The hard part of the economics of Covid-19
thereader.mitpress.mit.edu
thereader.mitpress.mit.edu
Also, the Italian government plans to hire a ton of medical and paramedical staff, money has been earmarked.
I am quite sure other governments are doing the same.
Where will this staff be coming from ? Are there medical professionals currently unemployed in Italy or working in other jobs ?
It’s insane. It’s trench warfare
Uh, psychologists have zero medical training or experience - maybe they could explain the patients their respiratory failure is a symptom of insecure attachment patterns.
If you mean psychiatrists, there aren't that many of them to move the needle.
https://youtu.be/7Iz5tWb9f8A [hoping the english subtitles work]
Look at the manufacturing ramp up that occurred during WWII for example.
"More than 60 manufacturers have been sent a blueprint for making up to 20,000 ventilators to treat coronavirus patients, “at speed”, as Boris Johnson called on British industry to help the government prepare for a surge in cases."
https://www.theguardian.com/business/2020/mar/16/vauxhall-ow...
I work for a very large global manufacturer w/ a presence in China, and does not produce medical equipment. My Chinese family told me (so take it w/ a grain of salt) they said 'Hey I heard your company is building ventilators to help out' and I said I don't know.
My gripe is why the other countries didn't do it too since we had more lead time. Infection rates are exponential...waiting too long to take action will cause more deaths.
Car factories, for example, could be retrofitted to fabricate ventilators. It will not be easy, it will cost money and a relatively long time, but it will probably be easier than building totally new factories, and it will be more productive than reading tweets the whole day.
https://www.reuters.com/article/us-health-coronavirus-draege...
If your country doesn't have a local manufacturer for these things, it seems you are kinda out of luck.
[ https://www.corriere.it/scuola/universita/20_marzo_13/corona... ]
A lot others already holding that certificaton were not working yet because positions in public hospitals where not accessible yet because of the turnover blocks put in place in the last decade while the government was trying to cut healthcare expenses.
I wonder how many clinic-hours we could add to our capacity by some kind of moratorium on that level of paperwork.
You’re just ushering small businesses faster off the cliff of insolvency if you legally require them to pay workers while they are also legally required to be shut down.
If the government is forcing a company to shut its doors, the government should be prepared to pay the employees “quarantine leave”.
True. But those are being done after the fact. It's too late already for Italy. By comparison, the U.S. still has time now before the curve shot straight up to the max - then no amount of measures are going to be able to keep up with the viral infection rate (and death counts)
How much time do you think there is? Until recently there have been very little testing, so we don't even know where the US is on the curve.
Even if we assume it's early, that's still just a couple of weeks if time.
Italy had 100 total cases only ~20 days ago.
The problem with this virus is that it goes from 1 case to hell in only a couple of weeks. If you already have 100 confirmed cases, it's too late to stop what's coming.
According to mathematical models the capacity of your hospitals will be exceeded by more than 30 times.
Give it another week or two.
https://www.imperial.ac.uk/media/imperial-college/medicine/s...
https://ourworldindata.org/coronavirus#trajectories-since-th...
Unfortunately not where it matters most, that is in Lombardia (where I live, and the hardest-hit of all regions). In fact the regional government took the matter into its own hands to attempt to convert a number of buildings in an old exposition area (not the 2015 expo area, FTR) into places to treat patients (there are still many "ifs" to see whether this will get done or not, though).
In fact, they are still going ahead with cutting doctors pay in the midst of it all. Maybe we deserve it for electing a nut job who only cares about budgets (Alberta)
As hard as it sounds for the economy to adapt to extreme social distancing for a short time and moderate for a long time, it seems like a better bet to me than trying to increase intensive care capacity - which already consumes a nontrivial fraction of gdp - by orders of magnitude and write off millions of lives.
We strongly react to strong threats. It's in the viruses interest to become a weaker threat like the common cold so we tolerate it instead of actively fighting it.
Covid is a bit different, because it has a longer incubation time, but that wasn't the issue with the 1918 influenza outbreak.
(Note well: I am not an epidemiologist.)
With the 1918 flu pandemic, mild cases of flu remained with their unit, while extremely sick cases were transported home via train for improved medical care. As a result, it was the severe cases that ended up sparking new infections, while the mild cases died out after generating herd immunity within an army company.
