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.
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.
> 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.
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.
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:
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.
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.
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.
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.
"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.
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.
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.
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
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 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 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.
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?
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.
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.
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.
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
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.
> 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...
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.
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 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.)
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.
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.
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.
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.
"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.”
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
> 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)
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.
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.
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?
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?
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.
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.
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.
"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.
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.
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.
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.
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.
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.
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.
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.
# 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
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.
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.
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.
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.
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.
> "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.
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.
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.
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?
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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...
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]
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.
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.
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).
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.
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.
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)
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.
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.
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"
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.
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.
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.
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.
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?
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.
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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.
This is fine for people like me that can work from home, no problem. But most of my neighbors are freaking out because they are not getting paid and have no way to pay bills, rent, etc. I can't see how this will not end up as the most major worldwide depression ever.
Suspension of rents seems like one of the biggest things I see missing across the board. Suspended mortgages are great... for those wealthy enough not to be renting. $1k/adult will cover rent for many couples outside of tech hotspots, but it won't go a lot farther, and that doesn't begin to address singles.
A significant percent, (I want to say most, but I don't have the numbers), of rental properties are covered by mortgages or other financing. "Pausing" mortgages can be done in a fairly centralized manner. Pausing rent is almost impossible because everyone has an individual contract and there isn't a central clearing house. It's a hard problem.
All it takes to pause rent, is passing a bill that says so. The reason why landlords can collect rent is because the government will enforce their property right and help them evict tenants who will not.
Rental companies are already sending "we won't evict you" / "please speak to us if you have financial hardship" communications. These help, but the bills will still pile up and the government check won't cover 100% of expenses.
Every expense is income to someone else. If I stop paying my mortgage it means some pension fund doesn't have the income to pay their retirees.
There's no real way out of a months long shutdown. Our economic out put will be cut ~10% on an annual basis for every month. Thats real economic production gone forever. And theres no pause button on the economy. Stopping it means businesses fail and the relationships/organization that generates economic value will go away with them.
Massachusetts about to do the same, in addition to whatever federal measures. One time payment (to basically every households that signs up), then additional monthly payments to those who qualify, for as long they feel it needs to happen.
That's the silver lining here. With sheriffs and legislators not enforcing evictions, we can pretty much squat in our apartments until the situation changes if rent money completely dries up. The landlords are out-numbered by the tenants and can't reasonably expect to find another tenant while on lockdown.
The lessors won't take not receiving rent quietly, and will certainly pull every card to threaten tenants, but they're ultimately empty threats. The landlords' hands are tied.
Keep in mind that if you get an eviction notice in your record, that can make it harder to find a place to stay the next time you want to get a new place. In 2009 when I could no longer afford to pay rent, I chose to leave my apartment voluntary to avoid getting an eviction notice. That was critical a couple months later when I got a dumpy-but-better-than-nothing place to stay that checked to see if I had previously been evicted.
> The lessors won't take not receiving rent quietly, and will certainly pull every card to threaten tenants, but they're ultimately empty threats. The landlords' hands are tied.
Or...they'll just resign themselves to "we're all in this together" and accept they will have to suffer a bit too.
I was just reading about Arizona evictions (for, umm, a friend) and it seems the courts are just not going to serve any notices for the foreseeable future so they can't really do anything about it no matter how they feel.
Things will get sorted out, landlords will get a bailout, everyone will be happy.
I'm not saying the courts and police will be evicting people if ordered not to, I'm saying I doubt the landlords will be happy about their income suddenly getting slashed. And furthermore, believe that they will still threaten evictions with their trademark red, bolded nastygrams and loanshark-level harassment, even if it doesn't have any legal teeth.
Or are you earnestly suggesting that slashing someone's income will not result in them vocally trying to recover that income? We're under pandemic, not in a bizzaro universe. Landlords are gunna landlord.
> Or are you earnestly suggesting that slashing someone's income will not result in them vocally trying to recover that income?
Pretty much, yeah.
The states are declaring state of emergency, calling up the National Guard and other various things so any landlord who starts in with the heavy-handed tactics is going to end up on the news --> https://kfor.com/health/coronavirus/norman-renter-says-he-is...
Most landlords face personal bankruptcy if they don't get the rent. This doesn't just apply to the landlords who are still paying mortgages on their properties. Insurance, maintenance, and taxes are all large expenses.
A lot of people in San Francisco seem to think landlords are evil, but they provide the majority of the housing.
Any law that protects tenants from eviction but does not protect landlords from their expenses is going to set people against each other in a struggle for survival.
Housing courts will likely not be processing evictions. You'll be incurring some nasty debt (and so will your landlord, probably) but not physically transferring possession.
The worst ever depression is a gross exaggeration in any imaginable case. During the world wars, most of the earth essentially devoted all of its resources trying to kill each other for years. How is some people not going to work for a few months going to be nearly that bad?
Keep looking up stream. The landlords have to pay property taxes and often their own mortgages on personal or commercial properties. Anyone with a balloon mortgage is probably feeling very anxious about now. The rental market is big business and many thousands of rental communities around the country are operated by corporations capitalized through big bank creditors with the power to unmake poor performers; if prospects of collecting rent look grim investment capital will dry up and these companies will be facing bankruptcy. It's times like these when you really need a good leader that's empowered to act but also capable of seeing the big picture.
Exactly. Programmers and other tech people can work remote all day. But what about truck drivers, service industry workers, hair dressers, and more? People like this Twitter [0] use seem to suggest a shut down wouldn't have any negative effects because they can work from home.
There's nothing in that tweet or the thread its a part of that suggests the authors don't understand the seriousness of asking for a shut down. It also doesn't suggest they wouldn't support exceptions for all the hardworking people who can't work remotely.
So why link to it? Even if it wasn't your intention, it seems like the primary effect would be to direct abuse towards the author of the linked tweet.
Does it suggest they're aware of the consequences though? Not suggesting that they don't understand seriousness of asking for a shut down doesn't suggest that they do. The "seriousness" of a shut-down shouldn't be silenced.
