 Olympics after all...


I'm in Rome and I called my friend in Japan to enquire his whereabouts and he told me there they're not doing the same way Korea did it. Peoples continue to go to work. No mass screening. So cases aren't really reflecting the reality. It's like in USA. But one thing he conceide is Japanese are clean.


exactly. I don't understand why people are so eager to assign blame when in reality every one would be better of taking the good parts of what China did.


We should assign blame to a drunk driver who hits someone, no matter if he became sober after the accident enough to drive his/her victims to the hospital.

There's certainly lots of blame to assign to China and after all this comes back to a "normal" state again the international community should pressure China into eliminating the things that made all this possible: they should be draconic in not allowing things like the Wuhan wet-market be open ever again, all over China, for ever, they should be forthcoming in allowing international experts come and asses things as soon as a new disease manifests itself, they should allow their local medical experts have the upper hand over local Communist officials, at all times.


China was the first to have to handle the issue, so they had the difficult job of figuring out whether this virus was just like the flu (which some people are still claiming even today) or whether it was something to worry about much more than that. Imagine the cost to your credibility if you call it out for a huge danger, and it turns out it is just a new flu variant... The spread to other countries seems to only have started once the Chinese had conclusively shown this virus was very dangerous (and started the lock downs to prevent its spread). Hence, other countries had the benefit of this knowledge which China didn't, yet still failed to act. Some countries like the UK and Sweden even now pretending this is not a big deal and not taking anywhere enough measures to avoid widespread infection rates.


> They’re saying we should do the stuff that China did, starting from the decisive action part

You do realize that some of their “decisive actions” included enforcing quarantine via welded-shut doors, right?[0] I don’t think you’re ready to handle the kind of “decisive action” that China took.

0: https://www.cbc.ca/player/play/1703503427818


They only did that to people that refused to self quarantine.


Well, I guess that makes it alright then.

I don’t think you understand the significance of welding the doors shut... it means if they catch you outside you can’t claim you did it on accident. So, wink wink, they’ll cure you of the virus permanently after that.

Again, you’re not ready for Chinese-style “decisive actions.”


Don't worry about rights now, if you leave the door open and people walk about they will get even more decisive action from the virus, and gift the virus to others.

With the population it has, China could have been in a much much worse shape today were it not for the quarantine.


Yes, and so could many countries, including Italy. This is the deal we've been had, and need to look to the future.


>you're missing that China initially suppressed info abt this virus

Not only that, refuse to acknowledge, or share any information to international communities. The amount of things they do just to saves faces.


You mean like making the DNA public, posting statistics daily, sending doctors and resources to other countries to help train ...

That kind of not sharing information?


Like pretending it was an unknown disease that showed no sign of person-to-person spread when they'd already sequenced its entire RNA and found cases of it spreading within the community. Like having to be pressured into revealing what little details they did. Like, as I recall, only admitting that it was spreading person-to-person when another country spotted this. That kind of not sharing information.


It is a Novela virus. By definition you don't know anything about it until it is proven.

If you don't know the source (which is still unknown) then you cannot verify that it has spread human to human. (They should have assumed that it did)

Researches outside of China said there was no evidence of human to human transmission.

The first 2 weeks of January were handled rather poorly. But lack of information since then isn't really one of them.

What could China have done that would have made you personally happy?

People automatically distrust anything they say. What other information could they have provided?


When people dislike a certain government or person, they jump to the worst conclusions about them rather quickly. This is extremely dangerous. Imagine a sensitive situation develops where there's weak evidence the victim of your dislike did something that might endanger you or your country... if you immediately jump to conclusions, which you are very likely to do as this thread shows, then the situation would easily develop into a confrontation... this is not hypothetical. With Americans and Chinese (and Russians, Iranians) coming face-to-face in more and more sensitive situations around the world, it's only a matter of time until the mutual distrust will cause one side to pull the trigger under unreasonable circumstances.


so you mean what happened before JAN/20, now is MAR/14.


You mean like doing all that after they can no longer hide it from any one else and the world needs them before they started doing so.


I blame my own government for this, of course, the same that's getting all the praise and the "calls to responsiblity" from the press.

When we had the first cases its only concern was whether a minority party would leave the coalition or not.

It wasn't fit for the emergency, any emergency. Unfortunately, that's what we will be stuck with until it's over.


It's a completely different situation. If China contained the disease when they had only 10 cases, there would be no disease anymore. If Italy contained the disease when they had only 10 cases, new cases would arrive, again and again.


>Just like China, there was a time when Italy had 1 case, then 2 cases, then 4, etc.

Just like the spread of fire, the window of opportunity to put it out is right at the beginning.

Yes, Italy could put it out when it first came to Italy but they would have to do it many many more times to successfully contain it. China just had to do it once and they failed.


If it did indeed come from live animals in a wet market, that seems like a potential valid reason for some criticism, although the they did a superb job adapting imho.


The difference is china could have contained it with minimal disruption. The only option italy had was to shut down all borders for the next 6 months.


[flagged]


A bat infecting a pig could easily happen in Italy. Or anywhere else for that matter.


No, not even close. Those wet markets are a fucking nightmare. There are truly optimized for pulling new diseases into the human population. Thousands of animals, hundreds of different species, many known to be reservoirs of potential human pathogens, crammed together in close proximity with each other and with humans who eat them.

In his interview with Joe Rogan, Michael Osterholm called it "the perfect experiment that no university would let you do":

https://www.youtube.com/watch?v=E3URhJx0NSw

Their discussion of wet markets starts at around 1:01:00.


You are missing the point of my comment. A bat infecting a pig or some other two step is a pre-cursor to many Zoonotic events. Those wet markets are indeed a huge accelerator. But the pre-conditions exist in many places and all it takes is one butcher that isn't paying attention and you've got the ball rolling.

Africa and Asia have a lot of this and so are a recurring theme in these very unfortunate stories. But it could happen here, and viruses really don't care about location.

Wet markets and bushmeat is how we got SARS and HIV. We're not sure if COVID-19 was really transferred that way, maybe we'll never know. The Swine flu also jumped species in a regular farm. So there are lots of opportunities all over the world, some more dangerous than others.


Bushmeat gave us Ebola as well. Deer hunting might give us CWD soon (we observed transmission to human-model mice already) and that one is basically disinfectable only by using high heat and pressure together.


Bushmeat gives Ebola over-and-over again. It has crossed the species barrier many times already.

And let's not forget about diseases like these: https://en.wikipedia.org/wiki/Bovine_spongiform_encephalopat...

Even though they do not involve viruses they are still part of a similar kind of interplay between species.


What you're saying doesn't make any sense. You said, "A bat infecting a pig could easily happen in Italy". How is a careless Italian butcher in any way comparable to a seething, filthy wet market where live pigs and bats are crammed into stacked cages? How much bat do you think they eat in Italy? Do Dutch butchers serve bat or pangolin or dog meat, or keep wild birds in cages on top of ferrets, which are good animal models for human influenza infections?

As a vegetarian, I'll happily acknowledge the barbarity and health hazards of factory meat production in the Western world. But this really is a tortured apples-to-oranges thing you're doing here. There is simply no valid comparison between a European meat grocer and a Chinese wet market, and I think you know it.


The world is a lot larger than Europe, and there are documented cases of Zoonosis from all over the planet (in fact, a good 2/3rds or so of our pathogens are of Zoonotic origin). Also, this particular virus likely did not cross over in a wet market, there is no evidence for that.

As for how much better the EU is:

https://en.wikipedia.org/wiki/2009_flu_pandemic_in_Europe

Is a good example of what can happen here.


Again, you said "A bat infecting a pig could easily happen in Italy". I'm calling bullshit on that. I know it's just a silly example, but the risk of a virus hopping from a bat to a pig in Italy (again, how many bats do Italians eat?) is not comparable to a Chinese wet market, where beasts of all kinds, their waste, and products of butchery are intimately mixed every day.

