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California’s Roadmap to Modify the Stay-at-Home Order [pdf] (ca.gov)
252 points by infodocket 45 days ago | hide | past | web | favorite | 394 comments



This entire plan is based on models that do not align with what we are seeing. The graph on slide two[1] of the official CA govt plan shows hospitalizations With Intervention rising exponentially, exceeding our hospital capacity in early June. The actual new infection data shows that the rate of new infections has been decreasing since at least 4/4 [2], meaning that the graph of active hospitalizations should be a bell curve with a maximum value of ~10,000 on ~4/20.

The mismatch between their models and the observed data does not engender confidence.

[1] https://www.gov.ca.gov/wp-content/uploads/2020/04/California...

[2] https://covid-19.direct/state/CA


Something weird happened in California, where 20% of their tests were coming back positive, then all the sudden 04/04/2020 they started seeing <10% positive tests:

https://raw.githubusercontent.com/lettergram/covid19-analysi...

They also barely tested at all prior to 04/04/2020:

https://raw.githubusercontent.com/lettergram/covid19-analysi...

In generally though, the rate of positive tests is increasing nation wide:

https://raw.githubusercontent.com/lettergram/covid19-analysi...

Implying we are still on a solid growth curve, as our testing capacity has maintained relatively constant levels:

https://raw.githubusercontent.com/lettergram/covid19-analysi...

I can't speak to the hospitalization levels, but I suspect people are avoiding the hospital. My roommate decided not to get tested and stay home, even though he was having difficulty breathing. He seems past it after a couple weeks.


>Something weird happened in California, where 20% of their tests were coming back positive, then all the sudden 04/04/2020 they started seeing <10% positive tests:

This is not surprising. When tests were scarce, tests would be rationed to those most suspected of infection.


The cases reported per country, or state are only a narrow window into what is actually happening. The most advanced medical testing company in the world, Roche, is Swiss-German so Germany's testing capability relative to most countries is off the charts. Combined with a highly distributed, yet also highly co-ordinated health care system they have been ahead of the curve in testing on every conceivable metric. As a result they have reported relatively high case totals, because they have been doing mass testing for a long time, but very low death rates because this enabled them to effectively isolate cases quickly.

As countries increase their testing capacity it is quite possible some countries (or states) will end up eventually reporting accelerating numbers of diagnoses even if the actual new case rate in the population is falling.

One way to mitigate that is to report only cases requiring hospital admission. This isn't ideal by any stretch, but is a reasonable proxy for the spread of the virus and at least gives a good indication of the impact on the health care system.


> One way to mitigate that is to report only cases requiring hospital admission. This isn't ideal by any stretch,

It doesn't count all the frail people living in care or nursing homes who are put onto a palliative pathway and allowed to die, for example.

This could be about half of all Covid-19 deaths.

https://ltccovid.org/2020/04/12/mortality-associated-with-co...

> Data from 3 epidemiological studies in the United States show that as many as half of people with COVID-19 infections in care homes were asymptomatic (or pre-symptomatic) at the time of testing

> Data from 5 European countries suggest that care home residents have so far accounted for between 42% and 57% of all deaths related to COVID-19.


But hospital admission cases depends on perceived hospital resources too... if people think going to the hospital is worse than staying at home, or impossible, that will distort conclusions also.


That's true, but is mainly a problem when comparing one country or region with another. Within a region, assuming a roughly stable general perception of hospital capability, it should till give a reasonable indication of the relative rise and fall in numbers of severe cases. I don't know, it's a really hard problem.


Tests are still scarce.


Maybe but it’s all relative. Even a little less scarcity can change those numbers in significant ways.


I can't figure out what you mean, can I go someplace to get tested and put my mind at ease that I'm not about to die or kill my familymembers? That's the only "relative" that matters here.


Are they scarce everywhere? I was under the impression that LA county, at least, could test everyone that was symptomatic.


No, they have been available to only “seniors and high risk individuals”.

Literally just today Mayor Garcetti announced testing for everyone is available.


That's great for LA county but there are 320 million of us who don't live there. That is: should they be scarce anywhere?

Remember, this is the USA.


This whole thread is about California's roadmap. LA County is something like 25% of the state. Why stop at the USA? With people moving between places, outbreaks anywhere will matter until there's a reasonable vaccine/treatment.


Maybe or may not be true.

I just got an email from local urgent care that they have the fast test equipment that can offer a result within 15 minutes if you are negative.

The situation is changing quickly


My friend in SF was told he wasn't severe enough to get tested a few weeks ago, but he's convinced he had it.


Assuming that's the Abbott 15 minute test, there's only going to be 50,000 of those a day for the near future (and it seems less than that in the immediate future).

That's a big chunk on top of current testing, but probably not enough to make it easy to move forward with a testing based strategy.


And the stories I've read say their accuracy is questionable.


When testing is scarce it is used as a clinical tool to help make decisions about treatment. For example: patient has pneumonia. If its bacterial pneumonia a course of the right kind of antibiotics will be very helpful. If its COVID, those antibiotics won't do anything, and the patient may not get the therapies they really need.

Once testing becomes more available, doctors use it to rule out COVID even on patients who aren't very sick, to help make sure they those patients aren't spreading it, instead of just making treatment decisions.

Ideally once testing capacity gets high enough we could start testing every contact of an infected person, or just randomly sample people.


Those charts look very different from the Worldometer data, which shows the April 4th high water mark in new cases still holding 10 days later.

Their graph is linear growth in new cases per day until 4/4, followed by a gradual but spiky decline, even as tests/day keep increasing.


That’s because worldometer data is community reported. This data comes from the states (mostly):

https://covidtracking.com/


Additionally, notice that the orange data points (actual hospitalizations) are significantly under the "With Intervention" plot. So why even include the slide? Clearly the assumptions behind the "With Intervention" plot do not match reality TODAY, let alone in a few weeks.

Not a good sign if people are making actual decisions based on this.


> Clearly the assumptions behind the "With Intervention" plot do not match reality TODAY, let alone in a few weeks.

I feel like I’m taking crazy pills with the way people are talking about this whole thing still being out of control, when data shows the situation is even better than the most optimistic models were predicting. And by that I mean, pretend I was on HN 3 weeks ago predicting 25K deaths in the USA by today. I’d have been downvoted into oblivion and told I was delusional. But here we are.

Clearly NYC was hit far harder than the rest of the country, but it seems like every state and municipality is simply basing their models on NYC case numbers scaled by population. I don’t get it.


I don't understand what you're suggesting, that California should ease up faster? It seems to me that reality being better than models had predicted is more the result of everyone flying blind due to lack of testing... California has probably been lucky that it turned out its infection was lower than New York's turned out to be. It is just hard to make a model starting from extremely shitty and noisy base data about facts on the ground, but someone still has to make very difficult public health decisions based on the best models available.


> I feel like I’m taking crazy pills with the way people are talking about this whole thing still being out of control

A week ago, I remember reading how the Bay Area was bracing for a bracing for a surge and it was the calm before the storm. The Santa Clara county covid-19 dashboard told a different story: day-over-day, new cases were roughly the same for the past two weeks. 2+ weeks into the lockdown, there was obviously no surge coming.

https://i.imgur.com/LrFZj3S.png

Looking at that chart on the April 7th, nothing pointed to a surge.


Isn't this just California being in the "3.6 roentgen, not great, not terrible" phase? I.e. number of new cases reported is limited by the number of tests that are able to be made?


Every region (and almost every country) is generally believed to be severely undercounting cases because of limited testing. There's not much reason to believe the problem is worse in California than elsewhere, and a severe surge would be evident in hospitalization and death rates no matter how bad testing is.


In mid-March we were told that we are "10 days behind Italy" and shelter-in-place is not to stop the spread (already too late for that), but to give hospitals a bit of a breather before the surge of critical cases and the Death Wave that follows. That was the justification for such extraordinary measures as a state-wide lockdown.

It's mid-April now. Where is the Death Wave? Either this virus is much less infectuous than it was touted, or much less deadly. Or both.

Sweden never locked down. Denmark is opening up after a lockdown. Italy that was touted as the prime example of hell on earth, had ~21,000 people died by official count. Even if it was undercounted by 50%, that's roughly 40,000 people, mostly elders on their last breath, out of country of 60 mln. And that's the worst case so far, in the world of 7 billion people.

Disregard all that, we're still being told daily that it's "war zone", the zombie apocalypse is just around the corner, etc. Only Big Brother like surveillance is going to save us. The lockdown is not an extraordinary measure anymore, it was an absolutely necessary first step, and now we have to take it further. Much further.

I wonder what it felt like for people in 1932 Germany.


Sweden didnt lock down and as a result has around TEN TIMES more deaths than its neighbours, and the death toll is raising by hundreds per day, when its hovering around 10 with Finland and Norway. I don't think you want to give Sweden as a good example.


Wikipedia says 1,200 deaths so far in Sweden. Sure that might be ten times more than in Finland and Norway but given the dire predictions of two months ago, and even more dire predictions of a month ago, you'd expect this number to be ten times higher than it is now, or a hundred times. What about exponential growth and stuff? In a country with no lockdowns this disease should go rampant, right?

1,200 people dead of 10.3 mln is 0.012% of the populace. Not good but not scary either, for the Worst Pandemic Of Our Lifetime.


I think there was genuine concern that the quarantine as implemented would not be enough. You can see lots of stories locally wherever you are about how people aren't obeying the order. Italy was still in a lot of trouble despite having had some quarantine measures in place. Hindsight shows the quarantine was effective enough to get numbers down. The US, despite reacting too late, did lockdown fully relatively quickly.

I would agree that modeling after NYC seems like a bad idea given the lack of density and public transportation. On the other hand, Michigan looked pretty exponential, and as the lagging cases came in from other states, they also began to look fairly exponential as well. Despite cases staying elevated for now, the exponential growth has died down.

The US missed the worst of hospitals being overrun and it running away in multiple cities.


>The US missed the worst of hospitals being overrun and it running away in multiple cities.

I want to add ", so far" to the end of that sentence. I do not hold hope that this will be true as we fight among ourselves to reopen various portions of the country/economy.


> I do not hold hope that this will be true as we fight among ourselves to reopen various portions of the country/economy.

But things won’t be the same after reopening as they were before. People will be wearing masks (I see a lot of that already), keeping distance, etc. Couple that with common sense restrictions like “keep the elderly and sick at home”, “no big public events”, “no sporting events”, and “lots of restaurants have gone out of business”, it’s clear the opportunity for infection spread will be lower.


[flagged]


I know it's folly but I'm trying to follow the logic here. Newsom and Cuomo, who won their offices fairly easily in their respective elections, seized on a plan to drastically hurt the economies of their respective states. Because, being the ones who took charge of the situation, that would gain some intangible leadership points that would increase their chances of winning their next elections despite the inevitable severe unemployment and budget shortfalls that would much more certainly sink their chances.


Not sure if it is folly for me to try and answer here (no idea if my reply is going to be visible). Thank you for trying to listen anyway.

There is no need to look for malice when there are simpler explanations. No, I do not think Newsom and Cuomo were actively trying to hurt their states' economies; what I said is that they are using the present crisis to advance their political goals _disregarding_ economic fallout. And you are telling it exactly: they are already seen as "taking charge of the situation" while the federal government was "doing nothing". I've seen Newsom being called the savior of the state (nation is the next step, yes) in press and here on HN. Contrast that with what WA state governor was/is doing - I don't even know his name!

I wouldn't try to make projections regarding chances for winning elections; something tells me though that severe unemployment and budget shortfalls are going to be blamed on someone else like federal government failing to provide relief, etc etc. There are all kinds of ways to spin the situation, I would leave that to professionals. There is going to be plenty of them hurting for work.

