The hard part of the economics of Covid-19(thereader.mitpress.mit.edu)
thereader.mitpress.mit.edu
The hard part of the economics of Covid-19
https://thereader.mitpress.mit.edu/flattening-the-coronavirus-curve-is-not-enough/
267 comments
My government told us today that they have excess capacity and will not run out. They have been preparing for this crisis for “over a month now”
In fact, they are still going ahead with cutting doctors pay in the midst of it all. Maybe we deserve it for electing a nut job who only cares about budgets (Alberta)
In fact, they are still going ahead with cutting doctors pay in the midst of it all. Maybe we deserve it for electing a nut job who only cares about budgets (Alberta)
When I was in Edmonton and Calgary it always seemed like Alberta was hellbent on moving the exact opposite direction of the other provinces.
> but I am not sure that's true, in Italy they are building hospital wings or re-adapting abandoned hospitals in many places. Rome has 4 planned covid hospitals as of now.
True. But those are being done after the fact. It's too late already for Italy. By comparison, the U.S. still has time now before the curve shot straight up to the max - then no amount of measures are going to be able to keep up with the viral infection rate (and death counts)
True. But those are being done after the fact. It's too late already for Italy. By comparison, the U.S. still has time now before the curve shot straight up to the max - then no amount of measures are going to be able to keep up with the viral infection rate (and death counts)
> By comparison, the U.S. still has time now before the curve shot straight up to the max
How much time do you think there is? Until recently there have been very little testing, so we don't even know where the US is on the curve.
Even if we assume it's early, that's still just a couple of weeks if time.
How much time do you think there is? Until recently there have been very little testing, so we don't even know where the US is on the curve.
Even if we assume it's early, that's still just a couple of weeks if time.
The US, like most other countries, is only a couple of days behind Italy.
Italy had 100 total cases only ~20 days ago.
The problem with this virus is that it goes from 1 case to hell in only a couple of weeks. If you already have 100 confirmed cases, it's too late to stop what's coming.
Italy had 100 total cases only ~20 days ago.
The problem with this virus is that it goes from 1 case to hell in only a couple of weeks. If you already have 100 confirmed cases, it's too late to stop what's coming.
So conversely if US hasn’t gone to hell in a couple weeks, it indicates we’ve been doing something right?
Sadly that's not a possibility.
According to mathematical models the capacity of your hospitals will be exceeded by more than 30 times.
Give it another week or two.
https://www.imperial.ac.uk/media/imperial-college/medicine/s...
According to mathematical models the capacity of your hospitals will be exceeded by more than 30 times.
Give it another week or two.
https://www.imperial.ac.uk/media/imperial-college/medicine/s...
As a follow-up to this message, we're now 9 days later and New York is overwhelmed, predicted to run out of intensive-care beds tomorrow, with other states quickly following.
[deleted]
If our testing infrastructure is in place to get correct counts, yes. Countries can be "graded" based on their trajectory on this graph:
https://ourworldindata.org/coronavirus#trajectories-since-th...
https://ourworldindata.org/coronavirus#trajectories-since-th...
> Also, the Italian government plans to hire a ton of medical and paramedical staff, money has been earmarked.
Where will this staff be coming from ? Are there medical professionals currently unemployed in Italy or working in other jobs ?
Where will this staff be coming from ? Are there medical professionals currently unemployed in Italy or working in other jobs ?
Yes, for example ~10000 people holding a degree in medicine were still awaiting to pass an abilitation exam which was removed today, allowing them to now work in the hospitals without it
[ https://www.corriere.it/scuola/universita/20_marzo_13/corona... ]
A lot others already holding that certificaton were not working yet because positions in public hospitals where not accessible yet because of the turnover blocks put in place in the last decade while the government was trying to cut healthcare expenses.
[ https://www.corriere.it/scuola/universita/20_marzo_13/corona... ]
A lot others already holding that certificaton were not working yet because positions in public hospitals where not accessible yet because of the turnover blocks put in place in the last decade while the government was trying to cut healthcare expenses.
I watched an interview with one of the Italian Drs. He said they were using retired medical staff and also cancelling routine procedures which frees up staff, and they are remote training staff from other specialities.
They’re also handing out IKEA leaflets to orthopedists about how ICU and ventilators work; and sending them to production.
It’s insane. It’s trench warfare
It’s insane. It’s trench warfare
The source for that is a random tweet that contained a lot of misinformation and false statement. No Italian friend working in the medical sector was able to confirm that it even makes any sense, and there are no official sources for that
Mostly by fast tracking newly graduated, who normally have to attend a 2 to 6 year long specialty school. This would amount to around 10 000 new hires, according to the Ministry of University.
This makes sense. I guess I expected it to have already happened, probably should tap into senior-year med and nursing students as well.
The UK is planning to re-train other medical staff to deal with respiratory illness. I think that probably includes things like psychologists, etc. who have medical experience and can quickly be brought up to speed. Might be something like that.
> "I think that probably includes things like psychologists, etc. who have medical experience and can quickly be brought up to speed. Might be something like that.
Uh, psychologists have zero medical training or experience - maybe they could explain the patients their respiratory failure is a symptom of insecure attachment patterns.
If you mean psychiatrists, there aren't that many of them to move the needle.
Uh, psychologists have zero medical training or experience - maybe they could explain the patients their respiratory failure is a symptom of insecure attachment patterns.
If you mean psychiatrists, there aren't that many of them to move the needle.
No need to be harsh. What is moving the needle is postponing elective surgery. There are a lot of anaesthetists and they are medics who can manage patients on ventilators.
AFAIK, physicians in the U.S. are vexed by how many hours per day they spend dealing with insurers rather than patients.
I wonder how many clinic-hours we could add to our capacity by some kind of moratorium on that level of paperwork.
I wonder how many clinic-hours we could add to our capacity by some kind of moratorium on that level of paperwork.
there won't be any paperwork because there won't be any insurance. even your congress and senate realizes this by now. it's an unworkable proposition - you either bankrupt the 10-20% patients which require hospitalization or you bankrupt insurers. you're in for a revolution in healthcare.
The majority of patients who will require hospital care are already Medicare beneficiaries. And for many others, the insurers don't really bear any financial risk because they just process claims and pass the costs on to group buyers.
Congress just had to add a ton of exemptions to a bill to guarantee paid sick leave for CORVID, making it meaningless for a vast majority of americans, because of republican pushback. Never underestimate the greed and corruption baked into the influence channels in the USA.
The problem with the House bill is that it puts employers on the hook for making the payments.
You’re just ushering small businesses faster off the cliff of insolvency if you legally require them to pay workers while they are also legally required to be shut down.
If the government is forcing a company to shut its doors, the government should be prepared to pay the employees “quarantine leave”.
You’re just ushering small businesses faster off the cliff of insolvency if you legally require them to pay workers while they are also legally required to be shut down.
If the government is forcing a company to shut its doors, the government should be prepared to pay the employees “quarantine leave”.
And the equipment...my understanding is that ventilators are critical for those who have severe cases. Can't just magically wish for tens of thousands of ventilators....
In italy one and the only factory of ventilators which was selling worldwide 250 units per month is now producing 500-600 per month exclusively for the italian hospitals (and past orders not yet sent abroad were blocked bt the government and redirected to italian hospitals) for the next ten months.
https://youtu.be/7Iz5tWb9f8A [hoping the english subtitles work]
https://youtu.be/7Iz5tWb9f8A [hoping the english subtitles work]
The translated subtitles seem reasonable. I had to go in and switch it to translating to English.
Most hospitalised people will only need non invasive respiratory support and surveillance. I guess these cases could be handled by purposely trained health workers.
Germany ordered 10k from Drägerwerk:
https://www.reuters.com/article/us-health-coronavirus-draege...
If your country doesn't have a local manufacturer for these things, it seems you are kinda out of luck.
https://www.reuters.com/article/us-health-coronavirus-draege...
If your country doesn't have a local manufacturer for these things, it seems you are kinda out of luck.
And Dräger already announced, that they going to extend their factory in Lübeck
But we can just build them. At least we could if we weren't instead shutting down our economies.
Look at the manufacturing ramp up that occurred during WWII for example.
Look at the manufacturing ramp up that occurred during WWII for example.
Do you actually believe there is a ventilator factory somewhere that has been shutdown?
During WW2, there were not a large supply of shut down weapon factories.
Car factories, for example, could be retrofitted to fabricate ventilators. It will not be easy, it will cost money and a relatively long time, but it will probably be easier than building totally new factories, and it will be more productive than reading tweets the whole day.
Car factories, for example, could be retrofitted to fabricate ventilators. It will not be easy, it will cost money and a relatively long time, but it will probably be easier than building totally new factories, and it will be more productive than reading tweets the whole day.
How difficult can it be to build one? Ok, we're not going to have one tomorrow. But how about in 3 months time? 6 months?
I worked for a ventilator startup for a few years, and it took us about 18 months to get our line to the point where we could make first articles built to manufacturing instead of prototype processes. These first articles then continued to develop some performance problems which needed to be rectified over the following year or so. This was starting from an empty building, which is where you'd be even if you retrofitted a ventilator factory into a car factory, because none of the tools in a car factory are precise or accurate enough to build or test a ventilator.
Yes but if you start with complete specs for a well-established production model, as well as complete specs for all the tooling and assembly machines you've got a completely different scenario. If you take experienced machinists off another line to spin it up with consulting from people who are currently building it, I would guess you could do something in six months or so. I mean, IBM built M1 Garands in WWII.
Yes that's be doing done now
"More than 60 manufacturers have been sent a blueprint for making up to 20,000 ventilators to treat coronavirus patients, “at speed”, as Boris Johnson called on British industry to help the government prepare for a surge in cases."
https://www.theguardian.com/business/2020/mar/16/vauxhall-ow...
I work for a very large global manufacturer w/ a presence in China, and does not produce medical equipment. My Chinese family told me (so take it w/ a grain of salt) they said 'Hey I heard your company is building ventilators to help out' and I said I don't know.
My gripe is why the other countries didn't do it too since we had more lead time. Infection rates are exponential...waiting too long to take action will cause more deaths.
"More than 60 manufacturers have been sent a blueprint for making up to 20,000 ventilators to treat coronavirus patients, “at speed”, as Boris Johnson called on British industry to help the government prepare for a surge in cases."
https://www.theguardian.com/business/2020/mar/16/vauxhall-ow...
I work for a very large global manufacturer w/ a presence in China, and does not produce medical equipment. My Chinese family told me (so take it w/ a grain of salt) they said 'Hey I heard your company is building ventilators to help out' and I said I don't know.
My gripe is why the other countries didn't do it too since we had more lead time. Infection rates are exponential...waiting too long to take action will cause more deaths.
A gun is very different from a medical device. The tolerances your automobile machinists are used to working at are much wider. Ventilators have to measure fractions of a cmH20 above ambient pressure, and they have to do so accurately to deliver gas, especially smaller boluses. I'm not saying it can't be done, I'm saying that training someone who is used to the tools used to building automobile engines will be practically unskilled at building ventilators, and you need to validate your people as well as your production processes, irrespective of whether you have blueprints for equipment. You have to validate everything or you will kill people with these new ventilators.
This makes total sense. I appreciate an answer from from someone who knows what they're talking about!
From my understanding, on Italy the mortality rate of those that are hospitalized is 25%, however the mortality rate of those that are put on invasive ventilation goes over 95% (can't find the source), so for most it's basically a death sentence.
Likely retirees and early graduation from students.
> Rome has 4 planned covid hospitals as of now.
Unfortunately not where it matters most, that is in Lombardia (where I live, and the hardest-hit of all regions). In fact the regional government took the matter into its own hands to attempt to convert a number of buildings in an old exposition area (not the 2015 expo area, FTR) into places to treat patients (there are still many "ifs" to see whether this will get done or not, though).
Unfortunately not where it matters most, that is in Lombardia (where I live, and the hardest-hit of all regions). In fact the regional government took the matter into its own hands to attempt to convert a number of buildings in an old exposition area (not the 2015 expo area, FTR) into places to treat patients (there are still many "ifs" to see whether this will get done or not, though).
I know one national government which has delegated all the work to the regional governments.
The United States waived requirements for inspection for new hospital beds (thus allowing hospitals to increase bed count) and has ordered more ventilators and other equipment.
We know that sufficiently strong social distancing - and universal mask use - can reduce Re below 1, causing the epidemic to shrink exponentially instead of growing exponentially. Once it is small enough, good testing and contact tracing should be able to contribute a significant reduction to Re, so that you can back off on more costly measures.
As hard as it sounds for the economy to adapt to extreme social distancing for a short time and moderate for a long time, it seems like a better bet to me than trying to increase intensive care capacity - which already consumes a nontrivial fraction of gdp - by orders of magnitude and write off millions of lives.
