State projections for Covid-19

We are buying time to get more tests, more hospital beds set up, more ventilators, more medicine. The Navy is talking about turning Aircraft Carriers into hospitals. China is getting things under control and switching factories to produce medical supplies. It takes time to build these logistics chains, and we are buying that time by slowing our economy down and implementing social distancing.

I agree that this information is not well-circulated right now.

EDIT: another commenter posted this great link which I will also share: https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-th...

Giving up and attempting to resume normal activity is also unacceptable, full stop.

The best/latest explanation I've seen is https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-th.... Please read it (everyone, not just parent) if you haven't already.

Then if you're frustrated that your political leaders aren't moving to make best use of your sacrifice... let them know!

The details of managing the economics are more than a footnote, but if the worst possible peak isn't avoided everything else becomes irrelevant, because there's no surviving economy to speak of - except maybe one of local barter.

The economics are not externalities. The virus is.

The economics are a social and political choice. They don't actually require money or other symbols, although they'll probably be mediated through for reasons of comfort and familiarity.

They require enough basic provision of food and services to keep people alive, and enough provision of shelter to keep people from rioting, especially once winter comes.

The worst possible economic outcome - after a Killer Peak - is a critical mass of angry and hopeless people with nothing to lose.

Realistically, avoiding that will probably mean helicopter money and aggressive price controls to prevent gouging and profiteering. The usual rules about inflation won't apply because the alternative will be a cratering depression and mass deflation which will do far more harm to the economy than hand-outs will.

It may also mean something worse, like some form of civil conscription to get essential work done. I really hope that doesn't happen, not just because it's better to call for volunteers first, but because it's so easy to abuse politically.

But it's also true this has the potential to become the equivalent of a war time situation, and in extremis the rules may need to change to keep food+lights happening.

Shit choices. But it's a shit situation, and IMO there's no chance of business as usual returning for quite some time.

Perhaps the argument would be better stated: We need to balance saving lives and maintaining the thin veneer that is our economy.

That isn't quite as inspiring, but perhaps that is reality? Even if our economy is a "veneer" we still need it. I find it less compelling though. I'm far more willing to trade lives for a "strong economy" than I am to trade lives for "the illusion of a strong economy".

"Grandma and Grandpa died at home without medical support, but at least our economy is 'strong', so strong it could probably survive weeks of social distancing!"

If our "prize" for sacrificing hundreds of thousands of elderly to an exceptionally uncomfortable death is an economy we all know can't handle even a minor pandemic and is incapable of doing what China and other countries have done, that will be a sad trade.

Edit: Here’s the old paper from 2007 the CDC is using to inform some of the policy around “flattening the curve” below hospital capacity. https://stacks.cdc.gov/view/cdc/11425

I've been reading every whitepaper and journal publication I can find on this disease.

The picture that I'm seeing is that this disease is both more infectious (higher R0) and less deadly than previously thought.

In light of those facts I am fairly convinced the lockdowns and resulting economic impacts will be worse than just isolating the most vulnerable and letting the rest of the population go about their business.

https://www.medrxiv.org/content/10.1101/2020.02.12.20022434v... (Suggests the R0 is much higher and IFR much lower than reported)

https://www.epicentro.iss.it/coronavirus/bollettino/Report-C... (shows that the people dying are very old and very sick already. Also given the fact that part of the population is so impacted strongly suggests the disease is much more widespread)

Also, all of the celebrities, politicians and athletes that are testing positive are proof, in my opinion, of how wide this has gone.

Obviously travel etc. gum up this plan but instead of containment or mitigation we can move to a "time gapped reset" policy that predicts a continuous growth/halt cycle for the virus instead of pointlessly trying to eradicate it completely.

Loss of life to the inner vs loss of life caused by economic consequences, I've seen that argument before and it's not entirely unappealing. But wherever I saw it there was the unspoken assumption that the economy would just continue completely unaffected by an uncontrolled epidemic. But much of the economic damage will be there no matter which path you take. There are likely same areas where a short, hard wave would even be worse, economically, than a controlled lockdown. The delta is even harder to estimate than the cost of slowdown strategies, but an argument that only looks at the economic cost of one option is flawed.

