How coronavirus spread from patient zero in Seattle | Hacker News Reader

How coronavirus spread from patient zero in Seattle

bloomberg.com

143 pointspseudolus209 comments

> returning four days earlier from a visit with family in Wuhan, China

> County health officials located more than 60 people who’d come in contact with him, and none developed the virus in the following weeks. By Feb. 21, he was deemed fully recovered. Somehow, someone was missed.

A flight from China sounds like way more than 60 people to come in indirect contact with: same plane, same airport facilities,...

the u.s. has been extremely lackadaisical regarding the virus. somehow they thought that a travel ban was an end all solution. when i came back from china in january, there wasn't any tracking, questioning, checking, or anything of the sort. it was two CDC guys standing around talking to each other, completely ignoring the masses going through customs.

The ban went into effect Feb. 2nd so it's normal they weren't stopping people.

I wouldn't judge the direction of the country based on your 2 second visual of CDC agents talking at an airport.

I don't think they think it's an end all solution, but it helps bide time for research and helps control the spread.

how do you go from literally not even monitoring people to banning all travel (and then continue to not monitor)? that isn't "normal". it isn't logical.

You just said you arrived in January. The ban wasn't in place until February.

Are you arguing they don't know how to stop flights?

Did you go back to the airport and stake it out?

It wasn't failed isolation procedures like the title implies. He likely infected people before he was quarantined. We also don't even know that he was patient zero--he was just the first one diagnosed.

given his recent travel records and the genetic testing that linked his particular strain to subsequent patients, it's highly likely he was patient zero

He flew from Wuhan to Seattle. Presumably there were many other people on that flight. How likely is it that another passenger, who was asymptomatic or just didn't seek medical care, was the real patient zero?

I didn’t see any indication that this was a direct flight. Was there such a flight or did this person transfer somewhere in China?

Oh. True. I didn't think about that.

Up to 1 week ago in California they did not let you test people that did not have contacts with people that were tested positive to COVID-19 or that have travelled in counties that have the virus.

I know a person in Menlo Park that the whole family "had CODVID-19 symptoms" (Stanford doctor's word) and they were diagnosed with viral pneumonia but they were refused of being tested (after asking permission to the CDC) and sent home asked to be in "isolation and do not tell anybody because it may spread panic." The first person to get it in the family was one of the child in school that started have symptoms at the end of Jan.

I supposed that they were not the only ones.

Even nurses dealing with patients were refused to be tested according to this video: https://youtu.be/DiqVCQv__pE

I am not sure this is or was the policy nation wide but I have mixed feelings on how useful it may have been. I understand that more panic would make things worse in the hospitals in areas that were not prepared for massive outbreak but on the other side I wonder if somebody may have taken it a little light.

For example in the family of the person I know the youngest kid just cough a little for few days and never had a fever.

If a young child is the first person in a family being infected, you may think it is nothing serious and they may still send the kid to school.

It also did not help people making an informed decision about travelling in the area where supposedly only a handful of people had the virus.

Was it Steve Wozniak?

https://twitter.com/stevewoz/status/1234887637845983233

Nope. As far as I know he does not live in Menlo Park.

It's not a person that is well known like Wozniak.

If, for any reasons, conteining panic is the the goal, it does not surprise me that they would not ever want "Steve Wozniak victim of COVID-19" in the headlines.

Totally tangential, but is he actually well-known outside tech circles? Everyone knows the name Jobs, but Wozniak?

Depends on how "deep" the tech circle you are referring to is.

I bet a tech enthusiast will definitely know Wozniak, even if they don't work in tech. If anything, I bet Wozniak is way more known among the general populace than Satya Nadella or Sundar Pichai (Microsoft and Google respectively), despite their respective companies being widely known among the general populace.

Persol used his face for a major ad campaign in Tokyo, so it must be for a reason. https://media.boingboing.net/wp-content/uploads/2017/03/unna...

> The first person to get it in the family was one of the child in school that started have symptoms at the end of Jan

When you say "get it", do you mean viral pneumonia or coronavirus ?

San Mateo County's dept of health web page currently indicates 9 cases. All adults, no children. https://www.smchealth.org/coronavirus

because they were unable to get tested.

That's literally the point. Tests are getting refused so someone (like yourself) can respond with "But so-and-so says there are only X cases!!!!!"

This isn't an accident.

The diagnose was just "viral pneumonia" and they were refused the test for COVID-19.

If they do not want to increase the number of people infected of coronavirus, they will probably give you a diagnosis of "viral pneumonia" and refuse to test you so you cannot be counted in the coronavirus toll.

That was a CDC-imposed policy, to be clear.

https://www.nbcnews.com/health/health-news/after-missteps-cd...

And more on that:

https://www.nytimes.com/2020/03/10/us/coronavirus-testing-de...

There is no reasonable method to have a travel ban within the United States short of isolating regions by military force. At the individual level the only guarantee is imprisonment which is the not so nice way of saying you cannot leave this facility. This still requires people to volunteer to be tested!

Voluntary travel bans are only as good as the person applied to, especially in an age where self entitlement is near an all time high. Then throw in the malcontents who will just expose people for whatever irrational reason they want.

Even if we could test at point of departure what does that gain us? Say you could test at the Airport, you are positive, does the tester get taken off the line, how many people before and after? Everyone on that concourse?

If they closed airports and put up some checkpoints on the interstate to only allow select traffic through, I imagine that would cut travel pretty dramatically.

In fact, all you really need to do to bring all car traffic to a halt is start a traffic jam.

Of course, then healthy people couldn't travel either. But that was the case in Wuhan.

If they closed airports and put up some checkpoints on the interstate to only allow select traffic through, I imagine that would cut travel pretty dramatically.

Courts tend to believe that the Privileges and Immunities Clause gives a constitutional right to travel between states. It would be a big hairy mess. In fiction, Tom Clancy explored it in Executive Orders.

But Commerce Clause let's the Federal Government lock down travel between states. This hasn't been tested in the courts but it is what the Federal Government believes.

source: https://www.cdc.gov/quarantine/aboutlawsregulationsquarantin...

The Commerce Clause is essentially the catch-all for Congressional authority within the enumerated powers for doing the thing they want to do which has not been enumerated to them.

This kind of law would have to be tested.

Given that the Commerce Clause "allows" the Congress to regulate even intrastate (or intrahousehold[0] !!) commerce, I'm sure it can be found to allow regulation of intrastate travel.

