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Comment by hkmurakami | Hacker News Reader

Good move by Newsom considering there were photos of people in socal still going to bars.

Judging by how long the shelter in place has lasted and affected curves in Asia, we should be prepared for ~2 months as a baseline. From what we're hearing from friends, life is starting to return to normalcy in Hong Kong, with no new domestic cases reported (though now they're contending with new imported cases from overseas travelers returning home). They have a really effective screening/tracking quarantine system in place where they'll give you a location tracking wristband for remote monitoring.

Our family has been affected by this since late January, and there's a big mental challenge aspect to this. Being able to walk outside (unlike in Wuhan) is really big.

It's truly unfortunate that the the country's health services bungled their initial testing and screening ramp up.

View on HN

I don't understand how we get to Newsom's claim that 25 million Californians will get infected in 8 weeks. The math doesn't check out.

The best data we have at this point is from China. They have 81,000 confirmed cases to date, most of them happened over an 8 week period. Obviously not all cases of the virus were confirmed but people were hospitalized and tested aggressively.

Even if only 10% of the cases in China were confirmed (and 10% is a low guess at the percentage that might need to go to the hospital with serious symptoms, and thus be confirmed), that means under a million cases in a population of 1.4 billion.

California's population is 35x smaller than China's but Newsom is predicting California will have over 25x more cases.

Sure you can argue that China is lying about their cases (WHO disagrees). Or that they are authoritarian superhumans with a superior response. Or whatever. But this discrepancy is just too big to make sense. I don't think CA will have 25 million cases in 8 weeks.

I think he is trying to scare people into staying home. Staying home is still a good idea, because the health care system will collapse at a lot fewer than 25M cases in 8 weeks. But I think it's fearmongering.

> Or that they are authoritarian superhumans with a superior response.

I think that you discount this option too quickly. Have you been to China before?

Yes many times. I first visited a decade ago. I remember seeing shit smeared on the walls and ceilings of outhouses. A kid taking a shit on the steps of city hall. Today, they have come a long way in some parts of the country in terms of hygiene. In other parts there has been less progress. I have been to the wet markets in two Chinese provinces, and in other Asian countries as well. How about you?

I have also been to the wet markets in two Chinese provinces (Yunnan & Shanghai [not a province, I guess]).

At least in the most dense regions of China that I observed, the state definitely at least seemed to have the ability to enforce some form of effective mandatory social isolation. Even in rural areas, the government seemed to be able to project authority using tech.

Sure, their squat toilets are a mess but I don’t think that really reflects the technological capabilities of the state.

> I don't understand how we get to Newsom's claim that 25 million Californians will get infected in 8 weeks. The math doesn't check out. The best data we have at this point is from China. They have 81,000 confirmed cases to date, most of them happened over an 8 week period.

I believe he was making a point over what would happen without any mitigation. China put in place very aggressive mitigation efforts to keep its numbers from exploding out of control.

Everybody keeps saying this, but is China really “under control” right now? The virus is still here. Can’t it still infect everyone in China?

China is doing 14-day quarantines for all arrivals -- and this is actual guarded quarantine, not pinky-promise self-quarantine.

There's also a lot of monitoring and risk mitigation in place, so they should be able to catch inevitable slipups (eg medical staff treating remaining patients) pretty early.

So are we just supposed to accept this as the permanent state of affairs until a vaccine is developed? At worst, complete lockdown... and at best, quarantine any time you cross an international border?

What alternatives do you propose?

I mean, I don’t know. But I hope people maintain awareness of civil liberties throughout this ordeal. I’m not saying there’s anything nefarious afoot, but as citizens we should remain vigilant.

Sorry, I misread what you wrote about civil liberties being violated. I agree that they would be violated if more countries adopted the location tracking apps, but I think that we're already past the point of no return regarding the violation of civil liberties when police departments are using stingrays, people can be harassed when entering the country when they want to check their devices, and we have broad laws such as the CFAA.

Vietnam is also doing a mandatory 14-day quarantine at designated sites (hotels, military bases) for those arriving from ASEAN countries, the US, and Europe. There is no reported community spread yet, and all the cases are from people flying into the country and infecting a few individuals. The policy was only enacted a few days ago, but I really hope life here can return to normal if we start to catch all the cases before they leave quarantine. Additionally if we can test everyone before letting them leave quarantine.