Personally, given the choice, I'd take option C, "show me a rerun of 2019". Unfortunately this isn't in the cards that we are dealt.

I think the problem with this very common attitude is the demand for immediate answers, or else. It's an ultimatum.

We don't expect programmers and engineers to come up with complete, ready-to-commit solutions to a complex problem immediately. Thinking like a consumer doesn't help. An alternative is to demand transparency and to be engaged in the process of decision making. But that requires an attitude/intellectual realignment.

This was along the lines of my first thoughts as well. Theoretically, we want to maximize the usage of our medical resources (personnel, reusable supplies such as bed space, non-reusable supplies such as medication that become available at a variable rate), to keep just enough below the capacity to handle the needs and allow for some spikes (if we can even get it that low).

To my eyes, that calls for the ability to reassess and shift directives for the public (that is, maybe ease up on shelter-in-place next week, but put it back the week after), track and optimize resource flow, and coordination between locales. As a national level emergency, it makes sense there would be national level coordination on how to deal with it. Instead it appears we have governors and mayors making their own calls on what to do based on what advice they are personally getting, and the health care system is just struggling to figure out what to do.

What we don't have is any leadership putting forth an actual plan, or any real indication that they are even attempting to do so, or that if they are that they're putting any real teeth behind making sure officials are on board.

And no the vaccine is still too far in the future so the idea that the lockdown is biding time until the vaccine is ready is ridiculous.

Why have we all (I'm speaking for people in the USA) immediately bought into the idea that shutting down out lives and the economy is the only way to combat this thing? South Korea didn't shut everything down in an authoritarian fashion, and they already have this thing beat. I know, not a fair comparison, USA is way bigger, less experienced in handling disease outbreaks, different governments, etc, etc. But aren't there smarter ways we can handle this than just blanket isolation & lock downs?

From the CDC:

"Pandemics begin with an investigation phase, followed by recognition, initiation, and acceleration phases. The peak of illnesses occurs at the end of the acceleration phase, which is followed by a deceleration phase, during which there is a decrease in illnesses. Different countries can be in different phases of the pandemic at any point in time and different parts of the same country can also be in different phases of a pandemic."

So we know from South Korea's example it is possible to hit acceleration phase, execute a smart plan of attack, and have it carry you into deceleration, without blanket lock downs. Lock downs can still be an effective tool, and should be used in areas seeing steep acceleration to take pressure off the medical system.

Our plan doesn't have to be exactly the same, but we can learn from theirs. Seems like nobody is even trying to think out of the box. We just accepted that we have to turn our country into an authoritarian state and that's the only way to beat this.

Focusing on making testing widely and easily accessible is key for sure. If people could easily get a test, it would eliminate a lot of the fear/ uncertainly that is gripping everyone. Healthy people who are at low risk to get severe reactions could go about there lives normally, while still practicing 'social distancing' in public, not locked away in their homes in fear

With enough testing and sufficient frequency of testing, isolating just the people who test positive (and perhaps their contacts) should be enough to stop exponential growth, which means we could mostly return to normal life.

I liken it to the immune system. Shutting things down can work for a short period but if the system goes into a full panic it begins attacking good cells and shutting down organs and the host dies a slow, painful death.

We need to be using this bought time to building medical equipment, beds and places to put them, manufacturing existing therapies to help, training people to use specific equipment, creating a system for the most vulnerable to quarantine but get food, medicine, safely as they wait for acceptable safety to them.

We can’t lock down for months and months. People will eventually be fed up, see their risk is low, and throw the dice. The economy can’t grind to halt for a long time.

We need to prepare to minimize death and we need to do it now. Lockdown is not much of a strategy or something that will work beyond a few weeks before people ignore it massively.

Would this work for ya?

But the question in your third paragraph "what is being done with the time we're buying" could be restated as "what are we getting for our loss in economic output _in terms of economic output_?' That's not what we are doing, we are giving up economic output, not getting it. Of course any schemes/inventions/techniques that increase the coefficient of return of this trade off would be welcome, but doesn't change the fundamental direction of the tradeoff.

And that's not to say we are doing nothing at all with that time. Maybe we have "more time to develop a vaccine", or "time to make ventillators."? But those _are_ economic outputs. Those actions trade back lives (via increased transmission rates) for production of utilities that we believe will save lives in an equation that nets a positive. And it's not to say that people won't do some productive things during this (like the memes of inventing calculus in isolation or whatever), but for sure society is reducing it's overall economic output.

