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California governor issues statewide 'stay at home' order (reuters.com)
398 points by pseudolus 11 days ago | hide | past | web | favorite | 620 comments





Good move by Newsom considering there were photos of people in socal still going to bars.

Judging by how long the shelter in place has lasted and affected curves in Asia, we should be prepared for ~2 months as a baseline. From what we're hearing from friends, life is starting to return to normalcy in Hong Kong, with no new domestic cases reported (though now they're contending with new imported cases from overseas travelers returning home). They have a really effective screening/tracking quarantine system in place where they'll give you a location tracking wristband for remote monitoring.

Our family has been affected by this since late January, and there's a big mental challenge aspect to this. Being able to walk outside (unlike in Wuhan) is really big.

It's truly unfortunate that the the country's health services bungled their initial testing and screening ramp up.


I don't understand how we get to Newsom's claim that 25 million Californians will get infected in 8 weeks. The math doesn't check out.

The best data we have at this point is from China. They have 81,000 confirmed cases to date, most of them happened over an 8 week period. Obviously not all cases of the virus were confirmed but people were hospitalized and tested aggressively.

Even if only 10% of the cases in China were confirmed (and 10% is a low guess at the percentage that might need to go to the hospital with serious symptoms, and thus be confirmed), that means under a million cases in a population of 1.4 billion.

California's population is 35x smaller than China's but Newsom is predicting California will have over 25x more cases.

Sure you can argue that China is lying about their cases (WHO disagrees). Or that they are authoritarian superhumans with a superior response. Or whatever. But this discrepancy is just too big to make sense. I don't think CA will have 25 million cases in 8 weeks.

I think he is trying to scare people into staying home. Staying home is still a good idea, because the health care system will collapse at a lot fewer than 25M cases in 8 weeks. But I think it's fearmongering.


The best model I have seen so far is:

Take deaths, multiply by 400 and that's how many cases you have. This comes from the assumption of 1% mortality and 3 weeks to die.

So CA has ~8000. A doubling time is ~5 days. 8 weeks ~= 11 doublings. So 8000 * 2048 = 16M. Not too far off for a ballpark. Obviously, the exponential starts to breakdown somewhere... but where?

I don't think it's fear mongering. It's getting the public to understand the back of the envelope worst case... which is really bad. People NEED to panic... to get them to hunker down and take this seriously. The sooner than happens, the sooner we get it under control.

I had to yell at my inlaws to stop taking the train to work and going to the gym. They are 70 and have pre-existing conditions. This action will force them to take it seriously.


Take deaths, multiply by 400 and that's how many cases you have. This comes from the assumption of 1% mortality and 3 weeks to die.

I don't see where 400 comes from.

If we assume that people who died today now are 1% of those who got it 20 days ago, then that is a factor of 100. Project that forward through 4 doublings for the fact that we have about 20 days of doubling every 5 days and we get to a factor of 1600. You can complicate the toy model in a number of ways, but I can't get it as low as 400.

Anyways it is worth pointing out that the curve of reported cases will continue rising for a couple of weeks as people both get symptoms then get sick enough to come to the attention of hospitals. And if the measures work, it won't be obvious from death rates for about 4 weeks. And at that point the critical question is whether we managed to slow the rise, or create an exponential decline.

My bet is that we are only going to get a slow in the rise. Hopefully enough for us to get ahead of the need for emergency treatments.


“ My bet is that we are only going to get a slow in the rise. Hopefully enough for us to get ahead of the need for emergency treatments.”

Look at the curves for every where else on the planet, the US will be the same, take it seriously


> Look at the curves for every where else on the planet, the US will be the same, take it seriously

Except this is extrapolating ahead to assume no changes to treatment available. As time progresses, we find better, more effective ways to prevent death from COVID-19.


I think doubling time is a bit faster than 5 days from what I have seen elsewhere, and that might change the math to the 25.5M in that time frame.

Yeah the doubling time confuses me too. All the numbers from China, Italy and the Netherlands (where I am at) show the number of deaths doubling every 2 days upto the limit.

But even our dutch government is claiming it's 4 days standing in front of a chart where it's obviously 2 days.

After you reach the limit it's hard to count because people stop going to the hospital that can't take them in anyway. At that point you should just consider any increase in deaths compared to the normal the result of Corona. Wether it's a cancer treatment that got postponed because of Corona or Corona itself.


It seems like it’s difficult to get an accurate sense of the doubling rate right now, because of the confounding variable of increased testing.

You don’t have to get a sense of doubling via unreliable test data if you look at the doubling rate of the fatalities.

People count bodies much more reliably in pandemics. I don’t trust our confirmed case telemetry data much, but I do trust the fatality data. Unfortunately it’s about a two to four week lagging indicator. But the fatality rates also currently show this to be spreading much, much faster than it ever spread in Wuhan.

Wuhan is what happens when the curve is flattened. Not what happens when you don’t.


You still don't get accurate data if you just count bodies.

The issue here is every death is attributed to COVID-19 if the virus is present even if the actual reason is some other underlying health condition. Given that most victims are elderly and had serious pre-existing conditions this leads to massive mortality rate over-estimation.

You also cannot reliably compare EU/US data with Chinese: initially most deaths and cases of pneumonia in China were attributed to other illnesses. Secondly, Chinese government is notorious for flat-out lying in their official stats.


> The issue here is every death is attributed to COVID-19 if the virus is present even if the actual reason is some other underlying health condition.

That what you claim provably doesn't happen. Even old people simply don't die that fast otherwise, and we also have the data of the people who can't breath and have to be admitted to the hospitals: there were never that many cases before, happening that fast:

https://en.wikipedia.org/wiki/File:Is_COVID-19_like_a_flu%3F...

(the numbers were compared by the Italian National Biotechnology Association, each bar is one week of time)


Right, in some countries doubling was every 3 days.

Have a look at this site: https://www.worldometers.info/coronavirus/country/us/

Scroll down to "Daily New Cases in the United States". No real need to extrapolate data from other countries. New cases are doubling every 2-3 days.


Those aren't cases, those are confirmed cases. Which has more to do with how much testing we have done than how many are sick.

Problem with looking at case numbers is, you need to know how many tests have been executed. If they doubled the number of tests within those 3 days, then you measure the increase in tests, not an increase in cases.

That was the case for Italy until 4-5 days ago and I think it still is for Spain, definitely for Germany.

It feels like testing is a lagging indicator at this point. Whatever doubling happened, already happened.

>Take deaths, multiply by 400 and that's how many cases you have. This comes from the assumption of 1% mortality and 3 weeks to die.

So that 400 multiplier gives the number of cases as of 3 weeks prior to the death count used in the calculation?


The people didn't all die on the same day though...

yeah it would have to, right?

Worldometers shows CA with 1060 cases and 19 deaths. Where does ~8000 come from. If 8 weeks is 56 days and cases go up 20% a day as they have been then 1.2^56 * 1060 = 28.8 million cases.

Remember that scene from the Chernobyl series where they messure the radiaton and say it is only 3.6 roentgen — which oddly happens to be around the maximum their device can messure?

This is the situation with tested cases now. You can assume that there is no nation on earthq where the number of tested cases is an accurate representation of what is really going on. Deaths are far more accurate but lag behind ehat is going on by two weeks. And two weeks is a long time with something that grows exponentially.

The bad thing about this is, that this logic is flipped on it's head at times: my girlfriend had all the symptoms just like 6 of her alumni — not a single of them could get tested. And while they where still in bed their university proudly issued a press statement stating they have zero cases of Corona. Yeah — if you are not testing you will have zero confirmed cases, that is the way it is.

The dangerous thing here isn't the current number of cases, but the insecurity about it. If you have a huge number of people starting to get ill today your hospitals will fall apart in two weeks time. Doctors will have to send people home to die, like in Italy visitora can no longer be handled, people no lomger be burried — this is not a joke.


That's not 1060 cases, it's 1060 tested positive. You can't even get a test unless you're a celebrity or high risk... if you're a nurse and your wife is positive, they won't give you a test. We're under tested so there are a lot more than 1000 cases right now.

It's true though that they aren't using the highest rate they could (the 20% per day we got before social distancing). I hope that closing the schools helps... and the ICUs don't overflow immediately.


I do agree that people have a bad tendency to trust any numbers they can get over logic and common sense. And in this case the numbers are obviously a lower bound creating a big bias towards underestimating things.

But information on testing numbers is also lagging and incomplete. The CDC was doing over 5k tests per day a week ago when the number of new cases was around 500 per day. And the number of tests were exponentially increasing too. Does anyone have any better info about how much we have ramped up testing since then? It's a big country, and there's huge "publication bias" in the media where stories about a location or person running into testing issues get the attention and stories where things are working do not. I really don't trust anyone's ability to assess the situation at the resolution of 24 hours and make anything like an accurate prediction. I would like to see them just do full-on statistical sampling by testing people at random in different cities.


If I recall, China had about 500 cases confirmed positive, when they shut down Wuhan on January 23. And by that point, the confirmed infection count ballooned up to 80,000; even after they aggressively mandated their national lockdown. And this was during the early days, when nobody knew anything about the virus. And early test kits gave a lot of false negatives.

With California at 1060, then I can only imagine where the final number will land. And New York has 5712 infected, and yet, they still haven’t shut down the state.

====

Now, the following is likely incorrect, but this may give an general idea of the magnitude. But doing a basic extrapolation, China had a 160x multiplier, from the initial lockdown point, to get to 80,000 infected.

If we use that, then at this point, California might register about 169,000 infected. And New York, if they lock down now, might register 914,000 infected.

Sobering numbers indeed..

But these numbers are highly dependent on population density, mass transportation patterns, and social congregation scenarios. Wuhan has high speed trains, but California has Southwest planes. Car travel and ride sharing usage might be similar. So it’s unlikely the numbers are similar to compute.

At some point, the medical system will fail, and everyone will just give up, and we are now left to our own fate.


It is from my understanding that 19 * 400 ~= 8000. The OP suggested that for every 1 reported death there are 400 cases.

I wanted to clarify something. The parent poster wanted to know how the 25 million case number was arrived at. I just provided an example of how such a number might be arrived at. It is far too simplistic of a model though. I have also read there is confusion over the term “case”, as to whether it’s a hospital case vs total cases in general population.

Note that China implemented a draconian lockdown in Wuhan beginning on Jan 22nd, with 571 confirmed cases.

By Jan 25th, China declared a Level 1 Health Emergency in 30 out of 31 provinces, and began locking down other provinces.

On Jan 26th, China cancelled all inter-province bus service.

On Jan 30th, China closed the highways between provinces.

Also, all of this nicely coincided with the lunar new year holiday, when the vast majority of the country is already on holiday for 2 weeks, and not going to work, or school.