> Also, this particular virus likely did not cross over in a wet market, there is no evidence for that.

If you're relying on a lack of absolute physical proof to support your argument, then I guess you win. Otherwise, there absolutely is evidence that this virus jumped from an animal reservoir local to Hubei, and that the wet markets are perfectly designed to facilitate that process. You're being a bit slippery on this point, but it really isn't the least bit controversial among virologists or epidemiologists.

American-style factory farming of cattle, swine, and poultry, where uncountable animals are crammed together and kept alive with antibiotics, is maybe a valid comparison. America is creating it's own epidemic of antibiotic resistance with the help of these farms (and so is China for that matter). But that does not -- or at least logically should not -- assuage anyone's discomfort with the health hazards of wet markets.


> one butcher that isn't paying attention

What are you suggesting exactly--that a slightly inattentive butcher wouldn't notice the difference between a leg of pork and a bat?


No, that there is a typical one-two step to a Zoonotic event where the jump from a reservoir animal to an animal that is regularly consumed is made.

https://en.wikipedia.org/wiki/Natural_reservoir

For plenty of these events we do not know the reservoir animal (yet). So that butcher will know they are butchering a pig, not a bat. But that pig may have become infected and if the butcher isn't very careful he may infect himself and if the meat isn't prepared carefully it may infect those that consume it. And by the time we realize it has happened these important bits of data may have already been lost.

There is a very good book on the theme called 'Spillover', highly recommended and so far it seems to have been exactly on the money with how this whole thing unfolds. Uncanny actually, it is like having the spoiler for a movie that wasn't made yet.


What we know so far is that it's likely to have started at a wet market in Wuhan where people lived with bats and other wild animals. Chances of cross-infection are much higher in that scenario.


The virus cannot have started back in November and started at the wet market at the same time.

Either one is true or the other is true.

People don't live with bats. The animals they farm live near bats.



> Why on Earth is this a good model?

Because it worked. Millions of lives have been saved - 1% of 1.3B is 13M people. That's 1/5 of Italy.

Are there better models? Maybe. But there are also much worse models, as I suspect we might soon find out in the US [1]. Personally I'd much rather take the Chinese model for the next few months than risk me and my family dying or going bankrupt over the next few months.

And, instead of thinking that China could "afford to take the economical hit", consider the economic impact of 13M people suddenly dying. At this point, there's definitely going to be a hit to the economy. It's just going to be either A) from stricter lock downs and government aid, or B) from more people dying due to overrun hospitals. It might not be a wash in terms of the dollar amount, but it's clear which option will save more lives.

[1] Comparing China and US response:

- China has made treatment (not just testing) for coronavirus free for everyone. In the US...better hope you have good insurance.

- Tests performed per million people: China 2,800, US 5

- China is ordering banks to increase loans to SMBs rather than hoarding cash to protect themselves. It has rolled out a bunch of policies to support SMBs and employees. The US...well, not much so far.

Sources: https://www.sciencealert.com/here-s-how-many-coronavirus-tes... https://qz.com/1813181/china-is-taking-pleasure-in-us-mishan... https://www.scmp.com/economy/china-economy/article/3052474/c... https://www.china-briefing.com/news/chinas-latest-regional-m...


> Because it worked. Millions of lives have been saved - 1% of 1.3B is 13M people. That's 1/5 of Italy.

This is an inacurrate estimation. I guess your figure of 1% is from South Korea case fatality rate. The confirmed cases represent a biased sample of the population, and the mortality rate could be lower in reality (but not higher).

> consider the economic impact of 13M people suddenly dying.

The mortality is mainly for 70+ years old people, who are already not in the workforce anymore.

Those numbers cannot help us to evaluate or to compare one state's measure versus another state's decision


> This is an inacurrate estimation.

Sure, the actual number will likely be different for each country / state / city, but doesn't really matter for the sake of the argument. I was using 1% as a lowball number. Official mortality rate from the WHO is 3-4%; some studies say 2%, Italy is reporting 7%.

And for those 80+, current data suggests a mortality rate of 1/7 - not far off from a round of Russian roulette.

So if you have 4 grandparents who are 80+, there's a ~60% chance at least one will die if the disease spreads through our population in the next few months.

> The mortality is mainly for 70+ years old people, who are already not in the workforce anymore.

Firstly, if hospitals are overrun (which is the way we're headed), people of all ages will die preventable deaths. Hospitals in the US are already postponing elective surgeries.

Secondly, it's simply not true that older people don't contribute to the economy.

The elderly still consume food, housing, health care etc., and a negative demand shock is a recipe for recession. For example, think about what happens to nursing homes or physical therapists if a large percentage of older people die. Or what happens to local housing prices if lots of homes are suddenly put up for sale because elderly owners died en masse.

And many older people continue to work and volunteer (e.g. just look at our president, congressmen, and senators), and that some grandparents help with child care (like in my family right now).

Sources: - https://time.com/5798168/coronavirus-mortality-rate/ - https://www.buzzfeednews.com/article/lamvo/coronavirus-death... - https://nypost.com/2020/03/12/heres-why-the-coronavirus-deat... - https://www.economicshelp.org/macroeconomics/economic-growth...


Here's a quote from the first link you have:

"That means the total number of reported cases is very likely an underestimate—and by not counting many mild or asymptomatic cases, we’re likely overestimating the disease’s overall mortality rate."

It is not possible to know the mortality rate with the information we have. Extrapolating that dubious number into a prediction of deaths is not a meaningful exercise.


To be fair, they are using 1% which is an underestimate given what we know right now.

In general, with exponential growth the best time to act was yesterday.


The only reliable number are deaths assuming people aren't hiding (or burning) the bodies. The number of tests are reliable among themselves, but we can't necessarily compare specificity and sensitivity of the tests against each other. Maybe those numbers are out there, but i haven't seen them.

The amount of infected is not and will not ever be known and it's a dark time for statistics when many are taking the non-randomly tested and dividing by fatalities and projecting deaths on large populations.

Exponential growth is how successful infections progress. There is nothing new to see here. This sort of aggressive strain was easily foreseeable years ago and we rely on strategic, planned measures to be executed by government.

Random, localized shutdowns only serve to exacerbate the unwarranted panic we are now seeing. The time to think was years in the coming, the actions now display an enormous failure in leadership.


>>Personally I'd much rather take the Chinese model for the next few months than risk me and my family dying or going bankrupt over the next few months.

Always makes me sad when Americans willing give up essential liberty to purchase perceived safety. Personally I would much rather look the situation rational, may the assessment of risk for myself, then choose on my own what course of action(s) I will take. Not have those actions dictated and imposed on me by an authoritarian government.

I would rather lose my health or my life than to lose my liberty


It's not just about your health or your life. This is what R0 means - even if you end up fine after getting the disease, you're going to transmit it to other people who may end up dying because of you.

In other words, it's also your liberty vs other people's lives.

Are you going to be the grandson who kills his grandma? Or the employee who kills the CEO? Or the Trump supporter who ends up helping elect Biden?


The grandma and the CEO can quarantine themselves at home if they so wish.


Older people cannot just wall themselves off from the rest of society.

What if they live with or are cared for by other family members?

How will they get health care for existing conditions? Hospitals have been shown to be a major vector for transmission [1]. And how do they even get to the hospital if they can't drive?

What about grocery shopping over the next few months? The National Guard is stepping in to help deliver food in New Rochelle now. Can that scale to the entire nation? For how long?

What if they live in a nursing home? Look what happened in the Seattle one [2].

[1] https://jamanetwork.com/journals/jama/fullarticle/2761044

[2] https://www.foxnews.com/health/washington-state-nursing-home...


> Hospitals have been shown to be a major vector for transmission

Not sure how this is relevant to my post.

> What if they live in a nursing home in close proximity to other elderly people?

The nursing home could stock up and ban people from coming in or out of it.


> Not sure how this is relevant to my post.