So from this point on the questions (and threats of defection) you raise kinda presuppose that trading economic production for saving lives is not worth it (at whatever ratio you're expecting). Potentially this is because you expect higher economic costs/lower life savings than the generally accepted projections, or because you value life less, or you believe the economic loss will lead to greater loss of life long term. I think the burden then is on you to either produce better projections, or promote candidates into government/leadership positions that share your moral outlook, or formulate and promulgate a model that shows the dramatic effects you expect due to the economic loss.

To put it another way, a simplified answer to 'what are we doing with the time' could be 'approximately nothing', and our society at large seems to be on board with that trade. If you're not, change my/our mind.

That's not true. Even with massively ramped up hospital capacity, we'd still have to spread it out over years to support the whole population getting sick. And realistically, if you can keep the disease progression spread out over a long period of time, it means you've stopped the exponential growth (i.e. R0 <= 1), and it isn't that much harder to actually contain it.

What we want to do is to contain it using blanket measures until we can get our act together with large scale testing, contact tracing, and basic sanitation measures (e.g. general mask wearing, hand-washing, and social distancing by the public without needing to lock everything down). This was where China got to after an early lockdown, and it's where South Korea has always been (without the need for a massive lockdown in the first place). Then in a year hopefully the disease can be stopped altogether with mass vaccination.

a) Saves millions of lives.

b) Allows researchers to develop, produce and distribute a safe vaccine.

Universal Mask Wearing Is the Quickest Way to Restart the California Economy

We urgently need universal mask wearing to slow down the spread of COVID-19 and restore our economy.

This is CDC's advice on how healthcare providers can protect themselves if they suspect that a patient has COVID-19:

" Assess and triage these patients with acute respiratory symptoms and risk factors for COVID-19 to minimize chances of exposure, including placing a facemask on the patient and placing them in an examination room with the door closed." (What Healthcare Personnel Should Know about Caring for Patients with Confirmed or Possible COVID-19 Infection https://www.cdc.gov/coronavirus/2019-ncov/hcp/caring-for-pat...)

If a facemask on a patient can protect the doctor in close proximity, it surely can also protect the general public. Yet the message from our nation's leadership is that mask wearing is ineffective for the general public (Why Telling People They Don’t Need Masks Backfired https://www.nytimes.com/2020/03/17/opinion/coronavirus-face-...). Yes, it is not 100% effective in protecting an individual from others, but it is absolutely effective in protecting the general public from a potential patient. This is the herd immunity we can quickly achieve without waiting for a vaccine:

"An 80% compliance rate essentially eliminated the influenza outbreak. " (Modeling the Effectiveness of Respiratory Protective Devices in Reducing Influenza Outbreak https://www.ncbi.nlm.nih.gov/pubmed/30229968)

California is in a unique place to lead the nation and restore its own economy. We have a large Asian population that are receptive to mask wearing but are wary of being singled out. We have technology companies that can come up with solutions for mask making. We have idled workers that can be quickly retrained to jumpstart mask manufacturing. China was able to ramp up production 12 times in February alone. We can do it too.

What we need to do is to legally require people to wear masks in public and in the workplace to protect each other. We don't need to wear N95 respirators that are hard to use and that should rightly be reserved for medical workers; we can wear masks that are much more breathable to protect others from our own droplets. By making it a legal requirement, companies like Tesla will be motivated to either quickly secure masks from suppliers or, better yet, start making and supplying masks for their own employees and for the public. Asian countries have shown that universal mask wearing can prevent large outbreaks and slow down the spread of the disease without shutting down their economy. Let's learn from their experience. Governor Newsom should immediately work on this with the state legislature in order to lead us to a speedy recovery.

But right now no government dares suggest any vision past a few months.

And most if not all scientific and engineering models spread properties across a group of objects and use averages. R_0 is an average. And it's the average behavior that matters here

In a well tested population, you might be able to focus interventions on infected people and their contacts. In the US population, the people most likely to spread the disease are those who interact most with other people. That means getting those people to reduce their interaction rate.