It's not really comparable.


Yeah I watched a documentary on RUV (Icelandic state TV) last night that basically cobbled together the story in Wuhan from people’s cellphone footage.

People were literally dragged away by police/medical personnel in door to door temperature testing. Like physically picked up kicking and screaming and bundled into waiting vans. And at the time hospitals were so overloaded sick people were sat in corridors with the dead on the floor beside them covered by sheets. I think most people are pretty oblivious to what draconian means. I know I was!

The documentary was Danish and called De advarede om corona-krisen - og forsvandt for those interested.

The other thing to note is that a bunch of the people that recorded the footage are now missing which is terrifying in itself.


Thank you for sharing the documentary and shining a light on the insane measures taken out. I can't imagine the fear and uncertainty of getting sick and avoiding detection in China right now to say the least.

Please post to this site if English subtitles become available.

To further illustrate your point:

The UK and South Korea reported their first cases on the first day; SK has slowed new cases to a trickle and the UK is facing mass infection.


How is anybody still making this argument?

"It stopped in China, so we don't need to do anything."

It stopped in China precisely because they did something. Diseases don't magically stop themselves. This is on the level of thinking your dirty dishes wash themselves, because your roommate grudgingly does them.


" Diseases don't magically stop themselves."

No, but they usually stop, when the immune system is done fighting them, either successfully or not. And pandemies usually stop, when enough people build up immunity, or failed doing so. Or when the disease is so deadly it kills quicker than it can spread. Which is here not at all the case.

So even if nobody would be doing anything, this disease would eventually go away.

It is "only" a question of how many casualties it will take. And we are discussing the cost/benefit of the measures to society as a whole. Shutting everything down has real costs, too.


What if you don't build up immunity? I've read that there it's not certain we can build up enough immunity. Everybody takes this for granted but what if your immunity lasts for two weeks?

Then I would die, if there is no lung ventilator for me around. Eventual all the people vulnerable would die too. And the overwhelming rest would live on.

Right, until we either go extinct as a species or natural selection affords us the ability to fight it off and that new impervious population survives and thrives, thus passing on the immunity to new generations of humans.

"Right, until we either go extinct as a species or natural selection affords us the ability to fight it off"

And since the majority has no or very mild symptons ... it is not really likely to go extinct


Mutations. You don't want many people getting it because there is a higher chance it will mutate.

It has already mutated, the strains present in Europe aren't the same as the ones in the US and aren't the same as the ones in China

China's response is nearly impossible for any other country to replicate.

The lockdown is every word that true to its literal meaning during that period of time. People are not allowed to leave their own apartment. It is more like national level home arrest than volunteered quarantine.

All policies are enforced through each individual district, roughly equals to each apartment complex, that entering or leaving the complex requires its own passes. Let alone make a mask a requirement for everyone, without which you would put arrested in public.

I don't think any other countries can implement such a strict lockdown really. In California's case, I think the spread will no doubt slow down, but it is not going to be enough to burn out the virus. In the meantime, we need an effective treatment to be deploy to really battle this.

Can't believe this timeline is getting so intense this quickly in 2020, this is history making by everyday...


> China's response is nearly impossible for any other country to replicate. [...]

> People are not allowed to leave their own apartment

that's literally what's happening right now in Italy (and I think other European countries). It is not voluntary quarantine; although the level of enforcement is not at the level of China, you can get arrested if you are found outside without a good reason.


Plenty of Italians ARE leaving their apartments, to the point that the government has started issuing fines and criminal charges. And that's only sort-of working.

The Chinese meanwhile crack the whip -- and people listen, mostly 'cuz they know the government will back up their words harshly.


I heard on the radio that they pulled cell phone data in northern Italy (might be illegal) and determined that 40% are still going out.

And the curve is still going upwards. Are they all wanting to die?

1. I think nearly everyone besides WHO has the consensus that China’s released numbers is too low, especially when you compare it to the numbers from Italy and South Korea. Whether that’s due to corruption or the swamped hospitals and a lack of test kits in the beginning is debatable.

2. This white paper may explain Newsom’s numbers.

https://www.imperial.ac.uk/media/imperial-college/medicine/s...

The growth is exponential and not linear which throws off most people. Surprisingly, even though the paper’s R0 is on the conservative side (2.2-2.4) and so is their case fatality rate. However, their simulations still predict 2.2 million deaths in the US if there’s no gov intervention for social distancing


That paper is very good. And got the UK to reverse their disastrous "herd immunity" strategy.

Sadly https://www.theguardian.com/world/2020/mar/18/top-uk-covid-1... says that the lead author of the study has COVID and likely was infectious while he attended a press conference on COVID.


These are nonsense conspiracy theories. South Korea's Numbers are also too low?

No.

Our response in the west is just terrible because of all the political nonsense, the fact that scientists don't influence our countries, and most people are just too stupid or too spoiled to listen. Look at our countries, have you seen the kids partying in Miami? The people still protesting in France? How about everyone still going out for dinner?

Don't go blaming other countries' good performance for our crappy one.

Edit: on that note, other countries have been testing people on entry for months on entry. Russia has been testing people on entry. The Philippines tests everyone on the public transportation.


It’s not a conspiracy theory and I specifically said SK’s numbers are more trustworthy. Historically, mainly due to authoritarianism, Chinese provincial governors have a strong tendency to lie with better numbers to avoid being sacked by Beijing. This has happened numerous times already... and before your allusions to racism get more pronounced, I am Chinese. Their numbers also don’t conform to infection simulations pre-lockdown

There are also many Chinese accounts of thousands of bodies just being cremated without being tested. to be fair, Italy is now supposedly experiencing the same thing now due to hospitals being overwhelmed.


China's case fatality rate is half Italy's -- if anything, that tells us the Italian numbers are too low.

In China, 9% of people are 65 or older. In Italy, 22% are.

Since this is a disease with the highest mortality for the older age groups, Italy was always going to have a higher mortality rate.


Apparently in Italy even flu is deadlier than the rest of Europe [1].

[1] https://www.sciencedirect.com/science/article/pii/S120197121...


northern italy is extremely humid, this is a factor for the flue too.

> I don't understand how we get to Newsom's claim that 25 million Californians will get infected in 8 weeks. The math doesn't check out. The best data we have at this point is from China. They have 81,000 confirmed cases to date, most of them happened over an 8 week period.

I believe he was making a point over what would happen without any mitigation. China put in place very aggressive mitigation efforts to keep its numbers from exploding out of control.


Everybody keeps saying this, but is China really “under control” right now? The virus is still here. Can’t it still infect everyone in China?

China is doing 14-day quarantines for all arrivals -- and this is actual guarded quarantine, not pinky-promise self-quarantine.

There's also a lot of monitoring and risk mitigation in place, so they should be able to catch inevitable slipups (eg medical staff treating remaining patients) pretty early.


So are we just supposed to accept this as the permanent state of affairs until a vaccine is developed? At worst, complete lockdown... and at best, quarantine any time you cross an international border?

What alternatives do you propose?

I mean, I don’t know. But I hope people maintain awareness of civil liberties throughout this ordeal. I’m not saying there’s anything nefarious afoot, but as citizens we should remain vigilant.

Sorry, I misread what you wrote about civil liberties being violated. I agree that they would be violated if more countries adopted the location tracking apps, but I think that we're already past the point of no return regarding the violation of civil liberties when police departments are using stingrays, people can be harassed when entering the country when they want to check their devices, and we have broad laws such as the CFAA.

Vietnam is also doing a mandatory 14-day quarantine at designated sites (hotels, military bases) for those arriving from ASEAN countries, the US, and Europe. There is no reported community spread yet, and all the cases are from people flying into the country and infecting a few individuals. The policy was only enacted a few days ago, but I really hope life here can return to normal if we start to catch all the cases before they leave quarantine. Additionally if we can test everyone before letting them leave quarantine.


You could also ask the citizens to self contain, then we wouldn't need authoritarian measures. So far I believe asking for self containment has failed, I have no reason to think why asking citizens to remain vigilant about the freedom lose will work.

Yup. Suck it up buttercup because the alternative is a horrific and painful death for you, or your loved ones.

Great. I’m young, healthy and my loved ones are far far away. Better keep partying I guess.

I assume the 25 million number is assuming we don't stay at home and go about business as normal.

81k is what China got after instituting lockdown as soon as they saw 400 new cases in one day.


81k is what they reported. The CCP isn’t trustworthy.

Do you think they're likely to have _over_ reported the number of cases they had?

No, they probably under reported the numbers. Do you think they locked down wuhan with only 600 confirmed cases or were they way further along the curve?

The world was shocked when they started to build the new hospitals that the numbers didn’t seem to justify. Maybe the numbers were right and they understood what they were in for, which would be a real feather in their hat for their country’s model.


A lot of CCP members are trained in STEM fields. Possibly a much higher proportion of people in China’s government understood and foresaw exponential growth.

> The world was shocked when they started to build the new hospitals that the numbers didn’t seem to justify.

Only those parts of the world who don't understand exponential growth.

You should brush up.


I understand exponential growth thanks. If China was able to take the measures they did on January 23 with only 500 cases in wuhan, nothing amiss in the rest of the world, based on their understanding of exponential growth of the disease that is impressive. Every other government had China as a warning and all of them except three have waited to react.

The governments that have acted effectively have all had prior experience with SARS.

While 25million in 8 weeks might be exaggerated, the number reported by chinese is not credible neither.

The US flu death in 2018-2019 is estimated to be 34k. [1] China's flu death in the same year is 144. [2]

China's population is 4x to that of US. While the numbers cannot be compared directly, the difference in magnitude says at least something about its counting methodology, if not straight out lying

If I am to extrapolate, the corona virus death in china is at least two magnitude under reported

1. https://www.cdc.gov/flu/about/burden/index.html

2. https://www.yearbookchina.com/downsoft-n3019102807.html


Everywhere in the world but China, flu caused pneumonia is posted as flu cause of death. But China would list it as pneumonia, so you have to guesstimate flu deaths by a fraction of pneumonia deaths.

Okay, and how about Korea? Korea is also lying? Everyone is lying except the countries in the west?

Have you considered that those countries just simply have had a better response to mobilize than the western countries?


> Or that they are authoritarian superhumans with a superior response.

They literally welded doors shut on apartment buildings. They are not superhuman. They just have a different take when it comes to individual rights.

There is no reason to assume the growth rate will taper off in country x like it did in China if country x does not take similar, or equivalent measures.


> [China] just has a different take when it comes to individual rights.

Yet next door mostly democratic Taiwan started acting on 31st December, and no one’s talking about them because they have prepared well and avoided an outbreak. Most other countries haven’t done so well...


