And theories why the reaction in the US is or seems to be more intense?
Further the risk of transmission is higher from low wage workers who can neither afford to take time off nor afford health care. Sick days are not a guaranteed (California guarantees only 3) and many employers will fire employees who take even unpaid sick days.
these parts
https://en.wikipedia.org/wiki/List_of_OECD_countries_by_hosp...
US physician training is honestly excessively long, complicated, and expensive (although there are justifications for making it this way), but it's a simplification to point out that there aren't as many doctors, without noting all the other doctor-esque roles with significant overlap.
Comparing the number of doctors in the US to other countries is not a good measure of anything. But noting that americans spend more per capita and get worse health outcomes is pretty significant.
Here [1] we have more numbers.
Most importantly the # of beds seems to correlate strongly to the 'average time in hospital' eg. Japan has 3x beds but stays are 3x longer. That stays are shorter is not an indication of poorer quality.
The US has fewer doctors, about the same nurses, but 3x more MRIs per capita, and probably similar inventories of other kinds of equipment.
As for respirators? Who knows. But The US is a major exporter of medicine, equipment, and they spend considerably more. Just like in every major war there's a 'key weapons system' that wins the day while the underlying economy wins the war ... the US might be in a decent position with enough equipment, and a resilient enough economy and populace to fight coronavirus.
Don't be fooled by Trump's shenanigans, Americans are not fools. When they decide to do whatever they do it in a way that few can match. FYI I'm not American.
There will be ugly issues for those without insurance but I suggest that states will take over there with emergency solutions or else they'll all be voted out of office instantly and they know it. Even Trump isn't stupid enough to fail to recognize that people dying en masse on TV will make him look, in his own terminology 'really, really, really bad'.
Also, thankfully, once again, North America seems to be a tiny bit isolated from the 'rest of the world' and has just enough time to see what's happening in Italy and can possibly act a little sooner on some things.
I expect lock-downs and social distancing measures to take effect earlier in America on an per-capita-infected-basis.
[1] https://www.healthsystemtracker.org/chart-collection/u-s-hea...
One of our children spent a week in hospital and the out of pocket cost was 500yen (about $5USD)[1] plus food. My mother in law joked that it was cheaper then childcare.
Hospitals are also not incentivized to mess around with trying to extract the most from billing because its prescribed.
A friend from Australia needed stitches while in Japan and didn't have travel insurance. We went to the local doctor explained the situation and they refereed us to a hospital. They didn't charge us for the consultation because "they didn't do anything, only gave a referral". At the hospital we explained the situation and the bill was less then the excess they would have payed in Australia. My impression is that they didn't feel the need to extract every dollar because they were getting full payment from everyone else.
These are exceptional cases and the usually out of pocket is more like $30~$50 for a consultation.
1. Where we are children cost a flat rate of 500yen for a consultation and as the hospital stay was a result of the consultation that was also covered.
In the case of our child, we choose a 7 day inpatient treatment that could have been done as a more risky outpatent treatment.
Public health isn't quite healthcare.
(they overlap, but they are not the same thing)
Just as well, my commute sucked (1-2 hours). Our health insurance sucked. $13k deductible, no vision or dental.
I had interviews the very next week, 2 offers within 3 weeks. Higher salary, way better insurance and a 15 minute commute.
Edit: yes, I'm in the US
https://en.wikipedia.org/wiki/Clostridioides_difficile_(bact...
C.diff is something that you always have some of (you'll never be rid of it, nobody is), but it usually gets out-competed by other bacteria. But it's exceptionally hard to kill partly because it can form tough spores that go dormant. So if you take powerful antibiotics, there's a good chance that all that'll be left is the c.diff, which gets problematic when there's a lot of it. Fungus is similar in the sense that bacteria compete with it, so killing the bacteria leaves you vulnerable to fungus as well.
This is precisely why you're supposed eat probiotics during certain kinds of treatments. People talk about "healthy gut flora" or whatever like its a new age alternative medicine, but really you just need a ton of different kinds of benign bacteria filling the space so that no particular one strain of pathogen gets enough critical mass to have an effect.