Many older people cannot just stop getting medical care, and by doing so will be exposed to COVID-19. Especially because hospitals and clinics are overwhelmed by COVID-19 patients.

> The nursing home could stock up and ban people from coming in or out of it.

And all the nursing home staff will be locked inside and not leave for months? Where do they sleep / shower etc?None of the nursing home staff have families or children to care for?


>>Are you going to be the grandson who kills his grandma?

My grandparents are long long dead

>>Or the employee who kills the CEO?

Maybe the CEO should have thought about that and given his employees a work from home, or other policies to allow themselves to self quarantine.

I also find it telling you talk about the employees giving it to the CEO and not the other way around... I am sure there is a Parable in there about unwashed masses

>Or the Trump supporter who ends up helping elect Biden?

Not a Trump supporter, but I do find it amusing you believe only Trump supporters support liberty, and only Biden supporters support authoritarianism

Though I dont think anything will help Biden win, he less electable than Clinton was in 2016


> My grandparents are long long dead

er...what are you trying to say? So other people's grandparents can go f* themselves?

> I do find it amusing you believe only Trump supporters support liberty

Nope, I mentioned Trump supporters because Trump was dragging his feet on cancelling his massive rallies [1]. Thankfully they've been cancelled now.

[1] https://www.vox.com/policy-and-politics/2020/3/11/21174945/b...


Even if it's temporary?


Lost liberty is never temporary, once lost it is lost forever.

Government never roll back control they have ceased. Look at the after effects of 9/11, those provisions where to be "temporary" yet have been renewed endlessly and will always be renewed


Far more importantly IMO is the Chinese gov not shutting down live wildlife markets earlier, stopping dangerous non-scientific medicinal use, and enforcing trafficking of known-carriers. Specifically with COVID-19, the trade of Pangolins which are the "most trafficked animal in the world", which largely end up in China and Vietnam often via other SEA countries:

https://www.nature.com/articles/d41586-020-00548-w

https://www.nytimes.com/2020/03/05/opinion/coronavirus-china...

Xi was aggressive shutting stuff down but then went on to praise Chinese medicine (basically Naturopathy) multiple times after the Coronavirus became apparent. Which is where the quack medicine that results in people grinding up Pangolin scales and taking them like medicine, then eating the meat. Not to mention having markets with live wildlife in unsanitary areas in the middle of major urban areas with high density.

I'm surprised the continued spread of woo by Chinese authorities isn't taking more of a beating. Not just doing nothing, but promoting it.

Even the recent wildlife market "ban" has a giant loophole:

> The coronavirus epidemic prompted China to permanently ban trade of wild animals as food, but not for medicinal use.

https://www.nytimes.com/2020/02/27/science/coronavirus-pango...


China's initial response was terrible. When they realized what they had on hand and how fast it was developing they did what they could to turn it around.

That said, I would take any numbers coming out of China with a very large grain of salt; Italy looks way worse than China going by the numbers but I'd trust the Italian numbers more.

Also: it is much better to go by deaths and critical cases than it is to go by the number of cases themselves. The deaths and the critical cases are a lot harder to hide.


Really.

I mean sure - they dropped the ball on a new virus emerging from a familiar situation and getting blindsided by incompetent and image obsessed party officials who silenced the alarms and it took a while for the highly concentrated power structure of blindly loyal party officials to pivot and move.

However ...

It was not an unknown anymore for Europe There was months of warning time There is no suppression of scientific at scale There was daily warnings from WHO and many countries There was precedent for effective measures from Asia

There is no no no reason this should happen in a western democracy right.

And lets not even look at the US where image obsessed national officials with highly concentrated power and blind loyal party following have been actively downplaying (flu), suppressing the national response and hampering testing and effective containment.

It's like China in reverse - the stupid version playing out right in front of our eyes.

We all here love to repeat the virtues of western democracy over the autocratic China but right now we need to take a really good look at how much the theoretical ideals have been replaced by practices that combine the worst of both systems to absolutely devastating results.

If we don't want a major collapse down the road from all the other wait-and-see known threats, from antibiotic resistance to resource exhaustion to broken pension systems to climate change, we better start thinking about how we get of the 'reality is what we want it to be as long as we vote for people who tell us what we want to hear and cast out people who tell us what we need to act upon' train.

Darwin is about survival of the most adaptable to an ever changing world, not necessarily the strongest and right now China looks a lot more adaptable than we do- so if we like our values and system we better start making sacrifices to the gods of science and reality again.

That however would require us to even admit there is a problem and it's not looking promising


> Also, the Chinese Party is what caused this mess to begin with, by allowing this virus to spread all around the world.

That's not alarming.

What's alarming is that the Chinese regime admitted that the people who they placed in charge of the crisis response have been continuously lying and falsely reporting the real amount of victims and how far the disease has spread. They've done it jus prior of replacing them, but the Chinese regime just replaced them with loyalist party officials, which makes it sound like a desperate attempt to keep falsifying reports.


> Why on Earth is this a good model?

It's not but I guess it's the best they have right now.

Taiwan, Hong Kong, Japan and Singapore are still functioning and have "contained" the virus. The number of cases/deaths did not explode despite contracting the virus much earlier.


It's good you put "contained" in quotes. Japan, Singapore, and Hong Kong are all (according to this plot [0]) showing exponential growth in the number of cases. It's a slower exponential than elsewhere, but it's still an exponential.

[0] https://www.ft.com/__origami/service/image/v2/images/raw/htt...


Well, that's how these graphs tend to look like for a while for infectious diseases. All we can do at this point is reduce the growth factor so that doctors don't have to choose who gets to use lifesaving machinery and who dies like in Italy.


"China could afford to take the economical hit"

The faster and better that you deal with it, the smaller the economic hit is going to be. China is going to be the big winner here.


This.

The economy is going to be hit either way, it's just a choice between A) a lock down but most people staying alive and healthy or B) lots of people dying or sick and an overrun health care system.

Maybe we don't know which one will have bigger impact on the economy, but we know for sure which one will lead to more human suffering.


Especially because they are in the position to help other countries now, when everybody else have to think only about their own citizens. They sent doctors to Italy with medical equipment (Italy sent some help to China earlier on) so they're going to take some credit for the recovery. Then there will be the real recovery. Western Europe was rebuilt with US money after WW2 and the USA consolidated an hegemony which is still lasting now. I bet that China will be more than willing to help in the next years.


Maybe China will emerge as the winner because they kept the number of victims down, just like the US emerged as the winner of WW2 after its industry was spared destruction by bombing.


Seconded, but the USA also had the will to push their hand. They could have said goodbye and went back to the Americas, instead they did their best to control the world. Of course everybody in that position would have done the same but they had a competitor (the USSR) so it didn't come for free.


Although China has a large internal market, they still rely on exports. If those are curtailed due to slackening demand, quarantine and tariffs, how do they become the "big winner?"


Well, smaller loser than they would have been if they'd allowed the virus to spread unchecked.


I don't see any reason to think that China can better handle the economic hit.

China has more poor people than Italy, it stands to reason they are less well equipped to handle an economic down turn.


Maybe not. You want a society to develop herd immunity for a flu-like disease during warmer weather months. Since they failed to contain it, the disease is just going to show up in China again but this time from sick people traveling to China. The worst case scenario is lockdown during warmer months and then having it flare up again in winter months.

That said, we could just apply medical quarantine procedures used for animals to humans. Get a lab test 48 hours prior to international travel and have an additional test performed upon landing at the destination. The first test minimizes the likelihood of someone with viral shedding traveling and the lab test upon landing let’s you get the person and isolate them immediately before they’ve shed virally.


Even if it's not contained world-wide, there's still the chance that a vaccine can be developed to provide the immunity later.


It could do that because it could afford to take the economical hit and because it is an authoritarian state, which means you can get almost everyone to obey, in one way or another. Also, the Chinese Party is what caused this mess to begin with, by allowing this virus to spread all around the world.