Most respiratory viruses follow the first scenario, although there is a caution there for people who suggest eg. transporting sick people by airliner to regions with fewer cases to make better use of available hospital capacity. Ironically asymptomatic transmission is your best friend here: if all transmission is asymptomatic, the strains that get transmitted will be the ones more likely to not cause symptoms.
I think it may be a good harbinger of the public's willingness to endure repeated, long-term changes to their behavior. The way I see this going, we're going to get lockdowns in most countries within the next week or so. After 6 weeks or so, new cases will be negligible, and we'll declare victory and pick up our lives. The virus will silently spread from a few undetected cases during the summer, but then take off again around October, when we get a second wave. Assuming it hasn't mutated to become significantly less deadly (pretty likely - see sibling threads), that will be the real killer, because instead of starting from 1 index case in 1 city it'll be seeded from tens of thousands of sleeper cases across the globe. Public opinion won't support a second lockdown then - people will just be left to die with their families.
Is there somewhere to check that score, or is it a higher karma feature?
Yes, that or have 2-4% of the infected population die...
It wouldn't be crazy to ask international travelers to pay the marginal cost of extra testing and/or the negative externality of spreading the virus between worse and better controlled regions.
Anyway, if R0 can be brought below 1, it wouldn't need to be indefinite. The further below 1 it is, the faster the virus will extinguish itself. This was seen in China, where they went from exponential growth to fewer new cases each day and ultimately to the situation now where most new cases are imported from other countries.
You also don't need global coordination, although it helps. Any individual country can restrict outside travel from outbreak areas, get their own R0 below 1 via social distancing to eliminate the local outbreak, and then relax social distancing locally, relying on travel restrictions and temporary quarantines of travelers from outbreak areas, plus testing and contact tracing. If cases start to flare up again, increased social distancing measures can be brought in to get them back under control.
So in theory you could do extreme distancing for a period on the order of a few months, and then normalize somewhat. It would take a global response of that sort (unlikely), a vaccine, or a change in the virus itself though to end the situation entirely.
Re is effective spread rate, taking into account natural immunity, vaccination, contact tracing, etc. By definition, if Re>1 the epidemic is growing exponentially and if less it is shrinking.
2) invest into medical research
3) hope you can manufacture something effective by the time the next wave hits
1. Remove all testing bottlenecks.
2. Mandate face mask usage in all public settings.
3. Maintain massive queryable databases of cell phone location data for everyone. Goal is to easily find all potentially infected people if you identify a new case.
4. Keep mass gatherings (sports, conferences) closed due to difficulty contact tracing. (until number is really down)
Note that because so many countries screwed up already, a short term lockdown is necessary. But the above is how you handle life after
By all means let's investigate other options once the first wave is under control. But right now the first wave is growing out of control in basically every western democracy.
#StayHome now, then work on a better plan. Make it work first before you make it work fast, basically.
After that, the virus may go away on its own, or it might mutate into a weaker form. Or we might have treatments on the way.
Masks production can be increased. But you need hundreds of millions a day of production and won't get there in a short period of time.
(I've been trying to simulate this, but ended up battling matplotlib unsuccessfully to create a graph.)
It's really unfortunate that the general population of the US has zero cultural familiarity with using masks to prevent the spread of disease. This really seems like the time to do everything possible in that regard, but we don't have the supplies.
In normal times, surgical masks are cheap. If we had the supply, we should be handing them out by the dozen to households in infected areas, at airports, etc.
1. Perfection is better than imperfection
2. All our options are imperfect
3. Therefore, we will do nothing
I am almost sure that our society, even without prior preparation, could physically produce huge numbers of "more effective than nothing" masks (especially for protecting others from the wearer, which is easier) very quickly at, say, 10x the cost (because you are recruiting less than ideal resources, like factory lines designed for other things that need extra labor) and 75% effectiveness (because you aren't applying the usual extremely strict standards that apply to NIOSH masks or whatever). Even if everyone taped a paper towel or sock over their face I bet it would reduce large droplet transmission by 50%. But we are not able to do so, because
1. These masks would cost more than masks used to cost ("price gouging!"). Imperfect.
2. They wouldn't work as perfectly as physically possible. Imperfect.
3. Some people would make money selling fake masks or whatever in the confusion. Imperfect.
4. We already made a bunch of regulations mandating perfection and no one wants to take responsibility for removing them
and maybe also
5. The people who should have stockpiled masks (edit: in the government or medical supply chain, I'm not saying individuals should have thought of this!) would have to admit their mistakes
So, "we" lie to people that masks are useless (charitably, so doctors can have more; uncharitably, because 5) and do nothing.