Sure, if you want to go around the internet complaining that people didn't explicitly say they were aware of something they didn't happen to mention, go for it. I think you'll find that unfulfilling.
If you want to help remind people of the seriousness of a shutdown and how many people couldn't abide by one without society crumbling, then do that directly. Don't attack other people who probably don't even disagree with you to try to bolster your point.
Yeah, it’s all anecdotal. I have neighbors in similar jobs that are out of work. My next door neighbor is hospital staff (which you would think would be safe) but our state has cancelled all non-emergency hospital work, so a large percentage of the hospital staff has been furloughed, including my neighbor.
This will be the fastest economic decline ever (by fiat!) but not the longest. One way or another it will be over in a couple years max. Perhaps much sooner if we develop an effective vaccination, treatment, or tracking program.
That's downright frightening to imagine - much more even than the infection itself. For all of the zombie apocalypse movies, books & video games we have seen - our world & economy is just not prepared to operate like this..
In a big enough depression, even "the one percent" might not produce enough to cover that sort of expense. Where else where you go? This has a global reach, so you can't really borrow from the next country over. Can't really sell bonds to Americans, because that reduces liquidity further. Inflate and you'll kill what savings Americans have left and risk stagflation. So, how do you pay for it? Forget taxing certain people more or less, past a certain point, the money simply doesn't exist; there's no bottomless pit of money on which the gov't can draw in a second great depression.
I’ve been avoiding the news. How much will each American get? Will it be per individual, or only adults? Will people with children get more? Will it be more for more children? How many months worth of expenses should it cover?
It's a maximum of $1,200 per individual plus an additional $500 per child. The amount is based on your 2018 AGI. The amount you receive begins to decrease at $75,000 and if you made more than $99,000 in 2018 you don't receive any money.
This is also not just the government cutting a check, it's a rebate from your 2018 taxes. You won't get back more than you paid in taxes, unless you're part of a carve out meant to protect low income seniors, which still requires a minimum income of $2,500 in 2018 (including social security).
So it's something of a mixed bag. It won't help the truly destitute, and it won't help people who had a good year in 2018 but recently lost their job due to the virus (though those should qualify for unemployment benefits). The means testing is also not normalized by any kind of cost of living metric, so people in low cost of living areas will probably qualify disproportionately, even though the areas worst affected by the virus directly are urban, high cost of living.
This is Mao-esqe nonsense. You can't turn off the economy the imagine government is going to divvy up whatever stuff needs dispersing. The Soviet Union tried that.
They seem to have picked the green line and not the orange line. Hopefully they’re planning for intermittent social distancing, or have some other medium term plan.
If California’s “stay-at-home” order works and they extensively test everyone with suspected symptoms from now on, CA could be well on its way toward containment within a couple of months (not including ’imported’ cases from other states/countries).
I read that the paper cited does not include the effects of isolating cases and contact tracing to suppress new infections.
Added: Waiting period will result in asymptomatic people showing symptoms and they can then be tested and isolated. That is why the stay-at-home practice is useful during the incubation period. If the actual number of cases in CA is not too large and within family infections can be controlled, then part of everyday life can resume in about 1 month.
Why wouldn’t it be sustainable? As long as the supply chains hold I don’t see why it isn’t doable. There will be a severe economic impact but the alternative is worse.
Unless you have the military enforce the lockdown, people will eventually refuse to starve quietly in their houses and will brave the "terrifying" 1% chance of death from COVID to go back to being alive.
Honestly, with the governor this morning toying with "about 18 months", we are agreeing to give up more than 1% of our life just to reduce the risk of the 1% chance of death.
If you do order the military to enforce it, you are likely to end up with a civil war. Some people will eventually resist, and then either the army starts firing on Americans or they let people go on with their lives.
On a more personal note, the mental health cost of perfect social isolation is already getting to me, and frankly, I don't think I would survive more than a bare couple of months, even if the magic goods fairy delivered me every essential item I could ever want in infinite quantity.
Massive economic impact. After a couple of months, a good chunk of all retail businesses that aren't grocery stores are going to be irrecoverably bankrupt.
Sure but what happens if we do nothing for a month and let the virus spread rampant. Then we bankrupt the entire country paying for healthcare assistance packages for those who cannot afford it and are the hardest hit. Or would you recommend we just leave them sick on the streets?
The cost of healthcare for all of the illness even if 100% of the population got the virus this month is less than the economic destruction our self-imposed economic sanctions have already caused even if they ended today.
This is only true if you don't count the cost of massive casualties that are impossible to fully quantify the cost of and only count of the cost of running the healthcare system at existing capacity.
Let's cook up a fantasy scenario where we have unlimited resources and can treat as many patients as needed. Let's also optimistically pretend that only 1% of cases need ICU treatment. Take 1% of 327M and you get 3.2M ICU beds required. Now let's say that at the peak, half the population is sick (likely given the unmitigated exponential explosion scenario), meaning we need 1.6M ICU beds at the peak. We have roughly 100k ICU beds in the country, 1/16th what we need. The cost of those beds would be trillions of dollars. Of course we can't magically materialize ICU beds, so hundreds of thousands will die. I'd choose 6-12 months of the GFC over that _any day_.
Do you not believe these basic facts or just don't have empathy for other people who are at risk?
2: 12 months of not actually living is already giving up about 1.3% of the life of our whole population, and that's not counting the health problems caused by poverty or the mental health cost of eternal social isolation.
3:. There is no believable model where 100% of the population gets the illness. Even the absurdly pessimistic models end up at 60-70%
4: the models that assume nearly everyone gets sick require that there are already many, many, many undetected cases, which makes severity and mortality much lower than is being otherwise imagined
5:. This will sound callous, but 99% of fatal cases involve folks with other serious chronic illness, and at least 80% (good numbers are hard to find) are past retirement age. Though these people add.much value and happiness to our world, they aren't going to produce much more economic productivity. This doesn't mean they don't matter, but we were having a discussion on economics
Why do people think that waiting 2 weeks or 2 months will solve it? Only way that works is if enough people have it and now have immunity, which helps prevent spread when quarantine is over.