Can we stop using mode of government as an explanation for success and failure?

Clearly your country have its head screwed on better than mine. Meanwhile, my president is complacency in chief, more worried about the stock market than lives being lost. The local governments know what they're doing moreso than the feds, when it should be the other way around.

South Korea certainly seemed to have its head screwed most on head. They learned from previous lessons and are very successfully in applying them.


> Also, the Chinese Party is what caused this mess to begin with, by allowing this virus to spread all around the world.

So did Italy, and they even got a head start in knowledge about the virus of about a month. Yet, the majority of cases here in Germany can be traced back to Italy, and not directly to China.

It's depressing how every country still tries their best to ignore their own failings and defaults to "well China should have stopped it right in the beginning"

I am absolutely sure that things would have been at least as bad if not worse, had this virus originated in Italy. Or Germany, or pretty much anywhere else.


Part of the problem here is that people see this as a competition between nations, i.e. arbitrarily defined borders.

China has implemented measures that have objectively worked: that have effectively contained an outbreak of this disease within their nation, despite having had the least knowledge and warning, and within a short amount of time. So, this is a good model to follow, in the absence of any other.

Certain Western governments appear to have decided to stretch the limits of that model to protect their economy in the short-term.

That will potentially result in everyone across the globe suffering further outbreaks.

Your assumption that drugs will save us is not safe. Novel drug development may be quick, or it may take decades.


>Why on Earth is this a good model?

While a state like China would be a bad idea, here in America we could perhaps learn the benefits of not heading too far in the opposite direction.


It is a good model not b/c it's politically correct, nor adopted by an authoritarian state, it's good simply because it worked: brought over 3000 new cases everyday in Wuhan down to single digit in recent days.

Any government or organization is problematic if it puts 'principles' over human lives.


There are several non-authoritarian states in Asia that have successfully contained the virus by implementing similar strategies as China.

So there is no need to equate the need for an authoritarian government to successfully contain the virus.


Maybe they should include this 3Blue1Brown video to explain what 'exponential' means in this context:

https://www.youtube.com/watch?v=Kas0tIxDvrg


What caused this whole mess was the nature, not the Chinese party/people.

In the first few weeks of the virus transmission in China, nobody can anticipate the lethality of the coronavirus. People may think it is just another flu. Who knows? Yes, there were delays in the reporting and yes it could have been handled better. But the following actions of China were swift and determined. The fact is the coronavirus has been contained in China. The cases reported in China are single digit today. Fact shows China's model is effective, no?

You think the governments in EU or US could have done a better job if the coronavirus first appeared there? I'd say no. Why? Because the EU and USA have all the data and information about the coronavirus shared by China for months. You have witnessed all the mess caused by the virus in China for months and so what? Trump was down playing the danger of COVID-19 just a few days ago. The USA cannot even cover a fraction of its citizens for testing the virus.

We know it seemed to be a god sent opportunity to point fingers to the "authoritarian" system of China at this moment. But guess what? The coronavirus does not slow itself down regardless you are a democracy or not. Prove your system/model is better by saving the lives of your own citizens instead of bashing China, will you?

PS. we still don't know from where/what the coronavirus come from. I suggest wait for scientific proof before jumping to the conclusion that it started from China. last time I checked, the Spanish Flu did not originate from Spain.


China didn't just drop the ball, they literally went after anyone who tried to tell them there was a ball.

https://www.straitstimes.com/asia/east-asia/wuhan-doctors-sa...


First thing first, this is science, not politics.

Everyone wants a drug and vaccine, but good science takes time to happen. Make no mistake, no one wants a lock down, but so far, it's the only option in the lack of a functional medical solution. If tons of scientists tell us lock down is the only option for now, we should'd listen rather than discredit them.

Now, if someone really wants to move on to talk about politics. It's about a nation as a whole can do the right thing, not about authoritarian vs. democracy.

A ideal democracy society works because we trust reasonable individuals can collectively make the right decision. In this COVID-19 case, lock the hell down and do the best practice to stop it from spreading. I don't see why a functional democracy nation can't do that. But it has to be a functional one.

Unfortunately, authoritarian was necessary when the general population (including local governments at various level) cannot function as well. China for example, has to reply on THE ONE in the center to make the right call and execute order top down to be functional. At least according to the CCP, the general population cannot be trusted. Thus the authoritarian regime. It's easy to see it's effectiveness when there is the right order in place. But it's also equally easy to neglect the fact that such an order takes really long (from Dec 2019 to end of Jan) to materialize.

IMHO, I think both Italy and China failed here, while we are all ignoring the one did really well, at least so far, Japan. (Or maybe Taiwan and Singapore, but they are small states which is easier to govern).


I wouldn't view it as science vs politics. Science advises, correctly, the politicians. But the ultimate decision stays (for the good, or bad) with politics, because they have to balance things.

As I said elsewhere, a vaccine is likely less "important" in the immediate, especially because it can have far deeper side effects, and no test has been done on humans whatsoever, while most of the drugs are on Phase III (earliest data should arrive in April, at least for the studies I looked up).

Lock downs will help. But they will help in the future. They won't help the overloaded ICUs now, because they're getting now people who had been infected up to 14 days before. In case of no drugs, the alternative is getting makeshift hospitals in place to lessen the burden on the health system, and procure more equipment. However, just as the government was extremely fast in getting people locked in their homes, it was not for these things.

> It's about a nation as a whole can do the right thing, not about authoritarian vs. democracy.

It's hard to tell when the same government gives contradictory or confused statements. Some blamed "the ignorant masses" for the panic fleeing last Sunday, but in my view, people weren't just well equipped to understand (plus the early leak of the document) what was going on. The media also cherry picks the bad apples very well.


This is correct. All the methods help in the future.

It ultimately means that these methods should have been used in the past.

It does not mean that they should be not used today because without using them the future will be orders of magnitude worse.

I compiled a small investigation http://www.savespain.eu/italy-vs-germany It might be interesting for you.

If you want your future to be better, start acting today.

Every Italian should have realized by now that you should hide your grandma and grandpa if you want to see them alive.


China did handle the situation poorly in the beginning, trying to suppress the numbers maybe. But the thing is, other countries are doing the same mistake, while not being prepared to do what China did next.

Trump said there is nothing to worry about. He even compared the numbers to flu numbers. This is similar to what the CCP did in the beginning.

Wuhan was locked down at 100 new cases a day. This is much faster response than countries who had seen Wuhan and even had better data.

The CCP did screw things up in the beginning, but made up for that by a very effective response. Countries are matching CCP on the initial response, but not ready to match the final response.


You can’t fast track things past what they’ve already been fast tracked. Stop second guessing the experts. What is the use of a hurried vaccine tomorrow if next month it turns out to cause birth defects or global infertility or cancer.


I’m sure there’s still a ton of bureaucracy. We need to go back to first principles and really look at what makes a drug safe and how quickly we can find out.

And also take a look at what safeguards we are willing to cut when every day of delay is thousands of deaths.


Birth defects and infertility aren’t issues for most of these patients.


You don’t vaccinate patients, you treat them. Everyone else gets the vaccine. These are absolutely concerns for the people that would be vaccinated.


> You can’t fast track things past what they’ve already been fast tracked. Stop second guessing the experts

I'm well aware of how trials work (I happen to work in a scientific institution which does plenty). They may have been fast-tracked elsewhere, but not in my country.

So far there's just compassionate use, which means they're administered only to people who have truly severe sympthoms.

A vaccine can wait, to be honest, it's not as critical as a treatment to lessen the sympthoms. In fact, that's why Gilead is also testing their drug here (not sure when the actual protocols will start, though).

Note that I'm not advocating for "let's scrap all the trials stuff". But trials in phase III have, for obvious reasons, very lengthy time frames. And it's not the first time (I attended a talk a few years ago on the topic) where the system (which works, normally) shows its limits (not only emergencies, but for example orphan drugs).


