How to Respond to COVID-19(gatesnotes.com)
gatesnotes.com
How to Respond to COVID-19
https://www.gatesnotes.com/Health/How-to-respond-to-COVID-19
110 comments
> How could we expect the population to fight for a country that didn’t look after them in return?
One of the benefits of serving in the US military was free medical care for the soldier and his family.
One of the benefits of serving in the US military was free medical care for the soldier and his family.
I think the argument extends to potential need to draft general population in times of need. You want to draft healthy people.
the argument doesn't work, because the assumption is that you have a large, but unhealthy population. But such a population is unable to sustain itself in the first place!
If a country is doing fine (production wise), then there must be way more healthy, able-bodied people than sick people. The draft will just target those able-bodied people.
And then there's the new style of war these days - drones, remote weapons and nukes. It either comes down to a small skirmish against brown people with little more than an AK47, or it's nuke time. i don't see war going any other direction.
If a country is doing fine (production wise), then there must be way more healthy, able-bodied people than sick people. The draft will just target those able-bodied people.
And then there's the new style of war these days - drones, remote weapons and nukes. It either comes down to a small skirmish against brown people with little more than an AK47, or it's nuke time. i don't see war going any other direction.
It’s not purely a practical argument, though it has a strong practical component, to me it’s also a moral one. We expect loyalty and patriotism from our people. If we owe loyalty to our country and each other, I believe that carries obligations.
I’m no socialist, I’m a true believer in the individual freedoms and liberties at the heart of capitalism. Free enterprise is the most powerful force in human society, and it is generally a force for good.
I suppose where I part ways with American style conservatives is my attitude to government. To me, in a democracy we are the government. It’s not an external force, it’s something we all carry responsibility for, and can be a vehicle through which we meet our mutual responsibilities, and to me that’s tied to my sense of patriotic duty. I know America has a much stronger sense of individualism and personal autonomy. I don’t want to malign that or trivialise it, there are good historical reasons for it. It’s just that over here in the UK we learned different historical lessons for different reasons.
I’m no socialist, I’m a true believer in the individual freedoms and liberties at the heart of capitalism. Free enterprise is the most powerful force in human society, and it is generally a force for good.
I suppose where I part ways with American style conservatives is my attitude to government. To me, in a democracy we are the government. It’s not an external force, it’s something we all carry responsibility for, and can be a vehicle through which we meet our mutual responsibilities, and to me that’s tied to my sense of patriotic duty. I know America has a much stronger sense of individualism and personal autonomy. I don’t want to malign that or trivialise it, there are good historical reasons for it. It’s just that over here in the UK we learned different historical lessons for different reasons.
Pretty much my argument for universal healthcare.
People from both sides focus too much on emotional aspects of universal heathcare, but from a practical standpoint, the healthier your population, the longer they will be alive paying taxes. Obesity was a problem in the US only when too many people were too fat to join the military.
People from both sides focus too much on emotional aspects of universal heathcare, but from a practical standpoint, the healthier your population, the longer they will be alive paying taxes. Obesity was a problem in the US only when too many people were too fat to join the military.
I don’t think skepticism of governments is an emotional response. It is practical and evidenced by history & folks’ experience with it.
Folks against one method of caring for the population (ie “universal healthcare”) are not necessarily against having healthcare for as many people as possible nor against helping others... they’ve just seen governments do things inefficiently and occasionally dangerously and thus have a reasonable level of skepticism for the “universal healthcare solution” to the problem.
For example, in the US, the VA has a horrible track record that immediately turns folks, like myself, off of the idea that the government should have any more control over our decisions than it already has.
In addition, the political party that is more likely to bring “universal healthcare” to fruition--the Democrat party--had trouble counting votes in Iowa recently. That level of competence does not currently lend itself to running an entire healthcare system where lives are at stake.
All that to say... it’s much more complex than “people are emotional because they resist my solution to the problem”.
Folks against one method of caring for the population (ie “universal healthcare”) are not necessarily against having healthcare for as many people as possible nor against helping others... they’ve just seen governments do things inefficiently and occasionally dangerously and thus have a reasonable level of skepticism for the “universal healthcare solution” to the problem.
For example, in the US, the VA has a horrible track record that immediately turns folks, like myself, off of the idea that the government should have any more control over our decisions than it already has.
In addition, the political party that is more likely to bring “universal healthcare” to fruition--the Democrat party--had trouble counting votes in Iowa recently. That level of competence does not currently lend itself to running an entire healthcare system where lives are at stake.
All that to say... it’s much more complex than “people are emotional because they resist my solution to the problem”.
Doesn't the VA have a bad track record due to its disability rating classification system? If you have 100% disability but they deem you to have 50%, they won't pay enough for you to get what you really need. The problem with the VA is not that it's run by the government, it's that it is capable of fucking and bankrupting you, just like the rest of our healthcare system.
> The democratic party had difficulty counting votes in Iowa recently.
Seems like aggregating so much data from numerous sources by non-expert volunteers is very likely to have issues. More to your point, though, that setup is not how most government business is conducted, so it's not especially relevant.
> The democratic party had difficulty counting votes in Iowa recently.
Seems like aggregating so much data from numerous sources by non-expert volunteers is very likely to have issues. More to your point, though, that setup is not how most government business is conducted, so it's not especially relevant.
Just because you don't want healthcare controlled by the federal government doesn't mean you're opposed to healthcare itself, and some of the countries with universal healthcare have some of the highest infection and death rates so I'm not sure how your solution relates to COVID-19.
Yeah. Italy has a universal healthcare system funded from taxes, and not only are they now a major cluster of coronavirus infection and spread, their healthcare system ended up helping to spread the virus. Supposedly their healthcare is some of the best in the world overall too.
Yes, its amazing what difference actually testing people versus telling nurses to sent patients home makes.
Also: China has (near) universal health care. (https://www.internations.org/go/moving-to-china/healthcare#h..., https://www.sciencedirect.com/science/article/pii/S016885101...)
With universal health insurance, you're at the mercy of the government. If the government chooses not to cover your issue, or if the government tells you "you're not sick so stop telling people you are," that's too bad. The same thing happens in private insurance, to be sure (minus the "if you say bad things about us we'll put you in jail" part), since people get denied. With government run health care, you have fewer alternatives though. You can't try some other doctor to see if that one will work financially (since it's the same entity footing the bill ultimately). There's no alternate system or provider to go to (you can't do much to get better health coverage for next time).