The other reason no one is talking about them is that the WHO continues to list Taiwan as a province of China...

Since the "welded doors shut" thing borders on fear mongering, I feel the need to clarify.

Everything I have read states they closed off certain doors to ensure that you couldn't get in / out of the building without getting a health screen.


There were wide scale reports of authorities using chains and locks to seal individual dwellings on apartment buildings by chaining the metal gates closed. If you look at pictures from the field hospitals that they built you'll also note that there were metal grills on the windows as well. Although given what we are seeing here with people refusing to isolate and going out I don't necessarily blame them.

China's response in Wuhan in February was indeed superhuman, wrt quarantine, travel bans, medical personnel influx, infrastructure build outs, etc.

They built 2000 isolation hospital bed capacity in something like 6 days.


The statistical models I am running all consistently show that the exponential factor for the spread of the virus is 3 times higher outside of China than it ever was inside of China. Wuhan isn’t the worst case scenario. It is the lower more flat curve we would desperately like to put ourselves on.

The estimate Newsom presented is credible.


The China case is no where close to applicable to the US. They specifically locked residents into their houses so they couldn't leave and locked down all transport in and out of the province. We are doing nothing of the sort, which means our spread will be much different.

> Sure you can argue that Chinatown is lying about their cases (WHO disagrees). Or that they are authoritarian superhumans with a superior response.

The bigger difference is that California’s cases were more broadly diffused across the population than China’s at the same numbers (in part because it didn't originate from a single point in CA but had multiple points of introduction, and in part probably because of differences in lifestyle and social interaction patterns.)


> Or that they are authoritarian superhumans with a superior response.

I think that you discount this option too quickly. Have you been to China before?


Yes many times. I first visited a decade ago. I remember seeing shit smeared on the walls and ceilings of outhouses. A kid taking a shit on the steps of city hall. Today, they have come a long way in some parts of the country in terms of hygiene. In other parts there has been less progress. I have been to the wet markets in two Chinese provinces, and in other Asian countries as well. How about you?

I have also been to the wet markets in two Chinese provinces (Yunnan & Shanghai [not a province, I guess]).

At least in the most dense regions of China that I observed, the state definitely at least seemed to have the ability to enforce some form of effective mandatory social isolation. Even in rural areas, the government seemed to be able to project authority using tech.

Sure, their squat toilets are a mess but I don’t think that really reflects the technological capabilities of the state.


Simple, check this log scale chart of COVID-19 cases excluding China: https://pbs.twimg.com/media/ETgWL8rU8AA3OML?format=png&name=... They multiply by 10 every 14 days. So assuming governments did not take any action to change this trend, cases would multiply by 10^4 = 10,000 over 8 weeks.

There are urrently around 675 cases in California according to the CDPH (https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization...). So this trend would lead to 6 million cases in 8 weeks. The governor probably assumes there are 4 times more cases than detected. So 6M × 4 = 24 million.


USA had 5000 cases in the last 24 hours. It's growing exponentially. You're not starting at 1 like China did.

don't forget, testing backlogs are being cleared. We're seeing a large number of confirmed tests show up in the numbers. Until the backlog is cleared the numbers are misleading.

How are they misleading? You still have at minimum 14000 active cases in the USA today. In 8 weeks you'd have significantly more.

This comment hasn't aged well...

USA wasn't even testing until very recently. Those numbers IRL are probably insanely higher than that.

It really doesn't matter whether it's 4 or 30 million in 8 weeks, because by the time you reach a million people contaminated, you'll have overwhelmed California's ICU and ventilator capacity. People with all kinds of critical conditions, on top of critical COVID-19 cases, will die from lack of care.

There is a huge difference between confirmed infections and total infections because it is estimated that around 18% of the people never notice that they are infected.

But those that get sick get very very sick. And this will put much pressure on health care.

The fear is real. Take a look at the footage of Chinese hospitals and doctors.

Without lockdown the numbers will go up in 8 weeks.


why are you comparing California to the total population of china? China is regional too.

Tell me how a virus that started in China (a country with 1 billion humans and grew unchecked or for months), could really have less fatalities than Italy, a country with 25x less people...

Unless the numbers are crap, then it makes total sense.

But the WHO disagrees, ah well, then I guess we should stop using our thinking machines.


>grew unchecked or for months

It really didn't "grow unchecked for months".

>using our thinking machines.

OK. You first, then.


Well, I'm lighting kharma on fire to educate you @spats1990, so at least I'm trying.

Here's the timeline.

Nov 17 - First known case of coronavirus

https://www.livescience.com/first-case-coronavirus-found.htm...

January 3 - Whistleblower Dr Li thrown in jail

"Li warned colleagues on social media in late December about a mysterious virus that would become the coronavirus epidemic and was detained by police in Wuhan on 3 January for “spreading false rumours”. He was forced to sign a police document to admit he had breached the law and had “seriously disrupted social order.”

https://www.theguardian.com/global-development/2020/feb/07/c...

Jan 18 - Annual Wuhan Lunar New Year banquet. Tens of thousands of people gathered for a potluck. (Hosted by the Mayor of Wuhan)

Jan 23 - Wuhan put on lockdown

https://www.axios.com/timeline-the-early-days-of-chinas-coro...

The research also found that if interventions in the country could have been conducted one week, two weeks, or three weeks earlier, cases could have been reduced by 66 percent, 86 percent and 95 percent respectively – significantly limiting the geographical spread of the disease

https://www.southampton.ac.uk/news/2020/03/covid-19-china.pa...

Looks like a couple months to me.


> Jan 18 - Annual Wuhan Lunar New Year banquet. Tens of thousands of people gathered for a potluck. (Hosted by the Mayor of Wuhan) > Jan 23 - Wuhan put on lockdown

It reminds me of France:

March 15: French municipal elections (in all French cities)

March 16: General lockdown announced


OK so your original post was premised on there not being massive mobilised response to less than ~250 cases in a city of 11 million by mid-december. It's nice to have the benefit of hindsight.

Thanks for the response and links, but I basically regret this entire interaction and would rather leave the discussion here.


This is no time for math or common-sense.

Just stay inside, shut up, and be glad we aren’t being overrun by witches like back in Salem. Those were terrible days.. witches everywhere! Thankfully, Quick thinking politicians got rid of them.


People will never abide by a two month quarantine in this country. The number of people who say "I'll just get sick and risk spreading it" starts at much greater than zero and will rise every single everyday.

There will need to be back-and-forth quarantines, or targeted quarantines, or some other creative method of allowing people to live roughly normal lives after a few weeks.


yeah, i'm actually impressed the general public has been as accommodating as they have. It won't last forever though, I think the government knows they can only keep people in their homes for so long. Eventually, the people will be like eff this and start re-engaging their lives.

California probably has a month tops, nobody is going to accept completely halting their lives for two months let alone anything longer.

Just wait until the first few celebrities die. That'll change everyone's mind very, very quickly.

We'll probably lose many members of Congress. They're the worst case - old, meet with many people, not social distancing.

They have access to better healthcare than you or I, though.

Congresspeople on ventilators still sends a pretty strong message

Getting a ventilator if you need it is good, but even better not to need it.

Wait until 100,000 people die, which would only be 0.2% of the population.

The truth is most deaths are going to be people near or beyond average life expectancy. I don't want to minimize the impact of any person's death, but I think people in general are willing to accept a fairly high death rate among the elderly, especially considering the most likely to perish are those who were already the most likely to perish.

The death rate among the under-70 population is a different matter. If the medical system is overloaded and working-age people start dying en masse, I imagine that would change public consciousness quickly.


Young people don't necessarily die but they may very well end up in reanimation. The prognosis is hopeful if you're young and in reanimation, except if there aren't enough beds to host a sudden afflux of newly sick people in need of reanimation. Should I continue?

Do you mean resuscitation?

Probably. Sorry, my English is failing me when it comes to more technical words

That's about 14 days of people dying at normal USA death rate. Do you think people notice that happening and adjust for it?

hospitals will be overcrowded so your "normal" USA death rate will actually increase because the people who would normally receive medical attention will no longer receive it.

"my" death rate? My "normal" death rate? What are you saying?

There will be overlap between people who die of diseases routinely (the elderly, the immuno-compromised, and those with underlying conditions, and the unlucky) and those who die of this disease. No matter, the point still stands - if 100,000 people dying is what it takes to change people's behaviour significantly, that ought to happen every month, and it doesn't.


I'm more concerned about whether or not we can keep food, utilities, and housing running that long. If the front-line workers in the essential jobs are the most vulnerable to exposure, and the economy has screeched to a hault, can we keep everyone fed that long, keep the lights and sanitation going, while also not infecting everyone?

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If you look at the fear --in the supermarkets, in general lack of presence in public-- there are more people taking this seriously than not, with or without an official order.

People are in shock. Shock doesn't last two months. And don't forget all the people you don't see at the supermarkets.

As long as shelves remain empty, people will panic. You can not be panicked, see other people panicking, and then become panicked yourself. So it's going to be difficult for supermarkets to reverse what's happened unless they implement quantity limits.

The shelves are only empty because everyone is stockpiling at the same time. There are no food or toiler paper shortages. But the toilet paper truck doesn't come every 2 hours, so if people buy up all the stock they need to wait until the next regularly scheduled shipment arrives.

It's really not much of a problem, beyond the problem people have created by stockpiling too aggressively.


Similar to the airlines?

And international hotel chains, and... the list grows so quickly, who can possibly keep up?

If we all just stay in our houses forever, we all die anyway.

Might as well risk living before we die.


Without contact tracing and isolation of positive cases a lockdown won’t work. Since no system like this is in place I reckon it will take a lot longer than 2 months.

This is correct. This is how South Korea stopped it - early testing and isolation followed by contact tracing to test them too.

Think about it this way. The Ro spread factor is somewhere between 2.2 and 3.0 by most reports. People are contagious for 7 to 14 days before they know it. Therefore every infected person spreads a new case only once every 2 to 5 days on average. The problem isn't that the virus is explosively contagious per-interaction (measles is higher), it's that the incubation period is so long across so many interactions.

Cut that recognition time from that 7-14 days to 2, cut off those interactions, and that's how you get Ro below 1 to stop it. That's what South Korea did, by way of both rapid testing and contact tracing to test them too. Reports are that their rapid test gives false positives of up to 10%, but that's okay, a false positive is much less consequential than a false negative.

What jurisdictions in the Western world have the means and will to implement that remains to be seen.


Are you sure the tests can detect the virus two days after exposure? One reason the CDC advises quarantine and waiting for symptoms before testing is because they aren't sure it can be detected before symptoms start.

Though I guess whenever you are producing enough virus to be contagious you would probably test positive at that point too.