It is a good model because it works. The end justifies the means. You can't argue with the results.


As a physicist, it still feels odd to me they are talking about statistics with such confidence here.

It seems only SK has earned that right and has tested enough people to get reliable statistics. If you only measure the sick in the hospital...


The pattern is fairly consistent across countries [0]:

[0] https://www.ft.com/__origami/service/image/v2/images/raw/htt...


That is the most useful graph on this subject so far. Go look at it now. Most countries have exactly the same growth trajectory measured from 100 cases. That's solid data about how this behaves.

Singapore and Hong Kong have been able to slow things down by strong measures, but it's still a straight line on a log graph, just with 1/3 of the growth rate. Italy is on the same line, just 8 days ahead of Europe and 13 days ahead of the US.

Only South Korea shows flattening so far.


I still don't get how people - including apparently some governments - don't get or don't believe it. Getting this graph is as simple as 1) taking the daily measurements, and 2) plotting them on log scale (and technically 3) shifting the lines to overlap, but that's just cosmetics). The trajectory of the entire West being the same as Italy's is immediately apparent.


In part, because they think they already understand the situation, and the nature of that understanding precludes taking things like that seriously.

“It’s just the flu”

“It only kills 2% of people”

“The flu, cancer, car accidents, malnutrition, etc have killed far more people”

“People were worried about SARS, Swine Flu, and H1N1, and they turned out to be hardly kill anyone.”

“There number of cases here is small. Why are you panicking over nothing?”

“People need to stop panicking. People are going hysterical. The media is trying to make people panic. Just look at them hoarding toilet paper”.

“People are trying to ruin the economy over nothing”

“The experts — epidemiologists — say there’s nothing to worry about” (I’ve had this said to me and I was given a link to a news article that spun statements from some epidemiologists to make it sound that way. They were saying that they didn’t know how the situation would pan out, and this was presented as if it meant they didn’t think there was any issue).

I imagine that most people aren’t aware of the graphs. I imagine most people would be dismissive of them for reasons like the following:

They simply believe the apparent normalcy in front of them more than some abstract maths. They don’t grasp the notion of exponential growth, so it seems fanciful. They also don’t understand how it’s possible to project into the future like that. Maybe they think it’s just fear-mongering speculation. What concrete evidence do they actually have for the situation in Italy? And why should they believe what’s going on in a different country will apply to their country. Maybe their country has a good health care system, and they assume that Italy doesn't.


> I imagine that most people aren’t aware of the graphs.

And even if they are, they aren't aware of log scale.


Definitely. Noticing it's log scale (or anything non-linear) takes a trained eye.

I've worked with, presented, and consumed a lot of scientific data over my career and I still have a tendency to assume plots are linear no matter how many times I tell myself to always check scale first.


Any half-decent plot aimed at non-specialists will have "log scale" written in the title or surrounding description. The one linked by 'soVeryTired didn't, which is where FT dropped the ball. But it does not matter here.

The relevant axis on this chart is the time axis, the x axis. The chart is linear in it. You see a bunch of nearly identical trend lines, and you have to just count how many days a given country is behind Italy. It doesn't matter what scale the vertical axis is in.


> Any half-decent plot aimed at non-specialists will have "log scale" written in the title or surrounding description

I have to wonder how many non-specialists would even know what “log scale” means.


I didn't mean a non-specialist as in an average Joe; I meant an above-average Joe with some interest in one or more of: economy, physics, electronics, mathematics, biology. There's loads of such people.


>log scale

There's your answer. To 90% of elected officials, a "log scale" sounds like something a timber company might weigh their product with.


It's much worse than that. Italy's health system is already collapsing at 20,000 victims. The population of Italy is 60 million. That has to level off at some point due to saturation, but that's at somewhere in the millions or tens of millions.


FWIW, at the moment it's only lombardy's health system which is collapsing, because most of the victims are concentrated there and the growth rate there was _much_ faster because the lock down was only imposed late.

The growth rate is the same in other regions but delayed, and there is some hope that the rest of the country might be able to cope with it better if the lock down measures are effective.


Hopefully. But the health care system in Lombardia has to be the best or at the top of entire the country. Southern Italy will struggle with fewer cases.


Worse still, Italy has one of the better healthcare systems. This doesn't bode well for the rest of Europe.


Well Lombardy does (number 2 in the regions of the EU). I believe that some Italian commentators have said that one of the biggest reasons for the total country lockdown was that the health systems of Southern Italy were much much worse than Lombardy, and would definitely not be able to cope.


Because of normalcy bias: https://en.wikipedia.org/wiki/Normalcy_bias

"Normalcy bias can cause people to drastically underestimate the effects of the disaster. Therefore, people think that they will be safe even though information from the radio, television, or neighbors gives them reasons to believe there is a risk."

People just don't want to believe a disaster is about to happen. They will grasp at straws to explain why everything is going to be fine.

That's usually not a problem because disasters are rare, but it will catch us under-prepped when an actual disaster happens.


I have one issue with or maybe just question about this graph. Why it starts with 100 detected cases? It seems like arbitrary round number, but it also seems to be the smallest arbitrary-looking number that makes SK overlap other countries. Why is that? Why is the initial slow spread in SK irrelevant? What caused it to be initially slower than in other countries?


It's somewhat arbitrary, but you can't start from "patient zero" because that's not usually known. And the detailed circumstances of the first few patients matter. By 100 or so, the disease is in the population and starts to behave statistically. That's what's called "community spread".


People infected with the coronavirus tend to vary wildly in how many other people they infect from people who stay home with a fever and infect nobody to "super spreaders" who many infect hundreds of others. That means the spread rate when you don't have a statistically significant number of cases is going to be all over the map naturally and not really comparable.


It’s somewhat arbitrary, but also, countries can’t detect the presence of coronavirus when just a single resident has it. 100 is a good starting point for “this country has detected the virus within their borders — what’s going to happen?”


This doesn't really matter, you're just doing that to make it easier to compare. Shifting South Korea so it doesn't overlap the other countries is possible but not terribly useful.

They do seem to be missing Denmark though, which should stick out somewhere top-left of Norway.


They do seem to be missing Denmark though, which should stick out somewhere top-left of Norway.

I was just talking, via text, to a friend in Norway. They're going for major restrictions on contact and the people there are not worried enough yet. I sent her that graph.


Norway is going into full lockdown (stay at home, don't hoard). Borders closing except for export/import from Monday. Hut vacations now getting banned as well.


Which is a good plan and similar to what Denmark is doing, ie. stay at home as much as possible, everyone who can work from home does so, closing the borders for all non-essential traffic, and so on. There is a whole system being set up for compensation to concert venues and other businesses who are severely hit by the lockdown and blanket ban on gatherings of more than 100 people.

Open air walks are ok, as long as you keep a reasonable distance to other people. Only go shopping if it's absolutely necessary.

And yet some people are still going to crowded bars, like nothing's going on. It's amazing how stubborn some people are.


There's a distribution of who gets it when. The bans will be for those last 20% who just refuse to care about anybody else.



This could also be a measure of the rate of test kit production by country.


The graph can be reproduced with more recent data here [1]. It is based on WHO data, and lags a bit behind. If you want to see more data and graphs, see [2].

[1] https://ourworldindata.org/grapher/covid-confirmed-cases-sin...

[2] https://ourworldindata.org/coronavirus


As a physicist, you are familiar with formulas similar to this:

N_obs = p_detect * 2^( n_days / T_double )

N_obs : The number of observed cases p_detect : The fraction of actual cases that are detected (assumed to be constant) n_days : number of days T_double : The number of days it takes for the number of real cases to double

If you examine the formula, the p_detect constant is almost insignificant. If T_double = 2, a difference in a detection rate of 0.2 and 0.8 is only 4 days for n_days.