You could also ask the citizens to self contain, then we wouldn't need authoritarian measures. So far I believe asking for self containment has failed, I have no reason to think why asking citizens to remain vigilant about the freedom lose will work.

Yup. Suck it up buttercup because the alternative is a horrific and painful death for you, or your loved ones.

Great. I’m young, healthy and my loved ones are far far away. Better keep partying I guess.

China's response in Wuhan in February was indeed superhuman, wrt quarantine, travel bans, medical personnel influx, infrastructure build outs, etc.

They built 2000 isolation hospital bed capacity in something like 6 days.

I assume the 25 million number is assuming we don't stay at home and go about business as normal.

81k is what China got after instituting lockdown as soon as they saw 400 new cases in one day.

81k is what they reported. The CCP isn’t trustworthy.

Do you think they're likely to have _over_ reported the number of cases they had?

No, they probably under reported the numbers. Do you think they locked down wuhan with only 600 confirmed cases or were they way further along the curve?

The world was shocked when they started to build the new hospitals that the numbers didn’t seem to justify. Maybe the numbers were right and they understood what they were in for, which would be a real feather in their hat for their country’s model.

A lot of CCP members are trained in STEM fields. Possibly a much higher proportion of people in China’s government understood and foresaw exponential growth.

> The world was shocked when they started to build the new hospitals that the numbers didn’t seem to justify.

Only those parts of the world who don't understand exponential growth.

You should brush up.

I understand exponential growth thanks. If China was able to take the measures they did on January 23 with only 500 cases in wuhan, nothing amiss in the rest of the world, based on their understanding of exponential growth of the disease that is impressive. Every other government had China as a warning and all of them except three have waited to react.

The governments that have acted effectively have all had prior experience with SARS.

why are you comparing California to the total population of china? China is regional too.

Note that China implemented a draconian lockdown in Wuhan beginning on Jan 22nd, with 571 confirmed cases.

By Jan 25th, China declared a Level 1 Health Emergency in 30 out of 31 provinces, and began locking down other provinces.

On Jan 26th, China cancelled all inter-province bus service.

On Jan 30th, China closed the highways between provinces.

Also, all of this nicely coincided with the lunar new year holiday, when the vast majority of the country is already on holiday for 2 weeks, and not going to work, or school.

It's not really comparable.

To further illustrate your point:

The UK and South Korea reported their first cases on the first day; SK has slowed new cases to a trickle and the UK is facing mass infection.

Yeah I watched a documentary on RUV (Icelandic state TV) last night that basically cobbled together the story in Wuhan from people’s cellphone footage.

People were literally dragged away by police/medical personnel in door to door temperature testing. Like physically picked up kicking and screaming and bundled into waiting vans. And at the time hospitals were so overloaded sick people were sat in corridors with the dead on the floor beside them covered by sheets. I think most people are pretty oblivious to what draconian means. I know I was!

The documentary was Danish and called De advarede om corona-krisen - og forsvandt for those interested.

The other thing to note is that a bunch of the people that recorded the footage are now missing which is terrifying in itself.

Thank you for sharing the documentary and shining a light on the insane measures taken out. I can't imagine the fear and uncertainty of getting sick and avoiding detection in China right now to say the least.

Please post to this site if English subtitles become available.

The best model I have seen so far is:

Take deaths, multiply by 400 and that's how many cases you have. This comes from the assumption of 1% mortality and 3 weeks to die.

So CA has ~8000. A doubling time is ~5 days. 8 weeks ~= 11 doublings. So 8000 * 2048 = 16M. Not too far off for a ballpark. Obviously, the exponential starts to breakdown somewhere... but where?

I don't think it's fear mongering. It's getting the public to understand the back of the envelope worst case... which is really bad. People NEED to panic... to get them to hunker down and take this seriously. The sooner than happens, the sooner we get it under control.

I had to yell at my inlaws to stop taking the train to work and going to the gym. They are 70 and have pre-existing conditions. This action will force them to take it seriously.

I think doubling time is a bit faster than 5 days from what I have seen elsewhere, and that might change the math to the 25.5M in that time frame.

It seems like it’s difficult to get an accurate sense of the doubling rate right now, because of the confounding variable of increased testing.

You don’t have to get a sense of doubling via unreliable test data if you look at the doubling rate of the fatalities.