From where I'm sitting, it feels just as plausible that it had mostly hit far larger saturation than people realize. Such that, even if this works, it should have been done literally months ago.
My perspective is someone in Seattle that almost certainly had this a month ago
The article is saying do both which makes sense. In the case of CV19, we don't need to build new state-of-the-art ICUs. We only need to prepare a temporary overflow capacity that can handle a relatively brief surge of a very particular (and largely similar) kind of patient which is a still-challenging but much more tractable problem.
Space - Large circus tent-like temporary buildings used for conventions can be erected in hospital parking lots in a day.
Beds - While $5,000 robo-beds are wonderful, CV19 patients needing hospitalization have pneumonia symptoms and need to be at a constant ~30% incline - so La-Z-Boy lounge chairs are actually a decent option.
Mechanical Ventilators - The U.S. has about 160,000 ventilators. The key here is to get them where they need to be when they are needed. The chances that CV19 surges will happen everywhere at once in an area as large as CONUS are essentially zero. In Italy, while Lombardy in the North was running out of ventilators, there were hospitals in the south with unused devices. 98k of our national 160k vents are mothballed older versions in storage. Preparing some portion of these for rapid deployment, such as positioning them in FedEx / UPS overnight hubs in the central U.S. can have them ready to be wherever a surge begins to build in less than 18 hours.
Ventilator Operators - Becoming certified to operate a ventilator usually requires six months and the next gap will be having enough qualified operators where and when they're needed. An experiment was already conducted where various medically-trained, but not vent-trained, people from RNs to pediatricians to veterinarians were run through 2 days of intensive vent training and tested for apprentice-level proficiency. The winners were the veterinarians, outperforming the other specialties in performance (go figure). The resulting model showed one certified vent op can supervise six apprentice-level ops who each handle X beds (I forget the exact numbers). But you get the idea and fortunately, we have a lot of vets in the U.S.
We still have some low-digit number of weeks before likely patient surges start cropping up in different areas. Neither spread-reduction nor surge capacity increases will work perfectly, but by pragmatically working both issues together it's likely we can avert many preventable deaths.
> The winners were the veterinarians, outperforming the other specialties in performance (go figure).
1) Veterinarians deal with animals, which aren't as domesticated, civilized, intellectual, ... in some sense. So as opposed to humans they will not understand the reason why they are undergoing treatment, nor have blind faith in this human they don't know. So when an animal experiences higher or lower levels of comfort it will be more "honest" in it's body language in response to the way it is handled, or what it is feeling physically during treatment. Also the veterinarian doesn't need to model abstract conscious thought of the subject, while with humans this is inevitable and can be distracting. Could this explain the higher performance of veterinarians? After treating cows, horses, dogs, cats, ... they view the human in a way as just another animal, and pay more attention to the intuitive body language than to abstract social cues?
>CV19 patients needing hospitalization have pneumonia symptoms and need to be at a constant ~30% incline
this is with heads up, or feet up?
I read a (news, not journal) article with pictures of the Italian patients on their belly, because it allows the mucous to flow from the finely branched areas to flow into the more accessible pathways, so the mucous would collect there where it was easier to remove.
2) IF hospitals get overrun locally, and people are left to their own devices, would it be possible to disinfect a plastic tube, attach a digital endoscopic camera, disinfect both, and introduce it oneself to suck out any accumulating puddles? what would be the maximum tolerable cross section to get it to the point of collecting the mucous?
3) instead of ventilation which is very hard to DIY because of volutrauma and barotrauma, could circulating air work? I envision a double tube brought deep into the common pathway (without obstructing passage of air for breathing, or alternatively a third tube to atmosphere), and simply introducing the same volume as air as being removed by the other tube, so a significant fraction of air will directly exit again through the second tube, but some of the air will mix with the local ambient air in the lungs before exiting through the second tube. i.e. the setup does not replace nor displace breathing, but simply circulates air. This might inadvertently cool the lungs, so there should be proper temperature control on the high flow rate air.
The viral growth is not the only exponential thing here, the costs of bringing down R0 are also highly non-linear, and it works both for and against us.
Against: it is going to be much more expensive to get R0 from 1.5 to 1 than from 4 to 3.5. A plausible assumption may be that a constant percentage reduction carries a fixed cost. Also: the more infected you have the more expensive it becomes.