As hard as it sounds for the economy to adapt to extreme social distancing for a short time and moderate for a long time, it seems like a better bet to me than trying to increase intensive care capacity - which already consumes a nontrivial fraction of gdp - by orders of magnitude and write off millions of lives.
> As hard as it sounds for the economy to adapt to extreme social distancing for a short time and moderate for a long time, it seems like a better bet to me than trying to increase intensive care capacity
The article is saying do both which makes sense. In the case of CV19, we don't need to build new state-of-the-art ICUs. We only need to prepare a temporary overflow capacity that can handle a relatively brief surge of a very particular (and largely similar) kind of patient which is a still-challenging but much more tractable problem.
Space - Large circus tent-like temporary buildings used for conventions can be erected in hospital parking lots in a day.
Beds - While $5,000 robo-beds are wonderful, CV19 patients needing hospitalization have pneumonia symptoms and need to be at a constant ~30% incline - so La-Z-Boy lounge chairs are actually a decent option.
Mechanical Ventilators - The U.S. has about 160,000 ventilators. The key here is to get them where they need to be when they are needed. The chances that CV19 surges will happen everywhere at once in an area as large as CONUS are essentially zero. In Italy, while Lombardy in the North was running out of ventilators, there were hospitals in the south with unused devices. 98k of our national 160k vents are mothballed older versions in storage. Preparing some portion of these for rapid deployment, such as positioning them in FedEx / UPS overnight hubs in the central U.S. can have them ready to be wherever a surge begins to build in less than 18 hours.
Ventilator Operators - Becoming certified to operate a ventilator usually requires six months and the next gap will be having enough qualified operators where and when they're needed. An experiment was already conducted where various medically-trained, but not vent-trained, people from RNs to pediatricians to veterinarians were run through 2 days of intensive vent training and tested for apprentice-level proficiency. The winners were the veterinarians, outperforming the other specialties in performance (go figure). The resulting model showed one certified vent op can supervise six apprentice-level ops who each handle X beds (I forget the exact numbers). But you get the idea and fortunately, we have a lot of vets in the U.S.
We still have some low-digit number of weeks before likely patient surges start cropping up in different areas. Neither spread-reduction nor surge capacity increases will work perfectly, but by pragmatically working both issues together it's likely we can avert many preventable deaths.
The article is saying do both which makes sense. In the case of CV19, we don't need to build new state-of-the-art ICUs. We only need to prepare a temporary overflow capacity that can handle a relatively brief surge of a very particular (and largely similar) kind of patient which is a still-challenging but much more tractable problem.
Space - Large circus tent-like temporary buildings used for conventions can be erected in hospital parking lots in a day.
Beds - While $5,000 robo-beds are wonderful, CV19 patients needing hospitalization have pneumonia symptoms and need to be at a constant ~30% incline - so La-Z-Boy lounge chairs are actually a decent option.
Mechanical Ventilators - The U.S. has about 160,000 ventilators. The key here is to get them where they need to be when they are needed. The chances that CV19 surges will happen everywhere at once in an area as large as CONUS are essentially zero. In Italy, while Lombardy in the North was running out of ventilators, there were hospitals in the south with unused devices. 98k of our national 160k vents are mothballed older versions in storage. Preparing some portion of these for rapid deployment, such as positioning them in FedEx / UPS overnight hubs in the central U.S. can have them ready to be wherever a surge begins to build in less than 18 hours.
Ventilator Operators - Becoming certified to operate a ventilator usually requires six months and the next gap will be having enough qualified operators where and when they're needed. An experiment was already conducted where various medically-trained, but not vent-trained, people from RNs to pediatricians to veterinarians were run through 2 days of intensive vent training and tested for apprentice-level proficiency. The winners were the veterinarians, outperforming the other specialties in performance (go figure). The resulting model showed one certified vent op can supervise six apprentice-level ops who each handle X beds (I forget the exact numbers). But you get the idea and fortunately, we have a lot of vets in the U.S.
We still have some low-digit number of weeks before likely patient surges start cropping up in different areas. Neither spread-reduction nor surge capacity increases will work perfectly, but by pragmatically working both issues together it's likely we can avert many preventable deaths.
thanks for your insights,
> The winners were the veterinarians, outperforming the other specialties in performance (go figure).
1) Veterinarians deal with animals, which aren't as domesticated, civilized, intellectual, ... in some sense. So as opposed to humans they will not understand the reason why they are undergoing treatment, nor have blind faith in this human they don't know. So when an animal experiences higher or lower levels of comfort it will be more "honest" in it's body language in response to the way it is handled, or what it is feeling physically during treatment. Also the veterinarian doesn't need to model abstract conscious thought of the subject, while with humans this is inevitable and can be distracting. Could this explain the higher performance of veterinarians? After treating cows, horses, dogs, cats, ... they view the human in a way as just another animal, and pay more attention to the intuitive body language than to abstract social cues?
>CV19 patients needing hospitalization have pneumonia symptoms and need to be at a constant ~30% incline
this is with heads up, or feet up?
I read a (news, not journal) article with pictures of the Italian patients on their belly, because it allows the mucous to flow from the finely branched areas to flow into the more accessible pathways, so the mucous would collect there where it was easier to remove.
2) IF hospitals get overrun locally, and people are left to their own devices, would it be possible to disinfect a plastic tube, attach a digital endoscopic camera, disinfect both, and introduce it oneself to suck out any accumulating puddles? what would be the maximum tolerable cross section to get it to the point of collecting the mucous?
3) instead of ventilation which is very hard to DIY because of volutrauma and barotrauma, could circulating air work? I envision a double tube brought deep into the common pathway (without obstructing passage of air for breathing, or alternatively a third tube to atmosphere), and simply introducing the same volume as air as being removed by the other tube, so a significant fraction of air will directly exit again through the second tube, but some of the air will mix with the local ambient air in the lungs before exiting through the second tube. i.e. the setup does not replace nor displace breathing, but simply circulates air. This might inadvertently cool the lungs, so there should be proper temperature control on the high flow rate air.
> The winners were the veterinarians, outperforming the other specialties in performance (go figure).
1) Veterinarians deal with animals, which aren't as domesticated, civilized, intellectual, ... in some sense. So as opposed to humans they will not understand the reason why they are undergoing treatment, nor have blind faith in this human they don't know. So when an animal experiences higher or lower levels of comfort it will be more "honest" in it's body language in response to the way it is handled, or what it is feeling physically during treatment. Also the veterinarian doesn't need to model abstract conscious thought of the subject, while with humans this is inevitable and can be distracting. Could this explain the higher performance of veterinarians? After treating cows, horses, dogs, cats, ... they view the human in a way as just another animal, and pay more attention to the intuitive body language than to abstract social cues?
>CV19 patients needing hospitalization have pneumonia symptoms and need to be at a constant ~30% incline
this is with heads up, or feet up?
I read a (news, not journal) article with pictures of the Italian patients on their belly, because it allows the mucous to flow from the finely branched areas to flow into the more accessible pathways, so the mucous would collect there where it was easier to remove.
2) IF hospitals get overrun locally, and people are left to their own devices, would it be possible to disinfect a plastic tube, attach a digital endoscopic camera, disinfect both, and introduce it oneself to suck out any accumulating puddles? what would be the maximum tolerable cross section to get it to the point of collecting the mucous?
3) instead of ventilation which is very hard to DIY because of volutrauma and barotrauma, could circulating air work? I envision a double tube brought deep into the common pathway (without obstructing passage of air for breathing, or alternatively a third tube to atmosphere), and simply introducing the same volume as air as being removed by the other tube, so a significant fraction of air will directly exit again through the second tube, but some of the air will mix with the local ambient air in the lungs before exiting through the second tube. i.e. the setup does not replace nor displace breathing, but simply circulates air. This might inadvertently cool the lungs, so there should be proper temperature control on the high flow rate air.
A thousand times this!
The viral growth is not the only exponential thing here, the costs of bringing down R0 are also highly non-linear, and it works both for and against us.
Against: it is going to be much more expensive to get R0 from 1.5 to 1 than from 4 to 3.5. A plausible assumption may be that a constant percentage reduction carries a fixed cost. Also: the more infected you have the more expensive it becomes.
For: As you said, once it's brought under control, cheaper measures that don't work at scale can be be used it to keep it from flaring up again [1]. That's what China is trying to do and so far it seems to work well. The whole herd immunity insanity seems to be predicated on the idea that social distancing does not work and the second wave will kill you later. But evidence so far suggests the opposite, although this may change.
In terms of war-style production: It seems criminally stupid that so far no Western country has embraced readily available trivial and ridiculously low cost means to significantly reduce spread. Like getting everyone to wear face masks, all the time. There seems to be excellent evidence it is very effective for bringing R0 down massively, both from academic studies on influenza[2] and SARS and also from circumstantial evidence like just comparing case growth between face mask using countries and non-using countries for the current outbreak[3]. Of course that requires actually producing a lot of face masks – but how hard can that be? As far as I am aware the current state is that even terrible face masks would help massively with preventing carriers from infecting others.
[1] This argument is also made here:
https://arguablywrong.home.blog/2020/03/12/epidemiological-m...
The cost per live is somewhere on the humanitarian end of the spectrum, but I think this argument is worth engaging with. If there is any realistic chance of eradicating covid-19 rather than just mitigating it, clearly is is what we must do and will pay enormous dividends even in the fairly short term.
[2] e.g. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1539-6924....
[3] https://twitter.com/epsilon3141/status/1238838106440241152
The viral growth is not the only exponential thing here, the costs of bringing down R0 are also highly non-linear, and it works both for and against us.
Against: it is going to be much more expensive to get R0 from 1.5 to 1 than from 4 to 3.5. A plausible assumption may be that a constant percentage reduction carries a fixed cost. Also: the more infected you have the more expensive it becomes.
For: As you said, once it's brought under control, cheaper measures that don't work at scale can be be used it to keep it from flaring up again [1]. That's what China is trying to do and so far it seems to work well. The whole herd immunity insanity seems to be predicated on the idea that social distancing does not work and the second wave will kill you later. But evidence so far suggests the opposite, although this may change.
In terms of war-style production: It seems criminally stupid that so far no Western country has embraced readily available trivial and ridiculously low cost means to significantly reduce spread. Like getting everyone to wear face masks, all the time. There seems to be excellent evidence it is very effective for bringing R0 down massively, both from academic studies on influenza[2] and SARS and also from circumstantial evidence like just comparing case growth between face mask using countries and non-using countries for the current outbreak[3]. Of course that requires actually producing a lot of face masks – but how hard can that be? As far as I am aware the current state is that even terrible face masks would help massively with preventing carriers from infecting others.
[1] This argument is also made here:
https://arguablywrong.home.blog/2020/03/12/epidemiological-m...
The cost per live is somewhere on the humanitarian end of the spectrum, but I think this argument is worth engaging with. If there is any realistic chance of eradicating covid-19 rather than just mitigating it, clearly is is what we must do and will pay enormous dividends even in the fairly short term.
[2] e.g. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1539-6924....
[3] https://twitter.com/epsilon3141/status/1238838106440241152
> - and universal mask use -
It's really unfortunate that the general population of the US has zero cultural familiarity with using masks to prevent the spread of disease. This really seems like the time to do everything possible in that regard, but we don't have the supplies.
In normal times, surgical masks are cheap. If we had the supply, we should be handing them out by the dozen to households in infected areas, at airports, etc.
It's really unfortunate that the general population of the US has zero cultural familiarity with using masks to prevent the spread of disease. This really seems like the time to do everything possible in that regard, but we don't have the supplies.
In normal times, surgical masks are cheap. If we had the supply, we should be handing them out by the dozen to households in infected areas, at airports, etc.
This touches on another hobby horse of mine. Our society, both legally and as a matter of cultural habit, tends to prefer inaction to imperfect action. The fallacy, a sort of dual to the better known "We must do something, this is something, therefore we must do this", seems to be
1. Perfection is better than imperfection
2. All our options are imperfect
3. Therefore, we will do nothing
I am almost sure that our society, even without prior preparation, could physically produce huge numbers of "more effective than nothing" masks (especially for protecting others from the wearer, which is easier) very quickly at, say, 10x the cost (because you are recruiting less than ideal resources, like factory lines designed for other things that need extra labor) and 75% effectiveness (because you aren't applying the usual extremely strict standards that apply to NIOSH masks or whatever). Even if everyone taped a paper towel or sock over their face I bet it would reduce large droplet transmission by 50%. But we are not able to do so, because
1. These masks would cost more than masks used to cost ("price gouging!"). Imperfect.
2. They wouldn't work as perfectly as physically possible. Imperfect.
3. Some people would make money selling fake masks or whatever in the confusion. Imperfect.
4. We already made a bunch of regulations mandating perfection and no one wants to take responsibility for removing them
and maybe also
5. The people who should have stockpiled masks (edit: in the government or medical supply chain, I'm not saying individuals should have thought of this!) would have to admit their mistakes
So, "we" lie to people that masks are useless (charitably, so doctors can have more; uncharitably, because 5) and do nothing.