I'm not sure; that 2 days number was what I thought I'd read about South Korea's test, but could be wrong.

At any rate, that's an approximation. The key point is for the average testing and isolation interval to be shorter than the average time to pass on a new case, whatever that interval actually is. If that happens, then it's stoppable.


This is the most excellent description of South Korea’s efforts I have read so far.

Median incubation period is 5 days, 95 percent of cases are 2-14 days.

"Without contact tracing and isolation of positive cases a lockdown won’t work."

Why? In a total lockdown situation, the positive cases might infect their close people the live with, but not really anyone else. And in a half lockdown, with still going out/shopping ... the infection rate is much slowed, if a high enough percentage of the infected isolate enough. That is all that we want, I thought.


> contact tracing and isolation of positive cases

That works if there is a relatively low number of cases, or you have enough testing capability to carpet bomb everyone with tests.

Once the number of cases gets too high, contact tracing has lost, because you have too many unknown cases in the community.

If you can’t test a large percentage of your population, you can’t detect pre-symptomatic or asymptomatic people that are spreading the virus.


Yeah, my jurisdiction has a pretty high test rate (3800/million people), but there's community spread, and they've explicitly stated they will not have the test capacity to test everyone who's symptomatic in at least the short to medium term.

I live in Hong Kong and there are many failures like - Unable to activate the location tracking wristband (activation code sent by SMS not received) - Quarantine is done by people themselves, traveling from port to staying places = no monitor & unprotected

Many people (medical people) have experienced SARS in 2003 and they stay on alert this time. Except there are still enough people (especially the government personnel) not learning from / haven't experienced SARS.

If the current measure can eliminate the spread, I will feel lucky. But if the virus keeps spreading, I won't be surprised.


All of these shutdowns are weeks late and the US does not currently have the authority and means to lock down the way eastern countries did.

There are still millions of people going about their day here in LA and nobody will stop them.


I would disagree. If the national guard gets deployed, they will say otherwise.

forcing it means armed rebellion, Americans don't handle freedom taken away by force very well.

No it doesn't. 99.999% of Americans aren't going to respond with violence if the national guard enforces a quarantine.

This is the most ridiculous fantasy a subset of HN users love to bring up, but there is just absolutely no chance that this happens in any meaningful way.


It seems like less extreme measures may have fewer unintended consequences. For example, by closing down all restaurants, local grocery stores have been packed all day. I expect there is more cross contamination in your local supermarket than there would be in normal supermarket conditions plus one smaller restaurant setting per day.

My Chinese suppliers in Shenzhen have been back to work for a while now.

This is why their stock market is the best performing in the world this year...

At some point we do have to consider that shutting down the majority of the economy will ruin more lives than letting the virus infect everyone.

Keeping in mind that most young people who get the virus will survive, this is a massive generational sacrifice by the same people who left college around the time of the 2008 crash to protect older people. Anyone who thinks this is only going to last 3 weeks is just not being realistic.

Of course nobody wants to callously stand by while older Americans die of the virus. My own parents are at risk. I myself have asthma and I don't really know what my chances would be. However, the worst-case scenario in 20 years is that the older people we saved by sheltering in place will be gone, but the consequences of shutting down the economy will still haunt everyone living.

There are long-term trade-offs to consider here, particularly ruining the lives of the young in order to save the old, and I don't think they are being considered properly.

In an ideal world we would not need to make choices like this, but the choice is real and we can't fumble it.

I feel like a bit of a dick for posting this, but after reflection I do think it's a valid point and we cannot escape the trade-offs I described.


"Letting the virus infect everyone" at a 1% death rate means 3 million deaths in the US, right up there with the worst catastrophes of the 20th century. You can change the death rate and projections of number infected needed to get herd immunity and move that number around, of course, but not enough to change the overall moral calculus.

1% death rate assumes reasonable medical care. If you let everyone get infected, you'll have people dying on the streets. I bet this % jumps to 5% or more. We'd easily see 15m+ deaths.

Exactly. Death rate in Italy is over 5% I believe. Allowing it to spread unchecked would be an unmitigated catastrophe, and the deaths certainly wouldn't be limited to the elderly. What we need to do is massively expand testing so that the lockdowns and distancing measures can be ended without allowing the virus to go back to spreading through the community.

Keep in mind, the number you are talking about is known deaths / known cases.

Neither of these is a final or accurate number: many of the current cases will progress to death, and many who have been (or are) infected have not been tested (e.g. because they were asymptomatic or had only minor symptoms).

Here’s a more careful attempt to determine the numbers for Wuhan (published today) which results in numbers substantially lower (though still scary) than those suggested by the WHO previously https://www.nature.com/articles/s41591-020-0822-7


For sure, to have an accurate number you need to wait until all cases resolved AND you need to have thorough testing to know what the total number of cases were. Good to see that it may not have been quite as bad as thought in Wuhan. That said, they did enact pretty strict quarantine measures there and massively surged hospital capacity, so it's not like that number represents total healthcare collapse either. Regardless, to me it seems to great to just say it's outweighed by the costs of control measures, especially since there is another path to take.

That seems far worse than any statistics reported so far. What is the basis for that number?

Italy's current mortality rate is 8% (3,405 deaths, 41,035 confirmed cases). Of course their lack of testing is probably influencing the numbers somewhat, but still.

Source: https://www.wsj.com/articles/italys-virus-death-toll-on-the-...


According to a recent study from Columbia University up to 86% cases are undetected based on pre-lockdown Chinese data. That would bring this number down to ~1.1%. That is in the oldest-skewing population out there, barely any containment (assuming 14 days infection to death), and with overwhelmed healthcare capacity. Frankly I didn't even expect it to be this low, I thought it was supposed to be closer to 2.5-3% after healthcare collapse and 0.5% before.

Please be careful with every study you read or be talked about in the news: there's over one thousand studies on Covid19 so far, with a big discrepancy in results. Cherry-picking the one we want to hear is pretty dangerous if it gives us a false sense of security.

For the record, on the Diamond Princess (with everybody tested) the number of asymptomatic case was 60% with more than 1% death rate with Japanese healthcare (not overloaded). You can't generalize on these figures either for many reasons but thats's still a strong warning.


Well, tbh, to beat the WW2 death count, you'd have to infect 8.5B people

There is no scenario in which we see 15 million deaths. I would like to see a single real academic you can find saying anything like that.

Have a calculator?

# Italian deaths / Italian cases = percentage dead [1]

2_978 / 35_713 = 0.0833870019

# USA population * percentage dead = USA death scenario [2]

329_414_824 * 0.0833870019 = 27_468_914

It's prob not gonna get that bad, but Italy didn't see a scenario where people would die at a rate over 8%. So there's a scenario. Don't panic, but also don't dismiss scenarios you'd rather not believe. Americans who get laid off lose access to cheap healthcare, and many as already don't have it. Lack of healthcare doesn't sound like a great a situation.

[1] Source: Coronavirus disease (COVID-2019) situation reports # 59 for March 19

[2] https://www.census.gov/popclock/


That's confirmed cases. I doubt Italy is testing many people with mild symptoms, just like the US is also not testing many people with mild symptoms.

We don't really know the death rate in Italy. We shouldn't get too deep in to back-of-napkin math when the data changes every day.

So the 24% of the US population aged 0-18 is just as likely to die as the "confirmed" cases of COVID-19 in Italy? If anyone does anything but dismiss this stupid ass math, they should panic.

15 million in the US seems like a big stretch. But more than a million is plausible if no action is taken and people go about their everyday lives as usual.

Agreed, and as many as 2.2 million.

No need to make already awful numbers into lies by multiplying by 7.


Personally I think 2.2 million is extremely optimistic if we're talking about a worst case where no one reacts to mitigate the spread. But ultimately it seems like we agree that it would be really bad, whether it's 2M bad or 10M bad, so no need to argue about it really.

Agreed, because that's unthinkable, so lockdowns would be enacted instead. Without any measures taken to limit spread though, that would be the expected result.

Again, based on what? I have seen nowhere near that level of estimate assuming peak hospital overload and unmitigated spread.

Stats from Italy are going to be heavily skewed towards fatalities for a number of reasons that have been documented by epidemiologists.


Based on the death rates in Wuhan and in Italy where this actually happened.

Careful with those death rates, my guess is that they likely exclude a ton of mildly or asymptomatic patients who never got tested (skewing the death rate upwards).

Sure. And yes, Italy's population is more elderly as well. So I agree it's possible the death rate will be less than 5%. (Although I believe they're currently at ~8%, so we don't know that.) But those are the closest parallels we've seen so far as to what happens when a modern heathcare system gets overwhelmed by this, so they're the best estimates we have to work from.

And regardless, it would be very, very bad. If it's only 5M people instead of 15M, that's still catastrophic. Also while the hospitals are completely overwhelmed with COVID-19, people will die of other things that would normally be survivable.

And finally, we have an alternative: keep employing distancing and, where necessary, lockdown measures while scaling up testing. These lockdowns will get the cases under control, but they would flare back up as soon as they're ended. However, with the expanded testing, we can instead perform sufficient testing across the entire population to catch outbreaks before they start. With sufficient testing, things can go back to normal while remaining confident that we're not spreading the virus undetected and seeding a new outbreak. It needs to be orders of magnitude more than we have now, but it's entirely possible.


Surprised that I ended up in the red on that comment, yet not a single person has given me a paper where anyone says that 15 million is a possible worst case US death toll.

If you let it go wild is not gonna be a 1% death rate, health care collapses and it suddenly jumps to 5% or higher. With the health system collapsed deaths are not only about COVID-19, but everything else that depends on health care.

We're also betting on it not having any mutations .. the more people it sees, the more paths it can take as it replicates..

I think people are oblivious to some obvious ways our system operates.

Wealthy people have power.

It takes time to accrue wealth, most wealthy people are old.

Coronavirus kills 10% of 80+, and 5% of all 65+.

Old people vote.

If the hospital systems are overwhelmed because we don't flatten the curve, those percentages likely double or triple.

Look at how much we've learned about treating this virus in the 3-ish months we've been paying it the attention it deserves. If we slow it for another month, maybe these percentages could be cut in half.


Except it’s significantly less than 1%.

You should find the actuarial tables and life expectancies for an 80 year old. It ain’t sunshine and rainbows.


Permanent respiratory damage in ~2% of survivors is catastrophic as well.

Is there data to back this up? It would be very early to make specific declarations of the after effects of an illness that sprang in to existence 3 months ago.

I would expect doctors are able to make kinda accurate diagnostics on damaged lungs and have already lots of data on recovery prospects. Might not be 1% exact, but they are probably not on the wrong side either.

The death rate is probably a lot lower given all the under tested asymptomatic infections.