With universal health insurance, you're at the mercy of the government. If the government chooses not to cover your issue, or if the government tells you "you're not sick so stop telling people you are," that's too bad. The same thing happens in private insurance, to be sure (minus the "if you say bad things about us we'll put you in jail" part), since people get denied. With government run health care, you have fewer alternatives though. You can't try some other doctor to see if that one will work financially (since it's the same entity footing the bill ultimately). There's no alternate system or provider to go to (you can't do much to get better health coverage for next time).
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The difference is getting tested or treated in Italy won’t bankrupt you like it will in the US.
My post is a direct response to the Gates Notes article and his appeal for a concerted, coordinated response to this epidemic and possible future ones. I’m making a broader point along similar lines.
The spread of COVID-19 has barely started. Doctors and hospitals can’t physically go out into the population and stop people contracting the virus. Whether a traveller with the virus happens to have been to an area and had transmission contact with people has nothing to do with the quality of the local hospitals and health care workers. That’s just not their role, that primarily comes into play in dealing with the consequences.
The spread of COVID-19 has barely started. Doctors and hospitals can’t physically go out into the population and stop people contracting the virus. Whether a traveller with the virus happens to have been to an area and had transmission contact with people has nothing to do with the quality of the local hospitals and health care workers. That’s just not their role, that primarily comes into play in dealing with the consequences.
What if the threat is the government? We're to give them all the guns and all the hospitals?
Who said all the hospitals? In most of Europe universal healthcare coexists with private sector.
Indeed, I support universal health care and I am fortunate enough to be able to afford private medical insurance as well. I see no contradiction in this. My support of universal health care is part of my commitment to my civic duty, as I see it, and my private health insurance is an exercise of my individual freedom.
That sickliness was mainly from malnutrition, not health care.
Malnutrition was a major factor yes, but not to an overwhelming degree. For example dental issues were also a major problem, and of course nutrition itself is a health issue in which a well functioning health care system plays an important role.
During WWi it was mostly due to the Spanish flu killing 5% of the world's population, way more than the war the itself
What works best in normal times rarely works best in extremis. And vice versa.
It's less expensive than you'd think too. The key is that this only requires the vast majority of people to be able to work a large majority of the time. If it would cost more money to stop someone dying or going blind or suffering other major health problems than the typical worker is worth, the NHS just doesn't provide that treatment. There are plenty of other workers whose health care needs are much cheaper. Likewise, people wait months for the treatment of conditions that stop them going back to work, and that's fine - there are other workers. Highly-paid industries like IT which can't treat their employees like replacable cogs often offer private health insurance with lower waiting times as a perk that just happens to benefit them too.
This is across the board. On the one end of the spectrum, the NHS only rolled out flu vaccination for infants this flu season and vaccinates a lot less aggressively than the US in general - if you have to vaccinate a large number of people to prevent a few serious illnesses that doesn't work out cost-wise. On the other, a lot of the expensive cancer treatments, as well as cutting-edge treatmeents for chronic conditions like cystic fibrosis, aren't available either. (Though some utterly ineffective cancer treatments have been funded for political reasons.)
On the other hand, there was some bizarre business where the NHS decided not to offer a cost-effective cure for Hepatitis C to most people with it, even though it's a communicable disease with serious long-term health effects and curing them would probably save money in the long run, because the short-term cost was too high. I think they ended up making a deal with the drug companies very similar to the one a number of US states did, where they got reduced per-treatment costs as part of a program to aggressive find and treat everyone including homeless people and others who don't have access to healthcare. Sometimes the US and UK are less different than the press let on.
I'm not sure how well the NHS would cope with a coronavirus pandemic either. In a good year it barely has enough resources to handle the seasonal flu, and this has been the worst flu season for it in a long time.
This is across the board. On the one end of the spectrum, the NHS only rolled out flu vaccination for infants this flu season and vaccinates a lot less aggressively than the US in general - if you have to vaccinate a large number of people to prevent a few serious illnesses that doesn't work out cost-wise. On the other, a lot of the expensive cancer treatments, as well as cutting-edge treatmeents for chronic conditions like cystic fibrosis, aren't available either. (Though some utterly ineffective cancer treatments have been funded for political reasons.)
On the other hand, there was some bizarre business where the NHS decided not to offer a cost-effective cure for Hepatitis C to most people with it, even though it's a communicable disease with serious long-term health effects and curing them would probably save money in the long run, because the short-term cost was too high. I think they ended up making a deal with the drug companies very similar to the one a number of US states did, where they got reduced per-treatment costs as part of a program to aggressive find and treat everyone including homeless people and others who don't have access to healthcare. Sometimes the US and UK are less different than the press let on.
I'm not sure how well the NHS would cope with a coronavirus pandemic either. In a good year it barely has enough resources to handle the seasonal flu, and this has been the worst flu season for it in a long time.
All health care systems everywhere have to make decisions based on cost. Everywhere. It doesn't matter how they are funded or run, they all operate within the constraints of the resources they have available.
But the distribution of resources is significant - who they go to and what they are used for means that the value derived is very different.
There is a lot to disagree with in your post.
>If it would cost more money to stop someone dying or going blind or suffering other major health problems than the typical worker is worth, the NHS just doesn't provide that treatment.
My brother had an extensive program of neurosurgery as an infant, I would be amazed if the dedicated care that he received stacked up to less than 40 man years of expert effort (nurses, GP's, surgeons, anesthetists, radiologists, pharmacologists - the list goes on). Vast money was also spent on the equipment required to provide the care, and the drugs. This was all provided by the NHS, and is provided routinely. So - your statement is flatly untrue.
On the other hand I have received very little treatment on the NHS; I have required medical interventions but only after I was rich enough to get insurance. This is the key to the economics. Some people require heroic intervention to survive, most people (until they are in their old age) require very little (especially if engaged in preventative health improvement) - this is what makes it sustainable, not parsimony with the treatment.
>This is across the board. On the one end of the spectrum, the NHS only rolled out flu vaccination for infants this flu season and vaccinates a lot less aggressively than the US in general - if you have to vaccinate a large number of people to prevent a few serious illnesses that doesn't work out cost-wise.