1. Perfection is better than imperfection
2. All our options are imperfect
3. Therefore, we will do nothing
I am almost sure that our society, even without prior preparation, could physically produce huge numbers of "more effective than nothing" masks (especially for protecting others from the wearer, which is easier) very quickly at, say, 10x the cost (because you are recruiting less than ideal resources, like factory lines designed for other things that need extra labor) and 75% effectiveness (because you aren't applying the usual extremely strict standards that apply to NIOSH masks or whatever). Even if everyone taped a paper towel or sock over their face I bet it would reduce large droplet transmission by 50%. But we are not able to do so, because
1. These masks would cost more than masks used to cost ("price gouging!"). Imperfect.
2. They wouldn't work as perfectly as physically possible. Imperfect.
3. Some people would make money selling fake masks or whatever in the confusion. Imperfect.
4. We already made a bunch of regulations mandating perfection and no one wants to take responsibility for removing them
and maybe also
5. The people who should have stockpiled masks (edit: in the government or medical supply chain, I'm not saying individuals should have thought of this!) would have to admit their mistakes
So, "we" lie to people that masks are useless (charitably, so doctors can have more; uncharitably, because 5) and do nothing.
Yes, why isn't there more focus on getting R0 < 1? Flattening the curve seems like a good idea, but R0 < 1 also seems very important.
(I've been trying to simulate this, but ended up battling matplotlib unsuccessfully to create a graph.)
(I've been trying to simulate this, but ended up battling matplotlib unsuccessfully to create a graph.)
I think the focus is the same. Flattening the curve effectively means reducing the R0, and the steps being taken now could theoretically get it below 1.
South Korea seems to have done this; they have more testing than anywhere else, yet they have less new cases now than they did last week.
“Flatten the curve” is to increase compliance by making accomplishing something seem more realistic, even at an individual level.
So what are you going to do when the virus is gone in your city/state/country, isolate yourself from the rest of the world? Because the timeline/situation will be different for many other places.
Return to travel restrictions + contact tracing, and if community spread flares up again, reinstitute social distancing. Repeat until vaccine is developed.
I'm not sure why you're downvoted. That is exactly the right approach. Implement serious social distancing measures to reduce R0 below 1, get local outbreak under control, and then work on keeping it contained, increasing measures when necessary. Once it's more established which countries are effectively controlling the virus, travel could be more open with those countries, and more restricted with those that still have active outbreaks. (Which doesn't necessarily mean cutting off completely, but perhaps only essential travel and cargo, or unrestricted but 14 day isolation on arrival.)
Interestingly, that comment started out as +3 and is down to -2 now.
I think it may be a good harbinger of the public's willingness to endure repeated, long-term changes to their behavior. The way I see this going, we're going to get lockdowns in most countries within the next week or so. After 6 weeks or so, new cases will be negligible, and we'll declare victory and pick up our lives. The virus will silently spread from a few undetected cases during the summer, but then take off again around October, when we get a second wave. Assuming it hasn't mutated to become significantly less deadly (pretty likely - see sibling threads), that will be the real killer, because instead of starting from 1 index case in 1 city it'll be seeded from tens of thousands of sleeper cases across the globe. Public opinion won't support a second lockdown then - people will just be left to die with their families.
I think it may be a good harbinger of the public's willingness to endure repeated, long-term changes to their behavior. The way I see this going, we're going to get lockdowns in most countries within the next week or so. After 6 weeks or so, new cases will be negligible, and we'll declare victory and pick up our lives. The virus will silently spread from a few undetected cases during the summer, but then take off again around October, when we get a second wave. Assuming it hasn't mutated to become significantly less deadly (pretty likely - see sibling threads), that will be the real killer, because instead of starting from 1 index case in 1 city it'll be seeded from tens of thousands of sleeper cases across the globe. Public opinion won't support a second lockdown then - people will just be left to die with their families.
I would like to think that we would keep expanding testing infrastructure during the reprieve, and so wouldn't be caught off guard. For the most part the people running large scale public health policy are smart and well informed, so this risk won't be unknown.
> Interestingly, that comment started out as +3 and is down to -2 now.
Is there somewhere to check that score, or is it a higher karma feature?
Is there somewhere to check that score, or is it a higher karma feature?
If you wrote the comment you can always see the score (0 now, FWIW). At least I've always been able to; hidden comment scores arrived a while after I'd already amassed a pretty high karma level.
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It's also very normal for viruses to become more mild over time.
We strongly react to strong threats. It's in the viruses interest to become a weaker threat like the common cold so we tolerate it instead of actively fighting it.
We strongly react to strong threats. It's in the viruses interest to become a weaker threat like the common cold so we tolerate it instead of actively fighting it.
They can also become much more deadly. The first pass of the 1918 pandemic was not nearly so bad as the second, which slaughtered millions of people in their 20s and 30s.
That's a much rarer course and seems to be related to the conditions of WW1. Under normal circumstances, people with mild illnesses are out and about and able to spread the virus, while people with severe illnesses are confined to a bed or hospital and tend to result in an evolutionary dead end. As a result, the descendants of mild cases outcompete the descendants of severe cases, and eventually natural selection results in the dominant strains of the virus all being mild.
With the 1918 flu pandemic, mild cases of flu remained with their unit, while extremely sick cases were transported home via train for improved medical care. As a result, it was the severe cases that ended up sparking new infections, while the mild cases died out after generating herd immunity within an army company.
Most respiratory viruses follow the first scenario, although there is a caution there for people who suggest eg. transporting sick people by airliner to regions with fewer cases to make better use of available hospital capacity. Ironically asymptomatic transmission is your best friend here: if all transmission is asymptomatic, the strains that get transmitted will be the ones more likely to not cause symptoms.
With the 1918 flu pandemic, mild cases of flu remained with their unit, while extremely sick cases were transported home via train for improved medical care. As a result, it was the severe cases that ended up sparking new infections, while the mild cases died out after generating herd immunity within an army company.
Most respiratory viruses follow the first scenario, although there is a caution there for people who suggest eg. transporting sick people by airliner to regions with fewer cases to make better use of available hospital capacity. Ironically asymptomatic transmission is your best friend here: if all transmission is asymptomatic, the strains that get transmitted will be the ones more likely to not cause symptoms.
True. But I have heard that that was because, among all the soldiers in the trenches, it could be virulent and still be able to spread effectively, so it had no selection pressure to not be virulent.
Covid is a bit different, because it has a longer incubation time, but that wasn't the issue with the 1918 influenza outbreak.
(Note well: I am not an epidemiologist.)
Covid is a bit different, because it has a longer incubation time, but that wasn't the issue with the 1918 influenza outbreak.
(Note well: I am not an epidemiologist.)
Even if the whole world was in sync, you more or less have to hold Re below 1 forever or accept that 1-1/Re of everyone gets the virus. That's basically a tautology. But Re can be affected a lot by testing and tracing when the infected population is tiny compared to your resources, and not so much when it is huge. Re could also be affected a lot if we had a vaccine, which will probably take years in the current regulatory regime but is something that might actually benefit from disparate international approaches.
It wouldn't be crazy to ask international travelers to pay the marginal cost of extra testing and/or the negative externality of spreading the virus between worse and better controlled regions.
It wouldn't be crazy to ask international travelers to pay the marginal cost of extra testing and/or the negative externality of spreading the virus between worse and better controlled regions.
1) buy time by reducing Re
2) invest into medical research
3) hope you can manufacture something effective by the time the next wave hits
2) invest into medical research
3) hope you can manufacture something effective by the time the next wave hits
Don't think y our 1-1/R0 rate makes sense (I assume Re is equivalent to R0 - I'm not familiar with Re). At an R0 of 1, each person spreads to one other person. So everyone would eventually be infected, just at a linear rate. Your formula though gives 1-1/1 = 0. Similarly for an R0 less than 1 your formula goes negative.
Anyway, if R0 can be brought below 1, it wouldn't need to be indefinite. The further below 1 it is, the faster the virus will extinguish itself. This was seen in China, where they went from exponential growth to fewer new cases each day and ultimately to the situation now where most new cases are imported from other countries.
You also don't need global coordination, although it helps. Any individual country can restrict outside travel from outbreak areas, get their own R0 below 1 via social distancing to eliminate the local outbreak, and then relax social distancing locally, relying on travel restrictions and temporary quarantines of travelers from outbreak areas, plus testing and contact tracing. If cases start to flare up again, increased social distancing measures can be brought in to get them back under control.
So in theory you could do extreme distancing for a period on the order of a few months, and then normalize somewhat. It would take a global response of that sort (unlikely), a vaccine, or a change in the virus itself though to end the situation entirely.
Anyway, if R0 can be brought below 1, it wouldn't need to be indefinite. The further below 1 it is, the faster the virus will extinguish itself. This was seen in China, where they went from exponential growth to fewer new cases each day and ultimately to the situation now where most new cases are imported from other countries.
You also don't need global coordination, although it helps. Any individual country can restrict outside travel from outbreak areas, get their own R0 below 1 via social distancing to eliminate the local outbreak, and then relax social distancing locally, relying on travel restrictions and temporary quarantines of travelers from outbreak areas, plus testing and contact tracing. If cases start to flare up again, increased social distancing measures can be brought in to get them back under control.
So in theory you could do extreme distancing for a period on the order of a few months, and then normalize somewhat. It would take a global response of that sort (unlikely), a vaccine, or a change in the virus itself though to end the situation entirely.
At an R0 of 2, with no interventions, eventually half the population has had the virus and (hopefully) gained immunity. Now each person only spreads it to 1 other person, because the other person they would have infected is immune. (If R0 was 1, the epidemic would end as soon as the next person in the chain is immune.) This is where the people saying that the virus will definitely eventually infect 70% of everyone are coming from.
Re is effective spread rate, taking into account natural immunity, vaccination, contact tracing, etc. By definition, if Re>1 the epidemic is growing exponentially and if less it is shrinking.
Re is effective spread rate, taking into account natural immunity, vaccination, contact tracing, etc. By definition, if Re>1 the epidemic is growing exponentially and if less it is shrinking.
>So what are you going to do when the virus is gone in your city/state/country, isolate yourself from the rest of the world
Yes, that or have 2-4% of the infected population die...
Yes, that or have 2-4% of the infected population die...
Or more, since this amount of people die only when sufficient care is available. If you interpret the "requires hospitalization" percentage as "will die without hospitalization" (which I'm not 100 % sure is true), as many as 15 or 20 % people can die.
15-20% don't require hospitalization. More were hospitalized to be monitored, but only about 40/705 infected from the Diamond Princess ever progressed to serious condition. And the population of cruise ships skews older.
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Hopefully someone is manufacturing a billion masks somewhere in the USA.
I'm hesitant to put this out there but selfish game theory would be to go out and get it now, before all ICU beds are filled so that if you need a bed you can still get one...
It's too late for that. If you exposed yourself now, you'd be direly sick just as the first unhandleable wave is going to hit the health care system.
I suppose it might be possible to get 'ahead of the curve' by having a confirmed infected person sneeze directly in your face, but yeah, it would royally suck to end up needing an ICU in a week or two from now. Doesn't seem worth the risk.
Do we know this? How?
From where I'm sitting, it feels just as plausible that it had mostly hit far larger saturation than people realize. Such that, even if this works, it should have been done literally months ago.
My perspective is someone in Seattle that almost certainly had this a month ago
From where I'm sitting, it feels just as plausible that it had mostly hit far larger saturation than people realize. Such that, even if this works, it should have been done literally months ago.
My perspective is someone in Seattle that almost certainly had this a month ago
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Getting Re below 1 seems like the right approach, but I really hope that we can do this through extensive testing and travel restrictions. This way anyone who gets any illness and can be tested immediately, tell their friends to get tested, and isolate themselves. Meanwhile the rest of society can function more or less normally, even if they have to watch sports on TV instead of live, and after a sick individuals recover they can be retested and rejoin society again. This seems so much better to me having everyone spend 18 months in moderate isolation until a vaccine is approved.
At least summer is coming and it's substantially safer to be with people outside.
At least summer is coming and it's substantially safer to be with people outside.
Sounds like we will need the suggestion in this article just to ramp up mask production. And the willingness to make mask wearing mandatory by law. There are too many idiots out there who will not do it otherwise.
Exactly. I find it strange how otherwise highly creative and open-minded people don't see this. Based on other country's experiences you could get this reasonably under control with some rather draconian measures (that might cost 1%+ of GDP to hold), but far less than total shut-down. examples:
1. Remove all testing bottlenecks.
2. Mandate face mask usage in all public settings.
3. Maintain massive queryable databases of cell phone location data for everyone. Goal is to easily find all potentially infected people if you identify a new case.