[0] https://en.wikipedia.org/wiki/Wickard_v._Filburn

> If they closed airports and put up some checkpoints on the interstate to only allow select traffic through, I imagine that would cut travel pretty dramatically.

> Courts tend to believe that the Privileges and Immunities Clause gives a constitutional right to travel between states.

Interstate closures happen all the time for all kinds of reasons.

If someone wants to unconditionally exercise their "constitutional right to travel between states" when epidemic control measures are in place, they can walk or swim.

Or just reroute off an interstate onto a different road between states, which is a lot more likely.

Then somebody takes the whole thing to the courts, and the courts tell the Feds to knock it off and let people through because they are violating the law of the land.

> Or just reroute off an interstate onto a different road between states, which is a lot more likely.

If you're implementing a lockdown, you'd close more than just the interstates for that exact reason. At a minimum, you'd probably want manned checkpoints on the interstates, state highways, major county roads, and obvious choke points like bridges; and unmanned barriers on the minor roads.

> Then somebody takes the whole thing to the courts, and the courts tell the Feds to knock it off and let people through because they are violating the law of the land.

I'm skeptical that the courts would act as you assume when "the public Safety may require it."

Also, who says "the feds" have to implement it? It's my understanding that state authorities have broad powers to combat epidemics, too. They're also the ones with the manpower to implement lockdowns.

> Also, who says "the feds" have to implement it? It's my understanding that state authorities have broad powers to combat epidemics, too. They're also the ones with the manpower to implement lockdowns.

The authority to restrict travel into a state (from an adjacent state) unambiguously lies with the federal government, under even the narrowest possible interpretation of the Commerce Clause.

> The authority to restrict travel into a state (from an adjacent state) unambiguously lies with the federal government, under even the narrowest possible interpretation of the Commerce Clause.

Honestly, the scenario I had in mind was intrastate travel restrictions, especially around cities.

> Honestly, the scenario I had in mind was intrastate travel restrictions, especially around cities.

Also covered by the Commerce Clause, since 1937.

> Also covered by the Commerce Clause, since 1937.

So you're saying the commerce clause requires states to keep intra-state transportation infrastructure open, regardless of the public safety risk? That's unbelievable, since that infrastructure is regularly closed for public safety reasons (e.g. closing roads during blizzards):

https://www.mprnews.org/story/2019/12/01/blizzard-closes-hig...:

> To the west, the Minnesota Department of Transportation closed a stretch of Interstate 35 between Duluth and Cloquet. The Cloquet Police Department posted a photo of vehicles stranded along Highway 33 in that city late Saturday.

https://apnews.com/25d827c21bff49bba79339c51a6f3407:

> The Nebraska State Patrol has closed Interstate 80 from the Wyoming border east to North Platte as well as all state highways in the Nebraska Panhandle as a late-winter blizzard swept into the state.

The US Supreme Court has consistently affirmed that Americans have a right to freely travel by the common conveyances of the day, and this right cannot be restricted without due process. The government would be required to prove that a specific person has a high probability of harming the public before it would pass judicial muster outside of very narrow contexts that won't apply to most Americans. A vague "because you might have coronavirus" has the same weight as "because you might be a terrorist".

As an example, this is one of primary legal arguments for why the No Fly List is unconstitutional.

But there's a nuance there that I think needs clarification: is the right to not be discriminatorily singled out or a right to be provided access to infrastructure in all circumstances?

I think the right has to be the former, and general, nondiscriminatory restrictions would be OK. I posted in another comment that state governments regularly shut down roads and other infrastructure due to public safety concerns. I think closing roads in a lockdown could be done under similar authority.

The latter, to be provided access to infrastructure in all circumstances, is kinda nonsensical when you think about it. For instance, it would mean everyone had a constitutional right to drive through roads that have been closed for construction, which would be ridiculous.

No, this is not correct. There are only allowances for non-discriminatory "reasonable restrictions" such as closing roads during unsafe road conditions. There is no general "public safety" loophole that enables the Federal government to abrogate well-established rights, there must be due process for each individual so-deprived. This is essentially settled law in the US. And for good reason: it would give the government carte blanche to abrogate any Constitutional right using a nebulous notion of public safety as a fig leaf.

It is the same reason that courts have consistently rejected public safety arguments for depriving Americans of firearms without due process, as well as de facto deprivation attempts via regulatory technicalities like a million dollar tax on guns or banning ammunition.

> No, this is not correct. There are only allowances for non-discriminatory "reasonable restrictions" such as closing roads during unsafe road conditions. There is no general "public safety" loophole that enables the Federal government to abrogate well-established rights, there must be due process for each individual so-deprived.

Do you have a citation for that?

If you're correct, this interpretation is to be verging on Constitution-as-a-suicide-pact territory, and the Constitution should be amended or the opinion changed to correct the flaw, and allow suspension of those rights during serious epidemics.

This argument has been applied to many rights in the Constitution, and the courts have consistently held that any right that can be cast aside just because the government asserts an "emergency", regardless of type, is effectively a right that does not exist. The job of the courts is not to minimize risk to the population but to preserve their rights, and they mostly do that.

As a practical matter, this is on the right side of history. There are myriad examples of governments stripping basic rights from the population in the name of public safety or some other contrived (or real) emergency. It virtually always ends poorly for the population because governments consistently abuse this latitude when expedient for whoever is in power.

Would you have the courts remove all rights from anyone the government deems a "terrorist"? Or give Trump the power to suspend elections because pandemic/reasons? It is exactly the same argument. Giving people strong rights carries risks but also powerful benefits.

> This argument has been applied to many rights in the Constitution, and the courts have consistently held that any right that can be cast aside just because the government asserts an "emergency", regardless of type, is effectively a right that does not exist.

That's not my argument, though. I'm arguing against a kind fundamentalist absolutism that doesn't even allow for narrow, reasonable, and necessary exceptions in any circumstances. Applied to the First Amendment, that logic says you should be able to yell fire in a crowded room or libel someone, yet those things are prohibited and we haven't found ourselves in a dystopia on account of that. The Constitution itself even has such exceptions written into it, and the founders recognized their necessity even when not enumerated.