For: As you said, once it's brought under control, cheaper measures that don't work at scale can be be used it to keep it from flaring up again [1]. That's what China is trying to do and so far it seems to work well. The whole herd immunity insanity seems to be predicated on the idea that social distancing does not work and the second wave will kill you later. But evidence so far suggests the opposite, although this may change.
In terms of war-style production: It seems criminally stupid that so far no Western country has embraced readily available trivial and ridiculously low cost means to significantly reduce spread. Like getting everyone to wear face masks, all the time. There seems to be excellent evidence it is very effective for bringing R0 down massively, both from academic studies on influenza[2] and SARS and also from circumstantial evidence like just comparing case growth between face mask using countries and non-using countries for the current outbreak[3]. Of course that requires actually producing a lot of face masks – but how hard can that be? As far as I am aware the current state is that even terrible face masks would help massively with preventing carriers from infecting others.
[1] This argument is also made here:
https://arguablywrong.home.blog/2020/03/12/epidemiological-m...
The cost per live is somewhere on the humanitarian end of the spectrum, but I think this argument is worth engaging with. If there is any realistic chance of eradicating covid-19 rather than just mitigating it, clearly is is what we must do and will pay enormous dividends even in the fairly short term.
[2] e.g. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1539-6924....
[3] https://twitter.com/epsilon3141/status/1238838106440241152
At least summer is coming and it's substantially safer to be with people outside.
It's worth noting that every early "flatten the curve" illustration example that I saw had the lower curve still above the capacity, just not nearly as much, however by the time it reached mass media, it had somehow morphed to the lower curve at or below capacity... probably because they thought it sells the idea better? but at the cost of misleading the public about what's feasible.
Well, that's exactly my problem - I don't really know what kind of gap to expect. It is all very qualitative at this point but scenarios (and thus the best course of action) are wildly different depending on how exactly do the relevant quantities compare to each other. Of course "we don't know yet" is a perfectly valid answer but then it must be clearly stated in the article that this is just a speculation describing a plausible scenario.
If we're talking about high casualty numbers, stretching it a year or two, while we wait for a vaccine _might_ be feasible.
Not just a case of testing those for infection, that cat left the bag in every country on that end. Need to also test for those who are now immune without being aware.
Otherwise may well see spreads more than expected due to these people spreading the virus when they have no symptoms and also prevent paralysation of those who are immune, isolating when they don't even know they had it already.
So knowing that variable will become key in tackling this and currently we have no idea upon that.
This study shows the number of symptomatic patients broken out by age group on the Diamond Princess which was a very well-studied population. https://www.medrxiv.org/content/10.1101/2020.03.04.20031104v...
That article was heavily flagged because it has a bad title and a pessimistic message, but it was the first article that I saw with an approximate calculation of the size of the problem.
Here in Tokyo it looks almost like business as usual. Some companies are letting people stay at home but most are not. While cities in the USA are banning gatherings of 100 or more, here in Tokyo every train ever 3 minutes during rush hour has 8 to 16 cars stuffed with 100+ people per car.
I have no idea what the actual infection rate here is or the ICU usage rate. 2 weeks ago Japan was considered the place to avoid. Now it's the USA and Europe. Japan hasn't seemed to have taken any drastic measures so far or maybe I'm just not paying attention.
This has an infographic on testing - Japan was next to last (on the chart at least) per person testing for industrialized countries as of March 4. https://www.vox.com/science-and-health/2020/3/12/21175034/co...
The cynical take is that aging demographic is one of the biggest problems facing Japan today and this is a way to deal with it.
The problem is aging population are people who 40 or 50 now, not people who are 70 and 80. The latter may die because of cv, but the problem of aging population goes nowhere because people in 40 or 50 will get older eventually.
This my cynical response to you cynical take.
This is cynical nitpicking.
I think it's fair to say that advising social distancing is the norm. But actually doing it very much isn't yet.
COVID-19 is as much a flu as you are a fish. Probably less so.
So timing of such measures important and too early can be more damaging than too late, overall.
Guess more eye's will be upon the UK now after reading this.
If it sounds a lot like the Chernobyl script it’s because it is.
Ergo, managing capacity in a way that is mindful that winter 20/21 will come around faster than we realise. After all the West has just entered spring, so 6 months from now we are in Autumn and the seasonal impacts like normal flu etc start to traction up again.