We are going to have a worse economic impact from mass quarantine than the 200 thousand people (mostly over 60) that would have died.
Because if everyone isolated for a month it wouldn't spread and die-out. Having a deadly flu in the public causing mass deaths and difficult recovery for the young would bring the worst economic impact out of both scenerios.
You mean 2.2 million right ? I mean the reason why is that most humans have compassion and don't want their parents and grandparents to die. I think that having empathy and wanting to prevent death of other humans is an admirable trait or our species.
> Why do people think that waiting 2 weeks or 2 months will solve it?
Who said it will solve it? It will flatten the curve as it already has in other countries, hopefully avoiding a catastrophic overload of the healthcare system.
The Imperial paper said that 2 months doesn't really flatten the curve enough to kill it off, given where we already are. You're just moving that peak to a later date, but it will still vastly exceed the healthcare capacity (we can't upscale it 8x in that amount of time).
Hence their conclusion is that we'll have to basically do this on and off, flattening the curve just enough that we can let it rebound for a while without overwhelming the system, until vaccine is available. Which they estimate as 18 months, out of which 12 will be on lockdown - however you space it out.
So yeah, the economic impact will be massive. But it doesn't have to translate to people dying, if we focus on preventing that. One person could feed themselves and others with the fruits of their labor since the agricultural revolution. It's a question of distribution, not of availability.
As has been explained almost ad nauseum at this point: diseases grow exponentially. The number of possible solutions that explode to infinity (well, to saturation) and those that dwindle rapidly to zero utterly dwarfs the number of solutions "in the middle". Fitting an exponential curve to go straight through an "almost miss" scenario is really hard, basically.
Essentially: either this disease overwhelms us, in which case most people you know will have had it and multiple people you know will have died, or (statistically) no one you know will have gotten sick and the whole thing will look like a nothingburger.
But it wasn't. It was a disease that would have killed tens of millions if unchecked, we just got it under control. At least, that's what we hope.
Not sure why this is getting voted down, this is absolutely the case. Either you kill exponential growth via isolation/inoculation or damn near everyone gets sick in an exponential explosion and the healthcare system is overrun. This is simple statistics.
I can't figure voting out on this site anymore. It used to work a lot like other spots, with primarily upvotes given to express general agreement or reward insight, and downvotes reserved for comments that got something factually incorrect. Now I'm seeing about a 50/50 split with downvotes, and it generally doesn't correlate in any meaningful way with either correctness or the status of the debate. It's routine to see discussions with reasonable participation on both sides gets a wildly asymmetric split in votes, with half of them grayed out entirely. And it kinda sucks.
In this particular case here in this topic: there's a voting (but seemingly not commenting) population that just really wants COVID-19 to be a flop. I'd be tempted to say that's a political position, but in fact politicians have largely unified on this (finally). Maybe it's a counterculture or conspiracy thing.
No one should be surprised. This site, and its moderation, has (possibly even unintentionally) favored a certain political ideology for years. I and others stopped maintaining accounts over it. Any economic discussion is inevitably political, but strangely only certain types of comments and discussions get slaughtered by public opinion or admonished by moderators. (Easy to see in each passing day as it becomes obvious that direct relief / UBI are necessary and the libertarians of this site realize that caring for fellow human beings might benefit them too!)
I mean in the last week, multiple legit stories have been flagged off the home page about Coronavirus. Go back and look at the comments on the story that hit the frontpage about Trump trying to buy exclusive rights to a vaccine... A story that was ultimately confirmed as true. But yet it was flagged off the frontpage by Trump supporters that denounced it as "fake news" of course, as if he doesn't regularly do things that would be unbelievable without video/audio evidence.
Meanwhile, any comment, like yours, that mention the BLEAK REALITY THAT THIS IS GOING TO LAST MORE THAN 3 WEEKS is getting downvoted. Systematically. As if downvoting you changes basic fucking maths.
Frankly, I think it's massive cases of denial. I think people are just starting to get an image of how bad this is going to be and how fucked our social structure is about to be. Especially if this drags on for many months (like those of us paying attention understand is likely).
HN has just generally been particularly insufferable the last week and a half, but at least the really obnoxious deniers have mostly ... stopped.
People also chronically overinterpret whatever they see on HN that they don't like—again, myriads of comments make the opposite generalization to yours. Randomness plus cognitive bias equals narrative.
Yet it wasn't like this in the past. And while I won't make the same accusations I do think it would be good for you guys to look at the culture that gets encouraged here. There is a viciousness to the voting here and an intolerance of opinion that just doesn't match the seemingly sophisticated comments.
You seem to be talking about voting patterns while I'm talking about cognitive biases leading to bogus generalizations. Those seem like two distinct "it"s.
As for voting patterns, I'm not sure I agree. For example, it's not true that downvotes used to be reserved for something factually incorrect. The voting mechanisms are subject to the same psychology as they always were.
Your comments often argue in edgy ways that are not exactly in keeping with the spirit of this site. From my perspective that's more likely why they're getting downvotes. I took a quick look and your comments that I saw which were upvoted don't seem to have this quality. Usually, when people complain about downvotes, there's something in their comments that they're not aware of, but which is apparent to readers. Of course there are also downvotes simply because of disagreement, but all comments get those, and they usually get fixed by corrective upvotes if there's nothing else in the comment that has a downvoteable quality.
I came to this thread for this comment. It’s a really unintuitive point, and I think someone needs to create some type of visual representation of it so it sinks in.
IMO, this thing is a trap for politicians. A true lose lose for them.
There has to be an endgame to these measures that's not 'wait for a vaccine'. A few weeks is tolerable[0], but what happens when early April comes around and new cases are still popping up? The provisions will have to start unwinding or this could go from an economic hiccup to an economic catastrophe.
These meassures are pretty much already happening here in Czech Republic - masks/respirators (of any provenience, even a scarf will do) are now mandatory to prevent you from easily infecting others. And a plane with 100k high speed tests just landed the other day.
Human life is more valuable than the economy. Governments can print arbitrary amounts of money and use monetary policy to soften the blow on people. We can sort the economy out later, right now we should focus on minimizing loss of life.