I get where you're coming from, but I no longer believe that kind of absolutism is a protection from tyranny. Letting an undetected Typhoid Mary freely travel the country in the most convenient ways possible isn't actually going to do anything to prevent Trump from suspending elections or declaring Joe Biden a terrorist, if he likes, it's just going get a lot of people sick.

If there is ever an epidemic so bad that the Constitution becomes a suicide pact, then it would probably be cast aside in the name of survival, but the United States of America would cease to be a legal entity in its current form and we’ll have much bigger problems.

https://usconstitution.net/

Here’s a link to the Constitution, you can read it back to front. Congress writes Federal law, you can read Article I to confirm that much, and Article II and III to confirm that the President and the Courts do not.

You can then review Article I to confirm the limits of Congress’ powers, and then Amendments I through XXVII to figure out what changed. For example, the first five words of the First Amendment is “Congress shall make no law”, and the subsequent passage outlines the various rights that Congress shall make no law a about. It doesn’t say anything like “except in public emergencies” or “except if aliens invade” or “except unless they really really want to.” All case law related to the first amendment is related to what the press, association, peaceably to assemble, petition, redress, grievances, establishment of religion, the exercise of religion and so on and so forth even mean.

What it comes down to is, back to front, every right listed within the Constitution and even some that are not listed at all is considered a natural right, not a civil right, not an insert-descriptor-here right and it is outside the authority of the Congress, and by extension the enforcers and interpreters of the laws which Congress passes to curtail or abridge these with two notable exceptions in habeas corpus when suspended and in conviction of a crime after due process has been established and a sentence passed.

You were born with these rights and you will die with them as far the Constitution is concerned, and since we practice Constitutional supremacy rather than say, Parliamentary supremacy, it’s not within the powers of Congress, the President, the Courts or any other jurisdiction subject to the US Constitution to throw their hands up, squint really hard and say “no, not really, not in circumstances X, Y, and Z.”

Courts do tend to accept extreme circumstances as exceptions. I think any supreme court judge would give a warrant to everybody in the US to not travel between states based on the evidence at hand. It is a stretch but this time it might be deserved - it is less of the stretch than the ones required to lock up all Japanese descendants in WWII.

I don't know about the US but in Europe many police stations are situated beside a bridge. There is a reason for that.

Do you have statistics on that? (Should be possible to get from openstreetmap using overpass queries, but I am busy with other things right now.)

I don't see how closing airports and highways would be a Constitutional issue. Of course curtailing travel wouldn't stop travel, but it would sure slow it down.

If you want to travel, you can do so the way our Founding Fathers did. On horseback.

If you want to communicate with others, you can do so the way our Founding Fathers did. In person or by written letter.

The fundamental rights of a citizen are ideas above their implementation.

Airports and highways are both heavily regulated, so just asserting that you have fundamental rights to them is a pretty weak argument.

The US is based on the idea of fundamental rights being the first consideration. Regulation does not give the government the ability to violate those rights. I expect the only consideration for the court is the severity of the situation that would allow the government to temporarily suspend those rights on a massive scale.

It is a Constitutional issue because the court has consistently upheld that, as part of a right to freely travel, Americans cannot be deprived of use of the common means of travel of the day without due process.

The kind of de facto prohibition on travel you are proposing has been attempted by the government several times in the past in a variety of contexts and the courts have never looked kindly upon it. The court views these "you can still freely travel, but you'll have to walk" style arguments from the government as a transparent attempt to deprive individuals of a well-established Constitutional right absent due process.

9/11 had air travel shutdown.

Plus the president is effectively above the law these days. So anything is possible... likely? Who knows

A right to travel between states, sure. But a right to do so on a particular road? Roads are closed all the time.

As I understand it, the Italy "lockdown" isn't actually a case of "we will shoot you if you go there"; it's just making travel incredibly inconvenient. Given that we're probably too late for absolute containment, simply slowing the spread by 90% would be a huge gain, and might be possible through deliberately breaking the transport network.

N italy resident: you are correct. I am free to move, i am not as free to go to milan (2hrs by car). I can walk where i want. Apparently, i am absolutely not able to travel to austria .

The Italy lovkdown requires you to self-certify that the reason you need to move between regions is because of work, medical reasons or an “emergency”. You have to fill out a form to do so. Technically if you lie you can be fined or imprisoned for up to three months.

There was a case yesterday of some girls lying about an emergency to go to Sardinia, then they bragged about lying on Instagram and, i believe, the police later arrested them for lying on the form.

We also allow exceptional measures during bona fide emergencies, which this is. For example, the first amendment guarantees freedom of the press, but the press was heavily censored during WWII. Similarly, epidemics allow governments to do things they cannot otherwise do.

It's all academic anyway. Once there are police checkpoints on major roads shutting them down, what are you gonna do? It could take years for a case to wind through the courts, by which time the epidemic is long over.

Indeed, that's fiction. Tom Clancy isn't on the supreme court. You can bet that if the Federal Government decides it they could stop interstate travel pdq no matter what the outrage.

Fortunately fiction writers are not going to decide whether a continent suffers in some massive way or not.

It is fiction, but the actual court cases its based on happened and I think the court will have a very tough decision if someone tries to shutdown interstate travel. There is a lot of case law already decided. I doubt its actually possible on a practical level in the US.

I don't think that will fly. Emergencies trump the law. Hence the term 'emergency powers'. It is an illusion to think that given the choice of upholding old law that was not made with those circumstances in mind or letting a bunch of people die needlessly that the law would prevail unchanged.

What will happen is that the law will pending the emergency be rescinded and re-instated afterwards. Judges aren't stupid, nor are they robots.

It absolutely will fly. There are centuries of Supreme Court precedent on this very topic in the US, sometimes under difficult circumstances. Some rights cannot be circumscribed under any circumstances regardless of consequences except in very narrow ways, there are no exceptions for emergencies. The right to travel freely within the US is recognized as one such right. That's like telling Americans that we'll temporarily ban free speech or ban guns -- it isn't negotiable to a large portion of the population and, furthermore, States have considerable power to make any such bans unenforceable.

The few historical examples where the courts let enforcement of elementary rights slide for a bit due to "emergency" are almost universally national embarrassments because of the abuses that followed. Judges aren't keen to be named and shamed as one of those people that let that happen for the sake of expediency.

Maybe in other countries but not in the US. It is a fundamental misunderstanding of how individual rights work in the US.