The UK and NHS have strong policies and incentive structures to drive vaccination, precisely because without it a large number of people suffer illnesses that are very expensive. I don't know the numbers but I am pretty sure that 10k vaccinations are cheaper than 2 weeks in hospital for one child with measles. Your reasoning simply makes no economic sense; prevention is clearly better than cure, and cheaper.
> some bizarre business where the NHS decided not to offer a cost-effective cure for Hepatitis C to most people with it, even though it's a communicable disease with serious long-term health effects and curing them would probably save money in the long run, because the short-term cost was too high.
Or you could say "the NHS used its purchasing power to drive a procurement deal which enabled it to launch a program to eliminate Hep-C by 2025, and had to fight in the courts to make it stick" which would be factual.
>I'm not sure how well the NHS would cope with a coronavirus pandemic either. In a good year it barely has enough resources to handle the seasonal flu, and this has been the worst flu season for it in a long time.
Well - all health services will be stretched. We will see - when the numbers are available - which ones performed the best - for all citizens. I will hazard a guess that systems that routinely leave a large proportion of their population unprotected will expose that section of society to much greater mortality than those that are comprehensive public health providers. In terms of "barely has enough resources" isn't this the optimal? Isn't the point to have just enough laid on to deal? Rather than wasting the resources that could for example buy a proton beam system covering an epidemic that doesn't arrive?
>If it would cost more money to stop someone dying or going blind or suffering other major health problems than the typical worker is worth, the NHS just doesn't provide that treatment.
My brother had an extensive program of neurosurgery as an infant, I would be amazed if the dedicated care that he received stacked up to less than 40 man years of expert effort (nurses, GP's, surgeons, anesthetists, radiologists, pharmacologists - the list goes on). Vast money was also spent on the equipment required to provide the care, and the drugs. This was all provided by the NHS, and is provided routinely. So - your statement is flatly untrue.
On the other hand I have received very little treatment on the NHS; I have required medical interventions but only after I was rich enough to get insurance. This is the key to the economics. Some people require heroic intervention to survive, most people (until they are in their old age) require very little (especially if engaged in preventative health improvement) - this is what makes it sustainable, not parsimony with the treatment.
>This is across the board. On the one end of the spectrum, the NHS only rolled out flu vaccination for infants this flu season and vaccinates a lot less aggressively than the US in general - if you have to vaccinate a large number of people to prevent a few serious illnesses that doesn't work out cost-wise.
The UK and NHS have strong policies and incentive structures to drive vaccination, precisely because without it a large number of people suffer illnesses that are very expensive. I don't know the numbers but I am pretty sure that 10k vaccinations are cheaper than 2 weeks in hospital for one child with measles. Your reasoning simply makes no economic sense; prevention is clearly better than cure, and cheaper.
> some bizarre business where the NHS decided not to offer a cost-effective cure for Hepatitis C to most people with it, even though it's a communicable disease with serious long-term health effects and curing them would probably save money in the long run, because the short-term cost was too high.
Or you could say "the NHS used its purchasing power to drive a procurement deal which enabled it to launch a program to eliminate Hep-C by 2025, and had to fight in the courts to make it stick" which would be factual.
>I'm not sure how well the NHS would cope with a coronavirus pandemic either. In a good year it barely has enough resources to handle the seasonal flu, and this has been the worst flu season for it in a long time.
Well - all health services will be stretched. We will see - when the numbers are available - which ones performed the best - for all citizens. I will hazard a guess that systems that routinely leave a large proportion of their population unprotected will expose that section of society to much greater mortality than those that are comprehensive public health providers. In terms of "barely has enough resources" isn't this the optimal? Isn't the point to have just enough laid on to deal? Rather than wasting the resources that could for example buy a proton beam system covering an epidemic that doesn't arrive?
I totally agree with your point, but it is very hard for the US to implement healthcare like in Europe.
There are things like sugar tax in Europe, why? Because the governments spent so much money on health care. Corporations selling tasty but unhealthy food is profiting from part of the tax payer's money.
In Japan, the system works because people are generally healthier. In Europe, the system works because the governments are willing to pay the bill in the first place, then tax the unhealthy food industries to make the system more efficient towards systems like Japan.
In the US, it's pretty different because corporations have larger influences than in Europe.
Also, there are a lot of people who won't give up unhealthy foods -- It basically boils down to personal preferences to be healthy or not in the US, while In Europe it's a little bit obligated to be healthy because it's costing tax payer's money.
There are things like sugar tax in Europe, why? Because the governments spent so much money on health care. Corporations selling tasty but unhealthy food is profiting from part of the tax payer's money.
In Japan, the system works because people are generally healthier. In Europe, the system works because the governments are willing to pay the bill in the first place, then tax the unhealthy food industries to make the system more efficient towards systems like Japan.
In the US, it's pretty different because corporations have larger influences than in Europe.
Also, there are a lot of people who won't give up unhealthy foods -- It basically boils down to personal preferences to be healthy or not in the US, while In Europe it's a little bit obligated to be healthy because it's costing tax payer's money.
While unhealthy individuals cost the health care system more early on in their life, healthy individuals tend to cost more in the long run because individuals live longer and thus require more treatment [1, 2].
In fact, one could argue unhealthy people are better for universal health care and universal retirement systems because they collect less retirement while still generally dying after age 65~70 (after having stopped working and having paid the maximum amount of money into these systems through taxes and retirement savings).
[1] https://www.forbes.com/sites/timworstall/2012/03/22/alcohol-...
[2] https://journals.plos.org/plosmedicine/article?id=10.1371/jo...
In fact, one could argue unhealthy people are better for universal health care and universal retirement systems because they collect less retirement while still generally dying after age 65~70 (after having stopped working and having paid the maximum amount of money into these systems through taxes and retirement savings).
[1] https://www.forbes.com/sites/timworstall/2012/03/22/alcohol-...
[2] https://journals.plos.org/plosmedicine/article?id=10.1371/jo...
From a business perspective, be prepared for an extended period working from home, and be prepared for productivity to drop. Prioritize and set expectations accordingly.
I have colleagues in China who are facing down their fifth week working from home. At the beginning, they tried to maintain their normal (and excellent) level of output. But the stress of quarantine is starting to show.
Disruptions to normal routines, such as kids stuck at home and reduced/no access to childcare, are the non-newsworthy but most challenging issues for a large number of folks.