They're working on some pretty fast testing. Before being shut in for 18 months they'll probably develop a policy of weekly standard tests for the population, and require proof of a recent test to do anything in public.
Fortunately, a few measures have been mentioned here, but I like to address a more general point. You say there "has to be an endgame". My question is: Why? The virus is not something you can negotiate with, it's essentially a force of nature. As a more dire example, if a massive asteroid comes hurling towards the earth, we either get off this rock (rather unlikely), or we all die. Are you going to stand there and say "there has to be an endgame that is neither of those outcomes"?
The people ordering lockdowns only have limited tools in their arsenal.
We’re waiting for a lot of things- vaccines, respirators, treatments, the arrival of warmer weather, and social cooperation. We can’t plan for a month from now because we don’t know what tomorrow will bring. All we can do is try to buy time.
I'm just a mere software engineer, so I have no idea about this stuff. But, I feel like this sentiment "has to be an endgame to these measures" feels like wishful thinking.
Why is it impossible that we're headed for an economic catastrophe until a vaccine is out? I can totally see it happening - something where we will have to ration out our basic supplies even. <-- already happening wrt some stuff.
That would just be the cost of saving a few million lives.
Yeah, and at least they won't have to endure the rationing, because they were on death's doorstep already. I don't think a lot of people saying this kind of stuff are considering the deaths from an economic catastrophe.
What's the alternative? Let 10M people die to get back 15% of world GDP? (Both reasonable guesses at pessimal death counts and recessions, IMHO).
The hope is that it will work everywhere like it seems to have in Hubei and Korea -- near-zero new case counts and a regime of continued care, a few extra regulations, and pervasive testing. And it might work. But if it doesn't, yeah: we should turtle, accept the economic catastrophe, and wait for a vaccine. Would anyone sane argue otherwise?
> How many people do you figure are going to get rolled back into poverty at 15% world GDP loss?
A whole lot, but they'll get back to parity (on average) in about 6 years, assuming a 2.5% GDP growth. How many dead people do you think will come back to life after six years, in comparison?
I don't want to be glib, but I genuinely don't think you've thought this through. I just can't see a moral argument for allowing a 10M+ death count at the kind of economic impact we're talking about right now.
>I don't want to be glib, but I genuinely don't think you've thought this through. I just can't see a moral argument for allowing a 10M+ death count at the kind of economic impact we're talking about right now.
Then try thinking through the impact of what could become the biggest economic disruption since the great depression or the great leap forward. Those went well for people. 80 trillion GDP, down to 68, back to 80 in 6 years is a 36 trillion dollar loss in the next six years alone. That's 3.6 million per victim and to be frank, most people aren't worth 3.6 million dollars.
Look, this is a reasonable thing to disagree about but you aren't engaging in good faith.
Depends on level of enforcement. I heard one criticism of the model used in this paper is that it doesn't account for superspreaders.
Besides, it's better to contain it 'too much' because then you can loosen restrictions a bit and still have managable number of cases, than not contain it enough and have run away process you won't be able contain even with most severe measures you are able to enforce.
I don't know why takeout at restaurants is still an option. All it takes is one asymptomatic cook to infect hundreds. I'd rather eat canned beans for the next six months than eat a virus-filled burger.
I'm guessing you're getting downvoted because the CDC says:
> Currently there is no evidence to support transmission of COVID-19 associated with food. Before preparing or eating food it is important to always wash your hands with soap and water for 20 seconds for general food safety.
But, given that:
1. Takeout food comes in a container which we know can transport the disease, and
2. My local pizza joint has a hard enough time getting a good health department score as it is
I am going to be cooking at home for a while until I have a better idea about how this is going to play out in my own community.
In a way we have an experiment going on between California and New York since New York has so far declined to issue a shelter in place order. We'll really start to see if the curves diverge in another week, but new cases in New York already seem to be surging ahead of California.
Now Trump's tweet a few days ago makes sense...there was broad agreement across governors would enact shelter-in-place at a given benchmark, and Cuomo signaled otherwise...
They are assuming suppression measures are only in place for five months and then letup at once uniformly. I don't see a justification for that assumption. I doubt it will play out that way. I would would expect to see people fatigue on the distancing, governments to relax orders as the case numbers drop low, and then they'll be rushed into place again when the numbers start climbing again. We shall all become very bored of hearing about the disease cycle because it will be going on for the next 12 months or more.
Look at the graph.[1] Those are actuals, not predictions. This gets 10x bigger each week. The US is 12 days behind Italy. US at 10,000 now. 100,000 next week. 1 million in two weeks. The lockdown may slow that down. Probably not enough.
I don't see any scenario where you could hit 60% of the population that fast.
I mean sure, if you held up the same R0, yes, that math works out, but people aren't trees. They'll voluntarily socially distance, dropping R0 significantly.
I wrote a basic model in Awk for US and global "RoW" (ex-China) spread of COVID-19. Both sets of confirmed-case projections (for US see comments for the mathematically correct model) are tracking remarkably close. Lagging slightly below, but only just. (Deaths have trended higher than projection for RoW, lower for US, but the delta remains only a few days.)
The H1N1 epidemic in 2009 was objectively less contagious and less dangerous than COVID-19. In comparison, it grew mostly uncontained and eventually infected about a billion people. If COVID-19 was allowed to do exactly that we'd be looking at 10M fatalities, and realistically it would infect more people (being more novel than a mere flu).
The 25M number doesn't seem realistic because every country that has had a COVID-19 outbreak has freaked out trying to control it, and either succeeded via very expensive means or (in most cases) hasn't had the outbreak grow far enough to know whether or not they've failed.
Using the billion figure best case is 40 million not accounting for which countries would be hit the hardest which would increase the rate as the systems get overwhelmed.
I have no qualifications to speak on this. Not sure if you do, too.
My interpretation is overreaction should be what's done to mitigate the pandemic for the foreseeable future. Right now, almost every country is playing catch-up.