May well be a case sadly to say that every extra death now, will mean two or more less deaths in the comming winter. Sadly it may well get right down to that uncomfortable truth. Hard to say and honestly, not sure how anybody could articulate that without upsetting anybody in some way, shape or form. But that does seem to be the jist of it.
https://personalpages.manchester.ac.uk/staff/thomas.house/bl...
nb the UK has since issued stronger isolation guidelines and downplayed herd immunity in the media. Longer paper about their current model https://www.imperial.ac.uk/media/imperial-college/medicine/s...
> The reason that this happens is that social distancing measures do not lead to herd immunity, so once they are lifted the epidemic starts again. In the absence of a vaccine, it is therefore meaningless to speak about whether a policy 'aims' to get herd immunity or not, since every country in the world will reach herd immunity unless it is able to implement social distancing for an indefinite period of time.
i predict this is exactly what will happen: indefinite social distancing. impact may be reduced with fast tests and large scale testing so isolation and contact quarantining is immediate.
There are workarounds and corners to cut, like making last year students into doctors without exams, moving doctors from other specialities to intensive care. But it's not exactly the same.
It is in the public's best interest for the general public to only worry about what is within their control (so as to avoid panic). Therefore, the general public is being led to believe that all is going to be OK after a couple months of social distancing.
I guarantee you behind the scenes, those in control are scrambling to take immediate and drastic action to ramp up our medical treatment capacity.
Germany _did_ address this. Currently there are 25k beds with ventilator, the federal government ordered 10k ventilators more from the largest local supplier (Drägerwerke) and explicitly bypassed normal procurement laws. That company is now extending manufacturing capacity, but it won't be fast enough.
So all the people who are 90+ years old?
Given the large # of cases and their high concentrations in specific places, it seems likely that we would see many cases of reinfection if previous patients weren't immune.
And probably more, this is just quick out of my mind.
Here's a better approach: Hardcore lockdown for 2 weeks, which stops the spread and reveals the vast majority of cases. Then switch to high-volume testing and targeted interventions (with would be much more efficient than now because many of the processes can be improved).
> Immunity from Covid-19 is still an open scientific question but, let’s assume that is more likely to be true than not.
Huh? What's the basis for that?
> The concerns are that China, Japan, and South Korea may have actually pushed social distancing too far. Israel and now Italy are going even further to keep the virus out altogether.
I see no date on TFA, but this statement implies that it's maybe a week old.
I was wondering why we even expect persistent immunity.
The mass exodus from Europe is going to bring back a bunch of infected and asymptomatic people to America. Nobody wore a mask, or used gloves, or probably even sanitized their hands. They were just all in one giant Petri dish at JFK.
This, and flights from Seattle have been going on for over a month now, that infected people were already traveling all over the country, and the world.
By the time 1 person is confirmed infected by a test, they have probably already infected 10 to 20 other people, depending on their rate of social interaction, within the past 5 to 14 days. The average number of days before displaying symptoms is about 4 days. And it could go as high as 13 days.
The only way to stay safe is to avoid other people. And when you interact with someone new, it restarts the clock again.
In another week, America might not have 1 Wuhan sized epicenter, instead, it might have 50! And all the people rushing to Costco and Target, to hoard toilet paper, are just going to make things worse. It’s your local Petri dish, from just waiting in line, and re-breathing the same infected air from the recirculating HVAC.
If you can wear a mask in public, I would highly advise you do so. It may be imperfect, but it will at least help block something. This virus is airborne.
Anything that is not growing or transporting food or useful to treat patients should be shut down. It's difficult to say this, but sometimes you have to treat citizens like children. This is such a case.
And then get old people to stay at home, perhaps with a family member or carer to assist them.
9/11 shutdown the US economy for a couple of days.
This is shutting down production for weeks and global demand for many thing for months. It's completely unprecedented that I can think of.
At least I hope to god that’s what they’re thinking.
iirc it requires numbers closer to 2/3rds of a population.
But the big problem is that it might not even help, the worst case scenario is that absent a vaccine the virus becomes just a more infectious and deadlier cold that people risk getting every season.
There's already a vaccine which has been created and which entered the first phase of trials today (https://www.mercurynews.com/2020/03/16/first-stage-of-covid-...). If we're going for a radical plan (which, hope you're not offended, is how I'd characterize your proposal), then just skipping those trials and going straight to giving people that vaccine should be on the table.
So then you'd have to compare safety and efficacy of that against this vaccine. I'm not an expert at all, but it seems like we basically don't know the answer to any of those questions.