I live in California, in a smaller rural community way outside Bay Area. It hurts looking at the devastation this lockdown causes: boarded restaurant windows, closed businesses. It hurts listening to the local pediatrics calling us twice a day begging to schedule a virtual check-up "appointment" for kids basically so that they could bill our insurance and get paid _something_. It hurts when I stop by a grocery store and register clerk is happy just to see someone shopping so he could keep his job a little longer. I still have my cushy IT job but I don't have many illusions about keeping it for long if this goes on.

And all this carnage is for what? The latest numbers on Wikipedia state 128,000 deaths worldwide; you know, that's not very impressive for a zombie apocalypse. 760 people died in California so far. In mid-March we were told that California is 10 days behind Italy, and it's going to be hell in here soon. A month later, where is it?

Now take this "roadmap" that Newsom published yesterday. Literally the first bullet point talks about total Big Brother style tracing and monitoring as _necessity_ to even _think_ about lifting restrictions. You sincerely want me to believe all this is done for the sake of us plebe Joes?


I think again you are misunderstanding some severe things. Daily cases are flatlining now yes, but what happens if we open things up again? Why do you think we won't go down an expontential growth track just like before the lockdown?

You're literally saying "hey its not that bad, look at how good the numbers are while we are all staying home! Oh btw, can we stop staying at home?" Do you not see the inconsistency there?


> I think again you are misunderstanding some severe things.

No doubt that I am misunderstanding some things. A lot of things, more likely. Severe? That depends.

If you look at the numbers, they never did fit in the narrative pushed on us. Yes this virus is not just like flu, it is way more dangerous for specific cohorts of at-risk people. Key here is: for specific cohorts. Not for everybody. Why is everybody's life being crippled right now to save the few? Why cannot we quarantine people at risk instead of everybody? There is a wide spectrum of possible options between doing nothing and keeping everybody under house arrest.

Have you ever been laid off in the middle of an economic collapse? I still have my job but I don't think I'm going to keep it for long. And when the day comes I'll have to choose between paying ~$2,500 a month to keep my existing health insurance coverage in the middle of a pandemic, or keeping food on the table. No social healthcare here.

No, it's not about numbers looking good while we're enjoying our stay at home. It's about trying to weigh the risks and being rational instead of "saving lives at all costs". The costs are already staggering beyond belief.


You knew it was folly...Some people want rationalize rather than observe.

Our government's situation looks an awful lot like ignorance and error, not malice.


Ugh. Why let green accounts post immediately?


Because it does not make sense to introduce delays to stiffle discussion. Throw-away accounts are used to say things one does not want associated with "main" account; in my case the "main" account is easily doxxable and I knew the things I wanted to say are not going to be popular. I don't care if site mods have access to the logs and can use IP address to add 2 and 2; I just don't want that post above to be associated with my real name forever, via simple google search. I'll have to look for a new job soon, if layoffs continue at the present pace.

I would be happy to have this discussion face to face without having to hide behind an anonymous account but the rules for in-person debates do not apply on the Internet forums.


In rare cases, it allows useful contributions or participation involving someone who has never used Hacker News before, but summoned to participate because the discussion involves them.

There should be a flag that hides new users by default... but consider carefully if you really want to be that person that makes use of such a feature lol


I'd add that it's essential for throwaways, which are sometimes necessary for open discourse depending on the account and topic. Many highly active HN accounts are semi-professional, linking to off-site profiles.

The green seems to make for a good cautionary flag though.


Whenever I see the IHME charts[1] (which are great) I think “I wish I could see the what the model predicted before today’s date so I can assess it.”

This shows laudable transparency, in my view.

(Also the model was directionally correct, it’s not like it was entirely the wrong shape.)

[1] https://covid19.healthdata.org/united-states-of-america/cali...


The IHME model is proving to be wildly inaccurate on the downslope due to bad data coming out China. Their projections will continue to creep up in terms of deaths over the next few weeks because the predicted drop offs won’t be happening, sad to say.

If you want to see examples, check out their predictions on Italy. Their figures have been underestimating by over 50%, and the gaps will widen each day over the upcoming week. Heck, the ranges for the last few days have been outside their confidence interval.


A significant portion of this probably is compliance, but I'm with you completely on "the numbers out of China, particularly at the tail end are farcical". There was a drop off a cliff in cases.


Could you share how you would assess the model?

Do you have a background in disease modeling or anything?

I'm curious.


I think the point of the plot is to suggest that intervention efforts are being quite successful relative to expectations at the time the "With Intervention" model was generated.

The brighter dashed line is there to show what happens if intervention is disabled completely.

I really like that the milestones are placed as questions, rather than dates. It is the right way to message the unknown.


This is ridiculous criticism. There are so many unknowns with this virus. We don’t know how many people have it, how fast it is spreading or what the mortality rate. Everything is a fairly rough estimate.

It turns out that social distancing is working better than expected, or the virus isn’t as contagious as expected, or slightly less severe than expected. That doesn’t mean the lockdown was the wrong thing to do, or that it isn’t still necessary. What it does mean is that we’ll be able to start easing restrictions as the hospitalizations continue to drop — and perhaps we can stop it completely with testing and contact tracing.


My former physics professors would have not approved of a graph like this. D+ on the lab at best.


https://i.imgur.com/dJ7kHch.png

It's pretty sloppy to show surge capacity on the same graph as total hospitalizations, not active active hospitalizations.


The line is the average of high and low estimates. The issue we are dealing with exponential growth so 1/10th x to 10x makes it look like the estimate is wildly off even when it’s surprisingly accurate.

Further, these estimates are much older than the data so showing their accuracy is useful.


Why should infections follow a bell curve? Shouldn't it be the derivative of a the logistic curve, which should be approximately exponential on both ends. I don't see how a quadratic should show up in the exponent; either mathematically or epidemiologically.


That's a good question. If control measures are undertaken to "flatten the curve" down to the capacity of the medical system, we'd expect to see new infections per day and deaths per day level out, maybe decline a little, but not decline a lot. Which is what the actuals show for the areas worst off.[1]

At some point, there's saturation, and "herd immunity". For this virus, that's somewhere in the 60%-80% range of the population. US population is around 333,000,000, so saturation is somewhere above 200 million.

We're nowhere near that. Current known US total cases are nearing 2 million. Current estimates of undetected cases are in the 80% range, so current total cases is probably around 10 million. So about 20x more people have to get sick before herd immunity. That's well over a year away.

[1] https://www.ft.com/coronavirus-latest


The "curve" in "flatten the curve" is an epidemic curve, not a Bell curve.

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


And "bell" in "bell curve" shouldn't be capitalized -- it's not someone's name, it's just that the curve has (somewhat) the shape of a bell.


Fair. But the curves on the document referenced above are not epidemic curves. They’re unbounded exponential growth curves. My criticism of the report stands.


Yeah it was a great post. Just adding that note.

The exponential curves are somewhat useful early in an outbreak. It's confusing right now because some places are still "early" and some places are way past the point where those curves are descriptive. So they won't describe NYC at all but they're still somewhat working nationally.


> Current known US total cases are nearing 2 million.

It's 2 million worldwide. The US is now above 600,000:

https://coronavirus.jhu.edu/map.html


It seems like both the perception of and response to this pandemic are not reflective of reality. What am I getting wrong here?

- Around 200 million Americans will eventually get it, barring extraordinary events (like a vaccine arriving in 6 months). We cannot change this.

- Around 0.5% will die, overwhelmingly those who had a low remaining life expectancy to begin with. This is a much larger body count than most people seem able to accept, but also much less dangerous to the average American than many believe.

- All we can do is alter the timetable to keep the hospitals functioning, which has been done successfully in many places throughout the world albeit at great cost.

There's both good news and terrible news in those facts but none of it really seems to be in the consciousness of the public or of leaders, whereas "oh no you can maybe get it 8 hours after a guy sneezed in a lobby" is everywhere. Along with "everyone who stays at home is a hero" as we set ourselves up for a second Depression.


The death rate is 0.5% IF there's really good medical treatment. If there isn't then not only does the death rate from the covid go up but so do death rates for every other condition requiring medical treatment. And not only during the pandemic but for a some time afterwards as the health system recovers. That's not counting those who survive but have some form of permanent damage.

The way to avoid that is to at least spread out the impact over time. Telling people it'll be okay leads to no one listening and the health system collapsing. That's human nature. Telling people it's the apocalypse means most listen and the health system survives. Welcome to humanity.


I'm just very skeptical of this kind of noble lie. If authorities are known to tell people what's convenient for them to believe rather than what's true, is anyone going to end up listening to them in the end?


It is not a noble lie to tell people it won't be ok if it really won't be ok.

Really, if every jurisdiction in the world overwhelms their hospital capacity it won't be ok.


Agreed, it'd be wrong to tell people it's okay. It's not okay, a lot of people are going to die, and even more people would have died if we didn't take costly measures to stop it. This has been and will be the worst experience of a lot of people's lives, and it'd just be a lie in another direction to pretend that's not so.

What seems to be a noble lie is the apocalyptic mindset, where the coronavirus is literally the only thing that matters and we must never ask if a particular mitigation is worth the cost. Many authority figures are promoting this idea, even though they clearly don't believe it themselves and couldn't formulate effective policy if they did.


> even more people would have died if we didn't take costly measures to stop it.

The example of Sweden seems to disagree with this assumption. They never locked down, and the current mortality is (1,203 / 10,330,000) * 100 = 0.0116%

First case on Jan 31st, no lockdowns, death rate has already flattened. Where is that crazy scary exponential growth?


Sweden as the great success story when it is suffering the same economic devastation as its neighbors but a higher death rate is an interesting argument.

The thing about the lockdowns is that evidence so far indicates that stopping 80% of non-essential economic activities voluntarily is about as bad for the economy as stopping 90+% on a mandatory basis, but it seems that the health outcomes are much better in the latter situation.


> The death rate is 0.5%

You can't know that without testing the whole population, or at least getting some controls.


They did random anti-body testing in a small town if I remember correctly and found it to be 0.5% or so.


I discount any comments that argue IFR as the sole basis for how quickly we can let the disease spread to save jobs on a short term basis.

Hospitalization is a more important factor as it the death count goes up dramatically without intensive care.

These comments always come with a healthy dose of "people aren't seeing reality!?!?", which is a bonus given the level speculation surrounding IFR and the variance therein.


> Around 200 million Americans will eventually get it, barring extraordinary events (like a vaccine arriving in 6 months). We cannot change this.

"Significantly less than 200 million Americans catching it" is still on the table.

"Herd immunity" is just the point at which the reproduction rate of the disease falls below 1 because the average infected person does not encounter anyone else to infect (because everyone else has already been infected) before they recover. It's not a binary switch, though -- as the percent of the population that has recovered grows, the reproduction rate shrinks steadily.

This means, for instance, that if we had X infected individuals before the lock downs, and then -- because we can't stay completely locked down forever -- we at some point have X infected individuals again after the lock downs end, we're actually in a much better place, because the reproduction rate of the disease is lower and that X will become 2X much slower than it would have before the lock downs.

This also synergizes with stay-at-home orders, which also reduce the reproduction rate of the disease. Right now we're relying entirely on stay-at-home to reduce the reproduction rate to as close to (or below) 1 as possible, but in a month or two, once a portion of the population has recovered, we'll be able to rely on a mix of "herd immunity" and stay-at-home to achieve the same thing; it's entirely reasonable that we can drag it out for years, and that less than 50 or 100 million Americans will catch it before a vaccine is developed.

It isn't hopeless.