4. Keep mass gatherings (sports, conferences) closed due to difficulty contact tracing. (until number is really down)
Note that because so many countries screwed up already, a short term lockdown is necessary. But the above is how you handle life after
1. Remove all testing bottlenecks.
2. Mandate face mask usage in all public settings.
3. Maintain massive queryable databases of cell phone location data for everyone. Goal is to easily find all potentially infected people if you identify a new case.
4. Keep mass gatherings (sports, conferences) closed due to difficulty contact tracing. (until number is really down)
Note that because so many countries screwed up already, a short term lockdown is necessary. But the above is how you handle life after
I don't think people are rejecting those ideas so much as ignoring them for the moment. It's too late for planning, we need a solution now, and mass para-quarantine is really the only tool that can be deployed.
By all means let's investigate other options once the first wave is under control. But right now the first wave is growing out of control in basically every western democracy.
#StayHome now, then work on a better plan. Make it work first before you make it work fast, basically.
By all means let's investigate other options once the first wave is under control. But right now the first wave is growing out of control in basically every western democracy.
#StayHome now, then work on a better plan. Make it work first before you make it work fast, basically.
Exactly, let’s not focus on premature optimization. Let’s ensure our hospitals don’t get overwhelmed these next few months.
After that, the virus may go away on its own, or it might mutate into a weaker form. Or we might have treatments on the way.
After that, the virus may go away on its own, or it might mutate into a weaker form. Or we might have treatments on the way.
Of those, only the third is likely. There is some hope still that the transmission rate will drop over the summer. But realistically, the post-quarantine phase will be defined by careful monitoring, a bunch of still-extant rules, and the occasional surprise outbreak. And this will go on until either we all get it or until we all get a vaccine.
At some point the testing bottlenecks are real. You can't just remove them. South Korea has tested 0.5% of their population.
Masks production can be increased. But you need hundreds of millions a day of production and won't get there in a short period of time.
Masks production can be increased. But you need hundreds of millions a day of production and won't get there in a short period of time.
I've upvoted because the article encourages proactive thinking so that we don't just sit in our homes congratulating ourselves how well we socially distanced from each other. What is sadly missing is some back-of-the-napkin math estimating the required capacity increase. Like, is it closer to x2 or x100? is it feasible at all? What is the damage to economy from doing this compared to lock-down for N months?
One variable that is still not known and would make a huge difference is how many people are asymptomatic and with that catch this and have no symptoms. That effects infection rates and also getting a better grasp upon how many recovered as well as infected.
Not just a case of testing those for infection, that cat left the bag in every country on that end. Need to also test for those who are now immune without being aware.
Otherwise may well see spreads more than expected due to these people spreading the virus when they have no symptoms and also prevent paralysation of those who are immune, isolating when they don't even know they had it already.
So knowing that variable will become key in tackling this and currently we have no idea upon that.
Not just a case of testing those for infection, that cat left the bag in every country on that end. Need to also test for those who are now immune without being aware.
Otherwise may well see spreads more than expected due to these people spreading the virus when they have no symptoms and also prevent paralysation of those who are immune, isolating when they don't even know they had it already.
So knowing that variable will become key in tackling this and currently we have no idea upon that.
There have been a couple of population studies to try to measure asymptomatic infections. It appears that about 50%+ of people are symptomatic, so unfortunately significant percentages of people are going to need hospitalization.
This study shows the number of symptomatic patients broken out by age group on the Diamond Princess which was a very well-studied population. https://www.medrxiv.org/content/10.1101/2020.03.04.20031104v...
This study shows the number of symptomatic patients broken out by age group on the Diamond Princess which was a very well-studied population. https://www.medrxiv.org/content/10.1101/2020.03.04.20031104v...
I believe that nobody really expects to meet the gap between actual capacity and "required" capacity, i.e. that it can't and won't get met - nonetheless, raising the capacity to save lives will save more lives; even if it's not sufficient.
It's worth noting that every early "flatten the curve" illustration example that I saw had the lower curve still above the capacity, just not nearly as much, however by the time it reached mass media, it had somehow morphed to the lower curve at or below capacity... probably because they thought it sells the idea better? but at the cost of misleading the public about what's feasible.
It's worth noting that every early "flatten the curve" illustration example that I saw had the lower curve still above the capacity, just not nearly as much, however by the time it reached mass media, it had somehow morphed to the lower curve at or below capacity... probably because they thought it sells the idea better? but at the cost of misleading the public about what's feasible.
> I believe that nobody really expects to meet the gap between actual capacity and "required" capacity
Well, that's exactly my problem - I don't really know what kind of gap to expect. It is all very qualitative at this point but scenarios (and thus the best course of action) are wildly different depending on how exactly do the relevant quantities compare to each other. Of course "we don't know yet" is a perfectly valid answer but then it must be clearly stated in the article that this is just a speculation describing a plausible scenario.
Well, that's exactly my problem - I don't really know what kind of gap to expect. It is all very qualitative at this point but scenarios (and thus the best course of action) are wildly different depending on how exactly do the relevant quantities compare to each other. Of course "we don't know yet" is a perfectly valid answer but then it must be clearly stated in the article that this is just a speculation describing a plausible scenario.
I read some articles that did the math on that, but I can't easily find them now. IIRC it was an order of magnitude difference - i.e. flattening the curve enough to meet capacity would require to stretch it out to something 10 years (certainly an unreasonable goal), so flattening it out over a single year would be something like 10 times over the current capacity. It's hard to estimate how much reasonable actions can increase capacity - 20%? 50%? 100%? But nowhere close to 10x increase.
Again, irrelevant. Capacity increase is lives saved. Flattening the curve is a multiplier on that, and is thus also lives saved. "Enough" doesn't matter as much as the fact that "more" scales linearly. Every bed of capacity you add is at least one life saved, even if you never get close to enough.
flattening the curve also gives us more time to come up with a vaccine.
If we're talking about high casualty numbers, stretching it a year or two, while we wait for a vaccine _might_ be feasible.
If we're talking about high casualty numbers, stretching it a year or two, while we wait for a vaccine _might_ be feasible.
From the numbers of a previous article the answer is x17. https://medium.com/@joschabach/flattening-the-curve-is-a-dea... (HN discussion https://news.ycombinator.com/item?id=22575356 ) I prefer a rounded number to not give an illusion of precision, so x20, but there are too many approximations and unknown factor, so it's hopefully closer to x10, but it may be x30.
That article was heavily flagged because it has a bad title and a pessimistic message, but it was the first article that I saw with an approximate calculation of the size of the problem.
That article was heavily flagged because it has a bad title and a pessimistic message, but it was the first article that I saw with an approximate calculation of the size of the problem.
Thanks. Although the author is not an expert and he kind of lost me when he used normal distribution to model the curve, it still looks like the right ballpark. That's a lot.
He could have replaced the normal distribution by any other roundly curve and the result doesn't change too much. For example with the SRI model you don't get a Gaussian https://simple.wikipedia.org/wiki/SIR_model , but the graphic is close enough. It's less peaky than the Gaussian so it should make things easier, but the reduction probably will be a small factor, something between 1 and 2.
I'm curious what happened / is happening in Japan.
Here in Tokyo it looks almost like business as usual. Some companies are letting people stay at home but most are not. While cities in the USA are banning gatherings of 100 or more, here in Tokyo every train ever 3 minutes during rush hour has 8 to 16 cars stuffed with 100+ people per car.
I have no idea what the actual infection rate here is or the ICU usage rate. 2 weeks ago Japan was considered the place to avoid. Now it's the USA and Europe. Japan hasn't seemed to have taken any drastic measures so far or maybe I'm just not paying attention.
Here in Tokyo it looks almost like business as usual. Some companies are letting people stay at home but most are not. While cities in the USA are banning gatherings of 100 or more, here in Tokyo every train ever 3 minutes during rush hour has 8 to 16 cars stuffed with 100+ people per car.
I have no idea what the actual infection rate here is or the ICU usage rate. 2 weeks ago Japan was considered the place to avoid. Now it's the USA and Europe. Japan hasn't seemed to have taken any drastic measures so far or maybe I'm just not paying attention.
Japan has strange numbers. The infection grows steadily at a rate of 10% per day, compared to 20% in most other countries. It doesn’t seem to slow down however.
Indeed, given what I remember of Tokyo's morning peak hour density in subway cars it would have gone ballistic or will yet. Although they do use routinely use masks even in normal times.
The cynical take is that aging demographic is one of the biggest problems facing Japan today and this is a way to deal with it.
The cynical take is that aging demographic is one of the biggest problems facing Japan today and this is a way to deal with it.
Maybe it's the masks. Not by avoiding people catching it, but by reducing the spread to others. How tragically ironic it would be if the West has derided the most effective measure.
> The cynical take is that aging demographic is one of the biggest problems facing Japan today and this is a way to deal with it
The problem is aging population are people who 40 or 50 now, not people who are 70 and 80. The latter may die because of cv, but the problem of aging population goes nowhere because people in 40 or 50 will get older eventually.
This my cynical response to you cynical take.
The problem is aging population are people who 40 or 50 now, not people who are 70 and 80. The latter may die because of cv, but the problem of aging population goes nowhere because people in 40 or 50 will get older eventually.
This my cynical response to you cynical take.
The current 65+ bracket is already pretty heavy - heavier than Italy, the 40-50 bracket at the top of the inverted pyramid and will become a big problem couple of decades from now.
This is cynical nitpicking.
This is cynical nitpicking.
AFAIK they are doing very little testing in Japan, so there is no problem that can be reported, the USA and UK as far as we can tell were copying that until the UK got called out on it after that PM press conference and the states got testing approved independently of the CDC test.
https://www.upi.com/Top_News/World-News/2020/03/10/Japanese-...
This has an infographic on testing - Japan was next to last (on the chart at least) per person testing for industrialized countries as of March 4. https://www.vox.com/science-and-health/2020/3/12/21175034/co...
This has an infographic on testing - Japan was next to last (on the chart at least) per person testing for industrialized countries as of March 4. https://www.vox.com/science-and-health/2020/3/12/21175034/co...
what you're saying is extremely surprising. I'd love to have more infos on the situation in japan. Last time i read something about it, it seemed the japanese gvt wasn't very open on what they were doing.
It's sort of weird to hear everyone talking about how social distancing is now the norm, when in the last few days up through today, there have been viral videos of massive crowds at airports, bars, and beaches. The governor of West Virginia just held a press conference encouraging people to go out to eat at restaurants. Several states are supposed to have democratic primary elections tomorrow. I didn't watch the debates, but apparently candidates were encouraging their supporters to go out and vote.
That's still happening at a massive scale.
I think it's fair to say that advising social distancing is the norm. But actually doing it very much isn't yet.
I think it's fair to say that advising social distancing is the norm. But actually doing it very much isn't yet.
Telling the population to do social distancing and hoping they actually follow through is a fool's game. Several states have realized this and started taking measures into their own hands. This includes closing all resturaunts, schools and movie theaters. What they should do next is give the police P95 masks and disposable gloves and train them to use them. This would allow them to have the police drive around and distribute food to families that need it so they don't have to go to the store. They should also heavily incentivize all businesses to give their employees time paid off right now, or allow their employees to work from home.
It's up to the states to either postpone the elections or ramp up infrastructure to ensure they can be done safely (more polling places for no long lines, multi day elections to reduce the rush, lots of cleainging supplies with cleaning between votes, etc). But saying people shouldn't vote at all is antidemocratic. Why not shut down the national election as well and just give it to (candidate you dont like)?
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This article is really important. He is not making an economic argument about the value of social distancing. What's not being said often enough, because it's pretty scary to hear, is that no matter how much we lower the curve, everyone will be infected with COVID-19. Angela Merkel stated it very clearly last week, and this is why policy makers come to Jesus so quickly when experts and eye witnesses explain to them what is going on in China and Italy. Normal flu has some resistance in the population, but this novel coronavirus does not, and so, to put it very plainly, without emergency medical intervention 3% of the population will die. Curve flattening alone doesn't change that in the slightest. Flattening the curve, as the author of this article says, buys critical time right now, and we need to use it to increase targeted emergency medical capacity right now.
> this novel flu
COVID-19 is as much a flu as you are a fish. Probably less so.
COVID-19 is as much a flu as you are a fish. Probably less so.
"Second, flattening the curve assumes that you actually don’t go too far and that much of the population actually becomes infected and then immune. Immunity from Covid-19 is still an open scientific question but, let’s assume that is more likely to be true than not. If you reduce the infection rate too far, then most of the population does not become infected and that means that once you stop policies such as social distancing the virus can emerge once more and we all have to do this again."
So timing of such measures important and too early can be more damaging than too late, overall.
Guess more eye's will be upon the UK now after reading this.