I have colleagues in China who are facing down their fifth week working from home. At the beginning, they tried to maintain their normal (and excellent) level of output. But the stress of quarantine is starting to show.
Disruptions to normal routines, such as kids stuck at home and reduced/no access to childcare, are the non-newsworthy but most challenging issues for a large number of folks.
... until they realized that working from home and closeness to kids and family was really a wonderful thing?
Can confirm. I'm in Beijing and it's wonderful indeed, I'm not with my family though.
I already worked from home for a month as a developer, and we have confirmed we'll WFH for the next 2 weeks at least.
There's no sign of productivity dropping for now according to our regular analytics. We have similar velocity as in previous months, where the estimation was done before the Chinese new year (just to clarify).
I already worked from home for a month as a developer, and we have confirmed we'll WFH for the next 2 weeks at least.
There's no sign of productivity dropping for now according to our regular analytics. We have similar velocity as in previous months, where the estimation was done before the Chinese new year (just to clarify).
Right, and I must admit that was my initial reaction. I honestly hope that one positive from all of this will be that working from home (and remote work generally) becomes more widely acceptable.
Unfortunately, in this instance, what I'm hearing from people on the ground is that the balance has swung a bit too far into "cabin fever" territory at this point.
Unfortunately, in this instance, what I'm hearing from people on the ground is that the balance has swung a bit too far into "cabin fever" territory at this point.
... and come to realize how undervalued the work of full-time stay-at-home parents is :)
Note that in China it's common for people with kids to live with their extended family/in-laws (who look after their kids while they're working). Like anywhere else in the world, for many people spending time with their in-laws is not a pleasant experience.
> From a business perspective, be prepared for an extended period working from home
That's wishful thinking. I can guarantee you many (if not most) managers are too paranoid to ever allow it.
That's wishful thinking. I can guarantee you many (if not most) managers are too paranoid to ever allow it.
> The data so far suggests that the virus has a case fatality risk around 1%; this rate would make it several times more severe than typical seasonal influenza and would put it somewhere between the 1957 influenza pandemic (0.6%) and the 1918 influenza pandemic (2%).
That was a little shocking to read. I had no idea the 1918 influenza pandemic was only 2%. I lost relatives to it, assumed it was a larger percentage than 2%.
That was a little shocking to read. I had no idea the 1918 influenza pandemic was only 2%. I lost relatives to it, assumed it was a larger percentage than 2%.
I am not getting it either.
"It infected 500 million people around the world,[2] or about 27% of the then world population of between 1.8 and 1.9 billion, including people on isolated Pacific islands and in the Arctic. The death toll is estimated to have been 40 million to 50 million, and possibly as high as 100 million, making it one of the deadliest epidemics in human history"
500 million infected, 40-50 million deaths. Isn't that 10% death rate?
Perhaps it was 2% for people who were treated in hospitals.
"It infected 500 million people around the world,[2] or about 27% of the then world population of between 1.8 and 1.9 billion, including people on isolated Pacific islands and in the Arctic. The death toll is estimated to have been 40 million to 50 million, and possibly as high as 100 million, making it one of the deadliest epidemics in human history"
500 million infected, 40-50 million deaths. Isn't that 10% death rate?
Perhaps it was 2% for people who were treated in hospitals.
2% of 2 billion is 40 million. So perhaps it was 2% of the whole population.
2% would be over 6 million Americans. I don't understand why that percentage is often reported as insignificant.
that's legit -- the percentage is not insignificant -- but it does look like you're calculating 2% of all Americans (approx 327M). the 2% number is _case_ fatality rate, i.e., how many cases are fatal. so to get from there to actual deaths, you have to apply it to _cases_. so you need to combine that with the attack rate, or attack ratio.
the only number I've heard for the attack rate is 30%, from the virologist Ian Mackay, who caveated it as a guess:
https://twitter.com/MackayIM/status/1233511899083530240
it could probably never be anything but a guess, until after the fact.
anyway, it would not be 2% of the US population. it would be 2% of 30% of the US population, which is approximately two million people. with the caveat that all of these numbers are early estimates based on limited data.
2M people is still a lot of deaths.
but it's not just how many people are killed. the rate of hospitalization is 15-25%. approx 10% of patients in Italy right now are in intensive care. the disease expresses as severe pneumonia, so severe that survivors have experienced _organ failure_. you could be hooked to a ventilator for a month.
in the United States, if you survive a medical problem that serious, it still ruins your life. probably this country will see not just a significant number of deaths, but also a spike in medical bankruptcies -- which are already a huge problem here.
the only number I've heard for the attack rate is 30%, from the virologist Ian Mackay, who caveated it as a guess:
https://twitter.com/MackayIM/status/1233511899083530240
it could probably never be anything but a guess, until after the fact.
anyway, it would not be 2% of the US population. it would be 2% of 30% of the US population, which is approximately two million people. with the caveat that all of these numbers are early estimates based on limited data.
2M people is still a lot of deaths.
but it's not just how many people are killed. the rate of hospitalization is 15-25%. approx 10% of patients in Italy right now are in intensive care. the disease expresses as severe pneumonia, so severe that survivors have experienced _organ failure_. you could be hooked to a ventilator for a month.
in the United States, if you survive a medical problem that serious, it still ruins your life. probably this country will see not just a significant number of deaths, but also a spike in medical bankruptcies -- which are already a huge problem here.
So the question according to those numbers is, are we prepared to hospitalize 10% of the 30% of people who may get infected in the United States? In particular, do we have enough ventilation beds, the isolation infrastructure, the staffing? During a crisis you’d want daily briefings where questions like these could be asked.
I’ve said in other threads: it feels like the US is sleepwalking through this. If the CDC believes, as they said last week, that this will spread inevitably — what exactly are we waiting for? We have two cases of unknown origin in Santa Clara county, yet schools are still open as of now. Wouldn’t it make sense to close them for two weeks now to hopefully slow the spread and give us additional time to ramp up our medical response?
I’ve said in other threads: it feels like the US is sleepwalking through this. If the CDC believes, as they said last week, that this will spread inevitably — what exactly are we waiting for? We have two cases of unknown origin in Santa Clara county, yet schools are still open as of now. Wouldn’t it make sense to close them for two weeks now to hopefully slow the spread and give us additional time to ramp up our medical response?
we definitely do not have enough hospital beds.
as for the CDC, the Trump administration gutted the CDC in 2018. they fired its leadership and dramatically reduced its budget.
they went to Congress last week or so for an emergency $2.5B, which is better than nothing, but $25B would have been a more realistic number. House leaders were basically complaining like "you should have asked us for more money."