> Around 0.5% will die, overwhelmingly those who had a low remaining life expectancy to begin with. This is a much larger body count than most people seem able to accept, but also much less dangerous to the average American than many believe.

We're currently losing 12-17 years of life per death, based on the statistics out of New York. It's older folks, sure, but it's hardly just taking people off their death beds.


This is a great comment, thanks. So isn't there an argument in favor of infecting more people sooner in order to increase the immunity rate of the population, particularly if those people are at lower risk of complications for the disease?

For example why not pursue a policy such as: kids can go to school unless they live with someone who is at risk (since we know that children are at very low risk for complications). Similar to how we managed chickenpox before there was a vaccine.

I think we need to explore alternatives to lockdowns because I believe the economics of lockdowns will make them impossible to continue for very long. At the moment people see this as a "be heroic and do the right thing" issues, but most people don't yet understand the severity of the economic impact and haven't yet been personally affected by it. Lockdowns will probably become politically untenable by May or June whether anyone today likes that fact or not.


Eh, it's kind of like the decision on how bags of groceries to carry from the car to the house at once -- it's faster the more you take, but the more you carry the more likely you are to drop them and the more catastrophic the accident becomes when it happens.

It's tricky to take large bites here because of the short doubling time compared to the relatively longer recovery time -- in the ~3 weeks it takes your currently-infected cohort to recover, your infected population could increase 100-fold if you aren't careful. Mistiming things -- misjudging how many people are currently infected -- by a couple of days can be difference between exposing 10% of your population to the risk and exposing 15%. There's a reason pandemics are often compared to forest fires.

This will get easier as time goes on, as the doubling period gets longer and longer.

Based on current estimates of how many people will die in the US, you can infer that we currently expect 5-10% of the population to be exposed in this first wave; I believe what widespread testing there has been in Italy leans towards about 10% of that population having been exposed there as well.


""isn't there an argument in favor of infecting more people sooner in order to increase the immunity rate of the population, particularly if those people are at lower risk of complications for the disease?""

Only if you would like to see the hospitals overwhelmed with cases that don't result in fatalities but kill lots of other people and also kill people with underlying conditions that would otherwise live full and productive lives.


Chicken pox was a steady state. It sucked that kids got it, but their parents and most adults were likely immune, so when they brought it home from school, it didn’t spread to parents.

But if you expose kids to COVID now, they will in turn expose their parents, who will expose their coworkers, etc, etc

I could see that being effective strategy if we didn’t have a vaccine in 30 years, but for now, most people are still susceptible.


>For example why not pursue a policy such as: kids can go to school unless they live with someone who is at risk (since we know that children are at very low risk for complications). Similar to how we managed chickenpox before there was a vaccine.

Because kids are the most likely to ignore even simple ways of preventing infection. Then you get exponential growth via kids and the health system implodes.


How does this square with Denmark, which is opening schools tomorrow? It's possible they're wrong, but they must at least have some reason to think what you're saying won't happen.


It’s not 0.5% it’s closer to 2%.

You don’t have a normal economy if people don’t want to go out in public or the supply chain is interrupted as workers get sick. A pandemic will harm the economy no matter what we do, these efforts, it is hoped, will reduce the impact while also saving lives and the hospital system.


What's your source for 2%? A recent study which was featured on Hacker News estimated the infection fatality rate at 0.66%. [1]

I have seen a number of studies putting the case fatality rate at 2-3%, but this number cannot be generalized to the entire population because current testing is skewed toward the most serious cases. [2]

Long-term mortality in the total population may look something like 0.66% * 0.7 assuming there are no advances in treatment (possible but unlikely, given the unprecedented efforts that are underway, and how naive we were on day one).

In general more recent studies estimating IFR should be more accurate, early ones came with a lot of caveats. If there is a better estimate of IFR than 0.66%, I would like to read it.

[1] https://www.thelancet.com/journals/laninf/article/PIIS1473-3...

[2] https://en.wikipedia.org/wiki/Case_fatality_rate

[3] https://news.ycombinator.com/item?id=22828691


The CFR in Italy is nearly 13%. Even if you make incredibly generous assumptions that there are no unreported deaths and they're only catching 10% of cases that still leaves the infection fatality rate at twice the number you propose


That's almost certainly untrue. Recent studies have show that as many as 38% of the Italian population has been infected at this point [1]. That gives a fatality rate 0.03%. Let's say the official death count is 10x undercounting, you're still left with 0.3%.

[1] https://www.reddit.com/r/CoronavirusUK/comments/fxgk8q/early...


This published scientific article shows you why the CFR in Italy is so high -- and why it doesn't apply to the general population: http://jamanetwork.com/journals/jama/fullarticle/2763667

Takeaways: Old population, Pre-existing conditions, Skewed testing


Testing is severely undercounting cases here. People who just experience fever are told to self-isolate and aren't tested. Not all of these (luckily) end up hospitalized, so those are never, ever counted.


With an older population, a problematic medical system, and being caught totally unprepared, isn't Italy the worst case scenario? I don't think it would be representative of what's going to happen in other countries from here on out.


I don't know where this meme came from that Italy has a "problematic medical system" but that's certainly not true in Lombardy.


The US has a population riddled with comorbitities (obesity, heart disease, diabetes, etc.), a problematic medical system, and was caught totally unprepared. Isn't the US the worst case scenario, with the most deaths and most infections in the world?


You pretty much just described the US.


>Isn't the US the worst case scenario, with the most deaths and most infections in the world?

Adjust your numbers for population. Per capita numbers for the US are far from the worse case scenario.


I use the 0.66% number myself when estimating things, but it's worth noting that that is that papers best-guess estimated infection fatality rate for China, based on its demographics.

The paper has an overall estimate of the infection fatality rate for all ages of 0.2-1.6%.


And that also assumes everyone can get medical care, if all of the cases are happening at the same time, the mortality rate would increase as resource constraints force medical providers to pick who gets care.


No, 2% is the case fatality rate. The true overall mortality is far lower. Germany did a randomized test recently of a town and calculated that 2% of the population is actively infected, 14% possess antibodies indicative of a current/prior infection, and overall 15% have been infected at some point. Once this broader testing was completed, the overal mortality was found to only be 0.37%. For comparison, a typical flu season is 0.1%.

https://www.tagesschau.de/regional/nordrheinwestfalen/corona...


For comparison, a typical flu season is 0.1%.

That is incorrect. The worst flu wave to hit Germany in the last 20 years, 2017/2018, killed appoximately 25000 people (excess mortality). That's 0.03%, and it's not typical. Often, the number is much lower.

Note also that the results from the Gangelt study you're referring to are preliminary; there's a press release but no paper yet, not even in preprint.

https://edoc.rki.de/handle/176904/6253


> That's 0.03%, and it's not typical. Often, the number is much lower.

0.03% or 0.1% or 0.66%, the number is low enough to be perceived as not too dangerous by general populace. Contrast that with 13% mortality rate for Italy that was widely spun a month ago. Now _that_ was scary!


Just in support of your argument, new data is showing that the fatality rate is lower then previously estimated, due to a large number of undetected cases.

Just one example, tests of pregnant women coming into labor in New York show that 1/6 of them are positive for nCov, but 85% are asymptomatic or presymptomatic. (https://twitter.com/CT_Bergstrom/status/1249836446569181186)

Another example, Denmark is finding potentially as high as 30-80x undercounting of cases, which would bring the fatality rate down to 0.1-0.2% (like a bad flu season) [https://www.reddit.com/r/COVID19/comments/fxk917/covid19_in_...]

I've seen a few more of these data points coming out, and nothing is 100% conclusive, all the new data points are showing that it's less bad than mainstream thinking suggests.


> Around 200 million Americans will eventually get it, barring extraordinary events (like a vaccine arriving in 6 months). We cannot change this.

We don't know that's inevitable. Korea, Japan and Taiwan suggest another outcome is possible, and while a vaccine may not arrive in 6 months, lots of other things might: better treatments, better masks, better testing, better tracing, etc.

> Around 0.5% will die, overwhelmingly those who had a low remaining life expectancy to begin with. This is a much larger body count than most people seem able to accept, but also much less dangerous to the average American than many believe.

Death isn't the only metric. A lot more than those dying will be the amount of people that are hospitalized in very serious shape. Some of them will have long-term damage, and some of them will die if the hospitals are overwhelmed.


> Around 200 million Americans will eventually get it, barring extraordinary events (like a vaccine arriving in 6 months). We cannot change this.

This doesn't seem right to me. With social distancing now, and testing and tracing once we have enough tests available, it seems to me that we should be able to keep the total number of infected people well below 200M, even if a vaccine takes the expected 18-24 months. If there's a solid argument that this is not the case, I'd like to hear it.


1) SARS-2 is highly contagious.

2) Testing and tracing is working fairly well in S. Korea because they're treating it like a war, and they've been orgainzed since fairly early on. The US is not organized.

What most people, including HN, miss is that passing a test today means nothing about tomorrow.


Based on Italian serological and all cause mortality data I have seen, the death toll would more likely be about 1.4%. 0.5 IMO is quite optimistic. 0.1% of New York's population has already died.

This also discounts the unknown possibility of disability, reinfection, and limited time immunity.


I was under the impression that NYC had a confirmed infection rate of ~1%. Have they really had a tenth of confirmed cases die already?


No. Currently >200k confirmed, <11k deaths in New York State.

NY population is 18.8M. 0.05% of the population has died.


New York City's population is around 8.5 M, and more then 10,000 people there have died from from the virus so far (https://www.nytimes.com/2020/04/14/nyregion/new-york-coronav...). That puts the toll over 0.1 %.


I cited the correct, current numbers for the entire state.

You’re citing numbers released by the city where they haven’t confirmed cases, so it doesn’t answer the OP’s question.


Can you cite them, rather than saying that you cited them?


You're pointing out a great ambiguity in the state's graph. Is the hospitalization line a cumulative count of all hospitalizations? Or hospitalizations at any given time? Since the state's hospital capacity is related to hospitalizations at a given time, and not cumulative, I'm assuming the fit of that graph would be a bell curve with a max, followed by a decrease. People either die or leave the hospital.


You can approximate one with the other; it used to be common when normals were harder to work with early computers.

Eg, https://www.johndcook.com/blog/2010/05/18/normal-approximati...


It won't follow a 'bell curve' but the curve will 'look like a bell curve'.


Does anyone have the ability to walk through these explanations in a little more detail. I'm having trouble understanding why infections would be a bell curve, or derivative of a log curve.


So the basic assumption of an exponential growth curve is: "rate of change is proportional to a population."

However, in the case of a virus, you eventually run out of population to consume; so you tweak the model to be "Let the rate of infection be the probability that a infected person encounters a non-infected person" (nicely, for a large population, this will give you the same results initially). This is, approximately, proportional to the product of the number of people who are infected times the number of people who are not infected (think back to chemical reagents and reaction rates). That is, (1-infected(t)) * infected(t). A function who's rate of change is that is the logistic function (and you can verify by taking the derivative of 1/(1+e^-t))

This is a simple model, ignores geography, ignores population change, and ignores changing behavior. It basically pretends everyone is an ideal gas molecule in a volume. But if you want to model something that "grows exponentially with a limit" it works alright.

I don't know under what assumptions the rate of change would yield a bell (normal) curve. (e^-x^2).


Cumulative infections would not be a bell curve. They'd be a sigmoid curve, approaching some upper limit (e.g. 100,000).

Current Hospitalizations, which is the number we should be most concerned about, and is reflected by the orange dots on the state's graph, should start low, max out at a number, and eventually return to 0. That should follow something like a bell curve.