I'm not American, so forgive a question informed only by Hollywood - it seems circumstances can relieve you of constitutional rights, such as someone on parole being required to stay in the state, or age or criminal history precluding you from the right to bear arms?

In general, conviction of a felony will deprive you of the right to bear arms. In many states, it will deprive you of the right to vote, though this is changing. And, yes, age makes a difference--for voting, for signing contracts.

Travel bans stop the health services from being overwhelmed with cases by an exponential spread within the population. The aim is not to stop infections, it is to slow the rate of infection, and there are several stages to the response so at some point tracing and containment isn't practical, but it's useful initially.

All true, it is also to buy time to develop medicine. Every month we can push the worst cases into the future the more likely we have an efficient response.

Also to spread out over time the amount of people needing medical help. Perhaps a city can't handle 10k new patients in a day but it could handle it over the course of 2 weeks.

This is true in theory, but in Italy the virus arrived from a single German, and has spread through family contacts in a small province near Milan

In theory Milan should be the city with more infected people (in proportion) due to the high number of travelers and residents, it is not

Infection has spread brevi manu, travel bans have been implemented only starting from last Sunday (8th of March)

Social distancing and sanitary practices are hugely important for this.

It's not clear to me that large-scale travel bans are particularly helpful. A travel ban is about containment — keeping the number of cases in a region at absolute zero. Social distancing and other local behavior changes are about lowering the rate of infection and slowing the spread of disease in an area where it exists.

The latter is clearly important because it lowers the number of people who simultaneously need medical services in any particular area. A travel ban can help that if successful and it medical resources are easily shunted from a region with zero infections to a region that has them.

But once you've got a single patient zero in a region, the travel ban is fairly close to pointless. The disease is going to start spreading locally anyway.

At the same time, the economic effects of a travel ban do affect the daily lives of lots of people. So I think it's reasonable to focus mostly on local measures and slowing the spread.

Buying even 1 week can make a huge difference in the amount of preparation before a pandemic hits. Every extra day means more research into efficient and effective treatments, additional supplies, and even better public awareness.

The China approach shutting everything done can further slow the spread, but at massively increased costs and long term risks of reinfection.

How did the Chinese approach increase "long term risks of reinfection"?

The risk of reinfection is based in part on the amount of immunity in a population. Without a vaccine the way a population gains immunity is surviving an infection.

Unfortunately, even young healthy people are a significant risk of death so there are few good long term options.

> The China approach shutting everything done can further slow the spread, but at massively increased costs and long term risks of reinfection.

china did the things they needed to. if they didn't, the costs would be many magnitudes greater. it's clear that china's efficiency and response will not be able to be duplicated in the west.

There are things the state could do short of a travel ban, but beyond asking people to wash their hands.

For example, there are lots of public gatherings that can't afford to stop voluntarily - or if they can, can't afford to pay their employees through such a closure. Tell cinemas to stop selling tickets for two months but keep paying their rent and staff and some will go bankrupt.

A state that wanted cinemas closed could inject money (or motivation) to make it happen.

Likewise with theatres, gyms, casinos, restaurants, music festivals and suchlike. Much less travel if there's nothing to travel to!

> A travel ban is about containment — keeping the number of cases in a region at absolute zero

Italy has a nationwide travel ban right now. The goal is to avoid completely overwhelming the health services rather than to keep the rate at zero

> There is no reasonable method to have a travel ban within the United States short of isolating regions by military force.

Then until we are able to develop and distribute a vaccine, perhaps this is the right course of action on a temporary basis. What is happening right now truly is extraordinary.

There is no way in hell I would trust Trump to use military force on US citizens due to an “emergency”

And what do you do the first time someone drives around the checkpoint? Machine gun their car?

Relax, it won't happen. Americans would rather see every single one of their relatives over the age of 80 die before they allow the government to forcibly lock down travel.

> Then throw in the malcontents who will just expose people for whatever irrational reason they want.

I've heard some younger folks saying they want to spread coronavirus because it will kill off some of the old people who vote republican. So yeah, even if it's not happening some people do feel this way.

Just curious - where have you heard this? In real life or online? If irl, would you mind sharing your locale? If only so that older folk can avoid it...

Might be in a somewhat jokey fashion, at work I've already heard some jokes in the region of "corona will take care of the last-time voters" (Letztwähler, German word that inverts 'first-time voter')

https://www.snopes.com/fact-check/candi-cdebaca-tweet-corona...

Sounds like you are mistaking gallows humor for sincere intent. I've heard the same jokes but I'm 100% sure none of the people making them actually intend to spread disease.

I have heard the same things. I want to believe it's all internet bluster, but when I hear an angry group on r/politics talking about how they hope certain people will die, it doesn't sound very much like a joke, especially when you can go into the comment history of some of the people and find out that they have a long history of angry political comments.

What worries me is that there is always a population of people that buys into the rhetoric. Nazis on 4chan was just a meme, then it became a thing. /r/thedonald started as a really funny troll community laughing at the absurdity of Trump becoming president, then it became a thing too.

Social contagions do affect people.

You might be overreacting to dark humor from kids who are ironically parroting what they keep hearing about their generation from their elders: "play stupid games, win stupid prizes."

Don't worry, they're young enough that they won't vote either :P

Yep, stands in their way of implementing socialism. Of course, AFTER they get any inheritance.

It's easy enough to shut down all planes, trains, and busses, and then beyond that you just need to start putting checkpoints on the largest roads/highways/bridges. You can effectively shut down most long distance travel relatively easily.

(This subthread was originally a reply to https://news.ycombinator.com/item?id=22535953)

Travel bans: In the days when I traveled for work, I would occasionally catch a train back to Washington, DC, from New York. I would see a bunch of guys in suits get off in Wilmington, Delaware. Had you asked me, I was traveling. Had you asked them, they were commuting.

The commuter rail lines to Washington extend to Havre de Grace in the northeast and Spotsylvania in the south. Those are getting pretty close to Wilmington and Richmond commuter territory.

Halt the sale of gasoline and public transit.

>> short of isolating regions by military force

There are more guns in this country than there are people. The use of large scale "military force" against the population for any reason is, therefore, not a realistic proposition, by design.

> On Jan. 15, when the traveler to Wuhan who became the first known U.S. case returned to Seattle-Tacoma International Airport, ... At the time, 41 people in Wuhan had been diagnosed with the novel coronavirus.

Just goes to show how much the known case count lags the true infection count in the community.