> "Letting the virus infect everyone" at a 1% death rate means 3 million deaths in the US, right up there with the worst catastrophes of the 20th century

Every year nearly 3 million people die in the US already.

https://www.cdc.gov/nchs/fastats/deaths.htm

Are you saying we experience the worst catastrophe year in and year out?

The hyperbole and exaggerated fearmongering over coronavirus is something to keep an eye out for. Also, if everyone gets infected, it likely means that the virus is far less deadly than you assume and the death rate is far lower than 1%. Think about it rather than cherrypicking data to push an agenda.


This is in addition to that, not either or

There would be significant overlap.

I see a lot of replies treating this as an either/or: we all isolate, or none of us do. But that's not the real choice.

People who are elderly or have health conditions that put them at high risk could isolate themselves for the next several months while the virus makes its way through the population. When enough people get it, herd immunity will develop and then those people will be protected. High risk individuals have a personal responsibility to isolate and protect themselves.

I don't know if this is just my community, but I went to the store (out of necessity) twice during the past week or so... and both times it was filled with elderly individuals. It very much made me feel like we were all sacrificing so that the elderly didn't have to.


What you described (isolating older people but not younger people) seemed to be the approach of the UK but it looks like political pressure might be changing that and they will close schools and so forth. Herd immunity won't develop if everyone is at home.

It seems like their current plan is to do what everyone else is doing, after wasting a lot of time.


> People who are elderly or have health conditions that put them at high risk could isolate themselves for the next several months while the virus makes its way through the population... High risk individuals have a personal responsibility to isolate and protect themselves.

What people don't seem to get is that this was best-practice even before COVID-19. Influenza also disproportionately affects people with high-risk health profiles and there are millions of cases in the US every year, already, with thousands to tens of thousands of deaths.


The problem is, lots of GPs and teachers are in the 'high risk' category.

For teachers in OECD countries I found this chart: https://4cdn.hu/kraken/image/upload/s--n8f4dn-h--/c_limit,w_...

For GPs in Hungary I found this: https://4cdn.hu/kraken/image/upload/s--HqWJo4dH--/7Qfxe7y7fM...


I agree this is exactly the right approach. The goal is to flatten the curve, not try to obliterate it. We're not going to eradicate this virus without a vaccine, so we have to aim for transmission rates that don't overwhelm healthcare capacity. Keeping the virus away from vulnerable populations helps that significantly.

In the UK and Colombia (and maybe elsewhere) there are mandatory quarantines only for the elderly. I can see this being tried in other Western nations if blanket quarantines go on too long.


“Flatten the curve” is trendy but the graph everyone is sharing is just made up. It’s a nice visual aid but that’s all it is.

What if we all shelter in place but hospitals end up overwhelmed anyway? That seems like a real possibility and it kind of makes the argument irrelevant.

If we didn’t “flatten the curve” enough to get the imaginary hump below the imaginary dotted line, then the benefits of “shelter in place” are going to end up being a lot less valuable.


"What if we all shelter in place but hospitals end up overwhelmed anyway? That seems like a real possibility and it kind of makes the argument irrelevant."

There aren't just two modes: Hospitals OK and Hospitals Overwhelmed. The idea behind flattening the curve is to reduce the burden on the hospitals to whatever degree is possible. How is it "irrelevant" if a hospital is 200% over capacity versus 500% over capacity? The people who would die in the worst-case scenario but not in the "flattened" scenario would probably think it is extremely relevant.


This assumes that the virus doesn't mutate quickly enough that herd immunity and vaccines won't be very effective; it also assumes that the UK prediction of a bad winter resurgence won't happen.

Otherwise, what on earth is the strategy? Flatten the curve only to have an explosion later?


>2008 crash to protect older people

I had no idea they had audited the age of the bankers who caused that mess. Only one I'm aware of was https://en.wikipedia.org/wiki/Nick_Leeson who brought down an entire bank at the age of 25.

As for your darwinistic-eugenics as an old person, sure I'm happy with that, but the question is - would you be happy with that when your older and somebody else's kids suggests the same thing. Not that easy to answer.

But whatever age people are, the penchant to begrudge the age groups above them to varying degrees and reasons tends to be strong, at least until they reach their 40's. At least that is what I have observed from many years of experience of many age ranges.

> In an ideal world we would not need to make choices like this, but the choice is real and we can't fumble it.

I suspect the film Logan's Run would be worth a watch if you have not seen it. https://www.imdb.com/title/tt0074812/

Oh I'd also add, we have not seen results of sterility post infection - that data might change your perspective if we end up finding out that the chances of becoming sterile due to infection of this are high. Which is still an unknown and not to be ruled out.


I'd rather you be serious and address the very real trade-offs of shutting down one of the world's largest economies for a long period of time. We cannot pretend there won't be consequences.

I'm not very good at putting a price upon human life, for that is exactly what the equation is.

Still, once you put a price upon a life, you find yourself more open to other equations in which you have that variable and then you start reducing the value of that variable. It's a slippery slope.


I don't want to put a price on life either, but that doesn't mean there is not a price.

The decisions we make now will affect everyone, not just those who die.

My point is that we can't avoid the trade-offs. We cannot pretend that saving the lives of sick people does not affect other lives.

Our society is not having that discussion, but is focused on saving as many lives as possible. Not enough attention is being paid to the other side of that trade-off.


Of course there is a trade-off - why do you think that aircraft are still flying right now. Things didn't stop instantly and in many avenues, have still not stopped.

What is an economy, the generation and circulation of money. Then offset with humans and they reproduce and circulate.

However, whilst not all economic aspects are equal, human life is. Hence you will see essential aspects of the economy maintained and less essential will either ride it out, evolve or expire - including what may well be, older businesses as well as young ones.

let us not forget, some businesses are very dynamic and volatile at the best of times, restaurants being the classic example. Casualties of human life and economic are inevitable and with that, each country has a different plan, though mostly stimulus and loans.

However, fear has and will do more damage to the economy than this virus and if you do not have shutdowns, that fear will only rise - so yes it is a fine balance with much minutia.


There is a fundamental difference between money and blood.

Save the lives! Deal with the paperwork later.


For both individuals and governments isn't the line between blood and money terribly thin? Obamacare is such a transfer of money into life. Every other decision in government is a tradeoff between money and life.

There’s always a cost-benefit analysis to be made.

Generally speaking: health insurers will prefer to pay for procedures for those who will get the most benefit from them.


Look, do your analysis to find out what it cost, but under no circumstance should anyone be saying savings lives isn't, "worth it"

Health insurers are hugely part of the problem in America and should not be looked up to, as an example for how to behave in a crisis.

Other countries have figured it out how to take care of each other as a decent society.


Should we spend $1 trillion to save one life? I'll bet we agree we shouldn't spend that much money to save just one person's life.

Ultimately, there is a trade-off to be made between how much we use to save a life vs improving the quality of everyone else's life.

The EPA puts the cost of a life at $10 million [0]. Juries put it at $2.2 million, apparently [0].

But, of course, not all lives are (statistically) as valuable. A 65 year old might have 20 years of life left. A newborn has 80+ years. An 80 year old has a 4% (and rapidly increasing) chance of dying per year. [1]

Should we spend more to save an infant than an old person? I'd say we should because we're saving more units of life-years.

So to save 1 million people, we should spend how much, exactly?

If we go by the EPA, $10 trillion. If we go by juries, $2.2 trillion.

US GDP is $21.44 trillion to give a sense of the magnitude of the cost. The EPA estimate would entail asking the US to spend the equivalent of half its output or 12.5% of the entire world's output.

If it's 1 million 65 year olds, and life expectancy is 80 years, how much should we spend? A 65-year old has lived 80% of their life. Should we spend only 20%, then?

That'd be $2 trillion under the EPA estimate.$444 billion if we go by juries.

I have no idea if we should provide that sort of discount, honestly, but it's definitely worth thinking about in an era of intense economic impact to (primarily, but not exclusively) save members of that demographic.

The stimulus packages the US government is considering are within striking distance of these discounted numbers at $1.5 trillion or so depending on what passes.

And that stimulus doesn't come close to covering the full impact, either.

The S&P 500 market cap, only a portion of the immediately measurable economic impact, has dropped by ~$2.2 trillion over the last month. [2]

That plus the stimulus is putting us at $3.7 trillion, well over the discounted value of saving a million 65 year olds.

We have other measurements to consult, and we're not even getting started.

The total US stock market cap is 109% of GDP. It was 158% a month ago. [3]

That's a $10 trillion drop. I think the market was overheated, but coronavirus is a huge portion of that drop.

[0] https://www.bloomberg.com/graphics/2017-value-of-life/

[1] https://www.irs.gov/pub/irs-drop/n-19-26.pdf

[2] https://ycharts.com/indicators/sp_500_market_cap

[3] https://ycharts.com/indicators/us_total_market_capitalizatio...


My mom is 80. I don't want her to die in agony, lungs ravaged, suffocating slowly.

This isn't about numbers for me.

Distinguish between wealth and paperwork. As Bucky Fuller pointed out, if all the paperwork disappeared overnight we would have a hellofa fight over who owns what, but no one would (necessarily) starve. If the wealth itself disappeared: the factories, the distribution networks, and so on, we would be screwed.

In the situation today the physical basis of wealth is not under attack, the "human capital" is.

Nevermind the Goddamned paperwork. Save the lives.


Your inability to put a price on human life is precisely what is leading you to discount future lives.

Economic downturns lead to deaths of despair - long-term unemployment causes spikes in suicides, drug overdoses, even domestic terrorism brought on by a potent mixture of sheer nihilism and depression. Just because it's more difficult to count those future lives (more likely to be young) against a current model - who are you to discount them?


You're basically saying, a) should we care less today and let the virus spread more? OR b) should we care less in the future and let the poor bastards dope themselves to death?

Perhaps the solution is: Save as many people as you can today then, and when there is an economic downturn we should do a better job helping people get off drugs by talking to them and treating them, helping develop new markets, reaching out to young poor communities.

I feel like half of your problems listed are solved by hiring more therapists and psychiatrists. It sounds more like America has a lack of caring for it's people rather than anything else.


> You're basically saying, a) should we care less today and let the virus spread more? OR b) should we care less in the future and let the poor bastards dope themselves to death?

I think this is a really callous way of putting it, and it's only valid if you accede to the empathetic framing. The point of my original comment is to show that there is an econometric argument against the empathetic framing, even for one intended to allow empathy to dictate their opinion.

> I feel like half of your problems listed are solved by hiring more therapists and psychiatrists.

Part of any rational decision process asks about the costs of the different options. The cost of this economic recession will be high; the cost of improving mental health infrastructure would have been much lower.