I think the confusion is between the "total infections" curve and the "current hospitalizations" curve. The difference between them is huge, and really important. The "Flatten the Curve" idea refers to keeping the number of hospitalizations at any one moment below some upper limit, ideally the state's number of available ICU beds. That's a bell curve.


> think the confusion is between the "total infections" curve and the "current hospitalizations" curve.

I think the confusion is that if the CDF is the logistic function, then the PDF is the logistic distribution. This is what archgoon is saying.

Bell curve refers to a Gaussian distribution, which is different but looks similar.

https://en.m.wikipedia.org/wiki/Logistic_distribution

http://visionlab.harvard.edu/Members/Anne/Math/Logistic_vs_G...


Here's a neat video by 3Blue1Brown that shows some simple simulations of an epidemic, and give a good visualization of the bell curve.


the dotted line is what we would expect if the intervention is removed as of today. the red dots are actual hospitalizations as of right now. the blue line was the predicted line for hospitalizations... she mentions that we are doing better than the prediction as of right now. it was not altogether that clear but in the context of the press briefing it's more clear.


This is poorly designed graph because it can give the wrong impression when it isn't accompanied with the explanation that was given in the press conference. I am not usually one to make a "this should be higher" comment on HN, but this is the proper interpretation and lots of people are being misled by not seeing it.


> The graph on slide two[1] of the official CA govt plan shows hospitalizations With Intervention rising exponentially

It does not. The exponential curve, per the graph legend, is what would be expected without intervention.


The light blue curve, labeled "With Intervention", is an upward-facing concave curve. Even if it were linear, it does not align with the observed data referenced in the link labeled [2].


OK, looking at the new cases curve on your covid-19.direct page. As presented, you can't really see what the green curve is doing. If you remove the black, total curve, the green new case curve is visible but it seems to be going up and down fairly inconclusively. Until 4/1, it looks like exponential growth. After that, it goes down and then up. Sure, the optimistic view is it's plateaued or going downward and I hope that's true but counting on just twelve days of data seems foolish.


"If you remove the black, total curve, the green new case curve is visible but it seems to be going up and down fairly inconclusively."

The best fit line of new cases after 4/4 is a linear function with a definitively negative slope. It is conclusively not a function that contributes to the upward, concave blue line on the state's graph.


Who cares what the best fit is. There is simply not enough data. You're talking twelves data points with considerable variation. Using statistic doesn't turn muddy and ambiguous data into a clear signal magically.


My point is that there is no extrapolation of the data we’ve seen to date that yields the blue line on their graph.


Sure, but I think they are tracing the worst case scenario based on the underlying assumption that the virus increases exponentially.

What going to happen is indeed inherently uncertain so we pretty much have to prepare for the worst plausible series of events. Once it becomes clear that a better outcome is fairly likely, then the plans can shift.


Can you trust that data to be perfectly comparable? Testing capacity ramped up at a different rate than cases. Testing guidance has been spotty too. The days right after increases in testing access could be very noisy.

I would look to the deaths curve much before the new cases curve, even though it's less responsive to changes. I assume fewer deaths have slipped through the cracks (though I'm sure some have).


What bothers me the most is that the comparison is always against a hypothetical "do nothing" strategy, ignoring the fact that different countries have employed different strategies, some of them have been highly successful in containing the disease without any lock down (Korea, Taiwan, and Australia) come to mind.


"some of them have been highly successful in containing the disease without any lock down (Korea, Taiwan, and Australia) come to mind."

How are you defining lock down here? I live in Australia and most people I know have been working from home for weeks and have had kids out of school during that time. All restaurants have been closed for a while now. There are stops/checks at border entry points between states, even at points 1-2 hours in from the border, enforced quarantine for anyone arriving interstate. Weddings restricted to 5 people, funerals to 10. People are getting fined $1k+ for non-essential travel (group of kids this week copped big fines for getting up and congregating to see the sunrise).

At almost every "essential" business I've visited, there have been spacing markers on the floor. Supermarkets have plastic shields between the checkout operator and shopper. Gloves, hand-washing, etc at any food pick-up place I've seen.

I don't favour our current leaders at either state or national level, but since Morrison's Hillsong weekend, he's barely put a foot wrong. Senior politicians have been serious and escalated restrictions as appropriate (ignoring Ruby Princess). I'm sure there are more serious levels of lock down, but it's been part of the response in Australia.


I wish this was the situation here. The limitations in most of Europe and united states are much much harsher, including no schools and mandatory closure of all non-essential business.


Schools have closed in one Australian state at least. More than half of children are at home in my home state, from what I can tell, where schools are not closed. They've polled for the coming term and suggest that two-thirds will be at home.

One serious loss in productivity comes in overseeing homeschooling while trying to work from home. Can't imagine many non-essential businesses are running anywhere near 100%.


Most of Europe hasn't closed all non-essential businesses. Has anyone, aside from Italy and Spain? Non-essential public venues (gyms, museums, some stores, etc) are closed, but that's true in Australia, too.


Aren't the techniques that Taiwan and Korea have employed (testing, isolation of known cases, contact tracing) irrelevant at this stage of contagion? I doubt of the efficacy of contact tracing when you have enough of a percentage of population infected that a single visit to Costco or any other supermarket would mean a very high chance of being there at the same time as an infectious person...


I think that the answer is that we don't know what's the effect of each measure. The fact that Japan & Australia did not employ contact tracing, but also managed to contain the spread shows that there are other factors at play. It might be face masks use, or temperature (for Australia), but it does show that there are potential alternatives that could be viable.


That makes you think it should be a bell curve? Are you arguing it will be a bell curve with such a peak, even if restrictions are weakened or removed? That is unlikely.


I am not. I am arguing that the current trajectory data we're observing [2] does not align with the projections of our current trajectory provided by the government of California (the light blue line labeled 'With Intervention' [1])

[1] https://www.gov.ca.gov/wp-content/uploads/2020/04/California.... [2] https://covid-19.direct/state/CA


But you wrote "meaning that the graph of active hospitalizations should be a bell curve with a maximum value of ~10,000 on ~4/20."? You didn't mean that?


I meant that "the graph of active hospitalizations should be a bell curve with a maximum value of ~10,000 on ~4/20" with the current mitigations in place. That is not what the government report is projecting. They're projecting unbounded, exponential growth with current mitigations in place, even though that is not in line with the data we've seen over the past two weeks.


Also the hospital bed line that many draw are all based upon having medical staff for them. So does somewhat depend upon no staff shortages due to illness impacting capacity of hospital bed numbers.


This plan also ignores the question of the majority of people who have likely been infected with no symptoms that could be identified with widespread Serology/Antibody tests. I find it alarming that this plan ignores that, is the governor priming is for population wide vaccination that is likely to be unnecessary? If we confirm widespread recovery and immunity then larger numbers of people can get back to life as usual quite soon.


The plan ignores that because people working on this are consistently finding infection rates of less than a few percent. Stanford tested 2888 samples that were negative for flu and other respiratory viruses and didn't find any positive for SAR-COV2 until Feb 21st and Feb23.


14% of women giving birth in NYC test positive; 86% asymptomatic. https://www.nejm.org/doi/full/10.1056/NEJMc2009316


That's what a 15% infection rate looks like. New York City right now.

And you guys want to take it to 85%.


There could be some limitations in sampling. Multiplex respiratory panels at Stanford that come up negative for everything... what does that patient look like?


A source for what you are saying is the linked SF article [1] which indicates that of ~3k evidently sick people with flu symptoms, 0.1-1% were confirmed to have COVID-19. Though note this is not random population sampling, on an interesting scale, so ignores asymptomatic question. Worldwide analysis of death rates [2], indicates #infected-so-far = 700-1600 x #dead so far. And data from Iceland [3], the only country with widespread sampling of asymptomatic population, is aligned with these numbers. Based on the analysis and support from Iceland, Covid-19 testing to see if patients actively have the disease are likely inaccurate and also a policy of only permitting testing of severe symptom patients is depressing reported numbers of once infected.

[1] https://www.sfgate.com/coronavirus/article/Think-you-got-the...

[2] Analysis of #infected today from #dead today, using following assumptions:

1. death statistics are reliable, since cause of death tests can adequately collect fluid samples (a major source of inaccuracy in COVID-19 testing), source = talking to medical staff at Bay Area sites.

2. E[days between first infection and death] = 14 (lost the source at the moment), Therefore, number of dead today D => number of infected 14 days ago = 100 D

3. rate of death increase consistently trends around 25%/day or 15% with full lockdown, source CDC situation reports worldwide excluding regions with restricted access to journalists

4. therefore, #infected today = #infected 14 days ago growing at 25% daily = 22X, or 7X if your region was locked down for last 2 weeks

5. so #infected=2200D or 700D

[3] Last week, CDC reported 2 deaths today for Iceland, and admittedly-non-random sampling by DeCode indicated upto 1% of population have/had virus, upto 3600. Iceland has done strict quarantining of confirmed and suspected cases, and extensive testing since February, so despite no lockdown, I would put them at the 700X end of the estimate. They report ~1000 confirmed cases, so they would actually estimate 3600-1000 infected so far. My estimate would have indicated 2200-700 X D (= today's deaths, 2) = 4400 to 1400 cases.


San Miguel county in Colorado has found 0.5% of their population has confirmed antibodies after doing 1600+ tests (out of 8,000 people in the county).

As another data point, the theory of this thing being widespread in the population seems far fetched to me.


Well, Gangelt showed 15% had antibodies (subject to, potentially fair criticisms re: methodology) so I think it's fair to say it varies by locale.

While I understand that many folks from Wuhan travel all over the United States, the non-stop options from Wuhan to NYC and, if I recall correctly, SFO and LAX meant that more opportunities existed for early spread than the middle of Colorado. In fact, I can't actually pinpoint a city in San Miguel County, Colorado -- can you? (https://goo.gl/maps/F7CJ3yfDKaf1gQjDA) I guess there's a post office in Egnar... Telluride maybe?

Certainly the sparse population created natural social distancing precluding its spread.


The strain that is widespread in New York is the European strain: https://www.nytimes.com/2020/04/08/science/new-york-coronavi...


Very cool! I wonder if that's true in the Bay Area too.


San Miguel County is home to Telluride ski resort, an international destination with about half a million visits per year [1]

[1] https://www.telluridenews.com/news/article_1547199f-46bc-547...


True, population 2484.


I like how a factual point that goes against HN wishful thinking gets downvoted.


No one is priming for vaccination because a vaccine doesn't exist yet and we don't even have a reliable schedule estimate for one.


A real plan would look like this https://imgur.com/spemOeG specifying the levels of restrictions and the metrics we will use to track the metrics. This allows people to understand what to expect the best possible. We already have huge uncertainty, we don't need to add uncertainty of government response on top of uncertainty of the virus. I think there is huge room to debate the numbers and what goes in what level, but this is what a real roadmap looks like.

This "roadmap" is quite scary as this is not a plan that would pass muster in in YC Boardroom. (1) The one chart with data is horribly innacurate: (a) It shows interventions causing worse than no interventions in the short term? (b) Shows hospitalizations increasing despite the fact that they have not for some time. (c) Shows "Surge Capacity" as a static value, which you would hope they are increasing if they really think this is the issue.

(2) It does not specify in any fashion what the different levels of coming back are. When can medical procedures resume? When can non-essential work where social distancing is easy resume (e.g. Los Angeles apparently has banned gardeners, who don't need to get near a soul)?

(3) If he believes masks work (as I do and as indicated in this presentation), why are masks not required and businesses shut down? Shouldn't we do the less painful and restrictive measure first before we shut down businesses?

(4) Most importantly there is not an actual goal clearly articulated here. Is he going for suppression? Is he going for mitigation?

I like many others are deeply upset by leadership from both parties, at all levels of government.