* We think that you can't get reinfected once you've had COVID-19. But we aren't sure.
* I don't think a method of predicting symptom severity (like you suggested) has been created, so we don't know its reliability.
* We also don't know if any of the new vaccines are safe.
* Nor do we know if any of the new vaccines are effective.
As for building additional capacity with a WW mindset... how about just annex the currently empty offices and buildings?
...now to train some doctors!
https://time.com/5802293/coronavirus-covid19-singapore-hong-...
Taiwan can produce 10M masks per day in country of 23M
https://abcnews.go.com/Health/taiwan-sets-world-fight-corona...
Taiwan and Japan are outliers so far, and they are monocultures, with famous compliance rates.
Korea is somewhat similar to Japan, but took a hit early, and has managed to beat it back.
China appears to have peaked, but did this with massive application of governmental policies which would never fly in the West.
Flatten the curve doesn't change that a large number of people are going to get this disease. The best news is danger increases with age, unlike the Spanish Flu. Africa is very young (media age), the US and China are roughly the same, while the EU in general is older (Italy and Germany especially). What matters is not hospital beds per capita, but ICU beds per capita. The US does much better by that measure. You don't need an ICU bed to give oxygen, which is what most serious clinical cases require. MIT Sloan gave a prize last year for a less expensive, simpler ventilator designed for most cases in countries with limited resources. We have options that aren't explored yet.
Are we going to see some disease, such as measles, eliminated? What about chicken pox? The flu?
I'm really curious as to how this ends up affecting disease in society. I don't know if it will be enough to eliminate corona, but this may be enough to kill off other diseases.
But on the other hand, doing so might greatly decrease military readiness. Let’s not add a major war to the list of catastrophes. But I’d love to hear what military buffs think.
This doesn't seem like a very good alternative. Even with adequate hospital care, the true fatality rate seems to be in the neighborhood of 0.5% to 1%, which would be quite harsh if allowed to spread throughout the population.
I am hoping that improvements in treatment can make the difference. A vaccine may not be available for quite some time, but drugs that reduce the fatality rate might be ready sooner.
Of course the actual course of action must include some mix of all-of-the-above: containment, new hospitals, new treatments.
EDIT: as voidmain notes, we might also hope to quickly reduce the number of infections to the point where we can contain them with testing and contact tracing, rather than blanket shutdowns.
What's your basis for that? It seems like a vaccine will be available well before years have gone by.
Vaccines will likely take more time, due to long-term effects that need to be investigated (as many mentioned in some other HN story today).
And that is why drug development needs to go parallel with a vaccine. If a vaccine fails, we can fall back to drugs to prevent people from going into ICUs (hopefully).
Besides, partial resistance is a thing. When our immune system has seen some other similar virus, we get a much less severe version of the disease.
My sense is that the UK will probably fold and institute a lockdown once their ICU capacity gets overwhelmed and healthy young people start dying in the streets. Either that or they'll face a revolution and then have a lot more problems. Of course, by the time it gets to either of those points it'll be too late to effectively change course.
But it's interesting to see at least one country take the position that "Hey, we're going to let this run its course, take our lumps now, and try to get back to business as usual ASAP." I could be wrong, and maybe this is a genius application of heartless logic. Time will tell.
RemindMe!2months ;-)
Looks like that's already happening: https://www.buzzfeed.com/alexwickham/coronavirus-uk-strategy...
> Looks like that's already happening
Is UK ICU capacity overwhelmed and are young people dying in the streets?
No.
Don’t spread rumours in this situation.
> "We were expecting herd immunity to build. We now realise it’s not possible to cope with that," professor Azra Ghani, chair of infectious diseases epidemiology at Imperial, told journalists at a briefing on Monday night.
i can multiply numbers fifteen times in a row and come to that conclusion. alternatively, i can watch italian tv. did these people never looked up from their models to confront them with actual reality?
Related, if we take the numbers out of China at face value: A tiny tiny fraction of the population has been infected (acquired immunity). So what now? Lock everything down until a vaccine is discovered?
Basically, masks in public, no-contact thermometers everywhere, and QR codes that you scan to enter a subway or a building. There's more, but that's the core.
If you have a fever, then they send you to a specialized fever clinic: https://mobile.twitter.com/MikeIsaac/status/1238604080571772...
There, they determine if you've been infected. If you have been, they send you to a group isolation ward, where you spend a few weeks chilling out and doing group dance exercises. If can't stand up and dance, you get treatment.