So timing of such measures important and too early can be more damaging than too late, overall.
Guess more eye's will be upon the UK now after reading this.
The logic of the UK position is well articulated in this very HN-friendly article by a UK epidemiologist unaffiliated with the govt scientific advice team [complete with graphs, the Python code of his illustratory models and an appropriate caveat about the magnitude of the uncertainties of the assumptions the scientific advisory team's models will have made]
https://personalpages.manchester.ac.uk/staff/thomas.house/bl...
nb the UK has since issued stronger isolation guidelines and downplayed herd immunity in the media. Longer paper about their current model https://www.imperial.ac.uk/media/imperial-college/medicine/s...
https://personalpages.manchester.ac.uk/staff/thomas.house/bl...
nb the UK has since issued stronger isolation guidelines and downplayed herd immunity in the media. Longer paper about their current model https://www.imperial.ac.uk/media/imperial-college/medicine/s...
the article hints at a solution:
> The reason that this happens is that social distancing measures do not lead to herd immunity, so once they are lifted the epidemic starts again. In the absence of a vaccine, it is therefore meaningless to speak about whether a policy 'aims' to get herd immunity or not, since every country in the world will reach herd immunity unless it is able to implement social distancing for an indefinite period of time.
i predict this is exactly what will happen: indefinite social distancing. impact may be reduced with fast tests and large scale testing so isolation and contact quarantining is immediate.
> The reason that this happens is that social distancing measures do not lead to herd immunity, so once they are lifted the epidemic starts again. In the absence of a vaccine, it is therefore meaningless to speak about whether a policy 'aims' to get herd immunity or not, since every country in the world will reach herd immunity unless it is able to implement social distancing for an indefinite period of time.
i predict this is exactly what will happen: indefinite social distancing. impact may be reduced with fast tests and large scale testing so isolation and contact quarantining is immediate.
It's plausible that COVID-19 will lead to behavioural change around hygiene and remote work, greater travel restrictions and possibly even a degree of acceptance of periodic lockdowns, but the idea humanity as a whole is going to permanently shift towards social distancing after millennia of doing the opposite stretches credulity. At risk groups moving towards social distancing, maybe [for some old people that won't even be much of a change], but that's where the theoretical possibility of herd immunity of the general population not in permanent isolation comes into play.
indefinite does not mean infinite. effectively until a vaccine is deployed globally or global herd immunity is achieved after ten years of pandemic or however long it takes.
One of the few things epidemiologists can be certain of in their assumptions is that our economy and society won't sustain indefinite lockdowns. Extended localised lockdowns, until R0 drops below 1, yes. Repeated localized lockdowns, maybe but decreasingly so. Let's wait until we have a vaccine or something, no.
I agree completely, that’s what I had in mind, but wasn’t really precise enough - basically whatever’s South Korea doing right now. Access to testing, test all suspected cases, quarantine and isolate, and the economy can sort of be back to pre-pandemic order of magnitude.
And the NL. Seems that Rutte (NL prime minister) is betting the farm on herd immunization and minimizing economic disruption while letting the virus spread “under control”.
If it sounds a lot like the Chernobyl script it’s because it is.
If it sounds a lot like the Chernobyl script it’s because it is.
They are going for managed infection of those who need medical intervention with the majority not needing such intervention.
Ergo, managing capacity in a way that is mindful that winter 20/21 will come around faster than we realise. After all the West has just entered spring, so 6 months from now we are in Autumn and the seasonal impacts like normal flu etc start to traction up again.
May well be a case sadly to say that every extra death now, will mean two or more less deaths in the comming winter. Sadly it may well get right down to that uncomfortable truth. Hard to say and honestly, not sure how anybody could articulate that without upsetting anybody in some way, shape or form. But that does seem to be the jist of it.
Ergo, managing capacity in a way that is mindful that winter 20/21 will come around faster than we realise. After all the West has just entered spring, so 6 months from now we are in Autumn and the seasonal impacts like normal flu etc start to traction up again.
May well be a case sadly to say that every extra death now, will mean two or more less deaths in the comming winter. Sadly it may well get right down to that uncomfortable truth. Hard to say and honestly, not sure how anybody could articulate that without upsetting anybody in some way, shape or form. But that does seem to be the jist of it.
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It's not as easy as adding more beds. Each ICU unit has to have specific amount of staff around it, resource, which cannot be easily increased by planned economy.
There are workarounds and corners to cut, like making last year students into doctors without exams, moving doctors from other specialities to intensive care. But it's not exactly the same.
There are workarounds and corners to cut, like making last year students into doctors without exams, moving doctors from other specialities to intensive care. But it's not exactly the same.
Its not as good as a doctors or even an RN degree, but I wonder could a crash course for health care workers tailored specifically to the symptoms of this disease be sufficient to fill that gap?
This same argument process--that to "flatten the curve" in the way all the cutesy diagrams show isn't going to be sufficient to avoid chaos unless we maintain social distancing for years, and that we are deluding everyone into thinking this is "the solution" and that life is somehow going to go back to normal in a couple months (which is where most of the people I know--normal people, not all of my super paranoid friends ;P--are with their mental timelines) to the point where we are not concentrating any effort on anything else (to the point where believing "flattening the curve" is some panacea is maybe even a "dangerous delusion"), including capacity expansion and explicit tracing--was made by someone in an article on medium a few days ago. The prior article had the same little modified graphs showing the true problem, but had actual math to back up their back of the envelope calculations for why it will take years. FWIW, that article was shat on... hard... by people here on Hacker News, and was even flagged, because people even here are apparently so bought into the narrative that they take arguments that it isn't sufficient as somehow "so don't do it: social distancing is bad" (which is bullshit, and not what either of these arguments were/are saying). It is absolutely frustrating how much of an uphill battle it is to even get people to analyze this stuff quickly: we keep having to wait until things get notably worse and then we are willing to look at something only slightly more drastic. I have had friends making this same argument for like a month now and everyone just treats them as if they were literally insane or something :(.
https://news.ycombinator.com/item?id=22575356
https://news.ycombinator.com/item?id=22581950
https://news.ycombinator.com/item?id=22575356
https://news.ycombinator.com/item?id=22581950
I think you're conflating what the general public believes with what those in control believe.
It is in the public's best interest for the general public to only worry about what is within their control (so as to avoid panic). Therefore, the general public is being led to believe that all is going to be OK after a couple months of social distancing.
I guarantee you behind the scenes, those in control are scrambling to take immediate and drastic action to ramp up our medical treatment capacity.
It is in the public's best interest for the general public to only worry about what is within their control (so as to avoid panic). Therefore, the general public is being led to believe that all is going to be OK after a couple months of social distancing.
I guarantee you behind the scenes, those in control are scrambling to take immediate and drastic action to ramp up our medical treatment capacity.
...but I am an elected government official (for a hyper local government, though in a good position where I get to peak behind the curtain of the regional government above me) and the vast majority of my friends work in government; and when I present the argument about capacity expansion moving the line on that cute graph upward as a critical thing we should be doing in addition to moving the peak down and to the right using capacity expansion, the reaction was literally "huh, I hadn't thought about it that way before" :(.
I think "flattening the curve" is often misunderstood, because on diagrams it looks like both scenarios will lead to similar number of infected people. But in reality, the flatter curve can actually lead to significantly less people infected overall, because exponential growth is difficult to control if the disease is everywhere. So it is even possible, it seems to me, that the countries that flatten the curve more vigorously will actually deal with the problem faster. But, as other people noted, we will see.
> It is very clear that capacity expansion has to be the priority now. It has not seriously been addressed by any government as near as I can tell.
Germany _did_ address this. Currently there are 25k beds with ventilator, the federal government ordered 10k ventilators more from the largest local supplier (Drägerwerke) and explicitly bypassed normal procurement laws. That company is now extending manufacturing capacity, but it won't be fast enough.
Germany _did_ address this. Currently there are 25k beds with ventilator, the federal government ordered 10k ventilators more from the largest local supplier (Drägerwerke) and explicitly bypassed normal procurement laws. That company is now extending manufacturing capacity, but it won't be fast enough.
Another thing they do is recruiting med students as emergency staff, but this seems to be in an early phase.
And we're still comparatively early in the pandemic. In my perception our government is actually handling the situation surprisingly well until now. We even overcame years long blockades of our federalism.
A little off topic, but I found this sentence to be incredibly odd - "by we I mean the generation who were adults in World War II"
So all the people who are 90+ years old?
So all the people who are 90+ years old?
It threw me at first, but I think it is supposed to make this point: Although this kind of forced economic shift would feel very new for most of us, humans have managed it before. Specifically, and most recently, in WW2.
How much would mandatory use of mask reduce R0/virus spread? I see in all Asian countries everybody with a mask by default and am wondering what % of spread reduction could be attributed to that factor alone. Are there any data on this?
I really don't like the cavalier attitude with which this author treats the open question of Coronavirus immunity. "Let's assume it's more likely than not going to generate immunity" (paraphrased) seems unfair, and that a fair treatment would simply consider both alternatives.
I don't know who you are wanting to be "fair" to here. The stronger evidence seems to be on the side immunity.
Do you have links to solid evidence? I saw an article from an expert (I'm blanking on the specific article right now) that other "cov" viruses are known to have a limited immunity that lasts for possibly several weeks or so.
I wouldn't bet on "solid" evidence for a while. Hang around the /r/covid19 subreddit for the latest data. There have been very few reported cases of someone getting it again and of those a lot of evidence points to relapse rather than reinfection.
Given the large # of cases and their high concentrations in specific places, it seems likely that we would see many cases of reinfection if previous patients weren't immune.
Given the large # of cases and their high concentrations in specific places, it seems likely that we would see many cases of reinfection if previous patients weren't immune.
This plan has several serious drawbacks: many deaths, possible long-term effects, the fear and anxiety of getting an illness with a 1% fatality rate, the discomfort and pain of being ill, overloaded healthcare system even if you build hospitals because then new bottlenecks like medical staff appear.
And probably more, this is just quick out of my mind.
Here's a better approach: Hardcore lockdown for 2 weeks, which stops the spread and reveals the vast majority of cases. Then switch to high-volume testing and targeted interventions (with would be much more efficient than now because many of the processes can be improved).
And probably more, this is just quick out of my mind.
Here's a better approach: Hardcore lockdown for 2 weeks, which stops the spread and reveals the vast majority of cases. Then switch to high-volume testing and targeted interventions (with would be much more efficient than now because many of the processes can be improved).
Given that so many people are now staying home, working from home etc, I can't see how we can't slow the virus. Right now, I assume the people coming forward are those that have been possibly exposed a week ago before all the lock downs. I have hopes that this thing is thwarted quick, when the President (with info from the CDC) said this could last into July, I genuinely became worried about the state of the world after this. The state of the economy, I can't even say I'd have a job if it lasted that long.
TFA closes with an interesting proposal, but somehow I doubt that we'll get there before social collapse and martial law.
> Immunity from Covid-19 is still an open scientific question but, let’s assume that is more likely to be true than not.
Huh? What's the basis for that?
> The concerns are that China, Japan, and South Korea may have actually pushed social distancing too far. Israel and now Italy are going even further to keep the virus out altogether.
I see no date on TFA, but this statement implies that it's maybe a week old.
> Immunity from Covid-19 is still an open scientific question but, let’s assume that is more likely to be true than not.
Huh? What's the basis for that?
> The concerns are that China, Japan, and South Korea may have actually pushed social distancing too far. Israel and now Italy are going even further to keep the virus out altogether.
I see no date on TFA, but this statement implies that it's maybe a week old.
There have been sufficient reports of people who either got reinfected or else had an extremely long “false recovery” period to cause the question of whether or not immunity can be relied on to be debated. Various explanations are available but none are as of yet proven.
I was unclear. Sorry.
I was wondering why we even expect persistent immunity.
I was wondering why we even expect persistent immunity.
I agree, no one that knows that they are talking about expects persistent immunity; the number I’ve heard floating about is along the lines of six months’ immunity after recovering from the illness. I’m not clear on whether the article is written with that definition of immunity or not (and based off its suggestion that this would prevent a second wave next year, etc, I’m assuming not) but I assumed it was questioning whether even six months of immunity was on the table.
I think we’re going to be in for a rough ride.
The mass exodus from Europe is going to bring back a bunch of infected and asymptomatic people to America. Nobody wore a mask, or used gloves, or probably even sanitized their hands. They were just all in one giant Petri dish at JFK.
This, and flights from Seattle have been going on for over a month now, that infected people were already traveling all over the country, and the world.
By the time 1 person is confirmed infected by a test, they have probably already infected 10 to 20 other people, depending on their rate of social interaction, within the past 5 to 14 days. The average number of days before displaying symptoms is about 4 days. And it could go as high as 13 days.
The only way to stay safe is to avoid other people. And when you interact with someone new, it restarts the clock again.