The reason why your solution is not good is because it pigeon holes the government into expectations. The government doesn't have a crystal ball as to how this all plays out, they need to have the flexibility to change how they want to respond to each situation without having to defend an ultimatum.

For example, even in your own example here are several situations you didn't account:

-- The availability of tests for the public at large

-- Whether we're doing temperature checks everywhere

-- Whether we're requiring people to download a contact tracing app

-- How much capacity we have in the hospital system even though cases are going down

-- If we can find a drug that helps shorten the time people spend in a hospital

-- If we find new information like masks don't help or they greatly help

-- We run out of swabs but cases are low

There are a lot of factors that has to go into how the government changes the rules and while it might make it easier for the public to be at ease when the rules are hard, it also makes it a lot harder to adjust the rules.

I think being upset at the government is your right, but I also think you should channel your energy into something more productive and thank that at least in California we acted a lot faster than other areas of the country.

I think Governor Cuomo said something very interesting the other day, to paraphrase, when he was asked whether he should've started stay at home earlier and if that would've saved lives. Of course it would have, but the interviewer is not taking into account compliance and public sentiment. Likewise, for you, I think you're viewing this problem from a very individualistic point of view to get strict rules on what happens when, but you're not accounting for the edge cases where the government needs a backdoor to change the rules with new information and to play it close to public sentiment.


> I think Governor Cuomo said something very interesting the other day, to paraphrase, when he was asked whether he should've started stay at home earlier and if that would've saved lives. Of course it would have, but the interviewer is not taking into account compliance and public sentiment.

That’s great, but right up until the shutdown, De Blasio and other NYC officials were encouraging New Yorkers to go out and support their local theaters, restaurants, and bars. And at no point did initial shutdowns meet with any substantial resistance. This is just retconning the history of the past six weeks to make himself look better.


This is true. Speaking from California here, several Bay Area counties were the first I knew of. NYC started doing shelter-in-place like 3 weeks later.


I'm all about more data, more columns. It's the framework for thinking about things. Counterproposing with a more detailed plan would be great. It's the type of dialog we should be having (e.g. what are the thresholds for mandatory masks). Not vague political grandstanding.


> I think Governor Cuomo said something very interesting the other day, to paraphrase, when he was asked whether he should've started stay at home earlier and if that would've saved lives. Of course it would have, but the interviewer is not taking into account compliance and public sentiment.

I'm living on the West Coast, but the way I remember the news from NY was that De Blasio wouldn't shutdown the city because he said he lacked the authority; he passed the buck to Cuomo to issue shutdown orders. Cuomo said that it was the Federal governments responsibility to organize and order shutdowns, passing the buck to Trump while implicitly admitting it was something that needed to be done. Trump in turn said that it was the states' responsibility. Importantly, De Blasio and Cuomo knew the stance of the person they were passing the buck, which means they knew nothing would be done. Equally as importantly, they both ended up later ordering measures they previously refused, and otherwise contradicting their earlier selves.

Meanwhile, over here on the West Coast, we saw real leadership--making hard decisions in a moment of public paralysis.[1] Cuomo and De Blasio seem to be smart administrators, at least smart enough to recognize and follow expert, consensus opinion smacking them in the face. But they clearly suck as leaders.

I'm still astonished how quick we all are to retcon recent history. (And I don't mean to imply that you are doing that, though I am responding to a sentiment that seems to defend Cuomo.) Similar revisionism happened after 9/11 and the Great Recession, where people ended up judging people and events according to narratives and sentiment that arose weeks and even days subsequent, despite obvious contradictions with then recently reported facts.

[1] Not just politicians. Noteworthy (and apropos HN) is how Seattle Flu Study researchers stuck their necks out and bent the law rather than twiddle their thumbs while the CDC fumbled.


I recommend you read this which details how Breed's actions seem somewhat politically motivated to steal show. Chiefly, there was an agreement that all counties would let their health director's announce the lock down order and Breed jumped ahead to announce it herself.

https://missionlocal.org/2020/04/covid-atlantic-london-breed...


The story leaked that morning. The SF Chronicle reported on it at ~11:30AM, explaining "County authorities were expected to announce the move at 1 p.m. and gave a draft of the order to media outlets to prepare. The Chronicle is reporting the story after a television station published the news early." https://twitter.com/sfchronicle/status/1239620219376504832

I knew Breed jumped the gun and thought it a little showy, but I assumed she did it partly to get ahead of the rumor mill. Maybe her office coaxed the TV station (KTVU?) to leak it early?

Anyhow, this is all largely irrelevant. I purposefully didn't single out Breed in my previous comment. What's relevant is that these counties had clearly been working on this order long before the announcement, which means that for her part Breed would have known about it and approved of it days prior. Which is in stark contrast to mayors like De Blasio and most other politicians outside the West Coast and especially outside the Bay Area--Newsom was almost too late in ordering a state-wide shutdown, judging by how bad Los Angeles got. They were consistently days late, during a time when days and even hours mattered.

I'm not very concerned by Breed trying to capitalize on her decisions. What matters is that she has made decisions that could have easily resulted in intense blowback (and still might) while others sat around on their thumbs too afraid of the political costs. There's plenty to still criticize Breed for, but relatively speaking she deserves some praise. And that's basically how the Mission Local article lands, too.

EDIT: See also Breed's first tweet at 11:57AM, which I think comes before her press conference, though Youtube isn't showing the time of the video, just the date. https://twitter.com/LondonBreed/status/1239626809865416704 Speaking of which, it's highly annoying how the SF Chronicle and the Mercury News update their articles in ways that obscure the timeline of what was said and when.


The attached spreadsheet is basically I've been waiting to see. I figured from the title of this post that's what this would be. Everyone I talk to is asking, "Now what? Do we just keep doing this until there's a vaccine?" This post is "California's Roadmap" as in California the government, not California the public. They all seem like questions they should have been asking themselves at least a month ago.

Sure, keep the green columns internal, but broadcast the "Levels" and restrictions, incorporate your bullet points (like temp checks). That way people can prepare for moving to "Level 4" with a rough timeline. With a possible second wave and next fall/winter being inevitable I don't think anyone would be surprised about moving backward.

Personally, I'm not upset by this. It just doesn't seem very useful to the public.


Thanks for chiming in. As I said in another thread I think at least this is the kind of framework for a discussion. Want to add more columns? Great. Want to double a number or halve a number, great.

I personally think there is zero downside to publishing the numeric targets. Of you get more data in to change them, just change them (it's at least better than now where they have dates that they just keep changing). I don't see how having a date that you keep changing is locking political leaders more than metrics that you change.


What was touched on in the reply, things like the amount and distribution of testing, the compliance and effectiveness of measures like wearing masks, and other information and treatments could change the criteria marked in green--which means they'd have to be revised publicly causing confusion. Kept internal they can revise it as things change and just announce Level changes publicly.

All of those numbers in green have been called out as likely incorrect at the moment. You can see positive tests jump as more are done in the daily numbers. In situations where people are dying they're often foregoing tests to save them for the living. At some point we'll hopefully have wider testing which will change the numbers and likely the criteria for level changes.


Thanks for replying! I agree I would like to see better numbers. However, I don't think that things like mask compliance would change the criteria marked in green, rather it would change the actual tracked metrics and require another lockdown.

While I am highly confident I didn't get everything right, I did account for the testing angle because I think that while tests are coming in on average (something like 7 days) very high positive, it is a very good sign that test quantity is wildly off. That is why I personally look at that metric. If 95% of tests are coming back negative (assuming good tests), that is a sign testing is going well. If 40% are positive, we aren't testing enough and should be conservative.

If our testing goes up which dramatically shoots up cases, even though its is a good thing I think its prudent to potentially escalate measures to be sure.

It should only be when everything is at least as good as a certain level should things decline. So for example if there are 1000 new cases in a week in california, with 2% growth rate, but 25% positive tests for some reason, then lock it down again (this is a very made up example).


The government has the power to check temperatures, force people to use a contact tracing app, require masks etc.


It actually largely doesn't have that power.

I mean, it does until challenged, and it could impose restrictions on entering government buildings -- but the government really doesn't have an unlimited authority to declare arbitrary restrictions on the right of people to peaceably assemble.

Not legally, anyway.


At least at the state level, states' general police powers have usually been interpreted to give pretty broad authority to enforce measures like quarantines and mandatory isolation if necessary to protect public health. There's a bit of recent case law from the 2014 Ebola quarantines: a few nurses who had had contact with a suspected case (but had no symptoms) were put under mandatory quarantine, and sued for unlawful detention, but courts upheld the quarantine.

There's some limit to these powers, e.g. a quarantine in SF in the year 1900 was struck down as being racially discriminatory in a way not justified by public health (only ethnic Chinese were quarantined). But courts are reluctant to second-guess this kind of thing unless it seems like a pretext.


There is a distinction between quarantining someone who is sick for the duration of their illness and putting the entire population under indefinite detention and building a long-lasting deep surveillance operation with mandatory universal participation


I think we all know each right has its limits when the greater good is at stake. Largely, it's intent that matters.


The idea of inalienable rights is antithetical to this outlook. No matter how noble the authorities’ intentions may be, certain essential rights are allegedly sacrosanct.


> The idea of inalienable rights is antithetical to this outlook.

There's no such thing. The idea that a right is inalienable is aspirational. While we should respect it, we should also respect that nothing is absolute and the best laid plans of mice and men and whatnot. We cannot allow perfect to become antithetical to good.


The draft is still legal and constitutional. If society and the constitution thinks it's acceptable to send 18 year old boys against their will to get machine-gunned in a foreign jungle in the name of "national security", then by those standards none of the measures being proposed to combat the coronavirus are an unprecendented or unacceptable violation of any so-called inalienable rights.

The virus poses a larger threat to national security than the Viet Cong, after all.


> Largely, it's intent that matters

I'm sure Earl Warren said that to himself when he locked up the Japanese Americans during WWII.


Everything comes in shades of grey, and that's a particularly dark one. That doesn't mean small concessions aren't the right thing from time to time. In the same way while Americans are allowed to bear arms they aren't allowed to bear nuclear arms. I doubt you'll find a single person in favor of unrestricted domestic nuclear proliferation in the name of the second amendment.

Especially when the country isn't even sure about bump stocks.

How about we address such things on a case by case basis?


> It actually largely doesn't have that power.

Yes it does. This is war.


No war has been declared.

But in a way, you are right. We are in a war for our futures, and we are losing.


Now you're right in a way. We're in a war for our futures against an opponent that won't do any damage to the vast majority of the population and will disproportionately negatively affect a small slice. That small slice must be protected and the rest of us need to venture out of our burrows.


>> I like many others are deeply upset by leadership from both parties, at all levels of government.

I'm sitting at home in Michigan where the governor has closed almost all businesses. Politicians bicker over weather governors or the president have the authority to reopen things. And yet there is no plan as far as I can see. No goals, no criteria to trigger next steps, nothing. Meanwhile the press just snipes at people.


it's tough to have productive coordination when the president knows so little about civics and government. it's best to ignore the president in this case, especially since he constitutionally has very little say in a pandemic response.

instead, focus on putting political pressure on your state and local politicians to come up with a concrete plan and timeline, as they're the ones who do hold power in this case.


I think this would be a very good advice in any other politically charged situation, that requires quick action. However, in the case of pandemic your own plan has to depend heavily on the worldwide plan.

If my state would manage to kill 100% of the virus within its borders by quarantine-like measures, and then reopened the economy and everything else before other states and countries do the same, we'd quickly get the spread back on track. So if there's no federal/worldwide cooperation on that coming from the top, local politicians must push up as hard as they can for a global plan to be made.

