I live in Canada and our response between January - mid March was in line with the U.S. where the government said things like "the risk to Canadians was low" and "asymptomatic people are not main drivers of epidemics." That laissez-faire attitude perpetuated the belief that we didn't need to screen people at airports, or force people coming in from hot zones to self-isolate for 14 days.
Meanwhile, a country like Vietnam which doesn't have the same technological or financial resources as North America managed to quell the spread through mass quarantines and aggressive contact tracing done as early as February. They literally fenced off a village that had one known infection.
Taiwan acted quickly and decisively throughout the key time periods of the crisis. Things like stockpiling and producing more PPE in January, making quarantine taxi's ferry potential infected to their homes instead of allowing them to take public transit, using technology to aid with contact tracing, mandatory use of masks in public spaces, thermal screenings at airports and stations...
Looking back, I think we both woefully under-estimated the potential for asymptomatic/pre-symptomatic individuals to spread the virus. As a society we looked at the low numbers and scoffed at the idea of doing proactive preventative measures... until it all hit the fan and we had to hard stop.
i think there is a lot of superiority feeling in Western countries over Asia and then in Western countries against each other. For example when things started happening in Italy
the Germans thought that it's an Italian problem.
As far as the US goes it was pretty clear that the administration didn't want to deal with this at all at home. So they were constantly behind the curve and did things only when basically forced.
> For example when things started happening in Italy
As someone who lived in Italy and now lives in the US, this was driving me absolutely crazy. They have a great health care system, and are a transparent democracy. When things started to happen rapidly there, it was very, very clear that the same situation would play out in the US, and yet there were still a lot of "just a flu" people.
> When things started to happen rapidly there, it was very, very clear that the same situation would play out in the US...
When it was still restricted to China, I was able to reassure myself into complacency with memories of the original SARS. China contained that, so maybe they will contain this one, too?
As soon as it hit Italy hard, that story didn't work anymore, and it was clear it was only a matter of time before it spread everywhere.
> Didn’t the mayor of Florence have a “hug-a-Chinese” day in February? There was so much political correctness around banning travelers from China that it probably cost significant lives.
They were one of the first countries to ban travel from China.
What you call "political correctness" was just an anti-racism message.
Italy certainly had some things go wrong in some areas, but they were also unlucky in some ways, being the first country to get hit hard.
I went back to my home-town in mid-Feb and we had thermal screening at the Airport. All the staff working there wore mask and gloves. We were asked lots of questions, noted our contacts, backup contact just in case mine fails. The north-eastern region of India, including my home-town, have zero to low positive cases right now. We also border with Myanmar.
That same week, I flew in and out of Delhi, UP, Rajasthan, and Bangalore without seeing any screening.
A few days back (mid-APR), we (me, my father-in-law, and my wife) got calls asking how my Japanese friend is doing as he was there in my home-town too (in Feb).
Taiwan did not warn the WHO. Go read the actual letter, it was verbatim of what was released by China.
Go read the WHO press release again. It literally said "no evidence of human to human transmission" at the time. It did not say "NO HUMAN TO HUMAN TRANSMISSION." Stop spreading FUD.
In the December 31 2019 email, Taiwan specifically references seven cases of “atypical pneumonia” as well as mentioning it was not found to be SARS (and by implication that it may be something else).
Taiwan’s position is that by making it clear the new diaease was an was “atypical pneumonia”, it could reasonably be inferred that human to human transmission was likely.
The WHO claiming “no evidence” after this was pointed out to them is the issue - there was some evidence, even if it wasn’t conclusive.
This is the actual email, it does not mention human to human transmission.
> "News resources today indicate that at least seven atypical pneumonia cases were reported in Wuhan, CHINA. Their health authorities replied to the media that the cases were believed not SARS; however the samples are still under examination, and cases have been isolated for treatment. I would greatly appreciate it if you have relevant information to share with us. Thank you very much in advance for your attention to this matter."
Remember, when WHO says, “no evidence,” it means there is currently no scientific evidence to prove it, not that it can’t happen. Anecdotes are not evidence.
I agree it does not use the words “human to human transmission”.