In another week, America might not have 1 Wuhan sized epicenter, instead, it might have 50! And all the people rushing to Costco and Target, to hoard toilet paper, are just going to make things worse. It’s your local Petri dish, from just waiting in line, and re-breathing the same infected air from the recirculating HVAC.
If you can wear a mask in public, I would highly advise you do so. It may be imperfect, but it will at least help block something. This virus is airborne.
The mass exodus from Europe is going to bring back a bunch of infected and asymptomatic people to America. Nobody wore a mask, or used gloves, or probably even sanitized their hands. They were just all in one giant Petri dish at JFK.
This, and flights from Seattle have been going on for over a month now, that infected people were already traveling all over the country, and the world.
By the time 1 person is confirmed infected by a test, they have probably already infected 10 to 20 other people, depending on their rate of social interaction, within the past 5 to 14 days. The average number of days before displaying symptoms is about 4 days. And it could go as high as 13 days.
The only way to stay safe is to avoid other people. And when you interact with someone new, it restarts the clock again.
In another week, America might not have 1 Wuhan sized epicenter, instead, it might have 50! And all the people rushing to Costco and Target, to hoard toilet paper, are just going to make things worse. It’s your local Petri dish, from just waiting in line, and re-breathing the same infected air from the recirculating HVAC.
If you can wear a mask in public, I would highly advise you do so. It may be imperfect, but it will at least help block something. This virus is airborne.
For now I think governments should think about maintaining the essential necessities: food, water, electricity, while shutting down everything else. Stopping long range transports, including cars, should be a priority.
Anything that is not growing or transporting food or useful to treat patients should be shut down. It's difficult to say this, but sometimes you have to treat citizens like children. This is such a case.
Anything that is not growing or transporting food or useful to treat patients should be shut down. It's difficult to say this, but sometimes you have to treat citizens like children. This is such a case.
Surely it's better just to build as many ventilators as we can.
And then get old people to stay at home, perhaps with a family member or carer to assist them.
And then get old people to stay at home, perhaps with a family member or carer to assist them.
It's pretty clear that the economic impact of this is much bigger that the 2008 GFC, than 9/11 and the 1987 stock market crash. 2008 and 1987 were financial/market crises which caused issues elsewhere.
9/11 shutdown the US economy for a couple of days.
This is shutting down production for weeks and global demand for many thing for months. It's completely unprecedented that I can think of.
9/11 shutdown the US economy for a couple of days.
This is shutting down production for weeks and global demand for many thing for months. It's completely unprecedented that I can think of.
Isn’t part of reducing cases now so we have time to get on a war footing for those things?
At least I hope to god that’s what they’re thinking.
At least I hope to god that’s what they’re thinking.
It it was possible to have a very reliable predictor of who will take the infection in an asymptomatic way, or with very trivial symptoms, a plan could be to infect all those, that are believed to be at least 50% of the population, to create a solid immunity base in the society.
That's basically the UK "herd immunity" which experts think is kinda crazy, also it's not even known that a long-lasting immunity is created for this virus in people who are infected either symptomatically or not.
iirc it requires numbers closer to 2/3rds of a population.
iirc it requires numbers closer to 2/3rds of a population.
Nope it's very different than the UK pseudo plan (apparently they don't really have such plan). I mean, if there was a simple way to test _before_ people get infected, if they'll develop just very mild symptoms, we could do it. Even if you need more than 50%, 50% is still a lot of a barrier that lowers the virus R0 a lot.
Even if there was - testing and controlled-infecting 50% of the population would be a huge effort and probably not shorter than isolating old people and allowing an uncontained infection to burn through.
But the big problem is that it might not even help, the worst case scenario is that absent a vaccine the virus becomes just a more infectious and deadlier cold that people risk getting every season.
But the big problem is that it might not even help, the worst case scenario is that absent a vaccine the virus becomes just a more infectious and deadlier cold that people risk getting every season.
It's an interesting idea, but seems like that proposal would have to compared to the alternative of vaccination.
There's already a vaccine which has been created and which entered the first phase of trials today (https://www.mercurynews.com/2020/03/16/first-stage-of-covid-...). If we're going for a radical plan (which, hope you're not offended, is how I'd characterize your proposal), then just skipping those trials and going straight to giving people that vaccine should be on the table.
So then you'd have to compare safety and efficacy of that against this vaccine. I'm not an expert at all, but it seems like we basically don't know the answer to any of those questions.
* We think that you can't get reinfected once you've had COVID-19. But we aren't sure.
* I don't think a method of predicting symptom severity (like you suggested) has been created, so we don't know its reliability.
* We also don't know if any of the new vaccines are safe.
* Nor do we know if any of the new vaccines are effective.
There's already a vaccine which has been created and which entered the first phase of trials today (https://www.mercurynews.com/2020/03/16/first-stage-of-covid-...). If we're going for a radical plan (which, hope you're not offended, is how I'd characterize your proposal), then just skipping those trials and going straight to giving people that vaccine should be on the table.
So then you'd have to compare safety and efficacy of that against this vaccine. I'm not an expert at all, but it seems like we basically don't know the answer to any of those questions.
* We think that you can't get reinfected once you've had COVID-19. But we aren't sure.
* I don't think a method of predicting symptom severity (like you suggested) has been created, so we don't know its reliability.
* We also don't know if any of the new vaccines are safe.
* Nor do we know if any of the new vaccines are effective.
Firstly, is a physical shortage of beds the problem? Capacity is not just physical, where do the doctors come from?
As for building additional capacity with a WW mindset... how about just annex the currently empty offices and buildings?
...now to train some doctors!
As for building additional capacity with a WW mindset... how about just annex the currently empty offices and buildings?
...now to train some doctors!
The part of the article I did not find compelling is handing things over to the military. The army that I served in is not exactly led by the best and the brightest, and armies in other countries can be actively malicious entities.
This actually sounds great. Why not basically have war economy for this, esp given how many people are becoming jobless - forcing a dramatic capacity increase could be a significant Keynesian stimulus.
You know what I'm interested in? What will the effect be on non-corona diseases with already lower RE?
Are we going to see some disease, such as measles, eliminated? What about chicken pox? The flu?
I'm really curious as to how this ends up affecting disease in society. I don't know if it will be enough to eliminate corona, but this may be enough to kill off other diseases.
Are we going to see some disease, such as measles, eliminated? What about chicken pox? The flu?
I'm really curious as to how this ends up affecting disease in society. I don't know if it will be enough to eliminate corona, but this may be enough to kill off other diseases.
I have also been thinking about having the military come in and start building hospitals. The president seemed to have no qualms about using that power for his wall.
But on the other hand, doing so might greatly decrease military readiness. Let’s not add a major war to the list of catastrophes. But I’d love to hear what military buffs think.
But on the other hand, doing so might greatly decrease military readiness. Let’s not add a major war to the list of catastrophes. But I’d love to hear what military buffs think.
"we ....the generation that were adults during World War Il..." Ummm he's 98?
This is something that I've been afraid of for a while. I know a few nurses that work in some of the most best staffed, well funded Magnet hospitals and they say they run at 90% capacity on the best of days.
I am not sure I agree with the thrust of this article. The gist seems to be: if we do a sufficiently good job with containment measures (e.g. social distancing), we might succeed in limiting short-term infections, but we will have to remain in this mode for years (with ruinous effects on the economy). The offered alternative is to acknowledge that a significant fraction of the population will be infected eventually, and so we should scale up hospital capacity to accommodate that.
This doesn't seem like a very good alternative. Even with adequate hospital care, the true fatality rate seems to be in the neighborhood of 0.5% to 1%, which would be quite harsh if allowed to spread throughout the population.
I am hoping that improvements in treatment can make the difference. A vaccine may not be available for quite some time, but drugs that reduce the fatality rate might be ready sooner.
Of course the actual course of action must include some mix of all-of-the-above: containment, new hospitals, new treatments.
EDIT: as voidmain notes, we might also hope to quickly reduce the number of infections to the point where we can contain them with testing and contact tracing, rather than blanket shutdowns.
This doesn't seem like a very good alternative. Even with adequate hospital care, the true fatality rate seems to be in the neighborhood of 0.5% to 1%, which would be quite harsh if allowed to spread throughout the population.
I am hoping that improvements in treatment can make the difference. A vaccine may not be available for quite some time, but drugs that reduce the fatality rate might be ready sooner.
Of course the actual course of action must include some mix of all-of-the-above: containment, new hospitals, new treatments.
EDIT: as voidmain notes, we might also hope to quickly reduce the number of infections to the point where we can contain them with testing and contact tracing, rather than blanket shutdowns.
> remain in this mode for years
What's your basis for that? It seems like a vaccine will be available well before years have gone by.
What's your basis for that? It seems like a vaccine will be available well before years have gone by.
Drugs (a few of them are in Phase III and trials are already ongoing, with some results expected next month) will likely help first. If you can treat the severely sick patients, and even just cut one week out of the 3-4 they need to spend in the hospital, it would be a huge success. In fact I'd argue that most of the problems we are facing are because there is no appropriate treatment.
Vaccines will likely take more time, due to long-term effects that need to be investigated (as many mentioned in some other HN story today).
Vaccines will likely take more time, due to long-term effects that need to be investigated (as many mentioned in some other HN story today).
What I am still trying to understand is if we get variations of the flu virus every year so dramatic that sometimes they guess on the vaccine completely wrong (like this year) then why aren't we going to have a Covid-19 variant this winter that everyone can catch again?
My (low-information) understanding is that coronaviruses have much lower mutation rates than flu viruses!
This is true, the influenza virus contains 8 small strands of RNA, which means that two different influenza viruses can combine to create a novel one.
They have a proofreading RNA polymerase, IIRC, which means that indeed they have a lower error rate than other viruses.
Apparently 30% of cases of the common cold are cause by coronavirus. And the worrying thing is that the immunity we acquire for those is only temporary.
At this point, I think it's just appropriate to say "we don't know yet". This is a new virus, and not much is known about it yet.
And that is why drug development needs to go parallel with a vaccine. If a vaccine fails, we can fall back to drugs to prevent people from going into ICUs (hopefully).
And that is why drug development needs to go parallel with a vaccine. If a vaccine fails, we can fall back to drugs to prevent people from going into ICUs (hopefully).
The influenza has a completely atypical rate or mutation. For most diseases, one infection is enough to make a person resistant for life.
Besides, partial resistance is a thing. When our immune system has seen some other similar virus, we get a much less severe version of the disease.
Besides, partial resistance is a thing. When our immune system has seen some other similar virus, we get a much less severe version of the disease.
Article misses the angle that we could flatten the curve and get herd immunity via a vaccine.
It'll be interesting to see how Italy (lockdown) compares with the UK (just let it infect everyone) compares with South Korea (extensive testing & contact tracing, plus social distancing) in a couple months.
My sense is that the UK will probably fold and institute a lockdown once their ICU capacity gets overwhelmed and healthy young people start dying in the streets. Either that or they'll face a revolution and then have a lot more problems. Of course, by the time it gets to either of those points it'll be too late to effectively change course.
But it's interesting to see at least one country take the position that "Hey, we're going to let this run its course, take our lumps now, and try to get back to business as usual ASAP." I could be wrong, and maybe this is a genius application of heartless logic. Time will tell.
RemindMe!2months ;-)
My sense is that the UK will probably fold and institute a lockdown once their ICU capacity gets overwhelmed and healthy young people start dying in the streets. Either that or they'll face a revolution and then have a lot more problems. Of course, by the time it gets to either of those points it'll be too late to effectively change course.
But it's interesting to see at least one country take the position that "Hey, we're going to let this run its course, take our lumps now, and try to get back to business as usual ASAP." I could be wrong, and maybe this is a genius application of heartless logic. Time will tell.
RemindMe!2months ;-)
>My sense is that the UK will probably fold and institute a lockdown once their ICU capacity gets overwhelmed and healthy young people start dying in the streets. Either that or they'll face a revolution and then have a lot more problems. Of course, by the time it gets to either of those points it'll be too late to effectively change course.
Looks like that's already happening: https://www.buzzfeed.com/alexwickham/coronavirus-uk-strategy...
Looks like that's already happening: https://www.buzzfeed.com/alexwickham/coronavirus-uk-strategy...
[deleted]
that article is pure gold, if it was the onion i wouldn't be able to tell.
> "We were expecting herd immunity to build. We now realise it’s not possible to cope with that," professor Azra Ghani, chair of infectious diseases epidemiology at Imperial, told journalists at a briefing on Monday night.
i can multiply numbers fifteen times in a row and come to that conclusion. alternatively, i can watch italian tv. did these people never looked up from their models to confront them with actual reality?
> "We were expecting herd immunity to build. We now realise it’s not possible to cope with that," professor Azra Ghani, chair of infectious diseases epidemiology at Imperial, told journalists at a briefing on Monday night.
i can multiply numbers fifteen times in a row and come to that conclusion. alternatively, i can watch italian tv. did these people never looked up from their models to confront them with actual reality?
