How to Respond to COVID-19
gatesnotes.com
gatesnotes.com
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.
One of the benefits of serving in the US military was free medical care for the soldier and his family.
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.
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.
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.
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”.
> 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.
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).
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.
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.
>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?
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.
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...
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 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).
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.
That's wishful thinking. I can guarantee you many (if not most) managers are too paranoid to ever allow it.
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%.
"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.
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.
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?
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.
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 trade-off between the options is being considered and quarantine is being used.
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.
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.
https://www.washingtonpost.com/health/2020/02/27/us-workers-...
https://time.com/5792135/coronavirus-whistleblower-hhs-emplo...
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.
[1] https://www.vox.com/2020/2/12/21134718/coronavirus-china-dea...
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.
Press censorship did also contribute to its spread.
"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]"
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.)
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...
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.
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%.
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.
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.
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.
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.
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]
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.
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.
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.
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?
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.
Paid sick leave is fairly normal for people on standard employee contracts.
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).
There is no such world.
Remember when trump closed China travel he was called an overreacting xenophobe