> Perhaps the solution is: Save as many people as you can today then, and when there is an economic downturn we should do a better job helping people get off drugs by talking to them and treating them, helping develop new markets, reaching out to young poor communities.

Why decide to pay both costs when only one needed to be paid?


Not putting a price on life simply means someone else will do it for you. It's a dirty job, and someone is doing it to make society run, even if we don't have to think about how the sausage is made.

You don’t get it: letting old people die will just magically solve all of our problems!

Parents? Grandparents? Who needs them! They’re just a strain on the economy.

/s


I'm sure if they remake Logan's Run( they probably will) That would make a great tagline for the market of today.

There is an alternative: locking down until testing can be significantly ramped up. This wouldn't need to take more than a month or two. The cost to test even everyone in the population on a weekly basis is much, much lower than the cost of being locked down, and once that infrastructure was in place, other measures could be dropped, because we would know and could isolate only those who are infected (symptomatic or not).

Edit: I should add that ramping up testing may take longer than that. I'm not an expert; just going by what I've read. Even so though, we should definitely aim to scale up testing as much as possible; the better our testing, the less restrictive and long-lasting isolation measures will need to be.


I'm fine with locking down if the government will man up and pause mortgage/rent/larger bills because I can't afford 3 months+ of this because I'll be out on the street.

Some states are not allowing evictions, foreclosures, or utility disconnections at least for the time being. How long this will last, and what happens afterward is yet to be determined.

>This wouldn't need to take more than a month or two.

Two months of this is going to be the beginning of the next depression.


It's going to be a recession, certainly. In the Great Depression there weren't significant stimulus measures taken though, until the stimulus provided by the war. Governments have already made it clear they're going to throw a lot of resources at the economic side of this, so I expect a couple months would be really bad, and some businesses will definitely fail (some already have), but not Depression level bad.

This is a great idea. The first thing that has given me hope since this set in.


This simple and brilliant. I hope plans like this are being worked in by those in power.

The newest CDC estimates are that young people require hospitalization at rates between 1 in 7 and 1 in 5. At scale, that’s an enormous number. The “flatten the curve” trope feels a bit tired at this point, but it’s true nonetheless. We have to avoid breaking our medical system at all costs.

If we don’t, what happens to the rather large percentage of young people who require hospitalization? It’s no stretch to assume that many would die. Let alone the fact that mortality for young people is already many times higher than the flu. Break the healthcare system and that goes up dramatically.

On top of that, break the healthcare system and what happens to all the normal, baseline, hospitalization needs? They’re not going to suddenly disappear. Survivable medical events become fatal.

How do you recover as a society from that, without an economic depression like none we’ve seen in our lifetime?

We desperately want to prevent an economic depression, and for good reason! But the chessboard is what it is. We don’t have a whole lot of moves.


What if the flatter curve is still above the dotted line that represents hospital capacity? Would shutting down most of the economy still be worth it?

That “flatten the curve” graph people are sharing is just a visual aid. It’s not based on real data. How could it be? Hospital capacity varies by region but everyone in the country is passing around the same graph.

It’s nice to flatten the curve, but if the flattened curve isn’t low enough then we will overload our health care system anyway, and we will add an economic shutdown on top of that.


Flattening the curve is not all-or-nothing as you imply. If we marginally exceed hospital capacity (in a given area) we will have a small number of people who cannot get the treatment they need. At that point every additional patient is another victim of too steep a curve.

I admire your optimism that the economy will not shut down when people are found dead at homes because hospitals are full. Which is what's going to happen if we let it spread now.

The death rate is not as high as people think, because far more people have the virus than the number of people who have been tested.

We are lucky this is not a super deadly virus, because I don’t think we would have handled it any better.

Based on last week’s numbers, unemployment claims are up almost 10x compared to the normal level. That is one indicator of the damage to the economy.

We need to consider that the human suffering caused by the economic shutdown will outweigh the human suffering caused by deaths, and it will last longer too.


When only (or mostly) the elder die, then the economy will not shut down, because of old people dying at home. Instead there will be a new big buisness of corpse disposal. Not nice, but necessary, if not government or voluntarily organized.

Only when everyone panics and people fight over live saving toilet paper, instead of keeping the power running, then the economy will shut down for good.

So I am not really scared of the virus, but rather panicked mobs.


The economy is going to shut down a lot harder than this when people start dying in the streets. The health care system will be overwhelmed early. At that point the mortality rate for cv and everything else will shoot up and people will be dying everywhere. You’re thinking, hey, let’s let the old people die, they’re going to die eventually anyway. But it’s going to be a lot more than some soon-to-be-dead anyway people dying. At that point, people will be far too frightened to just go to work like normal, and the normal infrastructure that delivers food, electricity and fuel will break down.

Im happy to share wealth for people I love.

Nonetheless I also think that they do factor this in. If your health system breaks down around the world it might become very catastrophic.

And in Italy there have been enough not only old people dying.


Even if you are right, in the US almost all old people vote and a small amount of young people do. Guess what that means for politicians? They do what is best for the old. Not to mention a lot of young people don't really want to watch their parents and other elderly family members die en masse so they would probably be against this too.

People need to really stop parroting this claim that young people aren't susceptible to COVID-19...data from Italy and the CDC indicates that young people are at risk as well...

> At some point we do have to consider that shutting down the majority of the economy will ruin more lives than letting the virus infect everyone.

At $10M/life, 1M deaths in the US is a $10 trillion cost. That's 50% of GDP - I fail to see how it can't be cheaper to "shut down the economy" (a term I find quite hyperbolic anyway) for a month.


I wonder if there is modeling related to global warming that pertains to this kind of conversation.

It's possible that a massive global economic slowdown could help solve the collective action problems there a bit, right? Maybe the spirit of cooperation necessary to achieve "war time" resistance to the pandemic can seamlessly transition into building a new economy that's more sustainable?


What lives are being ruined exactly? Some accountant for GrubHub who misses his paycheck? People still have food lodging etc, it just sucks that our "economy" is dependent on 100% of the working age people working 100% of the time otherwise ... collapse? Let's save the lives we can and keep the lights on. Society will be fine.

If you don’t think lives are ruined you need to get off your high horse. Not everyone is a software engineer that can WFH. Service industries are being hit hard, restaurants, hotels, airlines, etc. Even manufacturers like auto makers are shutting down. How do you suppose these affected people pay their rent.

And when we get kicked into the man made depression two weeks from now, anyone that doesn’t already have savings and wealths, their lives are ruined.

And that’s gonna be much more than 1 or even 5 percent of the population


It's highly unlikely those losing paychecks now will be starving on the streets since measures are being considered about missing paychecks already and society is not at all in a complete breakdown mode. Supply chains are still running at 100% capacity. Everybody will get fed.

However, if hospitals are completely overrun with uncontrolled spread, along with virus related deaths (1% to whatever), normal hospital cases of heart attacks, strokes, cancer, accidents etc will result in straight death too. Health services were already struggling to cope with those cases alone before the virus hit. Total death toll would be an almost guaranteed disaster. Any economic downturn of lockdown will seem a barely perceptible blip atop that body count. Lockdown naysayers need to get a grip on reality.


The only thing we've seen so far on the federal level is a measly one-time payment that won't even cover rent for most people who are out of a job. If that's setting expectations of how "everybody will get fed", mine are very low already.

How much savings exactly do you think most Americans have? Income just dropped to zero for most local businesses, and will be at zero for months. Congress is talking about giving everyone either $1000 or $2000. Yay!

I'm here stressing about finding toilet paper. I'd hate to be worried about affording toilet paper.


I live in what I would call a working-class area. Lots of contractors, plumbers, retail workers, restaurant workers, and gig workers. Most of them don't have a lot of savings and a month without work would really mess up their lives.

If you think a month without work would mess up someone's life, imagine how much dying would mess up their life. Most of us have lived through 2+ major recessions. They suck, but I'd gladly take a recession instead of the deaths of myself and/or love ones.

Most of those people would not die if they got the virus, which is central to my point. That's the trade-off we face.

So what if it was Ebola? Should we still allow air travel? Cruise ships? etc. People will self regulate to a certain extent but the idea that we kill a bunch of people so we can engage in more or less meaningful activities is pretty dumb.

This works for a while, but we can't realistically expect to just shut the country down for the next year or so. Surely there is some kind of plan to try to actively suppress the virus rather than just reduce the R0 slightly? While Congress throws around a trillion here, trillion there, why not make testing every last American (multiple times, as necessary) priority #1? Then we can get people back to work much sooner, and let the economy start to recover.

(not not an epidemiologist, just interested)

Once testing becomes widespread enough that it's feasible to test a lot more people it's quite plausible to relax the restrictions. One big problem before the recent "shelter in place" state is that community transmission by asymptomatic people was/is out of control.

If only strongly symptomatic people are "allowed" to be tested and health care professions aren't tested, it's basically impossible to restrict spread of something as infectious as covid-19. And once people with a lot of contacts have it, and stay in contact, further spread will obviously accelerate.

If you look at the buildup of test capacity in the US (far far to late obviously), it's improving at a decent rate (from a totally embarrassing starting point):

https://covidtracking.com/us-daily/

(there's a lot of differening sources, several lagging, but the trend is similar afaictl)

So there finally does appear to be some serious and successful effort in building up test capacity. Testing everyone in the US seems far off still though.

Given the rates of hospitalization and available beds / respirators, it'd however be insane to rely on testing at this point. Spread would be far too fast, and there's obviously not enough testing.

But if infections slow down due to the isolation, and testing ramps up at the same time...


In particular, if we have serological tests we can find out who has had the disease with no symptoms or mild symptoms.

Anyone who has had the disease and recovered can afterward go about their life again, as they cannot (for at least a few months, if not longer) be reinfected or spread the disease.


Right. Unless you can get this twice in a short period, someone who tests negative for the virus and positive for the antibodies on an ELIZA-type test has had the disease and is over it, even if they never knew they had it. Once testing for that is going, those people get a green card with a QR code and can move around freely. China is doing that.[1]

[1] https://news.cgtn.com/news/2020-02-20/China-leverages-techno...


Have there been any studies on if the virus can mutate?

It mutated its way from affecting bats to affecting people. Fortunately, the vast, vast majority of mutations either do nothing or make things actively worse.

https://qbrc.swmed.edu/projects/2019ncov_immuneviewer/

That's the chain of mutations for SARS-Cov-2 they've seen so far.


This works for a while, but we can't realistically expect to just shut the country down for the next year or so.

I read it more as a "Shut it all down please, then let's figure out which parts we can start to re-open in 4-6 weeks" order.


And 4-6 weeks is long enough for many of the infections to burn themselves out which decreases the R0 and decreases the likelihood of immuno-compromised people running into someone infected.