~3 million people die every year in the US. Even if you assume no overlap (which doesn't seem realistic), I'm having a really hard time seeing how a 33% increase is the death of US democracy (if it's even still alive).
What exactly is the alternative to democracy? Are we suddenly going to become authoritarian? Are you suggesting that we will devolve into anarchy, branch off into warring clans of hunter-gatherer's, substance farmers, and roving gangs of bandits?
"Perhaps our most significant conclusion is that mitigation is unlikely to be feasible without emergency surge capacity limits of the UK and US healthcare systems being exceeded many times over. In the most effective mitigation strategy examined, which leads to a single, relatively short epidemic (case isolation, household quarantine and social distancing of the elderly), the surge limits for both general ward and ICU beds would be exceeded by at least 8-fold under the more optimistic scenario for critical care requirements that we examined.In addition, even if all patients were able to be treated, we predict there would still be in the order of 250,000 deaths in GB, and 1.1-1.2 million in the US.
...
We therefore conclude that epidemic suppression is the only viable strategy at the current time.
"Fortunately it appears the parameters used in that model were too negative. The experience in China is the most critical data we have. They did their “shut down” and were able to reduce the number of cases. They are testing widely so they see rebounds immediately and so far there have not been a lot. They avoided widespread infection. The Imperial model does not match this experience. Models are only as good as the assumptions put into them. People are working on models that match what we are seeing more closely and they will become a key tool. A group called Institute for Disease Modeling that I fund is one of the groups working with others on this."
In a way, it sounds like Gates is saying that a widespread societal lockdown is a wise move, which is what any reader of the Imperial study would conclude. Unfortunately, it seems that such a move was not politically palatable until the study's release.
The other thing is that panic is bad, panic leads to much much worse outcomes. I've read the report, and I have access to non-disclosed orders, one of the major point is: do not spread too much information for risk of panics.
So we're all discussing this, and if you've read the report you already know more than most people, and we know that the truth is in the middle.
But what we should really think about as clever individuals is that whatever is going to happen this year, and however long the lockdowns are going to be: it has to happen in order.
Why do people keep saying that panic is bad? Sometimes panic is the appropriate action and is necessary to motivate us to take extreme life saving action.
> panic: sudden uncontrollable fear or anxiety, often causing wildly unthinking behavior.
When fear runs wild and uncontrolled, it can paralyze us into inaction, or worse yet, motivate us unthinkingly towards action that may end more lives than even inaction would. Or to put it another way - panic is a great way to waste a bunch of perfectly good fear.
Fear should be properly harnessed, controlled, and guided through proper thinking and wisdom - then we can maximize our chances of it motivating us to take those extreme, life saving actions you alude to.
Stress - as caused by fear - can shorten your lifespan and reduce it's quality as well. When possible, one should guide ones fears towards reasonable risks you can do something about - where the costs might be worth it - and away from the irrational or unactionable - where they are not.
The federal government doesn't have the authority to lockdown the whole country, only the national and state borders. To lockdown the whole country all 50 states would need to individually issue orders, which is unlikely.
I suspect the governors of some rural states are likely to issue weaker social distancing orders, minimizing the economic impact but still benefiting from national economic relief legislation the same as states more severely effected.
The federal government might just get such authority from Congress, if things keep going the way they are.
There would certainly be a lawsuit claiming that it's unconstitutional. It might even win... eventually. You know, back when SCOTUS is in proper session, and it's all kinda moot.
You implore people not to encourage panic in one breath then make the absurd suggestion that the US is going to impose "mandatory lockdown to the whole country soon".
At the risk of beating a dead horse, are the numbers coming out of China trustworthy?
We know for a fact there were some early suppression of the outbreak, so it wouldn't be too much to speculate that they're under-reporting new cases and/or over-reporting recoveries.
Even if so, there's the problem that totalitarian, high-control societies like China have tools to deal with these kinds of problems that other societies do not.. to put it lightly.
The generally seem to be, especially corroberated by other experience:
- HK, SG, KR, and JP have similar trends.
- No "patriotic virus" -- infecting Chinese only after leaving China.
- Limited spread / impacts outside Hubei.
- Lifting quarantine.
Testing numbers are all but certainly low, but given shitshows elsewhere (IT, US, PH, DE, ES, likely IN and others), due to logistics and limitations. Comprehensive population antibody testing should be interesting.
Cases in Hubei is likely under reported, but this is probably more attributed to early test kit shortages and the fact to ramp up test requires time, etc. We have see the same thing in Italy and other European countries as well, the capacity is limited and testing itself is biased not aiming for coverage.
But what China's data can tell, is that there is a strategy out there to contain the virus, if implemented. And it takes about 2 months of total lockdown. It is probably the most effective containment in human history, but with a cost.
So the exact number of China's data isn't going to be meaningful to others, but the actions taken have implications and we should follow.
> The USA never suffered casualties of 1+mil ever.
Proportionately speaking, that estimate is on par with the amount of American deaths per total population during WW2 and something like 1/7 the American deaths per total population during the civil war.
> Proportionately speaking, that estimate is on par with the amount of American deaths per total population during WW2 and something like 1/7 the American deaths per total population during the civil war.
You think if they had the choice they would have rather sat at home watching netflix?
This is difficult point to make delicately, but there is a difference between a million young healthy men (or women) dying for their country, and a million people dying who are mostly at a much greater risk of dying from sickness compared to the general population.
> A virus isn't comparable to people hijacking planes and flying them into buildings.
Being dead is absolutely comparable with being dead though, no matter what lead there. It's the absence of a person that matters, to the people who miss them, not what people removed from that think about it in the abstract.
I lost my father through a completely stupid accident, made possible through carelessness on his behalf I think. If he had been murdered by someone, I would have felt a lot of hate, and that would have sucked and damaged me no doubt -- but the grief of missing someone is still the same, and I'd say the difference between murder and an accident are both tiny pebbles compared to a person being gone. Even if he had died to save 1000 million people, I would miss him exactly the same.
> If a serial killer murders your father, we're going to react differently than if your father dies of a heart attack.