At the same time, Taiwan claims that by calling it “atypical pneumonia” there was an inference that human to human transmission was possible, or even likely, and so as a result the claim of “no evidence” by the WHO was overstated.
Taiwan is likely also overstating their case. That being said, if the exact same information was passed to the WHO from, say, Germany, it is quite likely it would have been taken with more seriousness.
Taiwan being excluded from the WHO to placate China is a bad thing if your primary focus is world health. Politics should play no part.
Bluntly, Taiwan lied as part of a coordinated propaganda campaign by US and Taiwan [1] [2]. This was around the time western media articles started spinning up revisionist Taiwan WHO stories. Nevermind, it's literally impossible for Taiwan to know epidemiological characteristics of covid19 on Dec31 when their first imported case was on Jan21. It's propaganda, not even good one since it assumes time travel.
Taiwan's email is basically what Chinese CDC reported to publicly [3] and to WHO [4] verbatim, note date and content - SARs like viral pneumonia treated in isolation which is standard practice. They provided zero addition information and tried to swing it as new information retroactively to manipulate public opinion. Taiwan's own CDC deputy director of disease control quoted in early January that H2H could not be determined until new cases are confirmed after Jan14 [5].
But I feel like there's an equivocation on "determined" here. Taiwan was screening passengers from Wuhan from the beginning of January; even if they didn't know human to human transmission occurred, they clearly thought it was a good thing to presume.
I think any sensible epidemiology response would presume H2H to be possible if the unknown viral pneumonia is compared to SARS. The fact is Taiwan, Hong Kong, South Korea, Singapore response are all inline with WHO recommendations to screen, test, trace and isolate on Jan23. Early Jan screening, pre testkit, was basically temperature checks that is insufficient given asymptomatic transmission. Most East Asian countries did this as well, but in retrospect it was essentially security theater. The only deviation in response was early travel bans to China (initially only to Hubei) but this was also AFTER Hubei lockdown which was a pretty clear broadcast that the situation was serious. I would argue also unnecessary since imported cases statistics from these countries (and others) demonstrate covid19 never spread much in China. For example, Taiwan repatriation ~1000 out of Wuhan with 1 positive test. At the end of the day, countries that took prompt actions based off WHO recommendations did well and without massive civic disruptions. The countries that waited too long suffered.
This is one of those completely false things that people only believe is true by repetition. Go back and actually read the full set of WHO statements in mid-January. They have a bunch of statements saying that nations should get prepared, one saying that specific studies haven’t yet found hard evidence for person-to-person transmission (because at that point most of the cases they’d managed to find were tied to the market). The WHO never, ever said that it can’t be transmitted, and they absolutely never said that people should do nothing about COVID-19. They were urging nations to act for months before they actually did.
I thought their statement was that there was 'no evidence' of human transmission (which I believe there wasn't at the time), rather than a definitive statement that there wasn't human transmission.
I could be wrong, there's a lot of information out there and I'm not keeping up
They said there was no evidence, but to a lot of people, "no evidence of" is basically the same thing as saying it "it doesn't transmit human to human". At least to me, saying "we don't know if it transmits human to human" seems more clear. "There is no evidence" to me implies that they checked and didn't find any evidence, not that they hadn't had a chance to look over the available information.
It'd be like if I said that "there is currently no evidence of global warming", just because I personally hadn't looked over the information.
That's not a comparable number since number of cases depends on how many are tested. For example, Denmark have drive through testing centers, Sweden doesn't.
I never said the number of cases in SE vs. DK was comparable. I said the cases to deaths ratio was very high in SE. Lack of testing only further proves my point.
> They literally fenced off a village that had one known infection.
Some countries frankly have a different arsenal of tools available to them in how they can respond.
It’s sad but true that the more authoritarian regimes are able to lockdown harder and faster.
When Trumped raised the notion of fencing off hotspots, Cuomo called the idea of a physical cordon 'totally bizarre, counter-productive, anti-American, anti-social'
Added that such an order would be tantamount to a 'federal declaration of war' and a 'civil war discussion'.