They got unlucky. But it‘s highly likely that the procedures successfully delayed or prevented some infections for now.

Considering flying from WuHan to Seattle, there would be more than a few people could be infected on the plane, at the airport. Yeah, it would have already spread prior to the lockdown. It doesn't really say anything about the effectiveness of Ebola-style Lockdown at all...

But the title sounds better that way. Why resort to calm, fact base reporting when clickbaiting is the alternative?

I find reading this irritating because of the logical gaps in arguments.

The whole lead in to this doesn't hold together. They say this guy was patient zero but did everything right - as if to say that wan't enough, but then fail to explain how he spread anything. Maybe he didn't? Maybe someone else did?

The author completely misses the people on the airplane. They started the analysis with his public transport from airport to home.

This was not a great article.

What these measures seem to overlook is that there have been cases where people looked and felt fully healthy, didn't have fever or cough symptoms, but still had the virus in their blood.

As such, quarantining only the people that are visibly sick is not enough to prevent the virus from spreading.

But it slows it down, as people who do not have the symptoms also do not spread it so much as they do not sneeze.

Also, what is the alternative? Quarantining everyone? That works only to a certain amount, before the system collapses.

It’s not about stopping the spread but slowing it so that medical resources aren’t overwhelmed.

> the number of active infections could reach 1,100 by March 10

That's today. How old is this article?

It says story was posted March 9th. Written some number of days before that? And what is that stat in reference to; the whole US or just WA?

I can only guess that someone other than the author wrote the closing paragraph, but it’s clearly wrong.

Known cases is all about testing.

Does anyone think the number today could possibly be this low?

it's probably already 10 times that.

Reported 647 across the US, 162 in Washington. Obviously that number is severely limited by testing capacity. But they are the only numbers to go with, everything else is just guessing.

Given that we know testing is behind, and that patients take about five days (?) to show symptoms, and that it's an exponential growth phenomenon, and that we have several other countries farther along in the process to observe, I'd say an educated guess is a lot better to go with than those numbers.

That would be in the Seattle area.

Total cases within the US -- actual, not "confirmed", likely represents a ~2 week lag. Based on reported cases, the US has seen about an 85x growth rate over 2 weeks. That would give ~150k cases presently in the US. Reported is now 640 cases, 26 deaths.

There's no evidence to indicate that he was in fact patient zero. Just because he was the first person to be diagnosed in Seattle doesn't mean he was the person responsible for the breakout.

On the contrary, Trevor Bedford has done extensive genetic analysis of the strains circulating in the area and has confirmed they are all descended from the one case.

Can you share a link?

How precise is the genetic analysis? Could it distinguish between if this individual is patient zero, or if they caught it from another theoretical individual on the same plane from Wuhan to seattle, who did not quarantine?

He has been tweeting his results as they come in. The latest is here: https://twitter.com/trvrb/status/1237394739143438338

What specific measures have they taken in South Korea? It seems to have been fairly effective. Lots of tests is the thing I know about. What else?

Everyone is wearing a mask, whether or not they are showing symptoms. SK gov has a mask delivery program through the post office. This helps limit the spread. While the US gov tells everyone to not wear a mask, unless they are showing symptoms.

There are not enough masks in the world for everybody to wear one. The US is best rationing the masks we have to those who need them most.

In many Asian countries the air is bad enough that most people wear a mask anyway for pollution reasons. Thus there is more mask availability infrastructure in place (I don't think SK was ever that bad but I don't know)

DIY masks such as simply pulling your T-Shirt up above your nose already help a lot[1], so not enforcing some manner of mask use for 100% of the population on the basis of an insufficient amount of surgical masks doesn't make any sense.

1. https://smartairfilters.com/en/blog/diy-homemade-mask-protec...

The implication is that South Korea has the resources and technology to produce and distribute masks to its citizens.

But I'd love to hear the details from someone that knows more. That's potentially a lot of masks to be churning out.

they are taking masks that could be used here instead. There are so any masks made in the world so every use of one is a mask that someone else couldn't use.

Obviously factories have abilities to ramp up production to meet demand so the above is simplistic. However they can only ramp up so far (or fast) when the limit is reached the above applies.

They are paper masks, not computers. It's trivial to produce them in adequate quantities, if a large enough actor really wants to.

Billions of paper masks in a matter of weeks? Even if the raw manufacturing capacity existed (unlikely), have you considered the supply chain and downstream logistics?

You know, "if a large enough actor really wants to" applies just as well well to computers as it does to paper masks.

This is why I'm curious about the details.

I don't think any of us are experts in the supply chain logistics of South Korean face masks. I'd rather read about it from someone who is than guessing.

The other day I spotted in the SF Chronicle a picture from the 1918 pandemic showing a gathering of people manufacturing gauze masks. [0] Gauze appears to be out of favor as a barrier material today, although I suppose one could get creative and add a paper barrier layer. There are several viable materials for the goal of mitigating transmission. At any rate, this is something open to some guided improvisation with existing supplies.

[0] https://www.google.com/amp/s/www.sfchronicle.com/oursf/amp/L...

> US gov tells everyone to not wear a mask, unless they are showing symptoms.

This bothers me greatly. People who wind up having symptoms cannot retroactively go and put the mask on for the week prior to them noticing.

Especially the large scale testing changes a lot. You are faster in quarantining cases, faster in following up on contact persons and you have a much better picture of the spread.

Do we know how long 2019-ncov can survive on contaminated inorganic surfaces if not sanitized?

At least 24 hours, possibly 48. There are a few similar viruses that can survive up to 9 days if they are humid and cold (near freezing). https://www.journalofhospitalinfection.com/article/S0195-670... But we don't have good info for SARS-CoV-2 specifically.

Thanks. Earlier this year we closed our school for two days plus the weekend to disinfect after we had an unprecedented near twenty percent of the student body absent due to an incredibly virulent strain of the flu. Trying to keep all these factors in mind while we make decisions on remote learning for this mess.

disinfection isn't going to do much of anything. the virus lives in people and spreads between people, even when they are mostly asymptomatic, at least for a few days.

sure, it'll stop people from picking up trace viral particles on surfaces, which is better than nothing.

but i see many places "closing for disinfection" as their go-to response to the virus, and if you understand the way that this disease transmits, it's mostly for show.

Closing for disinfection works in part because people don't go to those places while it is being disinfected and thus don't spread things in them.