People count bodies much more reliably in pandemics. I don’t trust our confirmed case telemetry data much, but I do trust the fatality data. Unfortunately it’s about a two to four week lagging indicator. But the fatality rates also currently show this to be spreading much, much faster than it ever spread in Wuhan.

Wuhan is what happens when the curve is flattened. Not what happens when you don’t.

You still don't get accurate data if you just count bodies.

The issue here is every death is attributed to COVID-19 if the virus is present even if the actual reason is some other underlying health condition. Given that most victims are elderly and had serious pre-existing conditions this leads to massive mortality rate over-estimation.

You also cannot reliably compare EU/US data with Chinese: initially most deaths and cases of pneumonia in China were attributed to other illnesses. Secondly, Chinese government is notorious for flat-out lying in their official stats.

> The issue here is every death is attributed to COVID-19 if the virus is present even if the actual reason is some other underlying health condition.

That what you claim provably doesn't happen. Even old people simply don't die that fast otherwise, and we also have the data of the people who can't breath and have to be admitted to the hospitals: there were never that many cases before, happening that fast:

https://en.wikipedia.org/wiki/File:Is_COVID-19_like_a_flu%3F...

(the numbers were compared by the Italian National Biotechnology Association, each bar is one week of time)

It feels like testing is a lagging indicator at this point. Whatever doubling happened, already happened.

Right, in some countries doubling was every 3 days.

That was the case for Italy until 4-5 days ago and I think it still is for Spain, definitely for Germany.

Have a look at this site: https://www.worldometers.info/coronavirus/country/us/

Scroll down to "Daily New Cases in the United States". No real need to extrapolate data from other countries. New cases are doubling every 2-3 days.

Those aren't cases, those are confirmed cases. Which has more to do with how much testing we have done than how many are sick.

Problem with looking at case numbers is, you need to know how many tests have been executed. If they doubled the number of tests within those 3 days, then you measure the increase in tests, not an increase in cases.

Yeah the doubling time confuses me too. All the numbers from China, Italy and the Netherlands (where I am at) show the number of deaths doubling every 2 days upto the limit.

But even our dutch government is claiming it's 4 days standing in front of a chart where it's obviously 2 days.

After you reach the limit it's hard to count because people stop going to the hospital that can't take them in anyway. At that point you should just consider any increase in deaths compared to the normal the result of Corona. Wether it's a cancer treatment that got postponed because of Corona or Corona itself.

>Take deaths, multiply by 400 and that's how many cases you have. This comes from the assumption of 1% mortality and 3 weeks to die.

So that 400 multiplier gives the number of cases as of 3 weeks prior to the death count used in the calculation?

yeah it would have to, right?

The people didn't all die on the same day though...

Take deaths, multiply by 400 and that's how many cases you have. This comes from the assumption of 1% mortality and 3 weeks to die.

I don't see where 400 comes from.

If we assume that people who died today now are 1% of those who got it 20 days ago, then that is a factor of 100. Project that forward through 4 doublings for the fact that we have about 20 days of doubling every 5 days and we get to a factor of 1600. You can complicate the toy model in a number of ways, but I can't get it as low as 400.

Anyways it is worth pointing out that the curve of reported cases will continue rising for a couple of weeks as people both get symptoms then get sick enough to come to the attention of hospitals. And if the measures work, it won't be obvious from death rates for about 4 weeks. And at that point the critical question is whether we managed to slow the rise, or create an exponential decline.

My bet is that we are only going to get a slow in the rise. Hopefully enough for us to get ahead of the need for emergency treatments.

“ My bet is that we are only going to get a slow in the rise. Hopefully enough for us to get ahead of the need for emergency treatments.”

Look at the curves for every where else on the planet, the US will be the same, take it seriously

> Look at the curves for every where else on the planet, the US will be the same, take it seriously

Except this is extrapolating ahead to assume no changes to treatment available. As time progresses, we find better, more effective ways to prevent death from COVID-19.

Worldometers shows CA with 1060 cases and 19 deaths. Where does ~8000 come from. If 8 weeks is 56 days and cases go up 20% a day as they have been then 1.2^56 * 1060 = 28.8 million cases.

It is from my understanding that 19 * 400 ~= 8000. The OP suggested that for every 1 reported death there are 400 cases.