I'm not sure how to interpret that table. The range of beds/person is amazing to me. Does that mean that some countries have more demand for beds or that some countries have shorter hospital stays (one bed serves more people per unit time) or that some countries have too few beds with people being turned away. Probably all of the above.
So that table just caused me to ask more questions rather than answering any.
This study looks at ICU/Critical Care beds, and finds also a large range but quite different ranking as above:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551445/
Number of ICU/Critical care beds per 100,000 people:
US: 20-31.7
Canada: 13.5
Japan: 7.9
UK: 3.5-7.4
China: 2.8-4.6
https://en.wikipedia.org/wiki/List_of_countries_by_quality_o...
This pandemic specifically requires assistance breathing for a huge amount of people. I'm not sure how closely that correlates to hospital beds, but it could be a big issue in the US where many hospital-like things are dealt with by urgent care.
Most estimates of the ratio of asymptomatic/minor-symptoms people are >=80%.
So the US has 277 hospital beds per 100k inhabitants, of which 20-31.7 are intensive care beds.
China has 434 hospital beds per 100k inhabitants, of which 2.8-4.6 are intensive care beds.
I'd say overall this may be one factor for assessing quality of healthcare, but also explains the respective system's focus on ambulant vs. stationary care.
And then Medicare has a wild model where they work to centralize care at regional hospitals. The local hospital here gets paid more per Medicare procedure by not staffing rooms that it does have (this is basically universal among rural US hospitals that were built more than 10 years ago).
In my current Bay Area employment, if I am sick I stay home. If I feel well enough to work I do, otherwise I don't. No questions/justifications asked besides giving my teammates a heads up over text.
When I worked for a French company, being sick meant having to go to the doctor (writing a 23 euro check out of pocket that was reimbursed a month or two later) to get an official sick note to justify my absence from work, otherwise I would get penalized.
I don't disagree with your hypothesis, but also European paternalism is real.
With the epidemy, remote consultation with a doctor will be more mainstream, it will be easier to book a quick 20 minutes consultation and get the dematerialized note.
In my opinion, requiring people to consult a professional only has benefit. People get help, employers get proof, doctors get work.
My employer, a large manufacturer, usually requires a doctor’s note for illnesses over three days, and I think that’s standard in Germany. Otherwise, think you have a cold? Stay home a day or two and drop the boss an email as soon as you can - no one wants you spreading it around! If I did that more than a few times a year, my boss might start requiring notes, but as long as we don’t seem to be abusing it, they assume we want to do our jobs when we can.
As for COVID-19, they’re being even more explicit: if you’ve recently been to Italy or other heavily-impacted place or have any of the symptoms, you must stay away from all company sites for 14 days, doing WFH if your position allows for it, or getting written off sick if you can’t (people actually running the machines or inspecting parts)
I think it only has downsides. If people really need help, they can get it even if they're not required to consult. When they don't really need help, they're just wasting everyone's time. Doctors around here (.fi) seem to have more than enough of work as it is, so there's no reason to create additional busywork for them; they've got more important things to attend to. Otherwise we might as well start breaking windows.
I know people who go to work (and school..) sick because getting permission to be sick and stay home is a PITA. Sigh.
My wife and I have both led by example in both choosing to work from home early on and arguing strenuously that our employers should make WFH company/University policy (which has now happened).
Be leading by example and staying home, you make everyone else safer. If the effective R_0 can be brought below 1, the outbreak will burn out. We must show our care for those who cannot fight this virus by staying home, connecting electronically, and practicing good hygiene.
But when whole populations need to act in a concerted way, a centralized decision-making mechanism is required. Everything else is naive dreaming.
I do not need a central authority to tell me to care for those around me. Furthermore, we can use our voices and examples to convince others to make choices that are likely to help others. It isn't perfect, it doesn't always work, but in this instance, I am certain that it helps.
Yes, about 1% soaking wet, with pockets full of bricks.
This anti-government religion can turn pretty dangerous in situations like this.
Look at Hong Kong, which spontaneously cleared the streets to fight the virus. With the protest movements, the government couldn't clear the streets. The trust in the authorities is minimal. But people chose to stay in. I have seen it suggested that this response is simply because HK remembers SARS.
Quarantines are hard to enforce with brute force. Consent of the governed will make this all way, way easier.