Trump et al also put Mike Pence in charge of the situation last week. Trump said, when announcing that Pence would be in charge, that "he's got a talent for this." however, as governor of Indiana, Pence prioritized ideology over public health, and the state experienced an HIV outbreak due to his leadership (a subsequent Yale study found the outbreak was entirely preventable).
long story short: yes, the Federal government's response is extremely inadequate. it will probably continue to be inadequate throughout the crisis.
as for the CDC, the Trump administration gutted the CDC in 2018. they fired its leadership and dramatically reduced its budget.
they went to Congress last week or so for an emergency $2.5B, which is better than nothing, but $25B would have been a more realistic number. House leaders were basically complaining like "you should have asked us for more money."
Trump et al also put Mike Pence in charge of the situation last week. Trump said, when announcing that Pence would be in charge, that "he's got a talent for this." however, as governor of Indiana, Pence prioritized ideology over public health, and the state experienced an HIV outbreak due to his leadership (a subsequent Yale study found the outbreak was entirely preventable).
long story short: yes, the Federal government's response is extremely inadequate. it will probably continue to be inadequate throughout the crisis.
Of course a small percentage of a huge number is a big number...
The point is to reassure people and to prevent panic. For the vast majority of cases this virus is not a big deal so people should be vigilant but not be overly scared for themselves.
The point is to reassure people and to prevent panic. For the vast majority of cases this virus is not a big deal so people should be vigilant but not be overly scared for themselves.
Another way to see it is that "panic" could save a million lives (eg through the use of quarentines). Is it worth it then? I'm not saying that it's an obvious answer (panic causes its own problems), but it is a trade-off worth considering.
It could also reduce the number of people that go get voluntary checkups if they believe to be infected. People tend to want to avoid quarantines.
Panic is never productive. Saving lives requires a reasoned and reasonable approach.
The trade-off between the options is being considered and quarantine is being used.
The trade-off between the options is being considered and quarantine is being used.
Panic can very much be more productive than inaction. It’s not the optimal choice, but sometimes doing something right now is better than doing something even better a little later.
Panic is not helpful (it should go without saying, but apparently not...). There is a huge gap between inaction and panic. There is no inaction at the moment, whether more actions should be taken is another issue.
Yeah. The part that should freak people out is this looks multiples more infectious to boot.
And I think its important to note that 2% is the mortality rate in a hospital where they have respirators, etc. The mortality rate outside of a hospital (e.g. in a quarantine wharehouse) is something like 20%. (I wish I could remember the source for this, will look and edit but it may have been The Atlantic).
It also seems like some survivors come out of this with pretty severe damage to their organs, especially lungs, because the persons immune system goes overboard and attacks healthy tissue. So, some fraction of people will live, but be disabled.
It also seems like some survivors come out of this with pretty severe damage to their organs, especially lungs, because the persons immune system goes overboard and attacks healthy tissue. So, some fraction of people will live, but be disabled.
A 20% death rate is highly unlikely.The Italian researchers who sequenced the Italian strain believe that the virus has been circulating widely in Italy since January, even before Italy banned direct air flight to China. This seems to be confirmed by the fact that almost all the new cases in Europe are originating from big Italian cities. If the death rate was 20% we should start to see a lot of death in Italy and it doesn't seem to be the case. Iran and Egypt also seems to be largely hit, as many tourist back from Egypt have been infected. Now getting the real death rate is going to be a very complicated game, especially if many infected patient remain without symptom.
I tend to believe the virus is already highly circulating in a high number of place of the planet where the health system is bad, and lacking testing capabilities. We are even starting to see untraceable cases in the USA.
Caveat: some of the "untraceable" cases are kind of "semi-traceable" in practice. The American government (against the advice of its own CDC) flew back American patients who had been on the Japanese cruise ship, infected and uninfected alike, and sent in HHS employees to interact with them, with inadequate training and hazard protections (i.e., no bunny suits).
This heightened infection risk for the uninfected cruise ship patients and the HHS employees, as well as anybody who knew them.
This plane landed at Travis Air Force Base in Solano County, California. Which is where the first "untraceable" case in the United States occurred.
This heightened infection risk for the uninfected cruise ship patients and the HHS employees, as well as anybody who knew them.
This plane landed at Travis Air Force Base in Solano County, California. Which is where the first "untraceable" case in the United States occurred.
You're mixing up two different evacuations. The whistleblower complaint about HHS employees with inadequate training processing evacuees was about the Wuhan evacuation, not the Diamond Princess one. Only about three of the Wuhan evacuees ever ended up testing positive for the virus, there's no reason to believe they were even infectious when flown back and none of the staff involved have shown signs of COVID-19. It's certainly possible that one of the people involved in the quarantine didn't follow precautions and was infected, even with full training, but I don't think there's any evidence tying the California case to it.
OK — I did conflate Wuhan and Diamond Princess, so thanks for correcting me there, but according to both Time and the Washington Post, HHS employees were sent (without proper training or protection) to meet with evacuees in each case:
https://www.washingtonpost.com/health/2020/02/27/us-workers-...
https://time.com/5792135/coronavirus-whistleblower-hhs-emplo...
https://www.washingtonpost.com/health/2020/02/27/us-workers-...
https://time.com/5792135/coronavirus-whistleblower-hhs-emplo...
I keep hearing about this- is there a source for this? Or drumf is inolved so must be true?
If a large population of infected people never show symptoms, you'd see a lot more untraceable cases in Singapore, who are doing tracing very well.
But if you look at their reports there are practically no untraceable cases. That suggests to me that there are not many cases without symptoms.
But if you look at their reports there are practically no untraceable cases. That suggests to me that there are not many cases without symptoms.
As long as you have enough intensive care units with a lung ventilator that 1-2 % might be correct. But 10% develop pneumonia and require ventilation. If only about 10% of the population gets infected the health system would be overwhelmed. After that, even a simple flu might become a live threating experience.
The 2% mortality rate of the coronavirus is likely greatly overestimated [1]. Early mortality rates of diseases are generally estimated to be too high because only severe cases are tested. The exact same happened with H1N1 (Swine Flu): initial studies showed a 2-3% case fatality rate, but afterwards it was found to have an actual mortality rate of around 0.15% [2], close to that of the flu at 0.1%.