At the very least, there must be a plan per continent.


immediate and pervasive reinfection is just not a primary concern, given what we've learned over the past few months epidemiologically and politically.

no governing body would open up everything immediately and let everyone go wild mixing it up. reopening will be controlled and coordinated enough to keep a lid on transmission rates (as implied by the CA roadmap), rather than attempting to eradicate all transmission in one globally-synchronous attempt. that would be wholly unrealistic.


It's also not like politicians are busy working on a cure. Almost their sole job right now is to communicate an exit strategy. And they can't even properly align text on slides (I don't actually care about that except as a symbol of how little attention to detail they put into this).


I doubt politicians are the ones putting together these slides.

But yeah, the slide thing is kind of silly. Looks like they did most of the work with a 4:3 template, then realized halfway that it would be shown on a widescreen projector/TV.


> Is he going for suppression? Is he going for mitigation?

This is the factor that has been missing from all the reporting on this crises. The goal of suppressing the virus to zero and merely seeking mitigate the virus surge effect on available ICU beds leads to drastic differences in all metrics most notably “peak deaths”. If the goal is mitigation with rolling shutdowns, there will be many many more deaths. Virus suppression require several months of shutdown. This is the most basic result of the “models”.

None of the major outlets have reported on this at all.


The idea of suppressing the virus to zero just doesn't really exist outside of certain circles. Every government I'm aware of has acknowledged that there will be many more deaths, and all of my friends and family expect that.


Unfortunately, those "certain circles" seem to include the World Health Organization...


> I like many others are deeply upset by leadership from both parties, at all levels of government.

Yes, I agree. What’a really upsetting is they try to justify why less transparency is good thing. When they are using this only as way to impose their authority.


I don't really understand your comment. This is more of a "vision" doc that sets a framework and principles on what the plan will look like. The next iteration will be a more detailed plan. It is fairly typical of tech product work, where you create your vision statement and then create a more detailed plan


It's actually pretty effective management and leadership. As a strategy consultant, I counsel all my clients to communicate the intended end goal, and how they are going to achieve that, before getting in the weeds of implementation.


(5) In 1918, due to a combination of shelter in place, and seasonality the virus had time to mutate into something much deadlier before herd immunity was established. What is the plan for establishing herd immunity before the next strain of COVID arrives (~this fall)?


It seems fairly obvious this is not, nor was it intended to be, a “plan”.

This “Roadmap” was likely rushed out as part of a coordinated political response to threats made by the POTUS to override state decisions.

It was framed in the local press even before it was announced that the governor would be discussing which metrics the state would be looking at to determine when and how to start opening things back up.

It was shocking/hilarious/predictable to see the headlines streaming out even before Newsoms press conference was over that “California releases plan to reopen economy”.

If I was expecting a plan, and then opened this PDF, I would want to rip it to shreds as well.


Well, I think we agree it would be a crap "plan". However I think for most people "California’s Roadmap to Modify the Stay-at-Home Order" is basically something like a plan.

And Newsom's twitter seems to really allude to it being "like a plan" with tweets about this like: "@GavinNewsom lays out parameters and tools needed before the state modifies California’s statewide stay-at-home orders" https://twitter.com/CAgovernor/status/1250136291347324928?s=...

and they "announced a shared vision" https://twitter.com/CAgovernor/status/1250212300147101697?s=....

A bunch of "parameters", "indicators", "vision", and "roadmap" to describe this one thing, means most people are going to expect something plan-like.

Was this thing rushed out? Probably. But why? This is literally the most important thing that Newsom could have been working on for the last 3 weeks. He pre-announced this yesterday, he could literally have had his whole team work on nothing else.

I mean if I had to make one of the top 10 most important announcements of my life tomorrow, I would really make sure it was good.

But to be fair, and I think this was at least part of your point, maybe it is exactly what he wanted. This is a political document, not really meant for California citizens to understand what the goal of the state is, what measures will be taken, and what kinds of numbers will be looking at to make decisions.


Roadmap v. Plan is an age old argument many PMs have had!

If I draw out a map to Disneyland, even going as far to include which freeway exits to take, or maybe even going further as to plot out a few stops for gas, this still says nothing about when I will actually start the trip, how fast I’m going to drive, how much coffee I’m going to drink beforehand and how many bathroom breaks that will require, how many flat tires I’m going to get, how many times I’ll get rear ended by another driver who is playing with their phone, or how many times I will get pulled over by the cops on the way.

Some of that information is impossible to know, and some of that information has a low ROI in planning further.

> This is a political document

I feel strongly this is the case.


requiring masks seems like a shitty policy when it's still pretty hard to get them. guess who will be disproportionately affected...


I don't really think you fully appreciate what how your "real plan" or your accompanying nitpicks would be received by the average citizen. The biggest pitfall, as has already been pointed out by another reply, is that it creates concrete expectations that the government will be held accountable for.

Secondly, most of your nitpicks are great if you want to nerd out over the details of the epidemic, but most people are not going to find small details like static versus dynamic surge capacity or suppression versus mitigation useful at all or relevant to them at all.

A sprinkling of Dunning-Kruger here..


Thank you for your reply. I don't understand the objection that this is locking government in. Every level of government keeps setting dates then changing them, so I don't see how changing a criteria for a level is worse.


That’s because you don’t understand what you are talking about. You have waded into a debate where people are informed and you are not, yet when faced with an informed opinion you dismiss it as it doesn’t make sense. This is type of argumentation is a disease, ruining our ability to learn things and expose ourselves to other opinions on HN


> this is what a real roadmap looks like

Sorry, but what's your expertise in what real public health plans look like? And why are you criticizing a slide deck as if it were a carefully considered public health plan?

If you want to talk about what you'd like to see, great. We all want things, and communications can always be better. But I don't understand why you're treating your preferences as overriding, especially when you don't even know who the author is. (Hint: it's not a he.)


Governor Newsom, the governor of California, is a man (source https://en.wikipedia.org/wiki/Gavin_Newsom). This slide deck was released as a part of his press conference today. If a female staff member created the slides I don't think that changes anything, and is a poor ad-hominum attack, as the governor has presented this as his plan.

This issue (the issue of reopening) is not actually that much of a health discussion. It's a discussion about tradeoffs of a horrific deadly shutdown vs a horrific deadly disease. Health experts can help determine R0 and Rt and IFR, but they can't make these tradeoffs for us, it's ultimately a question for society.

We have to change the conversation from yelling at each other to debating the real details.


The author, according to the metadata, is Dr Sonia Angell, MD MPH, currently director of the CA Department of Public Health: https://www.cdph.ca.gov/meet-the-director

Pointing out that you don't know the source is not an ad hominem, because you are apparently offering yourself as an expert as to what a good plan is here. You also don't appear to know the difference between medicine and public health. The latter, of course, is very much about the tradeoffs between medical and other societal factors.

So I'll ask again: given that you are presenting your opinions as more pertinent than the experts here, what's the expertise you're basing that on?


Am I missing something? I don't see any kind of roadmap in here - it's just 6 generic talking points without any actual plan or timeline.


He said during the press conference that exact dates might be available in two-four weeks. He wants to see a further reduction in hospitalizations, an increase in testing, and a supply chain for PPE before committing to reopening dates.


> He said during the press conference that exact dates might be available in two-four weeks.

That's incredibly vague. Almost worthless, given that they already extended the order by another month at the last minute.


Ok, thanks for the additional context. Was there any mention of actual targets for these things? Ex. "I'd like to see a 10% reduction of hospitalizations and at least 1M tests."


Why would there be? If something goes really wrong in one of those pushing it off a goal is going to be a problem.


Because without those things it's not a real plan. Anyone can say "we'll change policies when things get better". Defining what "better" means is the actual challenge and exactly what people as a whole are looking for.


Newsom said he was giving this information to the public in the interest of disclosure. He wants the public to know what they're doing behind the scenes. He said it was just what they've been talking about, not a plan. He stated that any of this could change at a moments notice and to keep on doing what CA residents are doing because we do seem to be plateauing a bit.


They'd have to take responsibility for real metrics and a way to measure their performance. That's not going to happen at the government level.


Is there a video of the press conference somewhere? It's hard to make sense of these slides without any context.



I think part of the point is that the clock does not determine when we can start to relax quarantine, it's our readiness/ability to detect and tamp down breakouts.


It notably does not present any sort of figures, expectations, statistics, or mathematics. No one wants to take responsibility. They'd rather have nebulous goalposts they can shift whenever they like. Hell, it's worked so far in convincing people mathematical models don't need to be accurate anymore - you have people in the streets defending embarrassingly poor epidemiological models.


I’m not into politics but as a person this is not good leadership. These people are not sharing in the sacrifices they demand. Ante up if you’re going to play with people’s lives and livelihoods to this extent.


Can't have antibody testing to determine who is immune and can get back to work, can't have antigen testing to know who needs to quarantine, can't have government support for those who are off work because of quarantine, can't have support for undocumented workers who make up a good proportion of the workforce in some industries. Not going to work.


I would cynically summarize this as: lockdown is economically unsustainable. We need to go back to work. Let's hope we can control the epidemics this time better than before the lockdown. We may have new tools this time (contact tracing, masks, test). But we're not really sure they'll work.

It's the exact same situation in France where we're planning to go out of lockdown in 4 weeks. It seems unclear that we'll have the needed tools by then. It's not even clear that they'll work but there are no other options.

At least the California roadmap isn't pretending they have the answers to the question they raised...


>>I would cynically summarize this as: lockdown is economically unsustainable. We need to go back to work.

Why? Canada is giving every Canadian $2,000 every month. Why can't the US do the same while we let this thing subside fully?

Instead we're bailing out corporations, while giving everyone a one-time $1,200 check, while expanding unemployment checks by merely $600.


> Canada is giving every Canadian $2,000 every month.

No they're not, if you worked even one hour, you don't qualify for any of the $2,000. Your income must be zero to qualify for that program.


Because you probably want to eat. And you probably want the electricity and internet to stay on. And you probably want things to continue to be available. All of those require the economy to be functioning.


All those need the supply lines and critical infrastructure to stay functioning, which they can be even if the rest of the "economy" isn't.

What's needed is money for households to pay for them, which is the biggest concern at the moment, but which can technically be solved by giving households a cheque.


Many of the things currently shut down are part of supply lines and critical infrastructure in the long term. Eventually we're gonna have to print books and build cars.


Books and cars are not ideal examples to pick in my opinion, in the case of books because they're easily substituted by electronic media. In the case of cars because all car manufacturing in the US involves imported parts [1][2], so that industry largely depends on other countries' sheltering policies. Also because both are very durable. I have tomes from the 80s, and a friend of mine just sold his van from 1995 haha.

I get the point though, and it's a fair one, but the "eventually" is important to consider here. Eventually when? No one is arguing in favor of permanent sheltering, Implying that the only option is to reactivate the whole economy "soon", knowing that there could be adverse health consequences isn't giving the alternative options, some of which might be better for public well-being, the consideration they deserve.

[1]: https://money.cnn.com/2018/07/02/news/companies/auto-tariffs... [2]: https://www.nhtsa.gov/sites/nhtsa.dot.gov/files/documents/20...


I'll claim the economy can function just fine with all the bullshit middle management and software engineers working from home. Let the essential people do their essential jobs at lower risk of catching the virus - and with less micromanagement.


Isn't it amazing that an absolutely massive privacy invasion that is called contact tracing is already accepted as _inevitable_ if we are ever to be allowed to step out of our homes?

Talk about cynicism.


> if we are ever to be allowed to step out of our homes?

In France, we need to fill a form every time we want to leave our homes. Any non-work related trip should be limited to one hour and 1km, at most once a day.