It’s more complicated than that, and closing for four days is somewhat like a reverse four-day quarantine. You have twenty kids starting to show symptoms that get their slobber all over everything (you have no idea how gross K-12 students can be, btw). They’ll stay home when the symptoms get worse (parents aren’t hell-bent on sending them to school, but would prefer to do so and as such will be in denial until it’s too obvious), but now they’ve already gotten all the high-contact surfaces contaminated: keyboards, mice, desks, toilets, chairs, water fountains, door handles, telephones, etc.

Kids don’t wash their hands. Kids don’t have a concept of personal space. Kids don’t cover their sneezes or coughs. Kids share food, containers, utensils, etc. such that even if you eliminate direct aerosolized contamination, the entire school is a germfest. One kid with a weak immune system picks it up from contact with an exposed surface, and the whole thing starts all over again.

https://www.journalofhospitalinfection.com/article/S0195-670...

"Human coronaviruses can remain infectious on inanimate surfaces at room temperature for up to 9 days. At a temperature of 30°C or more the duration of persistence is shorter. Veterinary coronaviruses have been shown to persist even longer for 28 d."

> Ultimately, Seattle’s experience shows the futility of travel bans

Is there a word or phrase for the act of poorly implementing an idea, then using the failed result as a way to discredit the idea? It's like a straw man argument but done in practice rather than in argument.

Politicking

Sounds like a variant to 'starve the beast' to me.

Never understood the "starve the beast" argument of reducing government. Take ten seconds to imagine being locked in a room with a starving beast--does that sound like a good idea to anybody?

Why don't you stop feeding your cat and see what happens.

I wonder which way you meant this

Cat will disappear really fast, finds new owner who will feed him.

If the alternative is being slowly eaten by the beast....

Don't get locked in the room with the beast. Or at least not until the beast is almost dead anyway.

Maybe https://en.wikipedia.org/wiki/Cargo_cult_science

Quarantine worked for American Somoa during the Spanish Flu : https://tedium.co/2017/10/16/american-samoa-spanish-flu/

From https://en.wikipedia.org/wiki/Spanish_flu "n Japan, 257,363 deaths were attributed to influenza by July 1919, giving an estimated 0.4% mortality rate, much lower than nearly all other Asian countries for which data are available. The Japanese government severely restricted sea travel to and from the home islands when the pandemic struck."

So evidence suggest it's not futile. So , you're right , maybe you're looking for "projection" or "cherry picking".

I think you've misunderstood what OP meant

But GP did help the point along, though

Yes, it's like "it didn't work this one time, let's just scrap that idea entirely"

I wish they would apply that logic to whenever they implement more surveillance measures.

Buried underneath this discussion is a lesson in incentives.

Also, there is no evidence that it didnt work.

The goal is to slow infection, not prevent it. We could hypothetically have a much greater infection rate than we do today.

It's fair to assume that everyone will get this, and 2.5% will die.

(Edit: when I said everyone, I'm thinking of 'everyone' with regards to contagion like the normal flu that goes around. There are always outliers and people who miss it. Didn't think I had to spell that one out. Evidently I did.)

However controlling the rate of infection (coefficient of the exponent) can make the difference between hospitals able to handle the disease, versus hospitals getting completely flooded and having more die due to not enough care.

Tl;dr. You're going to get it, but you don't want everyone getting it at once.

I hope your wrong. That the spread is somewhat contained and that a vaccine is developed before 2.5% of us die.

But I hope that someone in government is thinking like this and taking actions accordingly.

Being pessimistic isn't and overshooting your precautions is probably smarter than thinking we are going to have a "cure" in a few weeks, like POTUS said.

Anecdotally, I know 2 MDs in the Layfayette, IN (Purdue) area. Multiple people have come in with 100% of the symptoms, recently came from Seattle, and 1 worked in the Amazon factory with positive coronavirus. They were not tested because the tests are not available.

Because of the way 'We' (royal) have structured our economy and govt assistance systems, the working poor will have the highest contagion rates and serve to spread it rapidly. They have meager insurance, if any at all. They have no sick days, and certainly not paid sick leave. And being threatened to come to work sick is a common thing. Even Starbucks did that to me.

And from what I know about the laws, I don't believe quarantines can legally order you in. Everything so far has been a suggested self-quarantine.

I don't paint a pretty picture. That's because I've worked in food service while sick. I made your food, and infected you. I chose to do that vs be destitute.

Why are you being downvoted? Is this the equivalent of people sticking their hands over their ears and saying “la la la la! I can’t hear you!”

It seems obvious that you are right that everyone will get it. The real quibble is what will the death rate actually be. 2.5% seems like a middle-of-the-road estimate according to current knowledge.

I don't think it's obvious at all that everyone will get it, especially now that so many people are practicing social distancing and handwashing and avoiding gatherings. Yes, there are still a lot of people going about their lives without worry, but it seems totally plausible to me that if some percentage of people behave more responsibly, it will decrease R0 to some number below 1.

I think using simple exponential numbers to predict future cases is too simplistic if we don't take into account how people's changing behavior will affect the spread.

I guess it depends on where you live. In the city where I live I have seen absolutely 0 changes in behavior. All gatherings are going on as normal, no special social distancing. There are lots of jokes about it (we probably shouldn't shake hands, ha ha! [still shake hands]), but nobody is actually doing anything differently.

I've seen that same thing! But I live about an hour away from Seattle, and I'm generally seeing way fewer people shake hands and several people I know (my family included) are avoiding unnecessary trips into public.

I mostly just wonder where the threshold is between population density and social distancing and R0. Obviously total quarantine does wonders, and completely normal behavior is terrible, but is it enough if half the population takes precautions? Or 2/3 or 1/3?

I've been thinking of it kind of like a graph or a web, and if you cut enough of the connections, the spread stops, and "enough" isn't anything like "all," and the more strategically placed the cuts are, the fewer there can be, but it's not easy to figure out exactly how many cuts you need.

Well-informed sources I've read almost universally put their estimates at 1% or lower. The people saying 2% or 3% seem to be naively averaging together all the mortality rates they've seen in the news, even though almost all of those rates aren't meant to be good estimates of "how likely is the average person who catches the virus to die".

The case fatality rate is not something that can be applied across the world; it's specific to regions, to the corrective measures used, and to time. The CFR in China/Wuhan was initially around 20% since there was a steep learning curve. By Feb 1 it had dropped to around 5%.