That's not 1060 cases, it's 1060 tested positive. You can't even get a test unless you're a celebrity or high risk... if you're a nurse and your wife is positive, they won't give you a test. We're under tested so there are a lot more than 1000 cases right now.

It's true though that they aren't using the highest rate they could (the 20% per day we got before social distancing). I hope that closing the schools helps... and the ICUs don't overflow immediately.

I do agree that people have a bad tendency to trust any numbers they can get over logic and common sense. And in this case the numbers are obviously a lower bound creating a big bias towards underestimating things.

But information on testing numbers is also lagging and incomplete. The CDC was doing over 5k tests per day a week ago when the number of new cases was around 500 per day. And the number of tests were exponentially increasing too. Does anyone have any better info about how much we have ramped up testing since then? It's a big country, and there's huge "publication bias" in the media where stories about a location or person running into testing issues get the attention and stories where things are working do not. I really don't trust anyone's ability to assess the situation at the resolution of 24 hours and make anything like an accurate prediction. I would like to see them just do full-on statistical sampling by testing people at random in different cities.

If I recall, China had about 500 cases confirmed positive, when they shut down Wuhan on January 23. And by that point, the confirmed infection count ballooned up to 80,000; even after they aggressively mandated their national lockdown. And this was during the early days, when nobody knew anything about the virus. And early test kits gave a lot of false negatives.

With California at 1060, then I can only imagine where the final number will land. And New York has 5712 infected, and yet, they still haven’t shut down the state.

====

Now, the following is likely incorrect, but this may give an general idea of the magnitude. But doing a basic extrapolation, China had a 160x multiplier, from the initial lockdown point, to get to 80,000 infected.

If we use that, then at this point, California might register about 169,000 infected. And New York, if they lock down now, might register 914,000 infected.

Sobering numbers indeed..

But these numbers are highly dependent on population density, mass transportation patterns, and social congregation scenarios. Wuhan has high speed trains, but California has Southwest planes. Car travel and ride sharing usage might be similar. So it’s unlikely the numbers are similar to compute.

At some point, the medical system will fail, and everyone will just give up, and we are now left to our own fate.

Remember that scene from the Chernobyl series where they messure the radiaton and say it is only 3.6 roentgen — which oddly happens to be around the maximum their device can messure?

This is the situation with tested cases now. You can assume that there is no nation on earthq where the number of tested cases is an accurate representation of what is really going on. Deaths are far more accurate but lag behind ehat is going on by two weeks. And two weeks is a long time with something that grows exponentially.

The bad thing about this is, that this logic is flipped on it's head at times: my girlfriend had all the symptoms just like 6 of her alumni — not a single of them could get tested. And while they where still in bed their university proudly issued a press statement stating they have zero cases of Corona. Yeah — if you are not testing you will have zero confirmed cases, that is the way it is.

The dangerous thing here isn't the current number of cases, but the insecurity about it. If you have a huge number of people starting to get ill today your hospitals will fall apart in two weeks time. Doctors will have to send people home to die, like in Italy visitora can no longer be handled, people no lomger be burried — this is not a joke.

I wanted to clarify something. The parent poster wanted to know how the 25 million case number was arrived at. I just provided an example of how such a number might be arrived at. It is far too simplistic of a model though. I have also read there is confusion over the term “case”, as to whether it’s a hospital case vs total cases in general population.

1. I think nearly everyone besides WHO has the consensus that China’s released numbers is too low, especially when you compare it to the numbers from Italy and South Korea. Whether that’s due to corruption or the swamped hospitals and a lack of test kits in the beginning is debatable.

2. This white paper may explain Newsom’s numbers.

https://www.imperial.ac.uk/media/imperial-college/medicine/s...

The growth is exponential and not linear which throws off most people. Surprisingly, even though the paper’s R0 is on the conservative side (2.2-2.4) and so is their case fatality rate. However, their simulations still predict 2.2 million deaths in the US if there’s no gov intervention for social distancing

China's case fatality rate is half Italy's -- if anything, that tells us the Italian numbers are too low.

In China, 9% of people are 65 or older. In Italy, 22% are.

Since this is a disease with the highest mortality for the older age groups, Italy was always going to have a higher mortality rate.

Apparently in Italy even flu is deadlier than the rest of Europe [1].