This was decided with no vote or concertation within a couple of days. It also applies to people who live in rural area. They even fly drones in the mountains in order to catch lonely hikers breaking the rules. It's crazy.

Worth than that, part of the population is getting obsessed about rule-breakers, as if lone cyclists suddenly became a danger for the nation. The police is flooded with calls of people denouncing cyclists, hikers, or joggers...

Funny thing, our president said in his speech that this pandemics shall not restrict our freedom.


> Worth than that, part of the population is getting obsessed about rule-breakers, as if lone cyclists suddenly became a danger for the nation. The police is flooded with calls of people denouncing cyclists, hikers, or joggers...

I've definitely noticed on Facebook, since the beginning of this, there's a lot of shaming of people doing X, virtue signalling, I'm doing this right, how about you? etc. There's a huge political correctness and peer pressure angle to the social distancing policies.

Most people seem onboard with this so far, but I think at some point, the tide will shift. There will be growing social unrest. We're a social species, we're not meant to live in isolation indefinitely.


Did they take inspiration from Italy? That's the same stuff we are subject to every day. And yes, even here we have DDR Volkspolizei-like behavior from people eager to "denounce" those who "break the rules".

The way this lockdown has been implemented is going to cause a lot of problems at the society level afterwards.


Contact tracing does not need to be a privacy invasion - the Apple/Google implementation seems very well thought out.

https://ncase.me/contact-tracing


This is what the current plan says. Once implemented, the implementation can always be tweaked. In fact it can be tweaked in the next deploy coming a minute after the first.

Do you _really_ trust Apple and Google? I'm sorry but I don't.


Australia and Singapore's governments are rolling out an app that allows them to track every person you meet with for more than a short period of time.

Why would anyone trust them to not abuse this data?

If they wanted people to volunteer information, maybe they shouldn't have repeatedly abused trust.


Singapore is often refer to as soft-authoritarian.

It's like choosing N.Korea as an example and asking why you should trust them with your civil liberties.

https://privacyinternational.org/sites/default/files/2017-12...


I'm honestly not sure what to make of the People's Action Party winning something like 80% of votes. That's a Putin level of popularity.


I personally think we need a county-by-county approach. There is a high variation of the infection at local levels. All the news is currently about how bad New York is and it's true but we're not all New York. http://www.countycovid19.com/


It's true that regions are different, but I don't see how that translates. Can you be specific? How would a plan for Queens County, NY differ from one for Waukesha WI, except in trivial stuff like dates?

Some outbreaks are smaller, but you'll note that they all leveled off at roughly the same time and on the same schedule. That's because we locked down on "New York's schedule"[1]. If we didn't, these places which seem to have "handled" the outbreak would look like New York.

The plans should absolutely be regional in that the lockdown rules should be based on infection rate thresholds, etc... But to do that they all need exactly the same per-capita testing resources. It's the same plan.

[1] Really that's not true. We locked down on Seattle's schedule, because they moved first on most things. Seattle had by far the biggest early outbreak, but peaked earlier, peaked lower, and is now one of the better managed areas in the country. Cuomo gets all the attention but it's really Jay Inslee who saved us all.


Different regions have dramatically different population densities, and don't necessarily need shelter-in-place rules. In NYC, shelter-in-place is probably the only feasible way to reduce social interactions when case-count is exploding, but in Boise, where people mostly live in detached housing and drive cars and cases are measured in the hundreds, it might be sufficient to eliminate large gatherings and shut down restaurants. It's not just a matter of thresholds.

For all the various politicians are talking about "following the science", there's very little actual science backing up these measures. We're pretty much making it up as we go, and you would be hard-pressed to find "scientific" justifications for most of what we're currently doing.


> don't necessarily need shelter-in-place rules

Is there a cite for that? Because that's not the way the data looks.

Everywhere was growing with roughly the same exponent before lockdown. The numbers were bigger in NY because it grew longer pre-detection, but there's no reason to believe that everywhere else was any different. Really this disease's growth constant looks shockingly consistent almost everywhere in the world.

> It's unclear to me why we're making these policies at a federal level.

We... aren't. Literally every existing lockdown regime is being enforced at the state level or lower. For the Boise example you mention, the relevant regulation is a stay in place order from Gov. Little in late March.

Edit to show the point better: Go here (easily the best visualization site, FWIW), scroll to the bottom where you can see a log chart of per-capita infection rates normalized to a single "start time" metric, and compare the Idaho chart with the New York one.

https://91-divoc.com/pages/covid-visualization/

They are almost exactly the same chart, modulo a vertical offset and a kink in NY data in the second week (which consensus says is the testing backlog finally catching up).

If Idaho's detached housing and automobile dependence was reducing its rate of infection spread, it should be visible in the slope of this line. And it clearly isn't.


"Everywhere was growing with roughly the same exponent before lockdown."

No, they weren't. You're just asserting that this is true. There's effectively no way to know what the doubling rate was in a place like Boise before the national lockdown, because the numbers were in the low single digits:

https://covid-19.direct/metro/Boise?tab=glance

But even ignoring that...the site you're linking to shows a wide range of slopes on the per-state graph. You just think they look the same, because the log Y-axis compresses dramatic differences in scale, particularly near the origin. New York, NJ, Michigan and Louisiana are well above the diagonal line, while states like Wyoming, Montana, Vermont, Maine etc. are all well below it.


Idaho on 20 March was at 23 confirmed cases (above the "low single digits" metric you picked, but you can pick other points too and get the same result). On 31 March it hit 515.

That's a doubling period of less than three days. It was spreading every bit as fast as New York was. It looks like exactly the same chart with a different constant factor. Yet you insist that these identical results are somehow due to different underlying behavior? Why? Where's the research showing that?

Because the pretty obvious hypothesis is that the disease was spreading the same way because it's the same disease and doesn't care about whether you live in Boise.


One of the things we urgently need to figure out is how to prevent bad data visualization from leading to bad conclusions. Statistical malpractice isn't just a meme phrase anymore.


Edit to show the point better: Go here (easily the best visualization site, FWIW), scroll to the bottom where you can see a log chart of per-capita infection rates normalized to a single "start time" metric, and compare the Idaho chart with the New York one.

Number of cases is largely a proxy for how many tests are being done (https://fivethirtyeight.com/features/coronavirus-case-counts...). Looking at deaths is more accurate, and that shows Idaho (and all other states) well below New York.


But growing with the same exponent! The point was that Idaho doesn't need special mitigation rules, because unmitigated Idaho is somewhere around 2 weeks "behind" New York. Even here people seem not to get that point. The outbreaks are smaller outside the international cities because they were later, not because they're inherently better controlled.


They are not growing with the same exponent. You keep repeating this, even though the evidence you cite clearly shows that it's not true.


I literally gave you numbers elsewhere in this thread. Argue there and cite your own, please. You seem to be the one arguing without evidence.


I used the graph you gave me. You aren't reading it correctly.


All right, here's a different example. Loving County, TX, is roughly 50 or 100 people. It has roughly the area of Los Angeles County. "Don't leave your house" is a bit more ridiculous when the next humans are 20 miles away. Sure, maybe don't go visit them... but stay at home? Why?


OK. That seems like sort of a strawman, but fine. I'm OK with very rural areas having a "Stay home, OR at least 20 miles from the nearest people" rule. Is Loving Texas really chafing under the existing shelter order? I mean, surely that's the way it's being enforced currently, no?


Out there? I doubt it's being enforced at all. How would you?


Multiple states don't have shelter-in-place rules, but still remain very different from NY. (They still have some rules, of course; I agree it seems silly to claim that it was safe to do nothing.)


Those states are in for a surprise like Florida was - they may get lucky and just have a very low rate of spread into their state - but if they have a lot of community transmission the disease will spread very quickly and the lack of a reasonable response will be obviously stupid in retrospect once again.

Shelter-in-place is a good general rule - we can roll it back when we've got infrastructure to vaccinate people.


Florida isn't doing great, but it's not doing as bad as New York either.

I'm not sure what you're referring to about vaccination. As California's roadmap lays out, we'll need to roll back shelter-in-place long before vaccines are available and find less costly ways to mitigate the virus.


Jay Inslee and the Seattle Flu Study. Without the flu study going against medical guidelines (along with the guidance of the CDC to adhere to those guidelines) and testing some of their samples for COVID-19 (which isn't what they were collected for), Washington's timeline would have been pushed much further back.


Don't forget Newsom, who issued the first state-wide shelter in place order. That has been invaluable in keeping California safe(r).


> except in trivial stuff like dates?

Dates are not trivial when people's very livelihoods are at stake.


You know what I meant. You can write the same plan for different regions with parameters. There's no inherent regional interest that requires every county government in the US staff its own disease control department.


I live in Nevada County, which apparently has a very low infection rate (34 cases, none in the last week) but if you open this county, what prevents folks from other countries from flooding in and bringing more infection? This county was previous a tourist mecca so it would be especially inviting. But any county that was open would be an appealing destination for the closed counties.


Nevada County is a particularly good example here of one of the failings of a county-by-county approach because Sierra Nevada Memorial Hospital there isn't really equipped to deal with a large number of critical care patients, and neither are many other rural counties. It would take far fewer cases to incapacitate Nevada County's health care infrastructure than Placer County or others to the west.


> because Sierra Nevada Memorial Hospital there isn't really equipped to deal with a large number of critical care patients

That makes me think its sterling example of why we need a county-by-county. Don't just base it on infection levels though, as you pointed out. Include hospital support, ppe levels, interconnectedness, etc.


I see this as an argument for a county-by-county approach in which the specific circumstances of the county are taken into account.


Why?

I don't see why any "deemed safe" county wouldn't be overrun by visitors from unsafe counties, making the county unsafe again. Maybe you could find a county so remote it wouldn't matter but whether those extremely isolated places are opened up now or not probably doesn't matter either way. I doubt they're much effected by this situation regardless.


I don't understand your argument. Are you thinking that there will be two kinds kinds of counties at each point in time, those "deemed safe" and those "deemed unsafe"? If so, that would explain my confusion. I imagine that each county would be advised to implement one of a small number of strategies, in consideration of the peculiarities of that county, its economy, its normal levels of travel, its immediate neighbors, and the effect they are likely to have on their state (and even the nation) as a whole.

Are you thinking of the people who would be willing to drive far distances simply to, for example, go out to eat? I would assume that this analysis would be included. Close proximity to a large population that's on lockdown is, in my opinion, a reason to keep the lockdown in a county, even if that county doesn't yet have many cases. But the next county over might or might not open up. Sure, people near the border from the second county will just go into that third county, and that's fine - as long as there aren't too many people coming from the first county.

Politicians and pundits simplify and say stupid things, when taken literally, but when it really comes down to it no one is really suggesting that the state of affairs within a county be the sole determining factor for the degree and form of economic activity which will be permitted. We have to look at the larger region. But once we look at the larger region, it will probably make perfect sense to completely lift the shutdown in some counties (esp. in Alaska, Montana, Wyoming, etc) while keeping a strong shutdown in other places.

Edit: I assume that we will also be looking at individual industries independently. Can the companies in a certain industry in a certain region reliably commit to following strong anti-COVID practices? If so, we might let them open up, while other industries are not allowed to. We don't have the time to create certification bodies or licensing departments to handle these specifics, so politicians will just have to make the best decisions they can.


When I turn on the news at night, I don't see the information for the county I intend to visit once it's deemed safe(er) to travel. I see the information for where I live.


If you’re going to travel to another county, you could check the website for that county to see their rules.


Yes, we already have to do this at the state level, at the moment. It's in the best interest of a region's government (whether county or state) to make sure the rest of the country is aware of their rules, so they don't have people showing up with incompatible expectations.