What matters, to me, is that I can no longer speak to a person. How that came about is very, very minor compared to that. Even knowing that we all will die some day does not change the simple, banal, them-shaped gap someone leaves. That gap is what remains, what created it does not. I'm just speaking for myself, but that I do.
How and why people die is no doubt very important when it comes to very removed people using tragedies, which was very much the case with 9/11. For them it's the other way around: the gap never really mattered and is soon utterly forgotten, while that evil deed none of us most forget remains as long as it's useful. I remember families of victims speaking out against war after 9/11, and mostly being ignored by a nation angry on their behalf. The dead were exploited more than honored, if you ask me.
Car accidents do not pose systemic risk, a super contagious virus with a fatality rate of ~1-2% definitely does. I think a misunderstanding of this phenomenon (risk comes in different flavors!!) combined with an inability to grok exponential growth is really gonna screw us over, both in the next few months and more generally as a species.
Now imagine that if after 20 years worth of deaths car accidents would just go away on their own. Not ideal, but it's better than the current state of affairs with car accidents.
> Now imagine that if after 20 years worth of deaths car accidents would just go away on their own.
We don't actually know that will happen with the virus, it could become like the flu and continue killing every year. We hope natural immunity will last but that is far from a given, it may only last months or years. A vaccine is also not a given, it's older brother SARS doesn't have one.
5 billion hosts gives an awful lot of room for mutations to occur, this thing is still in a new environment it's not adapted to.
Then there's the lasting health effects, it's possible it causes permanent lung damage and we have no idea if it leaves any landmines behind like chickenpox does.
You're not wrong, there is a small possibility that this virus does continuously mutate to keep us from becoming immune, and that we don't find a vaccine or a cure.
If so we're pretty thoroughly fucked. We aren't going to manage to wipe out this virus by shutting down the developed worlds economy's because the rest of the world (especially warzones and the like) isn't capable of doing the same. We can't keep the economy shut down forever to prevent spread in the developed world and not all starve to death.
I'd argue that the best response should that turn out to be true is to pour more resources into medical research until we do find a vaccine... which rather requires having functional stable economies instead of us all going bankrupt because we shut them down.
the medium term plan is more capacity and equipment at hospitals
the short term plan alone will flatten the curve too much, if successful, and we simply dont have confirmations about whether we build immunity or the virus dies out, so without those features the short term plan being the long term plan or a recurring plan (even if we build immunity but we flattened too much, then clusters reemerge). But in conjunction with the medium term plan and most people not being reinfected its the best solution
long term plan either way is a vaccine, effective treatment
edit: can you engineers please tell me and the world what some of you disagree with about this information? this isn't the place to write a dissertation on every edge case necessary to explain whats going on, and the lack of that dissertation doesn't undermine the point or utility of what is written
I think that when there are calls for widespread testing it is a call for a system similar to what you see in S. Korea where there is a lot of testing, very quick contact tracing, and alerts about positive cases. This allows for lowering the R0 by isolating fewer people and letting more people continue to work.
FWIW, many of those countries that have been touted as testing+tracing success cases are now reporting patterns consistent with uncontrolled exponential growth of the virus in the past few days (although not in SK yet)
Imagine you wake up in the morning, first thing you do is take a swab test. Ten minutes later you have your result, and if it's positive, you self-isolate. If it's negative, you go about your day.
No at-home test exists yet, and we surely aren't producing 300 million tests daily yet, but this should be the target.
Yes that sounds great. We do not have the capacity to make this happen before our hospitals overload and potentially 2.2 million die unless we take containment measures now.
Tests are good. We need containment now if we want them to be useful.
Partially because of the idea that South Korea tested its way to safety. While its true that heavy testing was a key part of their containment plan, it also relied on a lot of investigative work, etc. It's also too late in the US since we already had uncontrolled and undetected community spread.
Partially because the US government screwed up the testing capacity. So people are overly valuing testing because its an easy way to assign blame. People love an oversimplified cause to a disaster because it makes life seem less random.
It's important to know the difference between people who are still infectious and those that have completely recovered and have no virus in their body. An antibody test can't tell you that.
Lowering peak low enough for our medical system for long enough is the real fantasy. If you plug the numbers in the model you’ll see that it will take 10 years or until vaccines are ready which will also take years.
You need tests to backtrack and force isolate the sick. This waiting it out shit won’t cut it
Which is why I said "and scale up medical capacity" (and unspoken but of course: yes, there will be hundreds of thousands of deaths at the minimum, even with these measures)
> You need tests to backtrack and force isolate the sick. This waiting it out shit won’t cut it
You can only test and isolate if you first institute quarantine measures. Even after instituting quarantine measures, we still will unlikely be able to prevent an eventual resurgence of the disease.
From everything I've read, there's no path out of this that doesn't involve either:
How are you going to train so many doctors in months? Total pipe dream to scale it more than 2x and then it will still take years.
Ofc you lock down then test everyone who comes in the hospital and then everyone who they came in contact with recursively until you stop finding any positives. Then you lock em all up for three weeks
Edit: and i dont mean self quarantine. I mean like the chinese did it
I agree that it is a pipe dream to suggest that we could scale up critical beds such that hospitals will not be overburdened. But I disagree that there is nothing to be done.
If we've bought time so that rather than 5 critical cases/bed we have 3, that is a huge improvement and still means potentially hundreds of thousands saved.
I am also skeptical that the primary or only shortage is labor.
The lockdown is just to slow it down so you can reasonably mount test and forced quarantine response. Realistically it will need military to step in or something like that. You can’t stop it with just lockdown. Currently US is barely doing the former and not doing the latter at all (unless you are celebrity). It is bad. My projection is at least 100k will die by the end of the year if nothing changes
Sure, but we have more than enough evidence to show that emergency room visits are increasing and emergency room deaths are mounting. Control then test.
CA Govt Code § 8665 (2017)
Any person who violates any of the provisions of this chapter or who refuses or willfully neglects to obey any lawful order or regulation promulgated or issued as provided in this chapter, shall be guilty of a misdemeanor and, upon conviction thereof, shall be punishable by a fine of not to exceed one thousand dollars ($1,000) or by imprisonment for not to exceed six months or by both such fine and imprisonment.