[1] https://www.sciencedirect.com/science/article/pii/S120197121...

northern italy is extremely humid, this is a factor for the flue too.

That paper is very good. And got the UK to reverse their disastrous "herd immunity" strategy.

Sadly https://www.theguardian.com/world/2020/mar/18/top-uk-covid-1... says that the lead author of the study has COVID and likely was infectious while he attended a press conference on COVID.

These are nonsense conspiracy theories. South Korea's Numbers are also too low?

No.

Our response in the west is just terrible because of all the political nonsense, the fact that scientists don't influence our countries, and most people are just too stupid or too spoiled to listen. Look at our countries, have you seen the kids partying in Miami? The people still protesting in France? How about everyone still going out for dinner?

Don't go blaming other countries' good performance for our crappy one.

Edit: on that note, other countries have been testing people on entry for months on entry. Russia has been testing people on entry. The Philippines tests everyone on the public transportation.

It’s not a conspiracy theory and I specifically said SK’s numbers are more trustworthy. Historically, mainly due to authoritarianism, Chinese provincial governors have a strong tendency to lie with better numbers to avoid being sacked by Beijing. This has happened numerous times already... and before your allusions to racism get more pronounced, I am Chinese. Their numbers also don’t conform to infection simulations pre-lockdown

There are also many Chinese accounts of thousands of bodies just being cremated without being tested. to be fair, Italy is now supposedly experiencing the same thing now due to hospitals being overwhelmed.

The China case is no where close to applicable to the US. They specifically locked residents into their houses so they couldn't leave and locked down all transport in and out of the province. We are doing nothing of the sort, which means our spread will be much different.

This is no time for math or common-sense.

Just stay inside, shut up, and be glad we aren’t being overrun by witches like back in Salem. Those were terrible days.. witches everywhere! Thankfully, Quick thinking politicians got rid of them.

> Or that they are authoritarian superhumans with a superior response.

They literally welded doors shut on apartment buildings. They are not superhuman. They just have a different take when it comes to individual rights.

There is no reason to assume the growth rate will taper off in country x like it did in China if country x does not take similar, or equivalent measures.

Since the "welded doors shut" thing borders on fear mongering, I feel the need to clarify.

Everything I have read states they closed off certain doors to ensure that you couldn't get in / out of the building without getting a health screen.

There were wide scale reports of authorities using chains and locks to seal individual dwellings on apartment buildings by chaining the metal gates closed. If you look at pictures from the field hospitals that they built you'll also note that there were metal grills on the windows as well. Although given what we are seeing here with people refusing to isolate and going out I don't necessarily blame them.

> [China] just has a different take when it comes to individual rights.

Yet next door mostly democratic Taiwan started acting on 31st December, and no one’s talking about them because they have prepared well and avoided an outbreak. Most other countries haven’t done so well...

The other reason no one is talking about them is that the WHO continues to list Taiwan as a province of China...

How is anybody still making this argument?

"It stopped in China, so we don't need to do anything."

It stopped in China precisely because they did something. Diseases don't magically stop themselves. This is on the level of thinking your dirty dishes wash themselves, because your roommate grudgingly does them.

" Diseases don't magically stop themselves."

No, but they usually stop, when the immune system is done fighting them, either successfully or not. And pandemies usually stop, when enough people build up immunity, or failed doing so. Or when the disease is so deadly it kills quicker than it can spread. Which is here not at all the case.

So even if nobody would be doing anything, this disease would eventually go away.

It is "only" a question of how many casualties it will take. And we are discussing the cost/benefit of the measures to society as a whole. Shutting everything down has real costs, too.

What if you don't build up immunity? I've read that there it's not certain we can build up enough immunity. Everybody takes this for granted but what if your immunity lasts for two weeks?

Then I would die, if there is no lung ventilator for me around. Eventual all the people vulnerable would die too. And the overwhelming rest would live on.

Right, until we either go extinct as a species or natural selection affords us the ability to fight it off and that new impervious population survives and thrives, thus passing on the immunity to new generations of humans.

"Right, until we either go extinct as a species or natural selection affords us the ability to fight it off"

And since the majority has no or very mild symptons ... it is not really likely to go extinct

Mutations. You don't want many people getting it because there is a higher chance it will mutate.