It's the equivalent of firebreaks in forest fires. We know it's there, let's prevent it from spreading where/when we can.


Not a doctor, but I’m skeptical of the idea that the virus can “burn out” or that we can “starve it.” Is there any scientific evidence to support this theory?

To me it seems like social distancing (“lowering the R0”) can delay propagation but has no effect on the underlying infection rate. It’s hard to see how we are not “delaying the inevitable” with social distancing.

Can anyone clarify this? Sorry if it’s been asked multiple times.


The theory behind "Flatten the curve" is that delaying propagation can buy time for our health care system to better cope, rather than being completely overrun.

I definitely understand that. It seems especially important because of the group of people that needs ICU and recovers. If hospital overflows, they don’t get ICU, so they die.

But it’s a bit discouraging if this is the only benefit of flattening the curve. So we are all gonna get sick, but in an orderly fashion? And the mortality rate is unaffected?


There are definitely more benefits. Every country in the world is now throwing their resources into fighting this. It's much more likely we'll have found an effective anti-viral treatment after the next 4-6 weeks. We'll have ramped up production of ventilators, built temporary hospitals as needed and we should be performing millions of covid tests a day.

Mortality rate without a ventilator is probably what you see in Italy and shortly the UK.

Yes you want to get sick, but the old fashion way. The way I think of it - if we get sick with healthcare services or without.

With healthcare services intact, I likely won’t know anyone who does from covid-19 (1/200, 50% infection rate, 1% fatality).

Without healthcare services I’m likely to know at least one person who’s died. (1/20, 50% infection rate, 10% fatality).

The more we flatten the smaller the denominator.


> The more we flatten the smaller the denominator.

Nitpick: bigger (20 -> 200).


The mortality is affected only in as much as you avoided the much worse mortality rate for the no ICU capacity scenario. This is what we saw in Wuhan and now in Italy. The difference seems to be something like 5x higher mortality or so (1% => 5%).

All of us getting sick in an orderly fashion has a huge benefit even if it turns out that’s the best we can do. But perhaps we flatten the curve for long enough we buy time for treatments to come online and to get closer to a vaccine.


Beside what people write about ICUs, this lets time to buy and build other things like masks, build up the infrastructure, get organized help from the army etc etc.

Also, while a vaccine is far, medication might be nearer. So buying time is essential, beside not wasting that time.


If R0 is driven below 1 the virus will theoretically fizzle out. In practice, it's possible that sub clusters with R0 > 1 will exist that will restart a transmission chain.

viruses “die” when they can no longer hold their infectious structure, presumably due to battling the elements (literally elements and molecules, heat, radiation, etc.), not to mention the active defenses of organisms.

it seems this virus dies in a few hours/days outside of a cozy host environment. so yes, get the transmission rate down far enough and it can die out.


While that’s encouraging (also, username checks out)... I find it difficult to put myself the shoes of a 60-80 year old adult in 3 months. At what point will I feel confident enough that I can leave my house?

It seems the most logical conclusion is that we’ll end up in a situation where the most vulnerable segment of the population remains self-quarantined at least until a therapeutic treatment becomes available, which could be over a year.

I have a very hard time imagining people able to do this.


I'm curious about the behaviour of the very old in Wuhan right now, with other people's regular activity going back to something more like normal (If I've heard that correctly), are the older-but-healthy still staying home too? Whatever the details are, looking to their experience in Wuhan as the disease progresses ahead of the western world's experience is useful for thinking about these things.

well first, you'd avoid threads like this that throw trumped-up early/misleading numbers around to scare the crap out of people. but realize that everyday risks, like getting into a car, are non-trivial too (~1 in 100 lifetime risk of dying in a car accident), but we do them anyway.

more to the point, epidemiologists will eventually reach concensus that the infection rate is under control (close to linear, R0≈1, i imagine). most 80+ year olds might need to stay cautious for the rest of their lives (depending on both the actual epidemiology and treatment/prevention options we develop), but that's true of a wide array of threats, like cancer, heart disease, or even just falling.

so basically, it depends on your risk tolerance once we have enough information to determine the actual risks of dying (vs the guestimates we have so far).


We should have a vaccine sometime next year.

Yeah, everyone is criticizing China for hiding numbers early on. Why is nobody criticizing the politicians in the rest of the world who weren't even authorizing testing?

you're right, testing is the long term solution. you can't control what you can't measure.

the embarrassing point is that in the US, isolation is the only effective tool at this point. it's embarrassing because ramping up testing was what South Korea did, and they started much sooner, and that's why they are over the hump now. the US simply doesn't have the testing scaled up.

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


Testing is only part of it. Korea never mass tested the population at large.

They traced the chains of the infections and quarantined everyone until they were tested clean. They found new chains through sick people who were tested.

Without investigation and tracing the chain of infections, you can't contain it through testing alone.

And the fact that were was an undetected outbreak in the west coast of the United States for several weeks probably made containment impossible, even using the South Korean model.


Yep. I keep seeing people saying Korea tested everyone, but they only tested ~0.5% of their population.

I think they mean they tested "everyone they could"

Testing is rising extremely quickly in the US. Over 27,000 in the last 24 hours: https://covidtracking.com/us-daily/


There's a difference between distributed and utilized. Is that confusing?

What's interesting is that the rate of negative results seems to be roughly constant. I would expect that with an expansion of testing we would see many more negative results as a proportion (if we were allocating tests early only to the most likely cases and are now expanding the reach of testing)

My guess is that we're still short on tests, so only people who most likely have the virus are getting tested.

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Sure, so the solution to idiots misinterpreting the data is that we need to make it impossible for experts to record the data. /s

What's the alternative? Wallow in ignorance some more? I prefer to know what's actually going on.

It sounds like we should be doing more education, rather than less testing.

The US neither (1) didn't take it seriously enough, and (2) CDC's initial test kits didn't work properly.

Korea and other nations in the area took it seriously due to their proximity to China and previous recent experience with infectious disease: HK experienced SARS, Korea experienced MERS.


CDC and/or FDA also banned everyone in the country from doing tests themselves.

And more importantly, the Administration never stepped in to fix it no matter how obvious a problem it was causing. It took them ages to have the FDA make an emergency exception to allow private testing.

actually reshaping FDA policy in the time they did is nothing short of miraculous. I know teams of 5 that can't change their way of doing things that fast.

> actually reshaping FDA policy in the time they did is nothing short of miraculous.

Yeah no. Not remotely. It was dead obvious. I think you're underestimating the influence a call from the head of the executive branch has. This was easily fixable weeks earlier.


The US could have used the WHO test in the meantime.

I've read that it couldn't. Those kits were never offered to the US: https://www.cnn.com/2020/03/18/health/who-coronavirus-tests-...

couldn't? sounds like the US didn't even try asking. the article says: "No discussions occurred between WHO and the CDC about providing tests to the United States"

and

"US chose to design its own coronavirus test"


Not really that embarrassing considering how big the US is, it's about as embarrassing as when European countries brag about their choice metrics.

> why not make testing every last American (multiple times, as necessary) priority #1

These discussions are so far divorced from the reality of the interventions available to policymakers.


That may be true, but when Congress is willing to spend trillions of dollars on mitigating this pandemic, then it doesn't seem so far-fetched to me any more. How much would it cost to develop a test method that could be engineered to support testing the entire population of the United States? In normal times I'd say obviously this is a non-starter, but now I'm thinking we have a pretty big budget.

In practice it would look something like "Test every last American [with insurance coverage]" plus the usual assumptions about people without medical insurance not existing.

Even still, we just can't scale up PCR like that.

How long does it take to build PCR machines? Why can't we build 100,000 of them (or whatever the appropriate number is)?

If it costs tens of billion dollars, so be it. That's far cheaper than shutting the economy for months at time.

This is essentially a war-time effort we are in. I believe government has the authority to mandate that companies with relevant manufacturing capability build and sell these machines in order to combat the virus.


Yea, having lab experience, I think as long as the equipment, reagents, and consumables are all available, lab techniques scale fairly well. You might be running your scientists ragged between installing the new instruments, keeping all the machines running and prepping assays, but it'll get done.

However, sufficient availability of supplies and equipment for this scale of operation is a pretty big if.


The idea is just to buy as much time as possible. There are hundreds of clinical trials for treatments going on across the planet...it's possible chloroquine may even be identified as prophylactic.

Also need to give our healthcare workers time to mobilize all their emergency measures to handle surge capacity. I'd imagine the Bay Area is about 2-3 weeks away from its peak number of cases given the quarantine just started last weekend.


The hospitals are gearing up for it. A friend is a cardiologist and he's going to be "on the Frontline" in the next week or two. Specialists are going outside their normal duties to deal with the influx. Their family is discussing living separately to avoid infecting inside the family.

Since most tech workers can work remote, people like DHH, and the Base Camp boys [0] spew their ignorance about other industries and encourage a 'shut down' since it won't affect their business, or their day-to-day work.

[0] https://twitter.com/jasonfried/status/1240818423795515393


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Lives are at stake from people losing their livelihood as well though, you need to weigh up the effects of the virus vs basically shutting down the economy.

Of course if half of Americans didn't deride any sort of safety net as communism the situation might be less uncertain.


It's a lot easier to print money and work to get a hold on inflation than it is to bring someone back from the dead.

There aren't enough tests, and we need time to scale out the testing. So a 3-4 week period to put a tight clamp on transmission is probably not a bad idea.

Frankly, I expect in 3 weeks people won't need the order because it will be like Italy and people will be terrified to go outside. But at that point, you STILL have 3-4 weeks before things turn around.


Young people are still going outside in Milan today, it's a big problem, you need to take these measures

Going outside and congregating outside are different things. Surely a walk outside is okay as long as we keep our distance from others.

I'm going to go ahead and say going outside should still be permissible (at least right now).

This doesn’t put a tight clamp on it. We’re not systematically testing and quarantining so this is more akin to a light tap on the breaks. The UK PM wouldn’t even venture end of June as his most optimistic forecast for returning to normalcy. Prepare yourself.

Testing is insufficient. There is no herd immunity to this and that is what they are building. With a disease this virulent, without herd immunity, it will just spread like wildfire again as soon as you loosen up restrictions. There's two paths to herd immunity: vaccine and everyone gets it. Vaccine is probably a year off and not guaranteed. Until then they will be going forward with a hopefully manageable rolling # of infected until herd immunity is built. We're at what, 14k have been infected so far? We're nowhere close to the end. In my opinion, until you start seeing herd immunity scale of people who have been infected and recovered, or a vaccine, we will see pretty stark differences in our lifestyles.

