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.
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.
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.
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.
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.
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.
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.
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.
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:
(the numbers were compared by the Italian National Biotechnology Association, each bar is one week of time)
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.
So that 400 multiplier gives the number of cases as of 3 weeks prior to the death count used in the calculation?
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.
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.
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.
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.
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.
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.
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.
"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.
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.
And since the majority has no or very mild symptons ... it is not really likely to go extinct
2. This white paper may explain Newsom’s numbers.
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
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.
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.
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.
Since this is a disease with the highest mortality for the older age groups, Italy was always going to have a higher mortality rate.
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...
> 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.
The Chinese meanwhile crack the whip -- and people listen, mostly 'cuz they know the government will back up their words harshly.
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.
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.
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.
81k is what China got after instituting lockdown as soon as they saw 400 new cases in one day.
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.
Only those parts of the world who don't understand exponential growth.
You should brush up.
The US flu death in 2018-2019 is estimated to be 34k. 
China's flu death in the same year is 144. 
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
Have you considered that those countries just simply have had a better response to mobilize than the western countries?
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.
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...
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.
They built 2000 isolation hospital bed capacity in something like 6 days.
The estimate Newsom presented is credible.
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.)
I think that you discount this option too quickly. Have you been to China before?
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.
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.
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.
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.
It really didn't "grow unchecked for months".
>using our thinking machines.
OK. You first, then.
Here's the timeline.
Nov 17 - First known case of coronavirus
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.”
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
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
Looks like a couple months to me.
It reminds me of France:
March 15: French municipal elections (in all French cities)
March 16: General lockdown announced
Thanks for the response and links, but I basically regret this entire interaction and would rather leave the discussion here.
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.
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.
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.
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.
It's really not much of a problem, beyond the problem people have created by stockpiling too aggressively.
Might as well risk living before we die.
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.
Though I guess whenever you are producing enough virus to be contagious you would probably test positive at that point too.
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.
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.
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.
There are still millions of people going about their day here in LA and nobody will stop them.
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.
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.
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.
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 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.
# Italian deaths / Italian cases = percentage dead 
2_978 / 35_713 = 0.0833870019
# USA population * percentage dead = USA death scenario 
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.
 Source: Coronavirus disease (COVID-2019) situation reports # 59 for March 19
No need to make already awful numbers into lies by multiplying by 7.
Stats from Italy are going to be heavily skewed towards fatalities for a number of reasons that have been documented by epidemiologists.
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.
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.
You should find the actuarial tables and life expectancies for an 80 year old. It ain’t sunshine and rainbows.
Every year nearly 3 million people die in the US already.
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.
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.
It seems like their current plan is to do what everyone else is doing, after wasting a lot of time.
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.
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:
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.
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.
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.
Otherwise, what on earth is the strategy? Flatten the curve only to have an explosion later?
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.
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.
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.
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.
Save the lives! Deal with the paperwork later.
Generally speaking: health insurers will prefer to pay for procedures for those who will get the most benefit from them.
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.
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 . Juries put it at $2.2 million, apparently .
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. 
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. 
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. 
That's a $10 trillion drop. I think the market was overheated, but coronavirus is a huge portion of that drop.
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.
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?
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.
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?
Parents? Grandparents? Who needs them! They’re just a strain on the economy.
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.
Two months of this is going to be the beginning of the next depression.
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.
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.
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.
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.
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.
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.
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?
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
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.
I'm here stressing about finding toilet paper. I'd hate to be worried about affording toilet paper.
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):
(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...
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.
That's the chain of mutations for SARS-Cov-2 they've seen so far.
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.
It's the equivalent of firebreaks in forest fires. We know it's there, let's prevent it from spreading where/when we can.
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.
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?
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.
Nitpick: bigger (20 -> 200).
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.
Also, while a vaccine is far, medication might be nearer. So buying time is essential, beside not wasting that time.
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.
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.
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).
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.
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.
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.
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.
"US chose to design its own coronavirus test"
These discussions are so far divorced from the reality of the interventions available to policymakers.
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.
However, sufficient availability of supplies and equipment for this scale of operation is a pretty big if.
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.
Of course if half of Americans didn't deride any sort of safety net as communism the situation might be less uncertain.
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.
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?
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.
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.
It's also hard to imagine that couples who live apart are actually going to stay away from each other until the vaccine.
What about the hundreds of thousands or millions  of illegal border crossings every year at the mexican border though?
 Naturally good stats for this are impossible to find, but in FY19 851,508 individuals were apprehended at the american southwest border . It seems reasonable to assume the same order of magnitude of people successfully crossed.
> 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.
(I'm also skeptical that stopping illegal immigrants will be as simple as tracking phones, but whatever)
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).
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.
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.
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.
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 could be wrong but that's how I remember it.
I think we don't get human cases because jumping to humans again is quite hard for SARS.
Seems to me that the virus that can spread among humans is a different version than the one common among the animal population.
I think so:
> 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.
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.
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.
I understand allowing reasonable time to complete trials, but let's not act like this is just a routine drug approval.
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.
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.
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.
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.