It has already mutated, the strains present in Europe aren't the same as the ones in the US and aren't the same as the ones in China

USA had 5000 cases in the last 24 hours. It's growing exponentially. You're not starting at 1 like China did.

USA wasn't even testing until very recently. Those numbers IRL are probably insanely higher than that.

don't forget, testing backlogs are being cleared. We're seeing a large number of confirmed tests show up in the numbers. Until the backlog is cleared the numbers are misleading.

How are they misleading? You still have at minimum 14000 active cases in the USA today. In 8 weeks you'd have significantly more.

This comment hasn't aged well...

China's response is nearly impossible for any other country to replicate.

The lockdown is every word that true to its literal meaning during that period of time. People are not allowed to leave their own apartment. It is more like national level home arrest than volunteered quarantine.

All policies are enforced through each individual district, roughly equals to each apartment complex, that entering or leaving the complex requires its own passes. Let alone make a mask a requirement for everyone, without which you would put arrested in public.

I don't think any other countries can implement such a strict lockdown really. In California's case, I think the spread will no doubt slow down, but it is not going to be enough to burn out the virus. In the meantime, we need an effective treatment to be deploy to really battle this.

Can't believe this timeline is getting so intense this quickly in 2020, this is history making by everyday...

> China's response is nearly impossible for any other country to replicate. [...]

> People are not allowed to leave their own apartment

that's literally what's happening right now in Italy (and I think other European countries). It is not voluntary quarantine; although the level of enforcement is not at the level of China, you can get arrested if you are found outside without a good reason.

Plenty of Italians ARE leaving their apartments, to the point that the government has started issuing fines and criminal charges. And that's only sort-of working.

The Chinese meanwhile crack the whip -- and people listen, mostly 'cuz they know the government will back up their words harshly.

I heard on the radio that they pulled cell phone data in northern Italy (might be illegal) and determined that 40% are still going out.

And the curve is still going upwards. Are they all wanting to die?

The statistical models I am running all consistently show that the exponential factor for the spread of the virus is 3 times higher outside of China than it ever was inside of China. Wuhan isn’t the worst case scenario. It is the lower more flat curve we would desperately like to put ourselves on.

The estimate Newsom presented is credible.

While 25million in 8 weeks might be exaggerated, the number reported by chinese is not credible neither.

The US flu death in 2018-2019 is estimated to be 34k. [1] China's flu death in the same year is 144. [2]

China's population is 4x to that of US. While the numbers cannot be compared directly, the difference in magnitude says at least something about its counting methodology, if not straight out lying

If I am to extrapolate, the corona virus death in china is at least two magnitude under reported

1. https://www.cdc.gov/flu/about/burden/index.html

2. https://www.yearbookchina.com/downsoft-n3019102807.html

Everywhere in the world but China, flu caused pneumonia is posted as flu cause of death. But China would list it as pneumonia, so you have to guesstimate flu deaths by a fraction of pneumonia deaths.

Okay, and how about Korea? Korea is also lying? Everyone is lying except the countries in the west?

Have you considered that those countries just simply have had a better response to mobilize than the western countries?

Tell me how a virus that started in China (a country with 1 billion humans and grew unchecked or for months), could really have less fatalities than Italy, a country with 25x less people...

Unless the numbers are crap, then it makes total sense.

But the WHO disagrees, ah well, then I guess we should stop using our thinking machines.

>grew unchecked or for months

It really didn't "grow unchecked for months".

>using our thinking machines.

OK. You first, then.

Well, I'm lighting kharma on fire to educate you @spats1990, so at least I'm trying.

Here's the timeline.

Nov 17 - First known case of coronavirus

https://www.livescience.com/first-case-coronavirus-found.htm...

January 3 - Whistleblower Dr Li thrown in jail

"Li warned colleagues on social media in late December about a mysterious virus that would become the coronavirus epidemic and was detained by police in Wuhan on 3 January for “spreading false rumours”. He was forced to sign a police document to admit he had breached the law and had “seriously disrupted social order.”

https://www.theguardian.com/global-development/2020/feb/07/c...

Jan 18 - Annual Wuhan Lunar New Year banquet. Tens of thousands of people gathered for a potluck. (Hosted by the Mayor of Wuhan)

Jan 23 - Wuhan put on lockdown

https://www.axios.com/timeline-the-early-days-of-chinas-coro...