Also consider the asymmetric knowledge here. The people in power surely know things they aren't telling you. Destroying the economy is not in their best interest. How bad must it have to be for them to be willing to destroy the global economy and potentially their own fortunes and power structures?


Do we know how long it will take to reach herd immunity with an infection rate that our health care system can handle?

The timeline really depends on how fast it spreads but we need 40-60% of the population to have immunity to have herd immunity

Bill Gates did an AMA on Reddit and said the optimistic angle is that the antivirals and various therapeutics, etc, will come much faster than a vaccine and bring the rate of infection down. Clamping down now buys some time. Nothing is guaranteed of course, except for letting it “run its course” in which case the system risks collapse and you end up with bigger problems than we even face now.

People treat this like a binary choice between “save the economy” and “save the elderly”, but if you’ve been following this at all it’s clear that there’s no simple answer in either direction.


>This works for a while, but we can't realistically expect to just shut the country down for the next year or so.

We didn't shut down. We stopped doing what's unnecessary.

There's a big difference, and now that reality has made us "wake up" we should probably reevaluate how we structure our economy and society.


The tests aren't perfect. False positive and negative rates are non negligible. Not saying that they are not useful, just they don't solve the problem on their own.

As a software engineer, permanent WFH sounds great. As a young adult thinking I should build more cooking skills, this is the perfect opportunity. But as a household of one, isolation is terrifying. I'm not sure how long literally zero human contact is sustainable. I hope we can at least re-enable 1:1 social visits at home before too many months pass.

It's also hard to imagine that couples who live apart are actually going to stay away from each other until the vaccine.


When I was a student, I had a summer with a month with nothing to do, and I had a big backlog of 20+ books. I spent the month almost reading from morning to evening, read around 20 books during the month. It didn't feel like restricting anything, but I was meeting friends every few days still. Yesterday I had a good call with my oldest friend, and it felt good despite being far from each other and unable to meet. So yeah, 2/3 months should be doable. More will be hard.

Good luck with suppressing the virus in the US while 5 billion people in the world get infected.

So, no country should do anything? Many Asia countries have shown they can contain the virus. Every country should at least try to do that.

Yes. But you can't expect to eradicate the disease. As measures are lifted cases start growing exponentially again.

What i imagine will happen is you’ll have to blow in a tube at CDP checkpoint to get into the country for quite some time

That's all well and good for legal immigrants... assuming you can swab babies or something, and can test in minutes instead of days.

What about the hundreds of thousands or millions [0] of illegal border crossings every year at the mexican border though?

[0] Naturally good stats for this are impossible to find, but in FY19 851,508 individuals were apprehended at the american southwest border [1]. It seems reasonable to assume the same order of magnitude of people successfully crossed.

[1] https://www.cbp.gov/newsroom/stats/sw-border-migration


There might not be any foreigners let in at all for a while. I was talking about citizens. Prepare for fundamental erosion of our rights - that one is almost guaranteed now. I won’t be surprised if they go to apple/google and telcos for location data to aggressively backtrack infected. It’s either that or millions of deaths. A perfect zugzwang

The Tweet is now deleted, so probably just a rumour, but Sky News tweeted earlier:

> Sky News understands the [UK] Government has asked mobile network O2 to hand over anonymous mobile phone location data in order to ensure people are following social distancing guidelines during the COVID-19 outbreak

I suspect it's at least being discussed.


My impression is that without (currently illegal) immigrants you won't have enough farm workers. How do you avoid a famine?

(I'm also skeptical that stopping illegal immigrants will be as simple as tracking phones, but whatever)


Japan is doing that with free Sims for people arriving

Oh. That's easy Trump will build a wall with CDC budget. ;-)

???

China is down to zero cases. South America except for the two black sheep (Mexico and Brazil) is shutting down (Peru had curfew-in-place since the weekend; anyone even driving their car outside is arrested). Europe is also going there, plus Israel, several Arab countries, etc.

Only big black sheeps right now are the US, parts of Europe, India, and Africa (which is only now getting their first wave).


India is handling this better than the US.

https://www.nytimes.com/2020/03/17/world/asia/india-coronavi...

Excerpts:

The authorities used GPS technology, CCTV footage and mobile phone records to trace the movements of one Indian family believed to be among the first infected here. They returned from Italy in late February, and within days, medical teams fanned out to all the places they had visited including banks, restaurants and churches and quickly quarantined just about everyone they had come in contact with — nearly 1,000 people.

India was also one of the first nations to essentially shut its borders, canceling visas and denying entry to all but a select few foreigners. Some states, such as Kerala, are beginning to beef up internal borders, taking the temperature of passengers in cars and screening people on trains.


I predict India will be hit very very hard.

Do you think their poor can eat if they self-isolate? If you are hungry then you keep working, you have few choices to avoid social contact, and you have few resources to help you if you are sick.

Do you think India has the capacity to test enough people to effect efficient blocks against transmission? Do you trust their bureaucracy to mostly act decisively and effectively for the majority?

Do they have the social mores to cooperate with rules to prevent transmission? (I’m not judging, I have some very conscientious Indian acquaintances, I’m just unsure about the population on average).

At least they will have some medicine - they produce a lot and they stopped exporting many drugs on the 4th March.


> China is down to zero cases.

Zero own cases, they still have imported cases. And that only means no cases that are symptomatic.

And zero cases just means zero cases now not in the future.

This thing spreads like a common cold. More infectious than a flu. You can't suppress common cold.

Not forever.

Humanity never eradicated a disease without a vaccine.


> Humanity never eradicated a disease without a vaccine.

SARS within the last 2 decades? Look, I think eradication is a pipe dream at this point, but it'd be worth mildly checking your facts before posting.

e: If I'm getting flagged, at least tell me why?


I don't think SARS was eradicated? They were able to contain it and it died out naturally, disappeared. But that doesn't mean the same virus couldn't come back.

I could be wrong but that's how I remember it.


I'm not sure if SARS is considered eradicated. There were no human cases since 2004 but I don't think we dealt with it in original animal population.

I think we don't get human cases because jumping to humans again is quite hard for SARS.


So when people are talking about eradicating the coronavirus, they also mean in the animal population?

Seems to me that the virus that can spread among humans is a different version than the one common among the animal population.


> So when people are talking about eradicating the coronavirus, they also mean in the animal population?

I think so:

https://www.who.int/csr/don/2003_06_19/en/

> Seems to me that the virus that can spread among humans is a different version than the one common among the animal population.

Not necessarily. Ncov that spreads in humans came to be in bats and skipped effortlessly to other species including humans with no meaningful changes.


Corona is a SARS that jumped over, the scientific name is SARS-CoV-2

Effective medication would go a long way if it can make the illness less aggressive and less deadly.

We can probably wipe it out in America by doing this, and Europe, and maybe China already has (though I have my doubts that there aren't still cases that they haven't detected).

What about places with wars going on... Syria? Yemen? Afghanistan? What about places with no functional government (which I will decline to list to avoid pointless arguments)?

It doesn't need to be a big black sheep to re-introduce this... it only takes one case.


Also it can infect other mammals quite easily. It originated in bats. There might be other animal reservoirs as well.

There's a huge international effort to develop a vaccine or a suppressant, etc.

The US doesn't have even close to the necessary number of testing kits or infrastructure to test 300 million people. They're working on ramping up production and availability of tests.


There is a reason vaccines take a long time to approve - if you are getting the general population vaccinated, you want to make sure the side effects a year down the road don't negate the benefit (if any, vaccines are not 100% effective)

There is no working vaccine. Multiple candidates will take a year and a half if everything works perfectly. It's possible that a vaccine will not be found.

They already have a corona virus vaccine for many live stock animals so at least that is promising

Historically, a reasonably safe vaccine has taken many years to develop. Rushing a vaccine through the system so it only takes months? Yeah, I not going to stand in line to get vaccinated.

There are promising treatments though, and these should show results within weeks or months.

Failure is a result that can be displayed, number of candidate treatments isn't a real metric for making predictions.

I think I don't fully understand what you are saying, but there have been preliminary trials suggesting that some of these candidate treatments are helpful in treating the disease.

even just vaccinating the people in the high risk groups would be a huge win. and those people are much more likely to get in line.

The vaccine candidate didn't take very long, because researchers were able to re-use the initial work done for making a SARS vaccine. But it will still take 12-18 months to test the vaccine candidates.

Historically, we've never seen the world's top researchers, governments, and pharmaceutical companies all racing to come up with a vaccine and treatment at once while sharing data at unprecedented scale.

I understand allowing reasonable time to complete trials, but let's not act like this is just a routine drug approval.


There are already vaccine trials underway, the 12-18 months is the minimum amount of time we allow for making sure the cure isn't worse than the disease. We're basically talking about giving this vaccine to every at-risk person in the world. If it's not safe, that would be a really bad outcome.

The unprecedented scale will allow more parallel efforts, to the point that the odds of a viable vaccine being available next year are much greater, but it won't speed up the minimum time.


My comment didn’t suggest otherwise. I was referring to both treatments and vaccines.

Besides supply issues, that hardly seems realistic when the US can barely manage to collect taxes, a trivial activity in other modern countries.

Testing leads to panic. The threat number one to the US economy is panic. Whatever happens next, panic is much much more damaging for the economy and for stability.

There's already a plan in place, and most people don't know it but there's already a timeline. At this point testing people is useless: hospitals already provide numbers to the government.


If we don’t test, that means doing nothing about it at all, letting it spread unrestricted. If everyone with serious symptoms got good care, we’re talking about 2 million dead. But, of course, a lot of Americans don’t have access to good care on a good day. Since the healthcare system will be massively overwhelmed, only a small percentage will get good care. So you’re talking about something like 5-10 million dead — in the course of months.

I don’t think it would get quite that far, though, because once people start literally dying in the streets, people will be afraid and massively self-quarantine. So... maybe four million dead and the economy completely shuts down anyway.

Really, the quicker and more aggressively we jump on this, the less the damage, both in terms of human life and economic impact.

We’re too late to have a small impact. We’ll feel this for years. Let’s at least try to make something we’ll forget in a generation. Let’s especially make sure we don’t have something they’ll be talking about hundreds of years from now.


I don't agree. The lack of testing means everyone is looking at everyone else as if they are carrying the plague. We're awfully close to full panic as it is. If we could implement wide scale testing with aggressive containment, people who aren't infected could pretty quickly get back to a mostly normal lifestyle.

It is much, much more comforting to have a plan than just hunkering down and waiting your turn to find out if you will live or die.


The more testing, the more you can control the transmission rate. This is all about the transmission rate (you may have heard "flatten the curve" several hundred times recently). Quarantines are a sucky but effective way to reduce the transmission rate. But with testing, isolation can be reduced, which is necessary because quarantines will only be tolerated for so long in Western nations.

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