It's a semi-empirical model, as are many if not most models used to make decisions.

That said, the implication that strict isolation should be maintained is almost certainly correct.

The symptoms as a whole didn't quite feel like a flu, we all thought they were weird, but hey who am I to know, right?

Well a few weeks later we remembered that two days prior to feeling ill, we had ordered some Chinese takeout. The delivery man (not a Chinese national) looked like he was going to collapse. He had trouble getting up the stairs, had a bad cough, looked like he had a fever - god knows why he was working. After taking the food and paying, I wondered if he'd make it back down the stairs but forgot about it for a few weeks.

We probably won't know if we had this bug or not, but it's definitely possible. Maybe I just happened to develop a respiratory distress caused by a bad flu right when the epidemic in China was not controlled, and not any other year prior. Who knows!

Right now, as I type this, many hospitals in the United States have had all of their excess intensive care capacity used up by Covid-19 cases. Not all, but many.

Once large groups of hospitals reach capacity, then there will be no choice but to black tag people who could otherwise be saved and leave them to die in the hallways.

Click this graph, then click Logarithmic at the top: https://mackuba.eu/corona/#united_states

You're right to note that this is a global problem. Given that, the vast majority of human to human contact is NOT cross border.

This bug is probably going to end up infecting most of the people in the United States. The main thing we can do at this point is to keep hospitals from being too overwhelmed, to keep the number of black tagged people, dying in the hallways, to a minimum.

If a person get good care in hospital the rate of survival would be totally different.

For those country which had sudden high fatality rate was because their resources and supplies were exhausted - there were no bed, no consumable, even no protection for the nurses.

My critique of this analysis is that there is no way you are controlling for all of the factors: different starting dates for community spread, uneven testing / reporting of cases, random luck due to super-spreading events, differences in behaviors between regions, and so on.

City density, by its turn, is huge.

> * A second spike in disease may occur after social distancing is stopped. Interventions are important because they buy time to create surge capacity in hospitals and develop therapeutic drugs that may have potential to lower hospitalization and fatality rates from COVID-19. See full scenario definitions here.

Yes, that's exactly right, but 3 months (or even 1 month) may be enough time to prevent unnecessary deaths by preparing hospitals, getting more ventilators, rolling out testing, and hopefully finding a therapeutic drug (vaccines are probably farther off).

Nobody can predict the future, though.

New infections are modeled to noticeably slow down once ~1/5 of the total population is infected, but at that point things have already fallen apart.

Unfortunately, the US is further along the curve than all these sites are showing due to the fact that we didn't have any testing in the beginning (and still don't have enough).

They seem to be opening stores, starting flights to SFO, but surely China is not clear of the virus. So, are we expecting a pick up in infections now. And, if not, please explain why not.. I'm really curious..

It's just not so clear it's possible to do such a lockdown in non-Authoritarian, free, countries.

https://covidactnow.org/data/{{state_abbreviation}}.{{scenario_number}}.json (where scenarios go from 0 - 7)

There are some questions on if there was really going to be a curve to flatten. Such that, if we flatten it now, was it the social distancing we did, or was it going to flatten anyway?

These are not reasons to abandon caution. They do seem valid questions, though. Especially considering the costs of the actions we have taken.

In a couple weeks/months they'll start testing people to find out if they did have the virus. The tests right now only show if you currently have it. Once the real numbers come out I am confident it will be a massive over estimate for the CFR.

The fear bubble is causing people to underlook the data in places like SK, SG, Japan, Germany and overlook the data in Italy, China, Iran. It could be quite possible that a mixture of smoking, age, over reporting causes, and bad healthcare (gasp not in Italy where socialized medicine is world beating) is being overlooked.

So what we get now is stopping of society and the economy, millions of people will go through displacement and a host of negative things. People's savings will be depleted, not to mention teacher's/public servants/ pension and 401ks will take a MASSIVE hit. Oh and add to that more trillions of USD to the debt.

If you accept that premise, then the only solution is to manage hospital capacity. So I propose that we use hospital overload as a high watermark for quarantining the local communities. so basically you initiate quarantine when hospitals are say at 50% of their capacity (because they will peak after quarantine begin). Wait & once they fall below say 10% release the quarantine. Repeat the process until you get herd immunity or vaccine.