Six months of jail time and $1,000 is what they are threatening us with.
In SF at least it isn't really being enforced unless they absolutely have to. Based on the news Tesla has been the biggest offender so far. Plus people can still legally walk around outside, so the most tangible enforcement would come down to ensuring everyone in public is avoiding people they don't live with.
They've been defying the order all week, and were specifically told by the sherrif's office that they are non-essential, but continued to run. I think they've only just started to come around, after a visit from the sherrif's office.
> Tesla said it would temporarily suspend electric-car production at its Fremont plant after Monday, after days of apparent resistance to a county health order requiring an immediate shutdown.[0]
> The order is completely identical to the one in the Bay Area, meaning individuals can also leave their houses to take a walk or go for a jog so long as they are practicing the requisite precautions when coming into contact with another individual.
I read what I thought was the most official version of the California order [1], and it's frustratingly short. After reading it, I can't tell whether I can go for a bike ride. Even the fact that I can go to a grocery store isn't stated explicitly. Is there a clearer, more detailed version?
By comparison, the SF order [2] impressed me by how clear it is. For instance, it clearly allows recreation with sensible caveats.
UPDATE: The video announcement [3] implies that the intent of the CA order is, indeed, to allow all the things the SF order allows. Not sure whether that has legal force, but good enough for me.
Thanks for all the references. I also couldn't find any explicit guidance around "outdoor exercise" that was as clear as the SF order.
I do also agree that the video you reference implies that the CA-wide order allows the same sorts of things (Newsom references "walking your dog") but hopefully there is more explicit guidance.
Thank you... People need to know this part. It's an exemption in our county order here too.
I've been walking and hiking every day since reading that. Some funny stuff...
- I always wear a floppy sun hat. Been there, had the dermatologist appointment. I can tell people think I'm a weird prepper. But I'm just going hiking, and need good sun coverage...
- Sitting on a bench in the city park, holding a tiny shortwave radio, with antenna clipped on... I've been doing this for years now, but these days people slow down their cars and stare...
- Having some family fun with our GMRS license, as we do about 1-2x weekly, anyway my son had a walkie talkie in his hand when we visited a nearby store and the cashier said we gave him a "zombie apocalypse vibe" (then handed me a card and asked me to email him about getting a license)
- Walking near seniors and the elderly...SO sad. They look terrified and take ~20 foot detours. (Not terrified at me, just in general...I hope)
- Seeing groups, like families talking in the street... They're out just enjoying a bit of sun, laughing, but then they completely disperse or go inside when someone walks down the street toward them.
- People seem to be putting on a weird act if they see that you are looking at them, like, "see, this is how I get out of my car during a pandemic." lol.
- If you go around a corner and run into somebody... Even if no physical contact... Awkward. Lmao
- So quiet. It's like most of our city already died off. But there's only one case reported in our county, far to the south
It's weird. When I take a ham radio out hiking, I take one with a blue case, so people don't get the wrong idea...
Judging by my trip to Costco tonight, I don't think people really understand the whole 'social distancing' thing. Typical Costco, with no awareness of personal space. I tried to stay clear of people but it was useless. I had a much better experience at the grocery store a couple nights ago. People kept a wide berth.
People look at the thousands of deaths in China and Italy and may think this is an overreaction.
What they don't realize is that those figures are the result of tough lockdowns, without which, the death toll would've been easier an order of magnitude greater.
California has shown true leadership in this crisis. I hope New York and Washington will soon follow.
I think that California and very soon the whole of US would need to shift to survival of the fittest mode. The US population cannot survive multiple weeks without a paycheck. Any unemployment that is received is just enough to put food on the table but not pay rent.
Some statistics on lower wage workers
* 152 Million people worked in US in Feb 2020
* 16 Million of those in retail (A huge majority of them would be unemployed ~50%)
* 17 Million people worked in Leisure and Hospitality (If bars/restaurants/movie theaters/theme parks/casinos stay closed around 80% of them are unemployed
* 3 Million people work in educational services . With schools and colleges closing a majority of them are unemployed.
I think about this a lot too. China in general has a much higher savings rate. Where as the US has a large proportion of the population that live pay check to pay check. What happens after a month and things are still not contained?
For example should my local Best Buy remain open because it is part of the Information Technology sector? Or is providing people with headphone adaptors for work at home not critical infrastructure? I have no clue! I hope that they do.
California has the biggest agriculture, port and manufacturing base in the US basically. The county orders contradict the state.
OC is letting factories stay open with conditions and LA is saying the port stays open as well as the trains, airports (especially KSBD which is Amazon's home base). What a mess.
If the county says "you need to stay home if X" and the state says "you need to stay home if Y" then the effect is "you need to stay home if X OR Y". There's no contradiction.
More frequently though the effect is that people think "our politicians do not know what are they doing; I will do what I think is reasonable" and do what they want.
"you need to stay home if X OR Y" is the safe bet, but it's not always required, sometimes one thing preempts (invalidates) another. I'm not sure if that happens in this case or not though.
Consult a lawyer via telephone if it matters I guess.
LA has also issued its own stay at home "order." During the initial part of the press conference, it was explicitly described as not a lockdown.
The statewide order is similar. Strongly recommended that people stay indoors, but outdoor activities are still allowed.
In both cases, the orders do not include any potential punishments (to individuals) for violating the order. (There are punishments outlined for businesses.)
IANAL, but violating the county orders in the bay area was widely cited as a being a misdemeanor offense. There were also platitudes from law enforcement about "compassionate enforcement", but the potential for punishment is there.
In SF they said it was a misdemeanor, but that being cited for it would be a last resort, that they would seek voluntary compliance before getting to that point.
In the US it's not clear the federal government actually has the power to order a nationwide shelter in place; "police powers" are typically reserved for the states. The HHS/CDC can quarantine specific individuals or groups (with confirmation of infection) but I don't think can do this "in general".