As long as T_double is less than several months (and constant), an absolute catastrophy will occur. Within a weeks from now, nearly the entire fraction of the population that is receptive to infection will get infected, and will be sick basically at the same time. With 10-15% of the population requiring intubation, we can end up with a significant part of the population in each country ending up dead.


I believe you're focusing on the days aspect of that equation without considering what a lower T_double/p_detect could mean relative to hospitalizations.

If the real number of cases is doubling significantly faster than those detected -- say due to not testing them because their symptoms are mild enough to be missed entirely or to not seek treatment -- the calculations around things like mortality rate and severity of illness may yet change. As I understand it, scientists have already identified mutations of the virus that may also impact its ability to spread or injure infected hosts. I should note that these changes can swing both good and bad, I'm simply pointing out that there are more variables and that these variables changing may represent something not obvious from the equation.

I'm not an expert; I have fun reading about medical statistics. Most papers I've read take the time to examine these various confounding factors and what unexpected variations in their proposed equations might mean.


If the number of real cases double every N days, the number of people needing hospitalization is also likely to double every N days. If not, it probably means that the infection rate spread at different rates in high risk vs low risk part of the population, but unless those populations are strongly segregated from each other, that is unlikely.

This could go in both directions. In both cases, though it would require that the high-risk subpopulation is primarily infected by each other (or staff) instead of being infected from the general population. If high-risk individuals are primarily infected by low-risk individuals, the doubling time for each group should be the same.

Note that such an effect could go in both directions. The high risk subpopulation could get it at a higher rate the rest if we let the infection spread like wildfire in hospitals and elderly housing centers, or it could spread at a lower rate if the risk patients are kept isolated.


The point is that the mortality rate estimates are going to be totally out of whack without accurate measurements. As well as estimates of the currently infected.

This matters a lot. The first number is obviously important. The second matters so Italy can plan for whether things have peaked yet, or how many weeks out until it does.


The mortality does matter a lot if we plan to let everyone become exposed. However, if we do that, we must expect 15% of the people that are currently having enough symptoms to be diagnosed in Italy to perish. Even if only 20% of the infected are diagnosed there now, that is up 14 million people in Italy (if everyone gets it), out of which 2-3 million would die.

Or, if applied to the US, 10 million.

Alternatively, we can shut down the virus in the same manners that China, South Korea or Singapore have been doing, and keep it supressed until we develop efficient treatment.

Unfortunately, that means shutting down all affected regions really hard, and maintain a high level of supression for maybe 2 years.

However, if we are going to do so anyway, both the human and economic costs will be lower the earlier we begin.

If we allow exponential growth to continue with a doubling time of only a few days (even if we can move it from 2-3 days to 6 days), the time until this move is forced is very limited.


That assumes you are sampling uniformly, and not in already saturated clusters. The doubling time is also not a known constant, as it depends on actions taken etc, and uncertainty in it will broaden the distribution.

Obviously, all this is basic statistics and should be known to epiodemiologists, who hopefully have some input to policies.

For large N_obs, this will maybe be less important as you're going to find the severe cases anyway, but the uncertainty is significant in the beginning stages, and it is unfortunately these stages where actions will have most impact.


As long as growth remains linear in an exponential plot, you are nowhere near the saturation point. When about half the population is already infected, the number of new cases should grow roughly linearly. In Italy, it seems to still grow exponentially.

Itally has already passed the number of simultanous cases that their healthcare system can handle. I don't believe they really want to find out at what level the saturation point can be found. That could mean hundreds of thousands, potentially millions, dead.


https://medium.com/@tomaspueyo/coronavirus-act-today-or-peop...

Start reading at "2. What Will Happen When These Coronavirus Cases Materialize?"


Who is this mr Pueyo? And why should we listen to him regarding this subject?

From his Medium profile page it seems he is a 'Storyteller' and 'Viral marketer'. So, someone who knows how to tell a story with confidence even if you know nothing of the subject.

I'm gonna listen to my government regarding this, rather than medium posts by viral marketeers. Thank you.


Your government is saying the exact. Same. Thing:

https://www.government.nl/latest/news/2020/03/12/new-measure...

https://www.rivm.nl/en/news/current-information-about-novel-...

> 15-03-2020 , 176 new patients, a total of 1135

> 14-03-2020 , 155 new patients, in total 959

> 13-03-2020 , 190 new patients, in total 804

> 12-03-2020 , 111 new patients, in total 614

> 11-03-2020 , 121 new patients, in total 503

> 10-03-2020 , 61 new patients, a total of 382

> 09-03-2020 , 56 new patients, a total of 321

> 08-03-2020 , 77 new patients, a total of 265

> 07-03-2020 , 60 new patients, a total of 188

> 06-03-2020 , 46 new patients, a total of 128

> 05-03-2020 , 44 new patients, a total of 82

> 04-03-2020 , 15 new patients, a total of 38

> 03-03-2020 , 6 new patients, a total of 24

> 02-03-2020 , 11 new patients, a total of 18

> 01-03-2020 , 1 new patient, a total of 7

...

Here's a log-scale graph: https://www.chartgo.com/embed.do?id=7e5c9f30aa

(And just for comparison, not log scale: https://www.chartgo.com/embed.do?id=7e5c9f30aa )

Looks like NL has had steady exponential growth over the past week or even 10 days.

As far as Mr Pueyo, in this context he appears to be an effective science writer, which is what matters. If you want a more succinct source from an academic, there's http://ctbergstrom.com/covid19.html .


Thank you. Recommend everybody to read this.


No one is 'confident' about a lot of things. But everyone who has seen what is happening in Italy is confident that taking a 'wait and see' attitude will cost lives.


i wish more countries did randomized testing over its whole population, or extensive testing, like SK.


Why even test? The decision procedure is the same: treat the ill, lock down everyone else at home, avoiding social contact at the max; enforce social isolation and/or masks in "critical" spaces (power plants, grocery stores, ...). What does a positive or negative test change?


Most complete lockdown would seem to coincide with health care system stress beyond a certain level.

Universal testing and full identification, isolation, and clearance of all patients across multiple checkpoints would result in the fewest number subject to confinement, confined in the least broad of areas for the shortest periods of time.

OTOH if insignificant testing has been achieved, lockdown itself will need to be inversely universal and long-lasting.

There is an exponential component involved, so the effect will be felt sooner than you think.

Theoretically either way, it's possible no one will be able to be unconfined across multiple checkpoints without a real-time valid negative test or credential.

That decision could be the same either way.

But the fewer and less reliable the tests, the fewer the number of citizens that can be expected to be allowed to move about with some freedom.

After pandemic stress exceeds the magnitude where there can be no treatment resources for additional patients anyway, movement will certainly not be relaxed, and those who might have had a chance with earlier & more thorough action & testing will be left to expire undertested in confinement.

Not every scenario is that uplifting.

Due to the excess rate of confinement resulting from inadequate testing, the greater stress on the marginal economic needs of a large contingent of the populace may result in a need for lockdowns to become oppressive enough to theoretically halt the spread of all possible crime in addition to disease.

Depends on how serious it gets, if it's bad enough you could get unrulyness or looting like there is during some disasters regardless.


How do we know when to initiate or let up on the lockdown if we don’t have any testing?


For the first question, the answer is: ANY country that currently is seeing exponental growth should take action at the same level of severity as China/Korea/Singapora, if not, they will be in the same situation as Italy in 1-3 weeks.

Once the growth is no longer exponential, measures can be rolled back slowly, especially if they have access to enough tests, masks and respirators.

The earlier action is taken, the cheaper it will be to stop this. Every week of delay can increase casualty rates by a factor of 10. A month of delay, can mean the difference between 10000 and 10 million dead.

Also, economic costs, both in direct treatment cost as well as the disruption to the productive side of the economy will rise sharply the longer we wait. (Well, at least if we don't see the death of sick and elderly as an economic benefit.)


A decline in cases to treat would be informative, no?


You're assuming that all cases are Coronavirus.