Once China's national government took the response seriously, the instantaneous and speedy construction of hospitals was really impressive. We see a little bit of that here in Seattle, with quarantine sites/hotels being prepared, but nothing on the scale which may be required.
https://www.ecdc.europa.eu/en/geographical-distribution-2019...
I don’t know if Germany is magical or lucky, but assuming a 1% death rate may be a stretch. They seem to be doing far better than Italy.
I see that the numbers on the same link have now updated to today’s stats, and there have been 2 deaths and 1139 cases in Germany. It doesn’t change the point I was making in the slightest, which is that Germany has a death rate far, far below 1%.
Did you even bother to click the link?
These are the official European statistics from today. The ones from my original post were the official numbers from yesterday. These numbers are not out of date.
The source I posted always points to the most current official numbers. You should read it, instead of arguing.
The death rate is calculated by dead / (dead + recovered). The there are 2 deaths in Germany and 18 recoveries. That's 10%. This is probably skewed higher right now since they're not testing people with only mild symptoms.
because panic isn't really helping anybody and we've never been a particular panicked bunch. Well I guess unless inflation shoots up and we get Weimar PTSD or something. Just about the only thing that seems to really scare anyone. I think the behaviour of the tech companies is mostly theatrical because they love the PR of being at the cutting edge of pandemic behaviour or whatever but these companies employ hyper-aware nerds who probably won't touch their face in the next three month so meh.
>Germany went from 20 diagnosed cases to 1600 in about a week.
We also only had two deaths or so up until now so I think the conclusion here is that the disease is severely underdiagnosed in other countries with the exception of South Korea. We were able to diagnose so many cases because we have a relatively decentralised medical infrastructure who all have relatively high capacity.
That's one possibility; the other is what is happening in Italy right now, i.e. initial 2 weeks of infections are done and now the severe cases remain and pass away. Like in South Korea 98% cases are in progress, so the outcome is not known yet and making any stats out of those is premature (i.e. too optimistic). I'd say nobody is going to shut down whole megalopolis cities if it was just a more severe flu...
>I'd say nobody is going to shut down whole megalopolis cities if it was just a more severe flu.
I mean a severe flu by a factor of five or so is basically what this is, it's just that this in and of itself is really, really bad because nobody has the capacity to handle that many cases.
Neither does this virus, typically. However some people end up having severe complications, as do people with the flu which is why the latter causes a few ten thousand deaths each year in the US, and half a million worldwide.
The issue here really is a matter of quantity. Covid-19 is not a mysterious super disease, but it is dangerous enough to overstress an unprepared healthcare system.
Also, if the entire population of Northern Italy was infected and mortality rate was .5%, you would be seeing 13K deaths (which isn't impossible given the situation but far from 6-700 deaths so far).
Which is to say, you're right that infection on a large scale is far more problematic than infection on a small scale but I don't think infection on a large necessarily contradicts the Diamond Princess results. A lot of people can die and it is social catastrophe even with percent of the entire population.
But I want to be clear that nothing I said above is anything like a solid prediction, just a pure back-of-the-envelope rough comparison. There's nothing I'm going to predict here.
I think you're putting forward a weirdly deceptive view that the two possibilities (under-diagnosis and long-dying-process) are exclusive. It seems extremely likely both factors are involved in current statistics - nothing in one excludes the other.
A nation that's systematically testing and finding all the cases will start with a lower death rate and watch it creep upward - but for the manageable number of cases they will see as they get patient quarrantine. A nation or region that's not systematically testing will have a high death and high recovery rate as they only see cases after the fact but then they'll see all cases spike, their health system overwhelmed and things in a mess (ie, Italy now, Hubei earlier).
I'm heartened that the US is now finding more cases rather than just seeing more death but clearly the US slacking on testing and surveillance.
One recommendation I would make, buy a box of face masks and some hand sanitiser, but only buy the minimum amount you need. I found it absolutely ridiculous that some people here bought all the stock, so that they could keep themselves and their family safe for years, obviously that doesn't help prevent the spread if other people don't have access to those goods.
It seems the measures Hong Kong has taken works, with only around 160 cases so far. I was surprised how quickly it spread over in Europe.