I think this one is up to the state governors who typically do have the power to do this through state health laws -- as has now happened in CA and undoubtably will happen in many more states over the next 48 hours.
I am confused. Here in the midwest all the states that I know of have cancelled school, shut down bars, and made restaurants convert to delivery, curb side pickup, or drive through.
Further, we are supposed to avoid groups of more than ten people.
Seems to be the case across much of the US. Certainly, in Oregon, it is the case. We still have not issued a shelter-in-place order, but it is getting discussed every day.
The Midwest isn't uniformly avoiding contact. In Illinois they had a freaking election. Lots of elderly poll workers didn't show up (and were entirely justified in that), so they had to close a bunch of polling places and the remaining polling places were crowded and voters had to wait for hours. This fiasco definitely will have killed some people over the next month...
It's not just about America, I do mean the other countries too. For example, Brazil's president is still running rallies, he keeps downplaying the virus like Trump was doing a few weeks ago.
And in America I can imagine the situation varies from state to state, from county to county.
The difference is you are merely supposed to do it. Here you can be arrested for not doing it. This is a good move. A lot of people are not taking it as seriously as they should
They aren’t actually going to arrest anyone, but the police are stopping people on the streets and questioning them (not guessing; I know people who have been pulled over). At most, they will hand out citations that will result in a fine. But with a huge number of immigrants in the Bay Area on temporary work visas, there’s a chilling effect that a misdemeanor citation could result in being kicked out of the country ...
Any person who violates any of the provisions of this chapter or who refuses or willfully neglects to obey any lawful order or regulation promulgated or issued as provided in this chapter, shall be guilty of a misdemeanor and, upon conviction thereof, shall be punishable by a fine of not to exceed one thousand dollars ($1,000) or by imprisonment for not to exceed six months or by both such fine and imprisonment.
It has become clear who the leaders are as of late. There are some that are acting like true leaders, and making decisions, and taking responsibility.
To be honest, a few times I've heard of something happening that is proactive, and in a biased way assumed that "Well it must be a Democratic governor". Mike DeWine kind of made me realize I shouldn't do that.
This may buy some time but we can't be in lockdown forever. Testing infra really needs to ramp up during this time. S.Korea never actually ordered any stay at home order. People are voluntarily avoiding going outside and aggressive testing is paying off.
A 65+ year old family member works in the defense industry as an engineer.
They are being asked to continue a commute into Los Angeles, continue a job that doesn't allow for social distancing, and isn't being provided with any protection items, whatsoever.
They are told that they are essential, and that they cannot have time off. Let me make this clear : They are a civilian, entirely.
I SURE hope that those who do indeed get sick from the poor decisions of their employers will have some path available to them legally to make the irresponsibility righted in some way.
Given that at least one employee of a grocery store has tested positive in CA, it seems that grocery stores, where large numbers of people congregate and touch surfaces, could be a loophole to be addressed... somehow.
In my Neighborhood, there is street sweeping on Wednesday and Thursday. A couple days ago, the Mayor of LA announced that they won't be giving parking tickets because of the situation. Well, this morning everyone got tickets. It's not that the residents are too lazy to move their cars. This is LA, there is no parking. We only get space if a good chunk of us are at work.
Yeah, let's all stay at Home. But let's also not get punished for it.
Bond Beach in Sydney had several thousand people on it last night, pubs and bars are still operating as normal in my area - the only thing thats changed is most corporate people re working from home yet are still meeting with friends. I've had 4 invites to gatherings over the next few days.
We here in Sydney are (as usual) sleep walking into a big mess.
The order says only those part of CISA define critical infrastructure should show up to work, which doesn't seem to include pizza delivery or short order cooks.
If you don't have an "essential job" like working at a hospital, grocery store, power company, etc. You're allowed to go outside and walk in your neighborhood, but apparently the police will enforce it (probably just at ticket) if you're out for a non-essential reason. They also forcibly closed all gun stores in the state.
It's not martial law to the letter, but it's damned close.
Here in Spain they'll fine you 100-ish Euros for walking around while the lockdown is in effect. I'd expect something similar in CA. Besides, in CA if you go to work, everyone and their dog will tell at you to go the eff home.
Completely offtopic but how the hell are those beaches in Florida not closed right now? Those idiots are going to fly home soon and insert this virus straight into their communities.
This is a great move, but I'm not sure how this will hold up unless the state seals its border. If the entire country doesn't follow suite, is that the next step?
At this point, what sort of narcissistic, psychopathic fool needs to be told to stay home unless you really need to make a minimal trip out in order to survive?
Maybe someone who isn’t a software engineer and doesn’t make as much as you, and maybe has a family that depends on their income?
You need to check your privilege. Working from home isn’t realistic for most people. For many, the decision is squarely between a paycheck and staying home. You’re pretty out of touch if you would call someone narcissistic or psychopathic for struggling with that.
This is effectively stopping the economy and creates all sorts of rippling effects.
US has awful social support and this will hit the working population really hard.
The best case I see is we can ramp up testing kits and masks to 100s of millions. Test everyone repeatedly. Track and quarantine rigorously. At the same time give monthly stipends to everyone while “sit in a hole or die” order is going on.
Make sure banks don’t foreclose, people still have insurance and jobs (too late for some parts like hotels and restaurants).
I can see why people are panicking and buying guns in poor neighborhoods. We’re putting people on survival mode.
We first downplayed this for a long time when we had a 2 month head start (Thanks Trump and team) and still feel unprepared for the worst.
The case fatality rate of being 80 years old is 5.77%. Each year this many people age 80 die of various ailments. I don’t remember staying home for months praying this number goes down.
A bit late, but still so far best move of any US State. Originated myself in Central Europe and every day counts when I see the development in my home country and its neighbors!
It's more of a request for individuals, with the order being directed at businesses. There isn't any hard enforcement (at least none stated), and people can still go outside.
> The state projects that 25.5 million people in California will be infected with the coronavirus over an eight-week period, Newsom said in a letter sent to President Trump on Wednesday requesting the deployment of the U.S. Navy’s Mercy hospital ship to the Port of Los Angeles through Sept. 1.
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.