People will continue to get the Flu, Colds, HIV / AIDs even throughout this whole shebang. We need to know COVID19 cases specifically, to know if our lockdown methodology is being effective.


For that you just need to test in hospitals.


USA doesn't have enough tests even for that. I'm proposing we at least test the cases that reach the hospital stage.


Exactly. I don't see how trying to limit testing to people who had contact with known cases or traveled to at risk countries (as practiced in Germany) can be successful.


Are you sure that Germany does not perform extensive testing? I admit that reddit comments should not be used as sources but I would love to know more about German approach to testing.

https://www.reddit.com/r/askscience/comments/fguheu/why_have...

Earl_of_Northesk: The RKI is conducting random sample testing to keep track of Influenza in Germany. These tests now also test on COVID-19. So far, not a single prior undetected case of COVID-19 has shown up in these samples. It is thus highly likely that the extensive early tracking and testing means that Germany has, in comparison to other countries, a very low rate of undetected cases, which would obviously lead to a lower mortality rate. That's what the President of the RKI also said in todays press conference together with Angela Merkel.

Painy_: How big is the RKIs sample size tho?

patientzero_: All cases that had the flu and went to the hospital. So the more severe once. But they also re-ran the tests from the beginning of the year to test for Covid-19. If you can't detect it in there it wasn't in the country most likely

Sounds like a massive amount of testing that no other country can match.


For some context, researchers in China went back and reran old flu surveillance samples from Wuhan taken in December and the start of January. According to the WHO joint mission's report, 1 out of the 20 samples from the first week of January and 3 out of the 20 samples from the second week tested positive for Covid-19. China locked down Wuhan on the 23rd. Things were probably already really bad by that point in a way that wasn't reflected in the number of confirmed cases.


No matter good the test coverage in germany is, the growth is still exponential so the currect prevention measures are insufficient.


If the availability of testing kits is low and the ratio of infected to non infected people is extremely low, it makes absolutely no sense to sample randomly from the population.


How many do you need though? If you take 0.1-1% of your testing capacity, those handfuls of samples a day give you some information. Not regional level or very reliable data, but it gives an idea of whether people (as a population) are having it and are having mild symptoms and are not reporting anything, or if it isn't widespread yet and the hospital cases are the only cases.


Aldo if you expect the true positves to be a small percentage (which should still be the case in most countries), false positives will dominate in a ranom sampling. Apparently false positives are high for unsymptomatic cases. Of course if you can estimate the false positive rate well enough, the random sampling might still give useful statistics.


As far as I know lab performed PCR tests are assumed to have 0% false positives and about 29% false negatives. Antibodies tests have about 10% false-positive rate but to the best of my knowledge countries in Europe widely use PCR tests.


I think most places are switching from testing known contact/at risk countries to testing people in hospital with the symptoms. The first strategy makes sense if you're trying to contain a small number of cases, it doesn't make sense once people are catching it from other people in the area.


Everyone except the UK and the US notably.


If you make a bunch of assumptions about the distribution, you don't need a large sample size to make decent estimations about the population. Of course, the only way that works is with random or stratified random sampling. With reporting bias, I'm not sure any country has enough data to make statistically confident statements with any precision.

Folks with a stronger statistics background are welcome to correct me.


It's interesting that you lead by saying "as a physicist".

As a physicist I'm used to thinking about orders of magnitude and whether something grows like log(N) or N!. I'm pretty sure all the data points to this being O(a big problem) but I'd leave it to the epidemiologists to say anything with confidence.


So, as a physicist, you should know how exponential growth works. Let's say you have a pile of Uranium that's juuuust sub-critical. You would likely to be confident to stand next to it without significant fear.

But if someone throws on just enough additional Uranium for the pile to go supercritical, you would run for your life because none of the following will matter[1] all that much to the final outcome:

1) How much neutron radiation there was to start with.

2) The specific exponential growth coefficient.

3) How much total Uranium there is, as long as it's a nontrivial amount

4) Whether your Geiger counter is off by some constant factor or not.

None of those matter. It's going boom. It might go boom a bit sooner or a bit later, but it is going to go boom. That's just how exponential growth works. There's no maybe. There's no "let us wait and see". There's no "we'll hope for the best". No: It. Will. Go. Boom.

All of the factors that are irrelevant are just shifting a figurative vertical wall on your graph paper a bit to the left, or a bit to the right. It's adding or subtracting "a couple of doubling times". If the doubling time is short, then you're not really achieving anything by fiddling with constant factors.

With the Coronavirus just about every country has a doubling time of 4-5 days.

I live in Australia, where we're about a "month behind" everyone else. So of course, the dumbass government is saying things like "the heat here will slow it down". But it hasn't, our doubling time is 4.75 days at the moment. They're saying that it's "premature to lock down the country". No it isn't, it's already weeks too late and getting literally exponentially worse daily! They're saying that the hospitals are being prepared, but no amount of extra beds or ventilators will help. If they double the number, it just delays the catastrophe by 4.75 days. Not even a whole week! Quadrupling beds and ventilators buys just under 10 days before people are being turned away to go home and die.

So, again. I ask you: If you were the nuclear physicist in charge of a nuclear pile and someone told you it's gone critical and the radiation is rising exponentially, is your first reaction to: just "stand around and wait and see what happens", or to: take drastic action right this second? Do you SCRAM, or do you call the communist party leadership for permission? Are you the hero of the Chernobyl story, or the villain?

[1] Ignoring thermal effects slowing down the reaction. This actually has an analogy with disease spread, where there are fewer susceptible people remaining because everyone is already sick or dead. If we reach this point, we'll be seeing millions infected and hundreds of thousands dead.


I think this insight is exactly why the UK health experts are not advocating extreme measures yet. They know they will only delay the takeoff and they need to use those measures when it does, not beforehand, and these measures are meant to protect the most at risk from dying from the disease (I think the most contentious thing is how long these measures can work for. The UK experts are of the opinion they have a finite life).

Keep in mind, the UK advisors think the peak is maybe two months away, and that at-risk groups may need to self-isolate for a month either side of that peak. This is a far bigger response than any country has achieved so far (and it's extra difficult because the at-risk groups are probably the most dependent on external aid, as well as already lacking social contact). I don't think they're wrong to think that this will be difficult to achieve, and increasing the difficulty by starting earlier will make things worse.

There is no SCRAM button on this pandemic, not any more at least.


"This is a far bigger response than any country has achieved so far (and it's extra difficult because the at-risk groups are probably the most dependent on external aid, as well as already lacking social contact)"

How have they achieved this? What concrete measures?


They haven't yet (no-one has). The point is they are recognising that such measures are very hard on people, and so they don't think they can stay in force indefinitely.


Well, if I try hard to imagine how they think, without assuming incompetence, it would be as follows:

Assumption 1: Our country will not be able to take measures that are extreme enough to stop exponential growth. Assumption 2: Once a certain level is reached, we can drastically lower the doubling time so that the number of simultanious cases are kept below what our healthcare system can handle. Assumption 3: If we stay below the level that the healthcare system can handle, mortality rates will be low, maybe lower than 1%. Assumption 4: The total number of individuals that will require hospitalization is low enough that the healthcare system can treat all patients needing treatment in a few months.

If assumptions 2 is not met, the mortality rates of pations that require treatment is likely to be similar to what is seen in Italy, ie roughly 15%.

If assumption 3 is wrong, and the real mortality rate is about 3-5%, having about half the population infected, will still lead to huge numbers of dead, more than the population is likely to accept.

If assumption 4 is wrong. Italy is currently unable to handle 20000 cases. A country like the UK may be able to handle maybe 10000-20000 simultaneusly. If 10% of the population requires hospitalization, and each patient will stay there an average of 1 month, measures will have to be dragged out over several years, anyway.

Assumption 5: This only needs to be done once, meaning there will not be second or third waves or mutaded viruses that will need to spread in a similar fashion in the same time period.