It's clearly a society at war, and I'm sure some ugly details are hidden. But it looks better than hiding indoors while our medical system burns and our elderly relatives die (and at least some of us younger folk wind up with scarred lungs).
If you run their model for UK with weak mitigation, Moderate/North epidemiology, you get 390,000 total deaths.
Especially where our knowledge is imperfect and subject to a lot of latency, we have to accept that we have very little actual control over how quickly the curve speeds or slows. Thus the bell-shaped curves.
Waiting until the problem obviously seems like a real problem is exactly what crushed cultures under epidemics in the past.
And yes South Korea and China seem to have stopped the pandemic in their countries, and have done an impressive job at it, but its early days and not at all clear how sustainable their approach is, or whether that approach would work everywhere.
It is too late for stopping it and you can barely delay it either.
You delay a few days or maybe 1-2 weeks if stringent but it won't be as effective when you desperately need it to be. Likely more will die if you start too early.
Thank god.
Think about something akin to some sort of nuclear reactor with control rods up you've just started to insert.
They (we) have already shifted towards a lockdown (voluntary for now, but people have been told to avoid office, pubs and travelling[0]) due to the model used being updated with the data from Italy.
Of course, all it takes is a UK to screw everyone over by not playing along and providing a population pool for the virus to mutate. And then a ton of poor countries who probably can't do anything even if they wanted, where it's just starting.
Honestly, I think the UK, Sweden et al. will be "voted out" here. Commerce can't continue between countries that follow the China/South Korea model of keeping R0 < 1, because frequent large outbreaks are bound to follow. Britain can't economically dominate its neighbors like that today. Sweden, forget about it.
This is a spectacular high-stakes experiment. But if Boris Johnson isn't persuaded by public opinion and a high death toll, his trading partners will.
Both approaches put strong selection pressure on the virus to mutate to a milder form, so even in the absence of a vaccine, we'll win in the long term.
That's not what is being said. What is being said is that specifically to avoid people dying, you need to stop ICUs being overwhelmed, but that in their judgement and modelling an immediate hard clamp down is not the best way.
Trump just announced advice not to gather for 2 weeks. A 2 week restriction is a drop in the sea.
China is celebrating lifting of many restrictions. But the virus will come back in those areas and the restrictions will come back too.
is completely false. It was hyped by some out of context quotes by some media outlets and spread like a literal virus and people didn't bother to find out the reality, and so we see the same mis information being shared here.
We need to flatten the curve of these misinformation viruses
- schools/nurseries open
- theatres/bars/restaurants open
- stadiums open
- large gatherings allowed
The Mayor of London was still organising mass events a few days ago ( https://www.facebook.com/sadiqforlondon/posts/30260791107781... )
But they're crammed as usual.
And businesses can't claim insurance money if they close, as they're not required to close by law.
From https://www.bbc.co.uk/news/uk-51917562 social distancing is now in place.
The original announcements said that it would always be in place, but that they wanted to wait because it is hard for people over prolonged periods.
0: https://www.washingtonpost.com/local/trafficandcommuting/tra...
A working version of this that actually affects the asymptotics rather than just buying you a few weeks at best has to be able to identify new case clusters while they are small, and then find and isolate a significant fraction of the cases (working backward as well as forward). Table stakes for this is the ability to test everyone with flulike symptoms who tests negative for flu (and flu tests have horrible sensitivity, so that is a lot of people). As I see it from my comfortable armchair, CDC should have made sure long before the epidemic that the RT-PCR capacity to do that existed (doing other work at private and public labs) and could be recruited and online to do this within a few days of the virus being sequenced. You also would need everyone to at least moderately change their behavior because I don't think this would be enough by itself. Simple things like not going to work sick or tolerating co-workers or employees who do seem like feasible changes with both cultural and legal levers to pull that could be very low cost and contribute significantly to Re reduction.
More speculatively, you might be able to do even better using pooled PCR tests to look for RNA in large groups, giving you a chance to spot even asymptomatic cases. Is there viral rna in sewer water or garbage? PCR amplifies exponentially, it should be able to cope with a fair amount of dilution.
Sure, that may take 9-18 months. But preventing the "second wave" is more important than reacting to it.
When we look back in retrospective, the CDC and FDA will be under scrutiny to take more preventative measures.