I don't imagine there will a increased multiplicity of confusing rulesets beyond what we have now, either. Many counties will simply adhere to some standard recommendation from their state, and the rest will copy one of a small number of recommended levels along a spectrum of openness.


Agree completely, it seems like everyone wants to treat every municipality as NYC, just scaled down. I’d like to see county-by-county assessment, with added common sense restrictions like elderly and sick people self-quarantining, which I think at this point people are familiar and somewhat comfortable with.


In the live address they said that most implementations will be left to the county and local govts. The state isn't giving any specific guidance on masks, for example, leaving that to specific locales.


LA county now requires anyone entering an essential business to wear a mask.


Pretty sure that's just the City of Los Angeles, not the county. I haven't been to any grocery stores outside DTLA that required masks. (though 7-11 did)


As is Sonoma County, today.


this is probably a little overly cautious relative to the actual reduction in risk (you'd have to be especially unlucky to get infected just from regular breathing in a grocery store), but not terribly unreasonable, particularly for those with co-morbidities.

but i routinely see people with masks and gloves on while walking outside. not shopping, or going to shop, just walking. it's so odd, and frankly, wasteful.


> frankly, wasteful.

I think I disagree.

It seems that face masks are quite effective in reducing the spread of illness. For example, look at the numbers in South Korea, Japan, etc. (where mask-wearing is common) compared to ours. Masks don't need to do 100% of the job -- rather, we would hope that in combination with moderate social distancing, better hygiene, improved testing, etc. we could reduce the rate of transmission. If each infected person spreads the illness to an average of only 0.9 others, then it won't do much more damage.

Now, from an economic angle, the US government just passed a $2 trillion stimulus package, which works out to about $6,000 per American. There are calls to spend much more money. Suppose we spend 5% of this on face masks, so $300 per American.

Currently, face masks can be bought at $20 for a box of 50 on Amazon. That gets 750 face masks to every American, at a cost that is cheap relative to the other costs of Covid-19.

And this is ignoring economies of scale. If the government decided to distribute free face masks in every school, every restaurant, in every theater, etc., then it could produce them at much cheaper than 40 cents each.

All in all, it seems like a potentially good investment.


99% of the reduction in transmission comes from physical distancing alone while inside of closed spaces with strangers. hygiene is likely negligible outside of a very few high interaction zones inside those enclosed spaces. testing only improves targeting who to distance (isolate).

it's a virus that rides on tiny masses of water to hopefully jump into the nasopharyngeal cavity of the next host. if it doesn't make it to those warm and juicy brachiae, it exponentially decays to the elements in hours. relative to air, those virus-laden water masses are heavy. most fall at your feet. some fly a few feet. very few make it many feet.

then imagine your chances of making a full-court basket (94 feet, 9.4" diameter ball in 18" hoop) and then divide those odds by the several orders of magnitude smaller that viruses are relative to us.

wearing masks (or gloves) outside makes no sense. you might as well walk around with your own lightning rod too then.


Substantial research contradicts your claims. See https://www.masks4all.co for links.


that site serves to reduce anxiety rather than transmission risk. none of the graphs and pull quotes, presumably the strongest arguments they could find, address the added risk reduction of masks above other prevention measures like distancing, and especially not concerning outdoor, non-group settings for the general public.

emergency personnel, medical professionals, and essential business workers should wear masks because they are at elevated, face-to-face risk.


> 99% of the reduction in transmission comes from physical distancing alone while inside of closed spaces with strangers.

This is an extremely strong statement. Although it might be plausibly true, my impression is that the transmission of the disease isn't well enough understood to make such assertions with confidence.

Can you cite a reference for your claim?

I think it is agreed that physical distancing alone while inside of closed spaces with strangers is an extremely good idea. Wearing masks is, potentially, also an extremely good idea.

Shouldn't we adopt any and all measures that have the potential (not certainty; potential is enough) to substantially cut down on Covid-19 transmission, and whose economic and other costs are comparatively modest? Even if we later determine that only one of these measures was really necessary, I doubt that we'll regret our efforts.


"For example, look at the numbers in South Korea, Japan, etc. (where mask-wearing is common) compared to ours."

There seems to be a huge difference in the trajectory of cases in Japan, vs South Korea, so I don't know what you think you're saying, if you group them together. In South Korea, cases went up and then apparently flattened out almost completely. In Japan, the graph I saw has been lower than in other places but is, almost uniquely, not flattening so far, even in the way that Italy or the US has.

So it makes no sense to me to combine them and say "look, that is the example". If one is the example, the other most likely isn't.


Can't defend the gloves though.


I wear masks in public, even though I have no comorbidities, because of all the people I might subsequently spread it to if I got it. Remember that asymptomatic transmission for several days is common.

Putting on a mask takes a few seconds, so compared to all the suffering it might prevent, even at 0.01% probability, it's well worth it.


no one is arguing that you disregard others, especially those who have comorbidities, only that a mask adds negligible risk reduction outside, above and beyond the natural physical distancing of strolling down the sidewalk.

risks differ with context.


Do you have evidence that risk reduction outside is very small? I haven't seen any, and I think it would be nearly impossible to collect such evidence.

A plausible rule of thumb seems to be: if you could smell someone's cigarette smoke, you could inhale their viruses. I certainly smell smoke from smokers I pass on the street.


there are no studies done, because, as you note, it would be difficult and costly, and it's a simpler (and more easily followable) message to tell people to wear masks all the time.

but here's some additional intuition:

1. it's true that virus particles are roughly the same size as smoke particles, but infected people exhale virus "pucks" that are agglomerations of multiple viruses and water, leading them to fall while smoke floats (giving us the 3-6 foot rule, per prior coronavirus studies).

2. a single virus particle in the air without water could float around but is overwhelmingly likely to fall apart quickly. the air doesn't provide the countervailing forces to keep it together, and the bombardment of energies from all around also pull it apart.

3. the fact that a homemade mask allows smoke right through but filters out some portion of the virus pucks (as per your prior link) is evidence in itself of the differential affinities of smoke and virus pucks.

but let's face it, most people wearing masks (outside) do it because they think it's protecting them from the filthy other people. however, if you're sick, all you're doing is concentrating the virus pucks in one place right in front of a face we'll each touch 30 times an hour. no lay person consistently observes the contamination rules that hospital personnel do, especially when infection rates are <0.1% and failure to do so has no obvious downsides. masks could in fact be more dangerous because of a false sense of security.


Problem is the travel between counties, at least in CA. There's a lot of travel that could cause reinfection.


I'm not too sure reinfection is as important mathematically as some think when you realize the goal will be to operate below a threshold of cases, not eliminate covid entirely.


The problem is that Covid-19 spreads extremely fast in unprepared populations. It only takes one unaware person to infect hundreds. Check out what happened in South Korea where they had the problem contained until one woman decided to go to church.


The woman went to a very large church, with over 1,000 people in the room. Such large gatherings won't be allowed for a while.


A few religious leaders seem intent on making those large gatherings happen, regardless of prevailing medical and legal advice.


Churches are usually exempt from the shelter in place rules. Thankfully most are still observing the rules, but it's not because the government is forcing them to.


Reinfection is only unimportant if you don't have a large number of people who are going act to reinfect. If you do have a large number of infections, then of course refection is going to matter. And we do have a large number of cases in the most affected counties.

Basically, just like you don't want to overwhelm hospitals, you don't want to overwhelm your contact tracing infrastructure


It just takes one super spreader to reinfect a population, especially without herd immunity or vaccinations.


Which is exactly why we need to aim for herd immunity as fast as possible, but not too fast to overwhelm the healthcare system.


Thanks for sharing the link. But how do you enforce stay-at-home policies or any rigorous public health policies, in populated counties that border each other, such as San Francisco and San Mateo counties, or LA and Orang counties.


I think you are asking specifically about the enforcement issues that derive from neighboring populated counties with different policies? Neighboring counties can and should coordinate to address this, possibly choosing to enforce the same policies even if they have different infection rates, as they did for the initial lockdown in the bay area. This doesn't prevent us from using a county-by-county approach in other areas.


The county health officials would presumably coordinate with each other, as San Francisco and San Mateo are already doing.


But to your point, San Mateo is not closing off 280 and 101 to stop S.F. traffic. And the Governor has issued a stay-at-home policy to the San Francisco Bay Area, not just one or two cities. So that's why I think area-wide policies work better than county-by-county policies. We could have San Diego area ban and policy, L.A./OC/San Bernardino, Santa Barbara/Ventura/San Louis Obispo... you get the picture.


It was not the _Governor_ who issued those orders in the bay area, it was the local county health officers acting under the authority granted them by the state legislature. This wasn’t some top-down fiat. I am grateful that my local officials have decided to act in solidarity in this instance, but it wasn’t a structurally certain outcome.


Yeah, that makes sense to me. (And presumably the Bay Area is going to keep moving in lockstep as it has been.) It'd just be silly if Tuolumne County had to stay sheltering in place because of conditions in the LA area or something.


In all sincerity, New York wasn’t Wuhan either. If I were any any other state, I’d absolutely limit travel from NY and screen them.


Really? New York current has quite a few times the casualties of all of China (10834 vs 3341) with a small population than Wuhan and the casualties haven't stopped there. New York by itself has one of the high casualty levels in the world by any measure.


Any comparison using the officially reported death toll in Wuhan at face value is of no value whatsoever.


It has value - it should just be treated very skeptically.

And, honestly, the US numbers are highly inaccurate as well due to a simply lack of an ability to test (instead of a lack of will to publish the real numbers).


The casualty numbers are quite accurate. The US records every cause of death.


The US cannot record data it doesn't have. Covid is only the cause of death if the deceased had Covid; and we cannot know that unless we can test them. In aggragate, we can sidestep this issue by looking at excess death, but that is non-trivial (particuarly because the behavioural changes mean that we would expect other causes of death to differ in unknown ways). At the end of this, I would expect to get fairly accurate estimates for how many died to Covid, but while we are in the middle of it, the numbers are very murky.


Indeed, if you look at CDC's cause of death numbers you will see they only list till 2017.

https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

https://www.cdc.gov/healthequity/lcod/

At least that is what I could find. I was curious to see if I could find some month to month chart on all deaths for March, February, and January. I could not find one.


https://twitter.com/MarkLevineNYC/status/1250170016504430595

@MarkLevineNYC BREAKING: NYC publishes, for first time, data on fatalities that includes "probable" cases (those without a confirmed test result).

It has pushed the death toll in NYC up by 57%.

Was 6,589 before this adjustment. Now stands at 10,367. This is a painful but necessary accounting.


That is categorically false. They’re not testing every dead person for the virus, and most people die from one of its side effects, like pneumonia.


Have you been on site in Wuhan? Collected any data? Where can we get a copy?


No, we don't have solid data on Wuhan. Neither does anyone else outside of China (or so we strongly suspect). The question isn't whether someone has better data than you. The point is that you don't have believable data for Wuhan.


New York started their business closures and stay at home orders 2 weeks after Seattle and California closed down. That’s why they ended up with so many more cases and deaths than the former two.


New York on lockdown is also busier then Seattle on a regular day.

Have you seen any of the photos of the packed subway trains, a week and a half into the lockdown? Seattle doesn't see that sort of thing even in rush hour.

Likewise, if you live in a highrise in New York, you're going to be taking the elevator to go get groceries. Usually with other people...


Higher reported casualty rate.


The key thing is "reported" casualties. It's well known that actual casualties in China were MUCH higher than actually reported.


I suppose I worded it wrong. What I meant was, you might not be New York now, but you could be.

New York didn’t think they’d top Wuhan.


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