Currently, the global CFR is around 3%. In China, almost 4%. The CFR for the rest of the world (excluding China) is almost 2%.

https://ourworldindata.org/coronavirus

The CFR is just the number of known COVID deaths divided by the number of known COVID infections. There's no reason that number should be a good estimate of the question people are asking, "how likely is the average person who gets COVID-19 to die", and as I mentioned medical professionals are pretty unanimously agreed it isn't.

So you disagree with the WHO about the current CFR?

Again, the current CFR as calculated by the WHO is a mathematical artifact. I trust that they're accurately reporting the numbers they measured, and agree that dividing their death count by their case count yields 3.4%, but I don't agree (and don't think they said) that this is an accurate estimate of how deadly the virus is likely to be.

I assume because of the "everyone will get it and 2.5% will die" part. Nmbers are not making this very likely, in China this thing is slowing down already. Last estimate I heard was somewhere between 60 and 70% of the population will get. Add to this the fact tht the 2.5% are likely overstated (due to not testing everybody and having this huge Wuhan province outlier in there), and a statement like this is pretty alarmist.

China had a very strong response to this crisis.

They had hard quarantines up to and including jail-like cells to enforce those orders.

They had significant amounts of PPE brought in rapidly.

They built a hospital in a month at ground zero.

They provided thermal camera helmets to police to catch people with a high temperature (most common ailment with coronavirus).

In effect, they knew they had a diaster on their hands, and responded rapidly. And it shows in their numbers.

In the USA, We refused the the WHO's tests in favor of some for profit company. And we had 1/12 the tests promised by last Friday.

Hospitals aren't able to test even highly suspect cases.

Quarantines are considered optional, with dozens of cases of "I'm special and ignore quarantine suggestions".

There's no sick pay, so those who haven't been tested are working sick. Vomiting, a easy way to go home, is only present in 1% of the cases infected.

And perhaps 'everyone will get it' was exaggerating - but I'm seeing this as similar to the flu, with a 5 day asymptomatic period and a 2.5% chance of death, as opposed to .1% .

If "everyone's getting it" is an exageration, why are we ok with "everyone" being used as the basis to apply whatever percentage on?

Wuhan still stands out rearding mortality so, with almost 5%. Total deaths there stand at 3,000, the rest of the world, includig the rest of China, stand at roughly 900. Wuhan is overrepresented. No idea why, but I am certain experts are working on that question. South Korea on the other hand has mrtality rate of under 1%.

Source: https://www.who.int/docs/default-source/coronaviruse/situati...

Totally agree on the testing issue in the US, so. That, combined with the non-existing sick leave insentivising people to not see a doctor and continue to go to work could become a major problem, so. In Europe it's easy, just send people home on sick leave, Germany allows you up to 6 weeks per year per illness. Doctors visits are free for patients as are blood tests. Without all that, the game changes.

Mortality rate is now >6% in Italy

https://www.worldometers.info/coronavirus/

The interesting question is now why regions like Wuhan and Italy stand out while South Korea is sitting at the opposite side of the scale.

From what I understood the true mortality rate can only reliably be established after the pandemic. During it is moving target. Now, this uncertainty is something normal it seems. I can live with that.

What I would love, so, is a breakdown by age group, gender, preexisting conditions and so on. Also how these groups are overall represented in the population of the individual regions. Then at least we would have a first indication if certain groups are overrepresented or not.

Reducing COVID-19 to just one overall percentage number is insufficient I think. But yes, Italy stands out.

Stories of hospitals being overwhelmed in Italy are all over the internet if you look. AFAIK it's pretty well-established that's what happened in Wuhan too. This is why extraordinary measures to control the spread of infection are being put in place

I think _if nothing is done_ everyone will get this virus.

However, I think the lesson of china and italy is that when hospitals get overwhelmed, people will freak out and start staying home, so the rate of infection in a 'burn out' scenario is probably significantly lower than even 30 or 40%.

I'd amend your post further to say that the mortality rate ∝ rate of infection b/c the more attention healthcare staff can give to each infected person, the greater their likelihood of survival will be. In addition, the illness vastly affects a subset of the population more than others, should we be able to isolate the young and elderly so that we have fewer of those cases to treat, we have a good chance at lowering the mortality rate.

I think it’s a form of “sandbagging”, where competitors deliberately underperform at an event.

Maybe we should wait a bit until figuring out what works and what doesn't in this case.

Glass cliff would be a particular subset of this kind of thing:

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

This quoted sentence is quite dangerous.

It's also not unlikely that there are "other" patient zeros and then there are all the thinks about bad implementation of measurements and potential spread before measurements where implemented.

Also it's all about _slowing_ spread, with the properties SARS-Cov-2 is believed to have it's likely impossible to contain it anymore in long term. (IMHO)

But each day we gain saves lives by giving us more time in finding usable medicine or even vaccine and producing it.

Additionally it reduces the load on the hospitals, if we do not slow the spread it will infect to many people at the same time to early. Which likely will lead to people not getting the appropriate medical care which likely will make the infected->death rate increase noticeable.

So it's a typical "it's not perfect so lets not do it at all straw man argument" which is this case is very dangerous as it can cost human lives.

Also given that they wrote:

> County health officials located more than 60 people who’d come in contact with him,[..] fully recovered. Somehow, someone was missed.

It's strange to end up with travel bans are futile? A conclusion like "it's hard to find all contact persons" would be better.

> All the careful medical detective work, it’s now clear, wasn’t enough to slow a virus moving faster than the world’s efforts to contain it.

This is supper missguiding, sure in this case it's not wrong, but if a single of the 60 checked people would have had been infected this would have majorly slowed down the spread. In the end the first quote said it all: Someone was missed. And IMHO someone will most times have been missed and sometimes that one will have been infected, so the spread won't be stopped. But it will be slowed down. Which is most important.

>> Ultimately, Seattle’s experience shows the futility of travel bans

> Is there a word or phrase for the act of poorly implementing an idea, then using the failed result as a way to discredit the idea? It's like a straw man argument but done in practice rather than in argument.

I don't know, so I'm going to coin a term for it: dishonest experiment.

“Bad faith” research might be more appropriate, since it sort of acknowledges bias

I like both.

It's not the experiment that was dishonest, though - it's drawing conclusions from it as if it was conducted correctly that's dishonest.