The research also found that if interventions in the country could have been conducted one week, two weeks, or three weeks earlier, cases could have been reduced by 66 percent, 86 percent and 95 percent respectively – significantly limiting the geographical spread of the disease

https://www.southampton.ac.uk/news/2020/03/covid-19-china.pa...

Looks like a couple months to me.

OK so your original post was premised on there not being massive mobilised response to less than ~250 cases in a city of 11 million by mid-december. It's nice to have the benefit of hindsight.

Thanks for the response and links, but I basically regret this entire interaction and would rather leave the discussion here.

> Jan 18 - Annual Wuhan Lunar New Year banquet. Tens of thousands of people gathered for a potluck. (Hosted by the Mayor of Wuhan) > Jan 23 - Wuhan put on lockdown

It reminds me of France:

March 15: French municipal elections (in all French cities)

March 16: General lockdown announced

Simple, check this log scale chart of COVID-19 cases excluding China: https://pbs.twimg.com/media/ETgWL8rU8AA3OML?format=png&name=... They multiply by 10 every 14 days. So assuming governments did not take any action to change this trend, cases would multiply by 10^4 = 10,000 over 8 weeks.

There are urrently around 675 cases in California according to the CDPH (https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization...). So this trend would lead to 6 million cases in 8 weeks. The governor probably assumes there are 4 times more cases than detected. So 6M × 4 = 24 million.

There is a huge difference between confirmed infections and total infections because it is estimated that around 18% of the people never notice that they are infected.

But those that get sick get very very sick. And this will put much pressure on health care.

The fear is real. Take a look at the footage of Chinese hospitals and doctors.

Without lockdown the numbers will go up in 8 weeks.

> Sure you can argue that Chinatown is lying about their cases (WHO disagrees). Or that they are authoritarian superhumans with a superior response.

The bigger difference is that California’s cases were more broadly diffused across the population than China’s at the same numbers (in part because it didn't originate from a single point in CA but had multiple points of introduction, and in part probably because of differences in lifestyle and social interaction patterns.)

It really doesn't matter whether it's 4 or 30 million in 8 weeks, because by the time you reach a million people contaminated, you'll have overwhelmed California's ICU and ventilator capacity. People with all kinds of critical conditions, on top of critical COVID-19 cases, will die from lack of care.

People will never abide by a two month quarantine in this country. The number of people who say "I'll just get sick and risk spreading it" starts at much greater than zero and will rise every single everyday.

There will need to be back-and-forth quarantines, or targeted quarantines, or some other creative method of allowing people to live roughly normal lives after a few weeks.

yeah, i'm actually impressed the general public has been as accommodating as they have. It won't last forever though, I think the government knows they can only keep people in their homes for so long. Eventually, the people will be like eff this and start re-engaging their lives.

California probably has a month tops, nobody is going to accept completely halting their lives for two months let alone anything longer.

Just wait until the first few celebrities die. That'll change everyone's mind very, very quickly.

We'll probably lose many members of Congress. They're the worst case - old, meet with many people, not social distancing.

They have access to better healthcare than you or I, though.

Getting a ventilator if you need it is good, but even better not to need it.

Congresspeople on ventilators still sends a pretty strong message

Wait until 100,000 people die, which would only be 0.2% of the population.

That's about 14 days of people dying at normal USA death rate. Do you think people notice that happening and adjust for it?

hospitals will be overcrowded so your "normal" USA death rate will actually increase because the people who would normally receive medical attention will no longer receive it.

"my" death rate? My "normal" death rate? What are you saying?

There will be overlap between people who die of diseases routinely (the elderly, the immuno-compromised, and those with underlying conditions, and the unlucky) and those who die of this disease. No matter, the point still stands - if 100,000 people dying is what it takes to change people's behaviour significantly, that ought to happen every month, and it doesn't.

The truth is most deaths are going to be people near or beyond average life expectancy. I don't want to minimize the impact of any person's death, but I think people in general are willing to accept a fairly high death rate among the elderly, especially considering the most likely to perish are those who were already the most likely to perish.

The death rate among the under-70 population is a different matter. If the medical system is overloaded and working-age people start dying en masse, I imagine that would change public consciousness quickly.