[1] https://www.vox.com/2020/2/12/21134718/coronavirus-china-dea...
[2] https://en.wikipedia.org/wiki/2009_flu_pandemic
[1] https://www.vox.com/2020/2/12/21134718/coronavirus-china-dea...
[2] https://en.wikipedia.org/wiki/2009_flu_pandemic
So, should we even care if the actual rate is merely 50% above your regular flu? Is this 0.15% one winter/year or across several seasons?
It is still speculated to be more contagious than the flu, and the flu itself is no joke. Many people will die if the coronavirus gets out of control. However, it is certainly not the end of the world others are claiming either. Being aware of it and taking certain precautions (e.g. washing your hands more often and staying home if you feel sick) is a good idea.
It should also be noted that they did not have antibiotics back then. The Spanish flu today would have most likely a lower fatality rate than it had then.
Obviously those diseases are viral. But it seems that they can be helped by bacteria and certainly bacterial pneumonia is a common serious complication, and I believe that patients hospitalised for COVID-19 are given antibiotics for these reasons.
Obviously those diseases are viral. But it seems that they can be helped by bacteria and certainly bacterial pneumonia is a common serious complication, and I believe that patients hospitalised for COVID-19 are given antibiotics for these reasons.
The spanish flu would probably have been much less severe if it didn't happen right after WWI. Basic supplies for food and soap were not yet at their pre WWI levels and the population was still weaker and physically recovering from the war.
That's an additional aspect, yes.
On numbers from https://news.ycombinator.com/item?id=22432358 (and those numbers are not necessarily accurate for lots of reasons) the death rate is below 0.4% for all age groups below 49. Then it increases exponentially. I'm curious what the comparative age breakdown of the 1918 flu was, particularly given that a lot of people would have been malnourished due to the war, and health care was not as advanced as now.
The Spanish influenza affected young adults more than the elderly/weak because it caused the immune system to attack the body. The stronger the immune system, the more damaging the individuals illness.
There are some graphs broken down by age for the Spanish flu
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3734171/
Wikipedia is inconsistent for 1918 flu pandemic: https://en.wikipedia.org/w/index.php?title=Spanish_flu&oldid...
"The World Health Organization estimates that 2–3% of those who were infected died (case-fatality ratio).[51]"
"The unusually severe disease killed up to 20% of those infected, as opposed to the usual flu epidemic mortality rate of 0.1%.[2][54]"
"The World Health Organization estimates that 2–3% of those who were infected died (case-fatality ratio).[51]"
"The unusually severe disease killed up to 20% of those infected, as opposed to the usual flu epidemic mortality rate of 0.1%.[2][54]"
2% is very huge, it is every 50th person!
Context matters. We had almost no medicine back in 1918. That changes everything.
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The death rate was "small" but the reach was large. 1/4 of the world's population got it so the total death toll was large.
2% means 1 in 50 people. How many people do you know? How about people who are a friend of a friend? What is that number divided by 50?
In all likelihood, within a year, several people you know will die of covid-19.
(Also note that the effects will be different around the world and in different social strata; in poorer areas, the death rate will be much higher, and in rich areas much lower.)
In all likelihood, within a year, several people you know will die of covid-19.
(Also note that the effects will be different around the world and in different social strata; in poorer areas, the death rate will be much higher, and in rich areas much lower.)
Marc Lipsitch, a Harvard epidemiologist, estimates that 40-70% of the adult world-wide population will be infected. [0]
Assuming a conservative 1% mortality rate, that would mean 30-50M deaths, a tragically huge number.
[0] https://news.harvard.edu/gazette/story/2020/02/key-coronavir...
Assuming a conservative 1% mortality rate, that would mean 30-50M deaths, a tragically huge number.
[0] https://news.harvard.edu/gazette/story/2020/02/key-coronavir...
Most cases with mild symptoms are not even reported or noticed by those infected so the real number is lower than 1 percent in all likelihood.
This could swing both ways alas.
The optimistic case would be how swine flu played out, where initial estimates for fatality where in the percentage range but ended up in the per mille dimension.
However, for SARS 1.0, it was initially estimated to have a fatality of 2% - the final number was over 10%.
It's simply too early to tell.
Unfortunately, the latest WHO report suggest there isn't that big of an iceberg of undetected cases, which would sadly mean a higher CFR.
The optimistic case would be how swine flu played out, where initial estimates for fatality where in the percentage range but ended up in the per mille dimension.
However, for SARS 1.0, it was initially estimated to have a fatality of 2% - the final number was over 10%.
It's simply too early to tell.
Unfortunately, the latest WHO report suggest there isn't that big of an iceberg of undetected cases, which would sadly mean a higher CFR.
> Most cases with mild symptoms are not even reported
This is outdated. Dr. Bruce Aylward said in a WHO conference this week that the Chinese tested 320,000 samples in Guangdong and they are not seeing huge transmission beyond cases found clinically. It's at 47 mins in this video: https://youtu.be/-o0q1XMRKYM?t=2810
> so the real number is lower than 1 percent in all likelihood.
I disagree. When we calculate the SARS-CoV-2 CFR properly using
CFR = deaths / (deaths + recovered)
using the latest data we get
2,924 / (2,924 + 39,605) = 7% CFR
That's much more in line with the original SARS CFR of around 9%.
This is outdated. Dr. Bruce Aylward said in a WHO conference this week that the Chinese tested 320,000 samples in Guangdong and they are not seeing huge transmission beyond cases found clinically. It's at 47 mins in this video: https://youtu.be/-o0q1XMRKYM?t=2810
> so the real number is lower than 1 percent in all likelihood.
I disagree. When we calculate the SARS-CoV-2 CFR properly using
CFR = deaths / (deaths + recovered)
using the latest data we get
2,924 / (2,924 + 39,605) = 7% CFR
That's much more in line with the original SARS CFR of around 9%.
"The claim was quickly challenged by an infectious diseases expert who serves on a committee that advises the WHO’s health emergencies program.
Gary Kobinger, director of the Infectious Disease Research Center at Laval University in Quebec, said it would be highly unusual for there not to be mild or symptom-free cases that are being missed. He pointed to the fact that outbreaks have popped up in countries far from China — including Iran and Italy — because people with mild infections were not detected and traveled to other places.