I do wonder if the intent is to lockdown and contact trace their way all the way to the point until a vaccine is developed, tested, and can be administered widely, and if that is the intent if they will ultimately be successful and at what cost?
Depending on the overall timescale, this could amount to judging the race after the first few miles of a marathon.
There's pretty strong evidence that a light, mostly voluntary, shelter in order, with restrictions on crowds and certain crowded-y places like bars, (AKA the SF bay area policy) is largely sufficient. If the whole US had the bay area's mortality and infection rate we wouldn't be having the same conversation. In terms of "freedom", I haven't felt like if I needed to go into work it would be a problem, and I've gone in twice to take care of critical on-prem infrastructure.
> There's pretty strong evidence that a light, mostly voluntary, shelter in order, with restrictions on crowds and certain crowded-y places like bars, (AKA the SF bay area policy) is largely sufficient
Maybe that’s dependant on location. AFAIK Italy and Spain tried the voluntary model before having to be more authoritarian.
I don't know what italy and spain did, but when i say mostly voluntary, I really don't mean completely voluntary. the bay area has shut down bars and entertainment venues, and food service has no sit down service. Everything else has basically voluntary compliance - notwithstanding possible bad behaviors in neighborhoods I don't pass through anymore, there aren't cops going around arresting people for not obeying personal space distancing (though you could probably get in trouble, at least post facto via lawsuit, if someone found out your open air office was filled to the brim with employees).
I’m not 100% up to speed on San Fran stats, but looking here [1] it seems like up until last week they were running about 400 tests per day with about 20% coming back positive. Hospitals were basically empty.
I’m not sure what “mostly voluntary” means when businesses are forced to close.
Testing rate is much lower in CA than in NY and MA. So is case count and fatalities per million.
MA has been locked down pretty hard for about two months now. We are still seeing thousands of new cases a day. It certainly hasn’t had the same effect here as it did in the Bay Area.
I strongly suspect there is something distinctly different is happening in MA vs. CA and it’s not due to varying degree of lockdowns.
In April the average percentage positive was 10.4%. Over the last 56 days since the first positive test, the average positivity rate was 12.4%, and it was greater than ten percent 62% of the time.
Even granting what you just said it is still far from your 20% claim. And your way of averaging does not make sense. For example in March there was a day when 3 tests were reported with 1 test positive for a whopping positive rate of 33%, which would contribute half a point to the number you just calculated. How is that reflective of anything meaningful? To get meaningful average, you need to total the positives and divide that by the total tests over the period of concern. You can't simply average ratios.
You're right. Neither "with about 20% coming back positive" nor "mostly hovers in single digits" precisely describes the positivitiy rate for that area over time.
Rather than debate who was more wrong about the precise positivity rate in SF, I think the more fundamental discussion is around GP's comment that there's pretty strong evidence that a "light, mostly voluntary, shelter in order" is largely sufficient to achieve the low case count and mortality seen in the Bay Area.
I think that's not only far from proven, but there are many counterpoints of areas which have been locked down hard for many weeks and yet still saw pervasive community spread, and high case and fatality rates.
CA had it's first known case on Jan 25th, and a week later Day 7 the 3rd case in CA was discovered in Santa Clara, bring the US total to 7. Day 40 / March 4th CA reports its first death. Day 43 / March 7 San Francisco bans large gatherings in city-owned facilities. By March 13th (Day 49) Santa Clara bans gatherings of 100+ people and schools close as of March 16th. March 16th, Day 52, marks the first shelter-in-place orders.
MA had it's first known case on Feb 1, the second known case was not reported until March 2. (Do we call March 2nd as Day 1 or Day 30? Lets go with 30.) By March 6 (Day 36) total cases in the State were up to 8. By March 12 (Day 42) total cases were up to 108. On March 13 (Day 43) the Boston Marathon was postponed and gatherings of 250+ were banned. On March 15th (Day 45) Baker ordered all restaurants closed, and banned gatherings over 25 people, and announced public schools would be closed starting March 17th (Day 47). On March 20th (Day 50) MA had its first reported COVID death. By March 23rd (Day 53) the governor announced a "stay-at-home advisory", closed all non-essential businesses, recommended social distancing protocols, etc.