Young people don't necessarily die but they may very well end up in reanimation. The prognosis is hopeful if you're young and in reanimation, except if there aren't enough beds to host a sudden afflux of newly sick people in need of reanimation. Should I continue?

Do you mean resuscitation?

Probably. Sorry, my English is failing me when it comes to more technical words

I'm more concerned about whether or not we can keep food, utilities, and housing running that long. If the front-line workers in the essential jobs are the most vulnerable to exposure, and the economy has screeched to a hault, can we keep everyone fed that long, keep the lights and sanitation going, while also not infecting everyone?

Without contact tracing and isolation of positive cases a lockdown won’t work. Since no system like this is in place I reckon it will take a lot longer than 2 months.

This is correct. This is how South Korea stopped it - early testing and isolation followed by contact tracing to test them too.

Think about it this way. The Ro spread factor is somewhere between 2.2 and 3.0 by most reports. People are contagious for 7 to 14 days before they know it. Therefore every infected person spreads a new case only once every 2 to 5 days on average. The problem isn't that the virus is explosively contagious per-interaction (measles is higher), it's that the incubation period is so long across so many interactions.

Cut that recognition time from that 7-14 days to 2, cut off those interactions, and that's how you get Ro below 1 to stop it. That's what South Korea did, by way of both rapid testing and contact tracing to test them too. Reports are that their rapid test gives false positives of up to 10%, but that's okay, a false positive is much less consequential than a false negative.

What jurisdictions in the Western world have the means and will to implement that remains to be seen.

This is the most excellent description of South Korea’s efforts I have read so far.

Median incubation period is 5 days, 95 percent of cases are 2-14 days.

Are you sure the tests can detect the virus two days after exposure? One reason the CDC advises quarantine and waiting for symptoms before testing is because they aren't sure it can be detected before symptoms start.

Though I guess whenever you are producing enough virus to be contagious you would probably test positive at that point too.

I'm not sure; that 2 days number was what I thought I'd read about South Korea's test, but could be wrong.

At any rate, that's an approximation. The key point is for the average testing and isolation interval to be shorter than the average time to pass on a new case, whatever that interval actually is. If that happens, then it's stoppable.

> contact tracing and isolation of positive cases

That works if there is a relatively low number of cases, or you have enough testing capability to carpet bomb everyone with tests.

Once the number of cases gets too high, contact tracing has lost, because you have too many unknown cases in the community.

If you can’t test a large percentage of your population, you can’t detect pre-symptomatic or asymptomatic people that are spreading the virus.

Yeah, my jurisdiction has a pretty high test rate (3800/million people), but there's community spread, and they've explicitly stated they will not have the test capacity to test everyone who's symptomatic in at least the short to medium term.

"Without contact tracing and isolation of positive cases a lockdown won’t work."

Why? In a total lockdown situation, the positive cases might infect their close people the live with, but not really anyone else. And in a half lockdown, with still going out/shopping ... the infection rate is much slowed, if a high enough percentage of the infected isolate enough. That is all that we want, I thought.

All of these shutdowns are weeks late and the US does not currently have the authority and means to lock down the way eastern countries did.

There are still millions of people going about their day here in LA and nobody will stop them.

I would disagree. If the national guard gets deployed, they will say otherwise.

forcing it means armed rebellion, Americans don't handle freedom taken away by force very well.

No it doesn't. 99.999% of Americans aren't going to respond with violence if the national guard enforces a quarantine.

This is the most ridiculous fantasy a subset of HN users love to bring up, but there is just absolutely no chance that this happens in any meaningful way.

I live in Hong Kong and there are many failures like - Unable to activate the location tracking wristband (activation code sent by SMS not received) - Quarantine is done by people themselves, traveling from port to staying places = no monitor & unprotected

Many people (medical people) have experienced SARS in 2003 and they stay on alert this time. Except there are still enough people (especially the government personnel) not learning from / haven't experienced SARS.

If the current measure can eliminate the spread, I will feel lucky. But if the virus keeps spreading, I won't be surprised.

It seems like less extreme measures may have fewer unintended consequences. For example, by closing down all restaurants, local grocery stores have been packed all day. I expect there is more cross contamination in your local supermarket than there would be in normal supermarket conditions plus one smaller restaurant setting per day.

My Chinese suppliers in Shenzhen have been back to work for a while now.

This is why their stock market is the best performing in the world this year...

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