At some point, I think every country will realize that they need to take drastic measures, enough to stop the spread from being exponential. Doing that after detecting 100000 cases is VERY different from doing it after detecting 1000.

The downside, of course, of preventing exponential growth, is that most measures will have to be kept in place until there is a vaccine or other cure, and that could take 2 years.


The growth will always be exponential. What you can change is the exponent. I don't think they are crazy for suggesting that extreme measures are unsustainable and their use should be timed correctly. I'm not completely sure they're right, but neither am I sure that extreme measures are right. Keeping a quarantine on a whole country up for 2 years seems unlikely. As I understand it, this plan hasn't just been hastily put together overnight, a team has spent a while researching and modelling outbreaks in preperation for just such a scenario, and as such I am inclined to trust them more than politicians (who are always happy to be seen to be doing something about a problem) and laypeople on the internet.


Growth does NOT have to be exponential (or at least not with any near-constant exponent). Furthermore, if the doubling rate is half a year or more, it really does not matter that much if it exponential, unless the number of already infected is already huge, since a vaccine is likely to come within 2 years.

From my perspective, it appears that politicians do NOT want to take sufficiently drastic measures, as the economic consequences will be huge (let's assume that Spain and Italy will keep or increase the measures they already have for 2 years), and so far, their measures do not seem to be sufficient.


Most people will not go to the hospital, they'll stay at home and they wont die unless they dont drink water and eat food with poor nutritional value.

That's why I dont understand the crisis communication on the subject. I understand exponential growth, I dont under and the panic about getting sick with a flu like virus.

If it was something causing skin lesions I'd be in panic mode because the victims would be at a higher risk of co-infectious diseases. This is not that. But hey, fuck my civil liberties some more, for that matter fuck my freedom and that of my countrymen. I dont give a fuck anymore.


Most people aren't susceptible to dying from this. They are likely to spread it. Those who are susceptible to dying from this number in the millions. You can worry about your civil liberties and freedom after you worry about infecting someone who might die because you decided that the personal risk to you wasn't worth a few weeks of inconvenience.


I'd rather people die then risk the state grabbing power against the right to organize in groups.


What child of summer you are.


A lot of people have similar statements, but the use of the word "most" in this context just doesn't matter past some cutoff. The flu is very far on the safe side of that cutoff, and the coronavirus is very far on the bad side.

The flu and the common cold virus behave comparably to the current pandemic. The flu in particular kills about 300K per year after infecting about 20% of the global population. That's a mortality rate of 0.02% and a survival rate of 99.98% for the general population, which is not a fun statistic, but nothing to panic about either.

Critically, the hospitalisation rates for the flu are so low that the current infrastructure can handle it. People still die, but only if they couldn't be saved with medical intervention. Much of the time they will receive treatment and live.

Even if you shift the numbers around a lot -- say, 50% infection rate -- the orders of magnitude come out to about the same. Governments can just put out ad campaigns to encourage people to get the flu vaccine to compensate for a particularly bad flu season.

The critical thing with the cold and the flu is that they move well past the initial exponential growth phase into a "logistic curve" long before the hospital systems become overloaded with the sick. That is, each new strain of the flu runs out of victims by hitting the population ceiling of 7.6 billion. Not everyone is vulnerable, and the rest either become immune or protected by herd immunity.

Now compare this to the Coronavirus. It has a mortality rate of about 0.8% of confirmed cases, with medical care. Much more importantly, about 10% of the confirmed cases required intensive care.

Nobody really knows the ratio of confirmed-to-real cases, but I'll be generous and assume that only 20% of all cases get a confirmed diagnosis, with 80% of cases just shrugging it off as a case of the "sniffles". Similarly, I'll assume that the virus will halt at around 20% of the total population.

For Italy, with a population of 60M people, that's 12 million infected, equivalent to 2.4 million confirmed cases, 240K in intensive care, and 19K dead.

But I lied.

I lied when I said "240K in intensive care". There just aren't that many beds, or intubation kits, or CPAP machines, or even oxygen masks. There aren't anywhere near enough doctors, or nurses, or any resource you care to name. I know this to be true because all of these things have run out already.

Long before the exponential curve starts to "slow down" and become logistic, the entire medical infrastructure becomes overwhelmed and the cases that "would survive with intensive care" turn into "deaths".

Worse, this happened at a "confirmed case count" of about 10K. I said 2.4M above!

The conclusion is that the Coronavirus can overwhelm medical systems waaaaaaay before it hits the "knee of the logistic curve", making it a nearly pure exponential curve. Exacerbating this is the incubation time, meaning that any measure taken today will have essentially no effect for at least a week.

Act now and save lives, act tomorrow and see your loved ones die.

This is the difference.

3blue1brown explains it quite well, and I recommend everyone watch his video: https://www.youtube.com/watch?v=Kas0tIxDvrg


If they're making this statement based only on the cases they know about, then the argument is even stronger if there are more cases.


There are more cases, they are on average much more mild, the real mortality rate is much lower, it is actually not doubling every two days (it is the tests that are doubling every few days). Lots of possible and very consequential conclusions.


Deaths follow a predictable exponent too.


But with several weeks worth of lag. The number of deaths today should be divided by the number of cases N>10 days ago. The number of cases was much more severely underestimated N days ago than today. The death rate in Italy is basically unknown because the denominator is just noise with a time lag.


As someone who's dealing with analytics data regularely, thank you !

i absolutely don't understand how can someone give any ratio about this disease knowing how only the most severe cases got tested ( except in SK), and that the symptoms are almost undistinguisable from the flu.


It simply must be much more dangerous than the flu for the simple reason that comparatively few people have it and it is overwhelming hospitals.


i wonder if it's really true that "few people" have it. We do observe a huge amount of people going to the hospital in italy, but that could very well be because we reached the peak of the epidemie, where almost all of the population have been infected and remain asymptomatic. in this hypothesis, you implement a lockdown and see number drops over two week but what you're really seing is a population reaching herd immunity.


When we are getting close to the peak of the epidemic, the growth will no longer be exponential, but close to linear. A logistic curve looks exponential for about the first 3rd, close to linear for the second third, and then approaching the asymptote with a negative exponential growth for the last third.

Increasing social distancing will naturally lower the exponential growth rate, but unless the growth becomes linear, there is no reason to believe that herd immunity is anywhere close.

In the asian countries, we more or less know that they have been able to contain the virus, instead of waiting for herd immunity. That meanst that they must have found most of the infected cases (or at least quaranteened them). This gives a good indication of how many deaths are caused by a given number of infected. The numbers are not different enough from Italy to think that more than (at most) a couple of hundred thousand in Italy have reached immunity. If so, it means that we have about 2 more orders of magnitude of growth before herd immunity can be reached. That would be hundreds of thousands of dead, if not millions, just in Italy.


That would be for a homogeneous spread inside a country.

However if the epidemic spreads from region to region, you could reach a local herd immunity in the first regions infected way before seing the country-wide curve becoming linear.

But thanks, trying to find a counter-argument to your post made me realize a single-curve model probably doesn't make a lot of sense to try and understand accurately the spread of an epidemic.


There aren’t large numbers of random people testing positive for it where they’ve done wide spread testing. Korea in particular probably has close to an accurate count, and their mortality rate is still close to 1%


Because differences in testing methodology are a constant factor, which doesn't mean shit to an exponential function.


What do you think of the practice of only testing people who need hospital-level care and people who had contact with confirmed covid-19 patients (and people who traveled to at risk regions)?

I would think that this can only give you the infected from a few clusters and you can be surprised by an unknown cluster of patients suddenly needing intensive care.

Edit: And due to the long incubation period, that cluster can be quite large.


Testing the entire population is not viable. If you don't have many in-country cases, you can delay the epidemics arrival by controlling just the people that come from elsewhere.

Of course, after the disease starts propagating internally, testing becomes irrelevant, and it's time to reduce its spreading speed.


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