'There are mild cases that are undetected. This is why it’s spreading. Otherwise it would not be spreading because we would know where those cases are and they would be contained and that would be the end of it,' said Kobinger, who insisted that mild, undetected infections cannot be ruled out until people who haven’t been diagnosed with the illness can be tested for antibodies to the virus.
'As long as we do not have good serology data, I think that it is completely speculative to say that there are no undetected cases,' Kobinger said."
What Dr. Aylward says makes no sense and reads more like a PR fluff piece designed to praise China to keep them happy, and as Kobinger points out he's probably wrong. From the same press conference he says this "If I had COVID-19, I’d want to be treated in China."
Which is obviously bullshit.
As the specifics of the 320,000 cases. It wasn't a serum antibody test, so it wouldn't show people with low viral loads or people who recovered.
Also this is in Guangdong where the infection was potentially quickly contained, and if you'll notice the death rate is much lower in Guangdong.
Gary Kobinger, director of the Infectious Disease Research Center at Laval University in Quebec, said it would be highly unusual for there not to be mild or symptom-free cases that are being missed. He pointed to the fact that outbreaks have popped up in countries far from China — including Iran and Italy — because people with mild infections were not detected and traveled to other places.
'There are mild cases that are undetected. This is why it’s spreading. Otherwise it would not be spreading because we would know where those cases are and they would be contained and that would be the end of it,' said Kobinger, who insisted that mild, undetected infections cannot be ruled out until people who haven’t been diagnosed with the illness can be tested for antibodies to the virus.
'As long as we do not have good serology data, I think that it is completely speculative to say that there are no undetected cases,' Kobinger said."
What Dr. Aylward says makes no sense and reads more like a PR fluff piece designed to praise China to keep them happy, and as Kobinger points out he's probably wrong. From the same press conference he says this "If I had COVID-19, I’d want to be treated in China."
Which is obviously bullshit.
As the specifics of the 320,000 cases. It wasn't a serum antibody test, so it wouldn't show people with low viral loads or people who recovered.
Also this is in Guangdong where the infection was potentially quickly contained, and if you'll notice the death rate is much lower in Guangdong.
"If I had COVID-19, I’d want to be treated in China."
China probably knows how to best treat this, but as a patient you could either get that treatment, or get turned away or even get welded in your apartment apparently.
China probably knows how to best treat this, but as a patient you could either get that treatment, or get turned away or even get welded in your apartment apparently.
The problem are the people themselves. I have yesterday tried to persuade a colleague to cancel / postpone a conference in Lisbon with participants from all over Europe, including Milan in Italy. He didn't even take me seriously and other colleagues from Spain were making jokes about how all of their relatives are currently ill or they have Italian friends for a visit. Besides, half of my colleagues are from Italy, one of them just told me relatives from Piemont are planning to visit her next week.
With that attitude it is impossible to contain the virus. For all I know, I might already have it. I'm at a loss of how to react to such people, who seem to be the majority in Portugal. Working result-oriented in Academia I could in theory isolate myself for three months, but in practice this would be professional suicide.
With that attitude it is impossible to contain the virus. For all I know, I might already have it. I'm at a loss of how to react to such people, who seem to be the majority in Portugal. Working result-oriented in Academia I could in theory isolate myself for three months, but in practice this would be professional suicide.
3 months and professional suicide is a bit dramatic.
No, the assessment is realistic. The conference is in about one month. If the coronavirus is transmitted there, which is not unlikely, then it can take several weeks until someone gets symptoms, then another month until that person is no longer a transmitter. Not showing up to events during such a long time is unfortunately not a good idea for someone who doesn't have tenure. Maybe this changes once the official evaluation of the situation has changed. Right now it is "There are no cases in Portugal". Our university hasn't even provided hand sanitizers yet, and there is no official or inofficial statement from the administration about Covid-19.
I meant what you said about the 3 months could be a suicide for your carrear.
About the rest, I'm from Portugal and I agree - I believe there are cases in Portugal for some time and probably will be confirmed the first ones next week.
About the rest, I'm from Portugal and I agree - I believe there are cases in Portugal for some time and probably will be confirmed the first ones next week.
Within a month the currently hidden outbreaks will have become visible and we'll probably have measures similar to what Italy and South Korea are doing now in the whole of Europe.
[deleted]
Does anyone know where the 2% death rate for 1918 flu comes from? I've seen it quoted multiple times, but Wikipedia says:
It infected 500 million people around the world... The death toll is estimated to have been 40 million to 50 million, and possibly as high as 100 million
But later
The World Health Organization estimates that 2–3% of those who were infected died (case-fatality ratio). It is estimated that approximately 30 million were killed by the flu, or about 1.7% of the world population died. Other estimates range from 17 to 55 million fatalities[1]
[1] https://en.wikipedia.org/wiki/Spanish_flu
It infected 500 million people around the world... The death toll is estimated to have been 40 million to 50 million, and possibly as high as 100 million
But later
The World Health Organization estimates that 2–3% of those who were infected died (case-fatality ratio). It is estimated that approximately 30 million were killed by the flu, or about 1.7% of the world population died. Other estimates range from 17 to 55 million fatalities[1]
[1] https://en.wikipedia.org/wiki/Spanish_flu
I'm really surprised by this as well. From what I can tell, the estimate that was named is "above 2.5%". This could be simply by calculating how many people died compared to total population in the world. If 2.5% of total world population died, assuming everyone was infected, it is at least 2.5% case fatality rate and depending on how many people were not infected case fatality rate will go down.
Wouldn’t case fatality rate go up the more people were not infected?
Yes. But if you do not have a lower bound for number of infected, you can with certainty only say "above 2.5%".
“Global health experts have been saying for years that another pandemic rivalling the speed and severity of the 1918 influenza epidemic wasn’t a matter of if but when.“
Short-term-ism is the real epidemic in America. We seem paralyzed in taking preparedness steps in a host of issues that are a matter of “not if, but when.” From Climate Change, to infectious disease.
On individual level, we share some of the blame. I’ll admit that even in earthquake and fire prone California that prior to this current crisis, I’ve never kept more than a few days worth of food on hand. Even faced with a real risk, there’s inertia there — but ultimately realizing that being prepared as a household is the root of resilience for a neighborhood and community. It’s not a selfish act — it’s the responsible thing to do.