Disingenuous effort.

> Is there a word or phrase for the act of poorly implementing an idea, then using the failed result as a way to discredit the idea?

First off: I'm sure the Germans have something. :)

Otherwise, some candidates:

* https://en.wikipedia.org/wiki/Faulty_generalization#Hasty_ge...

* https://en.wikipedia.org/wiki/Nirvana_fallacy#Perfect_soluti...

* https://en.wikipedia.org/wiki/Cherry_picking

* https://en.wikipedia.org/wiki/Irrelevant_conclusion#Red_herr...

Ultimately, Seattle’s experience shows the futility of travel bans

Yes this is complete bullshit. Wuhan and now Italy are showing that travel bans are very important.

edit: When I say Travel Ban, I'm also thinking of a soft lockdown such as Italy have implemented, which is slightly different to a travel ban in some senses.

Wuhan shows they are important. Italy remains to be seen. Though given the reports I've read suggesting thousands of Italians returned south ahead of the travel ban, their efforts may indeed prove futile.

The whole country is now under a travel ban, so there should be plenty of areas that don't have the virus still, and without further travel, hopefully will never get it.

Those areas will get it. The virus has spread too far throughout Italy to stop it but reacting late, now, to how far it has already spread can slow down how quickly it continues to spread.

At this point its about slowing down the peak so that health services can keep up.

Thousands out of an area of 16 million people is small change. They are probably people who would have been heading home anyway. The Travel Ban in Italy doesn't mean nobody move, it means nobody move without a decent reason. The Italy ban is quite different to the Wuhan one, if you look at the details.

edit: To be clear, as well as restricting travel out of an area, we're also talking about reducing movement _within_ that area. So it ties into Social Distancing really.

Other countries no longer traveling to Italy will show they are important too. Only they decided a bit too late on that one. Still, every little bit helps and any restriction that we can impose on mobility without killing the economy is going to help slow down the spread of the virus.

I'd call it "Mythbusters-ing" since this is pretty much how many of their episodes go.

MB are fair but stern. Myths can be busted or confirmed, often surprisingly.

motte and bailey is similar in concept, but related to arguments.

"Don't let the perfect be the enemy of the good."

I don't know, but it reminds me of a saying from another context: Don't judge a philosophy by its misapplication.

Edit: I think that's a quote from some well-known person, but I'm having no luck looking it up.

> Is there a word or phrase for the act of poorly implementing an idea, then using the failed result as a way to discredit the idea?

It might not be that specific, but "faulty generalization"[1] might fit the bill. The Wiki article offers other phrases like "jumping to conclusions" and "fallacy of defective induction".

I would like to know if there is a name for specifically doing the poor implementation with the malicious purpose of discrediting the idea.

[1] https://en.wikipedia.org/wiki/Faulty_generalization

I believe US Republicans call this starve the beast when applying it to government programs they don't like.

Starve the beast is either (charitably) a way to encourage efficiency by introducing necessary scarcity or (uncharitably) a way to deliberately create artificial failure to leverage the phenomenon being described here where people will conclude that because something doesn't work, it can't work, and therefore should be abolished.

It's related, but it's not the same thing.

EDIT: Note that I'm assuming that prematurely leaping to the conclusion isn't deliberate on the part of the reporter here. If it were, then maybe it would be the same thing.

Starve the beast? Reaganomics? Deficit Hawks?

Some related phrases:

* "We already tried that."

* Once bitten, twice shy.

* Not giving the idea a chance; not giving it a fair shake.

* Giving up on an idea too easily.

* Closing your mind to a possibility.

For what it's worth, I think both the poor implementation and the wrong conclusion can be either deliberate or accidental. In this case, the poor implementation was almost definitely accidental, and most likely the reporter isn't actively trying to discredit the idea; they are just leaping to a conclusion. So the best phrase might be vary depending on whether it's just poor reasoning or an underhanded attempt to manipulate people's views.

Also, on a tangent, there's probably some validity to this kind of reasoning. Sometimes in problem-solving there are almost an infinite number of things you could try. If you spend all your resources going down one particular rat hole that doesn't seem to be working, you may never move on to exploring the rest of the solution space. In practice, it can make a lot of sense to essentially do a breadth-first search of possible approaches. The error isn't in using a breadth-first order; it's in deleting things from the FIFO queue of stuff to try eventually (or never adding). And the other common error is in assuming you can't or shouldn't try to do both in parallel.

Perfidy, in some contexts, means a promise to act in good faith but with intention to subvert the effort.

"Self-fulfilling prophecy" captures elements of this. Robert K. Merton.

https://en.wikipedia.org/wiki/Self-fulfilling_prophecy

The headline is stupid. Its pretty obvious that the transmission happened _before_ they got the patient into an 'ebola-style lockdown'. Based on another sentence in the article, you could change the title to 'Seattle's Coronavirus spread despite a lack of testing in a critical six-week window'.

My point is, its pretty obvious how you slow this thing down, and its not much to do with 'ebola-style lockdowns', its to do with lots of testing, social distancing and hand washing. South Korea has a 2 hour turnaround on tests, in the USA its still 5 days I believe.

My reaction exactly. A more correct headline would be:

"Patient 0 spread virus prior to Ebola-style lockdown"

But I suppose that doesn't play into the reader's fears as much and therefore may not draw as many clicks.

This was what I was thinking. I remember hearing that people are contagious some time before showing symptoms Also a large chunk of people only show mild symptoms. At the minimum all it would take is for them to infect a single person and for that person to only experience minor symptoms or to be not the type that goes to the hospital for some reason. This guy was on a plane 4 days prior. He might not even be the actual original person.

We've changed the headling above to the article's HTML doc title. That is often a more neutral title.

Not sure what the turnaround time is now, but my wife works in a hospital in Seattle and they were getting tests back in a day or two.

>South Korea has a 2 hour turnaround on tests, in the USA its still 5 days I believe.

Those kinds of inefficiencies don't have to exist. I wish I knew what the bottleneck was there. That time differential is so large that it has to be something pretty braindead that's holding the process up. Like we're still using test kits of type A when we should be using test kits of type B. Or everyone, nationally, is sending tests to a single lab with 2 staffers for evaluation. Etc etc.

The problem is, at once, solved in other places, and at the same time so glaring in our case that there is no way it can be insurmountable. We just have to get our heads out of our butts.

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