I've been looking for these this past week in Arizona, but the shelves have been empty. I started going to all the stores I usually shop at multiple times per day to find something; its a drain on my time and probably increases my risk of getting stuff just by being outside.
They even say it themselves: "Furthermore, we should bear in mind that this is an experimental study, with relatively small numbers of volunteers, which limits the generalisability of some of our findings."
That said, it’s known that you can be infected without showing symptoms. So if you only start wearing one when you show symptoms, it might be to late already.
"All types of masks reduced aerosol exposure, relatively stable over time, unaffected by duration of wear or type of activity, but with a high degree of individual variation. Personal respirators were more efficient than surgical masks, which were more efficient than home-made masks. Regardless of mask type, children were less well protected. Outward protection (mask wearing by a mechanical head) was less effective than inward protection (mask wearing by healthy volunteers)."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440799/
"A more specialized mask, known as an N95 respirator, can protect against the new coronavirus, also called SARS-CoV-2."
From the CDC website: "If you are NOT sick: You do not need to wear a facemask unless you are caring for someone who is sick (and they are not able to wear a facemask). Facemasks may be in short supply and they should be saved for caregivers."
There is aplenty of reasons why healthy individuals should wear the masks, including:
1. They could be sick, but don't know it
2. Sick people avoid masks if healthy people don't have them
3. It could help them avoid touching their faces
The study linked in GP seems to directly refute this.
"Overall protection factors calculated per type of mask were stable over time, and did not change statistically significant with prolonged wearing."
The quote from the CDC makes no claims about efficacy, only that supply is limited and healthcare workers should be given priority.
However, R0 is not a constant. For example, with good hygiene, avoiding human contacts etc it is possible to lower the rate of average number of persons each sick person infects. If we manage to do that, the threshold for herd immunity will be lower than 60 %.
Major universities decided to close today. Public events called off. Football games without spectators for next few weeks.
In France, events >5000 and then >1000 people were cancelled.
Though with the exception that if you can't take care of your children, you can bring them to their primary school.
Ie Germany has banned mass gatherings in most states, which the US has not done.
The situation is very fast moving though, I would expect similar reaction in Europe shortly.
https://www.healthsystemtracker.org/chart-collection/quality...
[1] https://en.wikipedia.org/wiki/List_of_countries_by_quality_o...
There are several other colleges switching to remote learning and limiting on campus activity: https://www.ohio.edu/news/2020/03/president-nellis-provides-...
Sadly, I think the majority of (much larger) US population will get the virus, too. H1N1, for instance, affected 57 million people in the US and caused almost 12K deaths. And COVID19 is much deadlier than H1N1, so we're probably looking at a low six figure death toll at least, when all is said and done, no matter what we do. I'd be surprised if we manage to escape this outcome.
That describes most EU countries. Germany is neither much older than the others nor more interconnected. Population density is high but that's the case for many countries in Western Europe.
However, hospital admissions in Italy are now at a median age of 65, so a younger population doesn't help hospitals, it just lowers mortality.
- University in southern Switzerland is closed - all universities and middle schools are closed in Slovakia
I hear similar things from my friends in other companies.
My company does not do WFH at all. Don't get me wrong, I wouldn't want to be 100% WFH (when there isn't a deadly plague going around, that is), but I think having one or two WFH days a week on a regular basis would be awesome for getting some dev tasks done.
I have a nice home office, that mostly goes unused during the week :(
There is no universal health care, and the fewer employees who get sick, the less money a company has to pay out in health expenditures/insurance plan premiums for the next billing cycle.
Also, this means that if you are out of work, you could easily die from preventable illnesses and nobody would really care.
Maybe its just Germany efficiency and pragmatism of just acknowledging some people are going to die and some pension obligations will disappear. Whereas the rest of us are trying not to let those thoughts surface.
If people in positions of power are trying to not let such thoughts surface, they’re being highly irresponsible.
EDIT: That same virologist also warned about a "second wave" of cases starting this fall, after a reduction during summer, due to seasonal strength of the immune system.
[1] https://www.youtube.com/playlist?list=PLkKON9te6p3OpxqDskVsx...
Have you seen how much the tv news networks are loving this? The 24 hour "BREAKING NEWS" about COVID-19 is enough to send your average Joe into a panic.