But at a leadership level, we seem to be waiting for some shoe to drop in this current situation rather than take proactive steps. We seem two steps behind this thing in the US.
Short-term-ism is the real epidemic in America. We seem paralyzed in taking preparedness steps in a host of issues that are a matter of “not if, but when.” From Climate Change, to infectious disease.
On individual level, we share some of the blame. I’ll admit that even in earthquake and fire prone California that prior to this current crisis, I’ve never kept more than a few days worth of food on hand. Even faced with a real risk, there’s inertia there — but ultimately realizing that being prepared as a household is the root of resilience for a neighborhood and community. It’s not a selfish act — it’s the responsible thing to do.
But at a leadership level, we seem to be waiting for some shoe to drop in this current situation rather than take proactive steps. We seem two steps behind this thing in the US.
Are you legally prepared? Do you have a will, an advanced medical directive, and other important documents? If not, take this as a cue to get that done today. Pandemic or no pandemic, you should have these.
Without these documents, you may very likely not receive the medical treatment you would wish to have should you become incapacitated. Also, your worldly possessions will likely not be dealt with as you would wish, and you'll be leaving a mess behind for your loved ones.
So, get your affairs in order.
Without these documents, you may very likely not receive the medical treatment you would wish to have should you become incapacitated. Also, your worldly possessions will likely not be dealt with as you would wish, and you'll be leaving a mess behind for your loved ones.
So, get your affairs in order.
> you'll be leaving a mess behind for your loved ones.
I don't have any loved ones.
> advanced medical directive
My country doesn't honor those.
Yup, I'm about as prepared as I can be.
I don't have any loved ones.
> advanced medical directive
My country doesn't honor those.
Yup, I'm about as prepared as I can be.
Some of that might work. If the pandemic is as harsh as some fear (anything like 1918) then the bodies pile up in the street. A will might not be important.
How about investing in "low- and middle-income" Americans and providing them healthcare? In addition how about providing required paid sick leave that can be taken without fear of losing one's job? These are actual things we could do to help people respond and deal with COVID-19. Yes, working on vaccines is important but testing and avoiding spreading the virus as much as possible are even more important. Right now, we have no hope of doing either in an effective manner. People will go to work sick, including with COVID-19 because they have no choice, because our government has left them no choice. They won't be able to get tested because they have no choice due to not having health insurance--another choice removed by our ineffective policies. I don't see any coherent plan by the government at this moment to address any of these issues and given the current situation, I would not be surprised if we have one of the worst outcomes of any developed country, possibly including China. The only hope is that the virus mutates into something less contagious or harmful and that should not be something we rely on.
I wonder if there will be a more general cultural change. For instance, will it become commonplace to have disinfectant dispensers in public places, like you might have drinking fountains and public bathrooms? Will workplaces and stadiums install these? I can't judge the advice on this, but it seems to be that disinfectants work.
Also, will people be told to stay home when they're even slightly ill? Currently people know that sick people spread disease, but we leave it to their own judgement as to whether to show up. What about a law that says you can't be paid as a contractor if you show up and you're ill? Could/should that happen?
Also, will people be told to stay home when they're even slightly ill? Currently people know that sick people spread disease, but we leave it to their own judgement as to whether to show up. What about a law that says you can't be paid as a contractor if you show up and you're ill? Could/should that happen?
“ What about a law that says you can't be paid as a contractor if you show up and you're ill?”
To my european ears that’s a very strange thought.
This is what paid sick leave was invented for. If we do as you proposed that strongly incentivises people to judge themselves not sick. Obviously the most intense cases will be found out, and according to your law sent home without pay, but by then the damage is done.
To my european ears that’s a very strange thought.
This is what paid sick leave was invented for. If we do as you proposed that strongly incentivises people to judge themselves not sick. Obviously the most intense cases will be found out, and according to your law sent home without pay, but by then the damage is done.
I mean contractors though. A lot of people in finance get paid per day they show up. I even have friends who will go to work while terribly ill because they get paid £1000 for it.
Paid sick leave is fairly normal for people on standard employee contracts.
Paid sick leave is fairly normal for people on standard employee contracts.
I'd be very happy of seeing everyone wash their hands after using the bathroom and sneezing in their elbows. As it is, a disturbing number of people truly are either careless or clueless.
For those who are interested in how to improve your own immune system function I recommend to watch a couple of videos of Dr Bergman and Dr Axe
who is still excited about pair programming? I think this will come to an end very abruptly. keyboards are disgusting.
I mean, it's pretty easy to do pair programming with separate keyboards or even computers..
Only when it's done over VC. I miss ScreenHero!
It's easy to raise the billions required to fight this. It's peanuts for governments and even larger companies hoarding tens of billions that have a lot to lose because of such pandemics.
Raise the billions to do what though? Pay for pharmaceuticals that can’t reach sick people because there aren’t enough people to work the production lines, the docks, the ships, the trains, the trucks, and the hospitals?
In a perfect world, Trump would appoint Gates to lead the Department of Health and Human Services, Gates would accept, the Senate would quickly confirm, and Trump would actually listen and defer to him on this.
It's interesting that this is directed to policy makers and other leaders, rather than individuals on the ground - e.g. it's about resource allocation, not personal preperation. (It was amusing to see the large-scale analogue to hoarding referred to as "lists of supplies to be stockpiled or redirected in an emergency." This presumes, of course, that governments will act as a force of mediating reason on people's irrational impulses; and we all know that sometimes it's the opposite).
It's interesting that this is directed to policy makers and other leaders, rather than individuals on the ground - e.g. it's about resource allocation, not personal preperation. (It was amusing to see the large-scale analogue to hoarding referred to as "lists of supplies to be stockpiled or redirected in an emergency." This presumes, of course, that governments will act as a force of mediating reason on people's irrational impulses; and we all know that sometimes it's the opposite).
Wait I thought Gates was in on this with the Chinese and released this as population control? Have I been getting my news from the wrong source?
Senate would quickly confirm.
There is no such world.
Remember when trump closed China travel he was called an overreacting xenophobe
There is no such world.
Remember when trump closed China travel he was called an overreacting xenophobe
Now we’re faced with Covid-19. This is a matter of national and international security and defence. Health care spending is national defence spending. It’s just a different type of defence against different types of threats, some mundane, some exceptional.