By CA's Day 40 they had 50 cases and a reported death, while MA at their Day 40 also had about 50 positive cases (most of which contact traced to a Biogen conference) but no reported deaths. By Day 50 MA had tested 5,000 and had over 300 cases and saw their first death. CA by their Day 50 also had about 300-400 cases. Both states closed on Day 52 or Day 53 of their respective outbreak.
At the beginning both states responded approximately the same. As of today, the outbreaks are entirely distinct.
I think a better analysis would compare e.g. Boston to one specific major metro area of CA, not a whole state-by-state level comparison.
I think what is clear is that China, the initial epicenter, exported far fewer cases than Europe. This can be seen by examining countries around China and far more integrated with China and overseas Chinese communities. Really this is a disease mainly spread by close contact. So the dominant spreaders are those with high community contact. I remember the feeling of OMG when seeing the announcement of all the high flying jetsetting group getting hit in March. I am on the west coast, yet our cases didn't start going exponential until after Europe exploded. Yes Seattle and Bay Area were likely seeded from China. But it started with low count, and coupled with our sprawl and high percentage of Asians who were attuned to the seriousness of the outbreak in China, it was a simmering outbreak. The east coast otoh got a major frontal assault from Europe.
It is unfortunate that this is getting downvoted, but I feel that it is true to at least have an open mind on the number. So, I'd like to give a bit of my own personal context here. I moved to Saigon 4 years ago and I follow the VN news very closely. I've traveled 15k+ km through the whole country (along with Laos and Cambodia), by motorbike. I have been in the largest cities and explored some of the most remote areas.
The thing you need you realize here is that this is the first time the govt, north to south, has really truly cared for its citizens. It sounds harsh, but think about it. No expense spared. 60,000+ people put up in quarantine. Borders locked. Full public reporting of the contact tracing. Locking down entire towns (some I've even been to myself in the not too distant past). The response has been swift and very very nationalizing.
Unlike watching US people split down the middle and fighting about everything, Vietnamese people are quite proud of their country. There is a lot of 'saving or displaying face' type news and actions. At one point, the country went two weeks without a new case... daily proud updates in all the news about this... until some girl flew in from out of town with it and super spread it to a whole bunch more people. After that, things got even more serious.
The point is... the govt is very proud of their track record of zero deaths. Reuters went in and tried to get the govt. to talk about their claims and nobody would speak [0]. If you are so proud of your number, why not tell the world all about how you got there?
This is a govt that hasn't been exactly known for being the most umm, how do I say it nicely ... clean? By the way, one of the heads of their cdc got caught profiteering off test kits.
So, while I'd love to believe that all the sudden the vn govt cares about its citizens more than anything else and that their numbers are magically amazing because of so much hard work. I just find it really hard to believe that a country that borders China and has a litany of social issues, could be so perfect.
I mean, how many millions of pigs did they cull from swine flu? It wasn't like they were able to do nearly as well controlling that one and it wasn't even human!
Oh and one more thing... this won't last. Social distancing is easing in the country. People are going out in masses over the weekend because it is Liberation day. The timing couldn't have been worse. Just look at some of the images in this FB group [1]. Da Lat is a very small mountain town, that is tens of thousands of people. Mostly kids... which means they will go home to their parents... =( This is Vietnam's Florida beaches event...
Meanwhile, a country like Vietnam which doesn't have the same technological or financial resources as North America managed to quell the spread through mass quarantines and aggressive contact tracing done as early as February. They literally fenced off a village that had one known infection.
Taiwan acted quickly and decisively throughout the key time periods of the crisis. Things like stockpiling and producing more PPE in January, making quarantine taxi's ferry potential infected to their homes instead of allowing them to take public transit, using technology to aid with contact tracing, mandatory use of masks in public spaces, thermal screenings at airports and stations...
Looking back, I think we both woefully under-estimated the potential for asymptomatic/pre-symptomatic individuals to spread the virus. As a society we looked at the low numbers and scoffed at the idea of doing proactive preventative measures... until it all hit the fan and we had to hard stop.