Truly incredible
How long did it take them to no longer expect herd immunity to build? 12 hours? That must be one of the most ridiculous acts of about-face in public policy in this generation.
>My sense is that the UK will probably fold and institute a lockdown once their ICU capacity gets overwhelmed and healthy young people start dying in the streets. Either that or they'll face a revolution and then have a lot more problems. Of course, by the time it gets to either of those points it'll be too late to effectively change course.
> Looks like that's already happening
Is UK ICU capacity overwhelmed and are young people dying in the streets?
No.
Don’t spread rumours in this situation.
> Looks like that's already happening
Is UK ICU capacity overwhelmed and are young people dying in the streets?
No.
Don’t spread rumours in this situation.
Yes, sorry, what I meant was that the lockdown was likely going into effect already, but not for completely apocalyptic reasons.
They aren't rumors. UK ICU capacity is already overwhelmed.
Nobody is dying in the streets of the UK. This is silly nonsense.
[deleted]
> UK (just let it infect everyone)
is completely false. It was hyped by some out of context quotes by some media outlets and spread like a literal virus and people didn't bother to find out the reality, and so we see the same mis information being shared here.
We need to flatten the curve of these misinformation viruses
is completely false. It was hyped by some out of context quotes by some media outlets and spread like a literal virus and people didn't bother to find out the reality, and so we see the same mis information being shared here.
We need to flatten the curve of these misinformation viruses
you must have missed that in the UK, unlike the rest of Europe :
- schools/nurseries open
- theatres/bars/restaurants open
- stadiums open
- large gatherings allowed
The Mayor of London was still organising mass events a few days ago ( https://www.facebook.com/sadiqforlondon/posts/30260791107781... )
- schools/nurseries open
- theatres/bars/restaurants open
- stadiums open
- large gatherings allowed
The Mayor of London was still organising mass events a few days ago ( https://www.facebook.com/sadiqforlondon/posts/30260791107781... )
Most of that changed as of 5 hours ago.
Boris asked nicely for people to think about maybe not going to the pub.
But they're crammed as usual.
And businesses can't claim insurance money if they close, as they're not required to close by law.
But they're crammed as usual.
And businesses can't claim insurance money if they close, as they're not required to close by law.
Theyve only asked, tho. Legally nothing has changed. Walked by my local at 9pm and it was half full...
Nope, schools are still open.
Research group at the Biozentrum, University of Basel, Switzerland has updated their COVID19-scenario explorer. https://neherlab.org/covid19/
If you run their model for UK with weak mitigation, Moderate/North epidemiology, you get 390,000 total deaths.
If you run their model for UK with weak mitigation, Moderate/North epidemiology, you get 390,000 total deaths.
Hm, if you change amount of beds total deaths don't change in their model.
Your post is out of date as of about 5 hours ago.
From https://www.bbc.co.uk/news/uk-51917562 social distancing is now in place.
The original announcements said that it would always be in place, but that they wanted to wait because it is hard for people over prolonged periods.
From https://www.bbc.co.uk/news/uk-51917562 social distancing is now in place.
The original announcements said that it would always be in place, but that they wanted to wait because it is hard for people over prolonged periods.
"social distancing" recommendation...but everything is still open
> My sense is that the UK will probably fold and institute a lockdown
They (we) have already shifted towards a lockdown (voluntary for now, but people have been told to avoid office, pubs and travelling[0]) due to the model used being updated with the data from Italy.
https://www.bbc.co.uk/news/uk-51917562
They (we) have already shifted towards a lockdown (voluntary for now, but people have been told to avoid office, pubs and travelling[0]) due to the model used being updated with the data from Italy.
https://www.bbc.co.uk/news/uk-51917562
A couple of teleconferences with Italian doctors was what spooked Norwegian authorities to institute wartime measures while we still had only 200 confirmed cases. Glad the rest of the world seems to follow.
Uk tactic looks very sensible to me. They will institute a lockdown long before that. But they recognize a lockdown for a prolonged time is very challenging in itself and there aren't many good reasons to be doing it too early.
That's... completely insane. There "aren't many reasons to be doing it too early"? Stopping, or at least slowing the spread of a worldwide pandemic isn't a good reason? Preventing 3% of your population from dying over the next year isn't a good reason?
Waiting until the problem obviously seems like a real problem is exactly what crushed cultures under epidemics in the past.
Waiting until the problem obviously seems like a real problem is exactly what crushed cultures under epidemics in the past.
The UK strategy is based on the idea that the pandemic cannot be stopped, but can be slowed down and directed away from the most vulnerable. So there are certain assumptions there that people can agree or disagree with. But its not 'completely insane'.
And yes South Korea and China seem to have stopped the pandemic in their countries, and have done an impressive job at it, but its early days and not at all clear how sustainable their approach is, or whether that approach would work everywhere.
And yes South Korea and China seem to have stopped the pandemic in their countries, and have done an impressive job at it, but its early days and not at all clear how sustainable their approach is, or whether that approach would work everywhere.
No, it is not.
It is too late for stopping it and you can barely delay it either.
You delay a few days or maybe 1-2 weeks if stringent but it won't be as effective when you desperately need it to be. Likely more will die if you start too early.
It is too late for stopping it and you can barely delay it either.
You delay a few days or maybe 1-2 weeks if stringent but it won't be as effective when you desperately need it to be. Likely more will die if you start too early.
Yeah, the pragmatic mindset might as well calculate the savings on pensions from deceased elderly. I personally find this unacceptable. More should have been done earlier and it didn’t happen. We’ll see how this affects the next elections though..
So far number of cases has been multiplying by 10 every ~16 days. Incubation period is 4-14 days. I.e. when you institute quarantine, cases will still multiply like crazy for another 4-14 days. In other words, you have to do it "too early". If you do it when you're nearing ICU capacity, you are waaaay too late.
This. I expect duplication every three days where I'm writing this until the effects of lockdown measures show up clearly in around two weeks time.
Think about something akin to some sort of nuclear reactor with control rods up you've just started to insert.
Think about something akin to some sort of nuclear reactor with control rods up you've just started to insert.
25 to 35% growth rates seem like the norm withiut (or nearly withiut) any restrictions and nearly no public awareness. That a full lockdown quickly stops the spread is obvious, but it will be interesting to see how well the UK/Swedish model works with. strict social distancing but without lickdowns or even shutdowns of e.g restaurants.
Our math might need some correction. The statistics I was citing is daily contamination rate of 15-25%, and multiplication by 10 every 16 days (which comes out to a daily contamination rate of 15%). A daily rate of 25% gives you multiplication by 10 every 10.5 days.
Don't think anyone is waiting for the ICU to be at capacity.
The UK backed away from this insanity and will be implementing social distancing.
Thank god.
Thank god.
They were always going to eventually, and they said so.
Was out tonight going to supermarket, the social distancing isn't enforced. I still saw half full pubs. Bare in mind it's Monday, if nothing changes expect full pubs and business as usual coma Friday. Nothing has changed.
Everything is still open in the UK
[deleted]
Maybe they want a flat curve in the sense of a rectangle. You know rapidly rise until just what the system can take and then keep it there..
You can't really do that. If you think of this in terms of the control over the virus being a Proportion-Integral-Derivative type system, then given how long it takes to gather more information about the current infection level in the populace you're either going to overshoot after the corner(too little pressure applied) or undershoot(too much pressure applied) after the corner. You can't apply perfect control to this kind of system such that the corner is perfectly square.
Especially where our knowledge is imperfect and subject to a lot of latency, we have to accept that we have very little actual control over how quickly the curve speeds or slows. Thus the bell-shaped curves.
Especially where our knowledge is imperfect and subject to a lot of latency, we have to accept that we have very little actual control over how quickly the curve speeds or slows. Thus the bell-shaped curves.
UK has just made what apparently is a 180, U-turn, or however you want to call it and started implementing more serious containment measures.
AFAIK the UK line has consistently been "we'll do it, but not yet, because we can only do it for a limited time and so far the numbers don't warrant it". That's not a U-turn, that's doing pretty much what you said you were going to do.
the 'soon' was always weeks from last Friday but miraculously happened today. i say somebody added uprising probability to the model.
The always said they thought the peak was 10-14 weeks away and that the UK was about 4 weeks behind Italy. They now say that the UK is about 3 weeks behind italy and we are at the beginning of the dramatic up-swing so, time to apply the brakes.
It might already be too late for UK. Italy missed the mark by a week and it's a disaster in parts of the country. I'm from Slovenia and we implemented a total shutdown of public life. Now we are now waiting to see if it'll work. We went from 1 confirmed case to a shutdown in 10 days. And it's far from guaranteed that shutdown will work as it might be a few days too late.
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I'm pretty confused by the European government's responses. While the UK is the most brazen, all others are essentially also saying that there's no other way other than letting a non-negligible percentage of the population die, and that the best they can do is try to ensure that everyone who needs an ICU gets one. And all the while incurring a massive economic cost. Italy, France, Switzerland and Austria have effectively halted most of the economic activity, initially for 2 weeks to a month, but it's likely that it's either going to be longer, or that they'll have to repeat the process. That's 100s of billions of dollars gone just there, not counting for the long-term impact and all the social problems that'll follow. I'm puzzled that the idle workforce and the lost money isn't diverted to urgent and massive scaling of testing and protection equipment.
Of course, all it takes is a UK to screw everyone over by not playing along and providing a population pool for the virus to mutate. And then a ton of poor countries who probably can't do anything even if they wanted, where it's just starting.
Of course, all it takes is a UK to screw everyone over by not playing along and providing a population pool for the virus to mutate. And then a ton of poor countries who probably can't do anything even if they wanted, where it's just starting.
Add Norway and Denmark to the list of countries that have halted large part of their economic activity.
Honestly, I think the UK, Sweden et al. will be "voted out" here. Commerce can't continue between countries that follow the China/South Korea model of keeping R0 < 1, because frequent large outbreaks are bound to follow. Britain can't economically dominate its neighbors like that today. Sweden, forget about it.
This is a spectacular high-stakes experiment. But if Boris Johnson isn't persuaded by public opinion and a high death toll, his trading partners will.
Both approaches put strong selection pressure on the virus to mutate to a milder form, so even in the absence of a vaccine, we'll win in the long term.
Honestly, I think the UK, Sweden et al. will be "voted out" here. Commerce can't continue between countries that follow the China/South Korea model of keeping R0 < 1, because frequent large outbreaks are bound to follow. Britain can't economically dominate its neighbors like that today. Sweden, forget about it.
This is a spectacular high-stakes experiment. But if Boris Johnson isn't persuaded by public opinion and a high death toll, his trading partners will.
Both approaches put strong selection pressure on the virus to mutate to a milder form, so even in the absence of a vaccine, we'll win in the long term.
> there's no other way other than letting a non-negligible percentage of the population die.
That's not what is being said. What is being said is that specifically to avoid people dying, you need to stop ICUs being overwhelmed, but that in their judgement and modelling an immediate hard clamp down is not the best way.
That's not what is being said. What is being said is that specifically to avoid people dying, you need to stop ICUs being overwhelmed, but that in their judgement and modelling an immediate hard clamp down is not the best way.
Who are you comparing Europe to?
Trump just announced advice not to gather for 2 weeks. A 2 week restriction is a drop in the sea.
China is celebrating lifting of many restrictions. But the virus will come back in those areas and the restrictions will come back too.
Trump just announced advice not to gather for 2 weeks. A 2 week restriction is a drop in the sea.
China is celebrating lifting of many restrictions. But the virus will come back in those areas and the restrictions will come back too.
uk announced social distancing and non mandatory isolation
>"Hey, we're going to let this run its course, take our lumps now, and try to get back to business as usual ASAP." I could be wrong, and maybe this is a genius application of heartless logic
Related, if we take the numbers out of China at face value: A tiny tiny fraction of the population has been infected (acquired immunity). So what now? Lock everything down until a vaccine is discovered?
Related, if we take the numbers out of China at face value: A tiny tiny fraction of the population has been infected (acquired immunity). So what now? Lock everything down until a vaccine is discovered?
Here's how China claims to be handling day-to-day life: https://m.youtube.com/watch?v=YfsdJGj3-jM
Basically, masks in public, no-contact thermometers everywhere, and QR codes that you scan to enter a subway or a building. There's more, but that's the core.
If you have a fever, then they send you to a specialized fever clinic: https://mobile.twitter.com/MikeIsaac/status/1238604080571772...
There, they determine if you've been infected. If you have been, they send you to a group isolation ward, where you spend a few weeks chilling out and doing group dance exercises. If can't stand up and dance, you get treatment.