This always felt intuitively true given exponential growth - realistically flatten the curve was more platitude than practical, an desperate appeal by media in democratic countries to position a "civilized" solution in order to avoid mass panic and draconian measures. Now they're elevating Korea as the exemplar response model when the country is practically an island like Taiwan, Singapore, Hong Kong. It's simply not applicable to geographic realities of most countries where borders can't be simply shut and where a lack of infrastructure investment make the kind of techno-authoritarian solutions that made agile responses in those countries possible. Canada doesn't even have an official Corona dashboard, instead news media as to collate information from an updated table using data from archive.org, people paying in cash, nothing is getting wiped down, minimal mask use etc. If anything, countries without Asian Tiger advantages need to crack down harsher to make up for these deficiencies. No one is going to build enough triage hospitals and medical material to outpace any variant of this curve. No developed country is civilized enough to sacrifice this much for the greater good. This is a stick, not carrot and certainly not rhetoric situation. If Corona is as bad as the numbers project, flatten the curve is going to kill a lot of people in retrospect because politicians can't stomach "lock it down".
E.g. The beds are already full EVERY flu season. Do the researcher's know this? The flu has killed over 12,000 people every year in the US for the last 10 years.
2 years ago, the flu killed 61,000 people in the US.
So, the logical question might be: Why haven't we been "flattening the curve" for years?
Roll forward to Coronavirus and a news media publicizing a "novel" flu that spreads and kills and maims at about the same rate and suddenly we're all running around like crazy trying to destroy the economy and our livelyhoods to "flatten the curve".
Our politicians, who literally have no plan, are making grand pronouncements bravely shutting down everything they can think of because they completely f'd-up the testing and tracking of the coronavirus and literally have no idea what else to do, but know they don't want to be the one at the center of one of those circles showing the number of sick in each city.
It's nowhere near "the same rate"?
"Scientists working at the London School of Hygiene and Tropical Medicine, Imperial College London and the Institute for Disease Modeling have used these approaches to estimate the infection fatality rate. Currently, these estimates range from 0.5% to 0.94% indicating that COVID-19 is about 10 to 20 times as deadly as seasonal influenza. Evidence coming in from genomics and large-scale testing of fevers is consistent with these conclusions. The only potentially good news is that the epidemic in Korea may ultimately show a lower CFR than the epidemic in China.
...
"On balance, it is reasonable to guess that COVID-19 will infect as many Americans over the next year as influenza does in a typical winter -- somewhere between 25 million and 115 million. Maybe a bit more if the virus turns out to be more contagious than we thought. Maybe a bit less if we put restrictions in place that minimize our travel and our social and professional contacts.
"The bad news is, of course, that these infection numbers translate to 350,000 to 660,000 people dying in the U.S., with an uncertainty range that goes from 50,000 deaths to 5 million deaths. The good news is that this is not a weather forecast. The size of the epidemic, i.e., the total number of infections, is something we can reduce if we decrease our contact patterns and improve our hygiene. If the total number of infections decreases, the total number of deaths will also decrease."
This analysis is a little old, however (from March 9th, a week ago), and assumes that the rate of infection of COVID-19 is comparable to seasonal influenza. A recent This Week in Virology podcast[2] had another epidemiologist, Ralph Baric, of the University of North Carolina Chapel Hill, who had this to say:
"The R0, or the number of people who become infected from an infected individual, is estimated somewhere between 2.5 and 3.2. That's actually quite high. That means that for every case there is two and a half to three additional cases. Contemporary flu is much closer to 2 or 1.8, 1.6. So this is very explosive spread and rapid transmission. It's even more explosive because you have rare individuals or maybe not so rare individuals who are superspreaders, who can infect 15, 20 people just passing through a room."[3]
"In Canada there was one example of a superspreader who simply walked through an emergency room that was packed that was fairly packed with individuals and infected 19 people in the less than the 15 seconds they were in the emergency room as they walked through it."[4]
With such explosive growth, the health care systems stands a very good chance of being overwhelmed, causing substantially more deaths. For instance, those 10% to 17% of severe cases that might have otherwise survived had they gotten care in an ICU could well die because they can't get that care. In addition many other, non-infected people who need critical care may not be able to get that care either and die, raising the overall death toll even higher.
[1] - https://www.marketwatch.com/story/why-this-epidemiologist-is...
[2] - http://www.microbe.tv/twiv/twiv-591/
[3] - about 8 minutes in to the program
[4] - about 38 minutes in to the program