It's clearly a society at war, and I'm sure some ugly details are hidden. But it looks better than hiding indoors while our medical system burns and our elderly relatives die (and at least some of us younger folk wind up with scarred lungs).
Basically, masks in public, no-contact thermometers everywhere, and QR codes that you scan to enter a subway or a building. There's more, but that's the core.
If you have a fever, then they send you to a specialized fever clinic: https://mobile.twitter.com/MikeIsaac/status/1238604080571772...
There, they determine if you've been infected. If you have been, they send you to a group isolation ward, where you spend a few weeks chilling out and doing group dance exercises. If can't stand up and dance, you get treatment.
It's clearly a society at war, and I'm sure some ugly details are hidden. But it looks better than hiding indoors while our medical system burns and our elderly relatives die (and at least some of us younger folk wind up with scarred lungs).
Immunity? There are two strains of corvid in China. Even if you had it you can get another variant.
Unfortunately it's not just the UK. Also in the Netherlands we have to live through this social experiment.
That's not even close to true, schools, restaurants, pubs and sporting establishments are shut down. Events with 100 or more people attending are not allowed and the government is actively working to help companies deal with less productivity due to people working from home or in staggered shifts. They also recommend social distancing. This is not "Hey, we're going to let this run its course, take our lumps now, and try to get back to business as usual ASAP." as the grandparent mentioned.
If U.K. goes it alone they will be out of sync with the rest of the world in terms of travel restrictions. No one will be going in or out of U.K. until everywhere else has caught up to their herd immunity or we have a vaccine. Not sure how this lack of travel affects their economy.
Also... I hesitate to say this because it smells of ad hominem, but in this view the enormous cost of extreme shutdowns is mostly the cost of a mulligan for poor decision making and actions early in the crisis. This may make this view less popular with the various organizations that made those mistakes.
This isn't a mulligan, that's the trouble. Previous contact tracing efforts had the advantage that we knew where the initial cases were coming from - China, primarily Wuhan - and could use that as a starting point. Those failed in most countries. After shrinking the epidemic down, the initial cases are basically just random people who have what looks like a cold. It'd be like searching for a few needles in a massive haystack.
I think that approach is exactly why contact tracing didn't work. A virus that spreads as contagiously and stealthily as this one means that contract tracing alone is not able to achieve Re<1. Eventually (in the case of Washington state, apparently with the first known case?) someone escapes your net and then exponential growth does its magic, because you aren't decreasing Re for anyone not already in your contact graph. (CDC refused to test anyone without a clearly documented link to Wuhan)
A working version of this that actually affects the asymptotics rather than just buying you a few weeks at best has to be able to identify new case clusters while they are small, and then find and isolate a significant fraction of the cases (working backward as well as forward). Table stakes for this is the ability to test everyone with flulike symptoms who tests negative for flu (and flu tests have horrible sensitivity, so that is a lot of people). As I see it from my comfortable armchair, CDC should have made sure long before the epidemic that the RT-PCR capacity to do that existed (doing other work at private and public labs) and could be recruited and online to do this within a few days of the virus being sequenced. You also would need everyone to at least moderately change their behavior because I don't think this would be enough by itself. Simple things like not going to work sick or tolerating co-workers or employees who do seem like feasible changes with both cultural and legal levers to pull that could be very low cost and contribute significantly to Re reduction.
More speculatively, you might be able to do even better using pooled PCR tests to look for RNA in large groups, giving you a chance to spot even asymptomatic cases. Is there viral rna in sewer water or garbage? PCR amplifies exponentially, it should be able to cope with a fair amount of dilution.
A working version of this that actually affects the asymptotics rather than just buying you a few weeks at best has to be able to identify new case clusters while they are small, and then find and isolate a significant fraction of the cases (working backward as well as forward). Table stakes for this is the ability to test everyone with flulike symptoms who tests negative for flu (and flu tests have horrible sensitivity, so that is a lot of people). As I see it from my comfortable armchair, CDC should have made sure long before the epidemic that the RT-PCR capacity to do that existed (doing other work at private and public labs) and could be recruited and online to do this within a few days of the virus being sequenced. You also would need everyone to at least moderately change their behavior because I don't think this would be enough by itself. Simple things like not going to work sick or tolerating co-workers or employees who do seem like feasible changes with both cultural and legal levers to pull that could be very low cost and contribute significantly to Re reduction.
More speculatively, you might be able to do even better using pooled PCR tests to look for RNA in large groups, giving you a chance to spot even asymptomatic cases. Is there viral rna in sewer water or garbage? PCR amplifies exponentially, it should be able to cope with a fair amount of dilution.
South Korea did just fine, they managed to prevent the exponential curve so far. In the USA, the government just fucked up and did nothing, even actively engaged in disinformation.
Not quite, the U.S. began adopting measures almost immediately [0].
0: https://www.washingtonpost.com/local/trafficandcommuting/tra...
0: https://www.washingtonpost.com/local/trafficandcommuting/tra...
Blocking direct flights from a single region? What else?
Half measures, if even half.
dboreham(2)
Tl:dr also take over the economy and conscript people to make hospital beds
Disappointed this article makes no mention accelerating development and distribution of vaccines by relaxing FDA approval processes.
Sure, that may take 9-18 months. But preventing the "second wave" is more important than reacting to it.
Sure, that may take 9-18 months. But preventing the "second wave" is more important than reacting to it.
These approval processes are there for a reason though. If you are going to inject some pathogen to millions of people, you better be sure that it has no strong, even long term, undesirable effect.
It's not so much the injections, but just allowing the development of alternative processes that may scale much faster than the 70 year old egg-based process.
When we look back in retrospective, the CDC and FDA will be under scrutiny to take more preventative measures.
When we look back in retrospective, the CDC and FDA will be under scrutiny to take more preventative measures.
Certainly, it seems like there's more bad information than good.
E.g. The beds are already full EVERY flu season. Do the researcher's know this? The flu has killed over 12,000 people every year in the US for the last 10 years.
2 years ago, the flu killed 61,000 people in the US.
So, the logical question might be: Why haven't we been "flattening the curve" for years?
Roll forward to Coronavirus and a news media publicizing a "novel" flu that spreads and kills and maims at about the same rate and suddenly we're all running around like crazy trying to destroy the economy and our livelyhoods to "flatten the curve".
Our politicians, who literally have no plan, are making grand pronouncements bravely shutting down everything they can think of because they completely f'd-up the testing and tracking of the coronavirus and literally have no idea what else to do, but know they don't want to be the one at the center of one of those circles showing the number of sick in each city.
*Source: https://www.cdc.gov/flu/about/burden/index.html.
E.g. The beds are already full EVERY flu season. Do the researcher's know this? The flu has killed over 12,000 people every year in the US for the last 10 years.
2 years ago, the flu killed 61,000 people in the US.
So, the logical question might be: Why haven't we been "flattening the curve" for years?
Roll forward to Coronavirus and a news media publicizing a "novel" flu that spreads and kills and maims at about the same rate and suddenly we're all running around like crazy trying to destroy the economy and our livelyhoods to "flatten the curve".
Our politicians, who literally have no plan, are making grand pronouncements bravely shutting down everything they can think of because they completely f'd-up the testing and tracking of the coronavirus and literally have no idea what else to do, but know they don't want to be the one at the center of one of those circles showing the number of sick in each city.
*Source: https://www.cdc.gov/flu/about/burden/index.html.
"a "novel" flu that spreads and kills and maims at about the same rate"
It's nowhere near "the same rate"?
It's nowhere near "the same rate"?
And it's not a flu.
From a Penn State epidemiologist (note that the quote below speaks of the "infection fatality rate", which is different from the "case fatality rate", the difference is explained in the article)[1]:
"Scientists working at the London School of Hygiene and Tropical Medicine, Imperial College London and the Institute for Disease Modeling have used these approaches to estimate the infection fatality rate. Currently, these estimates range from 0.5% to 0.94% indicating that COVID-19 is about 10 to 20 times as deadly as seasonal influenza. Evidence coming in from genomics and large-scale testing of fevers is consistent with these conclusions. The only potentially good news is that the epidemic in Korea may ultimately show a lower CFR than the epidemic in China.
...
"On balance, it is reasonable to guess that COVID-19 will infect as many Americans over the next year as influenza does in a typical winter -- somewhere between 25 million and 115 million. Maybe a bit more if the virus turns out to be more contagious than we thought. Maybe a bit less if we put restrictions in place that minimize our travel and our social and professional contacts.
"The bad news is, of course, that these infection numbers translate to 350,000 to 660,000 people dying in the U.S., with an uncertainty range that goes from 50,000 deaths to 5 million deaths. The good news is that this is not a weather forecast. The size of the epidemic, i.e., the total number of infections, is something we can reduce if we decrease our contact patterns and improve our hygiene. If the total number of infections decreases, the total number of deaths will also decrease."
This analysis is a little old, however (from March 9th, a week ago), and assumes that the rate of infection of COVID-19 is comparable to seasonal influenza. A recent This Week in Virology podcast[2] had another epidemiologist, Ralph Baric, of the University of North Carolina Chapel Hill, who had this to say:
"The R0, or the number of people who become infected from an infected individual, is estimated somewhere between 2.5 and 3.2. That's actually quite high. That means that for every case there is two and a half to three additional cases. Contemporary flu is much closer to 2 or 1.8, 1.6. So this is very explosive spread and rapid transmission. It's even more explosive because you have rare individuals or maybe not so rare individuals who are superspreaders, who can infect 15, 20 people just passing through a room."[3]
"In Canada there was one example of a superspreader who simply walked through an emergency room that was packed that was fairly packed with individuals and infected 19 people in the less than the 15 seconds they were in the emergency room as they walked through it."[4]
With such explosive growth, the health care systems stands a very good chance of being overwhelmed, causing substantially more deaths. For instance, those 10% to 17% of severe cases that might have otherwise survived had they gotten care in an ICU could well die because they can't get that care. In addition many other, non-infected people who need critical care may not be able to get that care either and die, raising the overall death toll even higher.
[1] - https://www.marketwatch.com/story/why-this-epidemiologist-is...
[2] - http://www.microbe.tv/twiv/twiv-591/
[3] - about 8 minutes in to the program
[4] - about 38 minutes in to the program
"Scientists working at the London School of Hygiene and Tropical Medicine, Imperial College London and the Institute for Disease Modeling have used these approaches to estimate the infection fatality rate. Currently, these estimates range from 0.5% to 0.94% indicating that COVID-19 is about 10 to 20 times as deadly as seasonal influenza. Evidence coming in from genomics and large-scale testing of fevers is consistent with these conclusions. The only potentially good news is that the epidemic in Korea may ultimately show a lower CFR than the epidemic in China.
...
"On balance, it is reasonable to guess that COVID-19 will infect as many Americans over the next year as influenza does in a typical winter -- somewhere between 25 million and 115 million. Maybe a bit more if the virus turns out to be more contagious than we thought. Maybe a bit less if we put restrictions in place that minimize our travel and our social and professional contacts.
"The bad news is, of course, that these infection numbers translate to 350,000 to 660,000 people dying in the U.S., with an uncertainty range that goes from 50,000 deaths to 5 million deaths. The good news is that this is not a weather forecast. The size of the epidemic, i.e., the total number of infections, is something we can reduce if we decrease our contact patterns and improve our hygiene. If the total number of infections decreases, the total number of deaths will also decrease."
This analysis is a little old, however (from March 9th, a week ago), and assumes that the rate of infection of COVID-19 is comparable to seasonal influenza. A recent This Week in Virology podcast[2] had another epidemiologist, Ralph Baric, of the University of North Carolina Chapel Hill, who had this to say:
"The R0, or the number of people who become infected from an infected individual, is estimated somewhere between 2.5 and 3.2. That's actually quite high. That means that for every case there is two and a half to three additional cases. Contemporary flu is much closer to 2 or 1.8, 1.6. So this is very explosive spread and rapid transmission. It's even more explosive because you have rare individuals or maybe not so rare individuals who are superspreaders, who can infect 15, 20 people just passing through a room."[3]
"In Canada there was one example of a superspreader who simply walked through an emergency room that was packed that was fairly packed with individuals and infected 19 people in the less than the 15 seconds they were in the emergency room as they walked through it."[4]
With such explosive growth, the health care systems stands a very good chance of being overwhelmed, causing substantially more deaths. For instance, those 10% to 17% of severe cases that might have otherwise survived had they gotten care in an ICU could well die because they can't get that care. In addition many other, non-infected people who need critical care may not be able to get that care either and die, raising the overall death toll even higher.
[1] - https://www.marketwatch.com/story/why-this-epidemiologist-is...
[2] - http://www.microbe.tv/twiv/twiv-591/
[3] - about 8 minutes in to the program
[4] - about 38 minutes in to the program
Also, the Italian government plans to hire a ton of medical and paramedical staff, money has been earmarked.
I am quite sure other governments are doing the same.