Army Corps of Engineers to Build Temporary Hospitals in NY | Hacker News Reader

Army Corps of Engineers to Build Temporary Hospitals in NY

governor.ny.gov

416 pointsantoncohen508 comments

The Army Corps of Engineers is one of the finer things in the US. I find it encouraging that they are involved with this effort.

Please note that's an extremely specific observation and doesn't implicitly suggest anything else, positive or negative, about the rest of this situation.

They are and they aren't. What they did for New Orleans is stupid-incredible. Stupid because it's a river-gulf city below sea level that the rivers are trying to absorb with no plans to relocate. Incredible because wow, that's an accomplishment. A lot of that is subject to political whims, though, so it's not necessarily the Corps's decision.

https://www.usace.army.mil/Missions/

As an onlooker I feel like once America awakens to a crisis it is impressive to watch. I mean this kind of should have happened weeks ago, and the executive branch is a bit of a panicked joke. But I mean... You've got this colossal capacity to deploy field hospitals and hospital ships and such and ramp up capacity.

Terrible hurricane? Show up with a massive floating power plant and water treatment facility plus air logistics.

And I think one of the strongest virtues of the United States is being proven by Trump: the incredible power of leadership at all levels of government. In the absence of a leader at the top you've got senators and congresspersons and governors and mayors and CEOs all getting shit done. This is all an incredible (but regrettable) exercise of numerous fail safes inherent in the American system.

> Terrible hurricane? Show up with a massive floating power plant and water treatment facility plus air logistics.

The US has a disastrous recent history of failing to respond to multipld hurricanes with adequate support, from Katrina to Maria.

True, but as an American, it definitely feels like we're bringing our B game to one of the nastiest challenges the world has ever faced. We had the ability to write a blank check and fire up mask, ventilator, and test production the second it was clear this was a global problem.

So instead of sending excess equipment around the world, we're playing catch up on our own shortage, and the control measures have to be a lot stricter because of it.

> the second it was clear this was a global problem

The problem is that the west has nobody in power with living memory of a pandemic. An unfortunate failing of human cognition is that most humans discount that which they have no direct experience of. So it was never going to be clear to most people that this was a problem until we had waited way too long. I mean, most people can't be bothered to not spend everything they make when the last recession was 12 years ago, so what do we expect when there hasn't been a pandemic in the west in over 100 years...

There have been multiple pandemics in living memory of ~all current world leaders, many of which killed millions.

What pandemics have people in the west directly experienced in living memory? As far as I am aware, all pandemics in recent memory have happened in Africa or Asia.

AIDS, Swine Flu, probably MMR?

AIDS: easily avoided

MMR: easily avoided

That leaves swine flu. According to this Wikipedia page about the 2009 flu pandemic (which is what the term “swine flu” references, as best as I can tell), worldwide fatalities are estimated at 575 thousand (upper bound) and worldwide infections are estimated at 700 million (lower bound). Given those numbers, the worst case fatality rate is 0.08%. Then there is this quote:

> A follow-up study done in September 2010 showed that the risk of serious illness resulting from the 2009 H1N1 flu was no higher than that of the yearly seasonal flu.

So my point remains: no one in the west had direct experience of a pandemic.

Wikipedia page: https://en.wikipedia.org/wiki/2009_flu_pandemic

Wow, AIDS and MMR has not affected the western world. That's a new one.

That is not what I have said anywhere in this thread.

>> So my point remains: no one in the west had direct experience of a pandemic.

From Wikipedia (pandemic and epidemic entries):

> A pandemic (from Greek πᾶν pan "all" and δῆμος demos "people") is a disease epidemic that has spread across a large region, for instance multiple continents, or worldwide.

> An epidemic (from Greek ἐπί epi "upon or above" and δῆμος demos "people") is the rapid spread of disease to a large number of people in a given population within a short period of time.

AIDS does not meet those definitions, unless you restrict “given population” to mean male homosexuals or recipients of blood transfusions.

AIDS cases have been to every country in the world which easily satisfies as a pandemic.

Epidemic is different with Covid19 not yet qualifying.

What’s useful about separating the ideas is discovering the root cause. Scurvy used to be epidemic among sailers, making it easier to find the root cause and treatments. Highly localized diseases generally have a specific local cause.

AIDS has not spread very rapidly. It has taken nearly 4 decades to reach its current spread. Covid has the potential to infect most people in the span of 12-18 months. It’s categorically different. And AIDS is easily avoided!

Rate of spread has nothing to do with the definition of pandemic. It took literally thousands of years for Smallpox to reach the America’s, but it achieved worldwide spread before eradication.

Malaria on the other hand has also killed hundreds of millions of people but as it’s a tropical disease with 93% of the cases occurring in Africa it’s not a pandemic.

Again person to person spread results in pandemics, making a definition based on geographic spread useful.

The definition of epidemic that I quoted above uses the word “rapid” and the phrase “short period of time”. The definition of pandemic requires there to be an epidemic. Those are not my invention, they are from Wikipedia!

Rapid as in a large number of cases a week, thus “within a short period of time.” Not rapid as in how long the disease existed.

The malaria epidemic is thousands of years old, nobody cares how quickly it spread 20 thousands years ago. Edit: Excluding academic intrest.

PS: And by Covid 19 not qualifying as an epidemic I meant it’s not an epidemic in every country. It however is an epidemic in several countries and will likely become an epidemic in most if not all country’s very quickly.

Malaria is not a tropical disease, although it's been eradicated in most tropical areas and not yet eradicated in most non-tropical areas.

The reason malaria is not a pandemic isn't the fact that it's been eradicated in some areas, but the fact that it's endemic. Only epidemic diseases can be pandemics; endemic disease (e.g. seasonal flu) cannot be. This is by definition.

Epidemics and pandemics relate to some change from the previous situation whereas endemic diseases refer to stability. This informs our policy responses.

I think you meant the reverse of what you said in the first paragraph. It’s true that Malaria (ague) cases occurred in Medival Europe as far north as England, but it was very much climate dependent. With massive differences between what became the Nordic countries vs say Italy. However, I have never heard a significant objection to calling it a tropical disease.

> AIDS does not meet those definitions, unless you restrict “given population” to mean male homosexuals or recipients of blood transfusions.

All the heterosexual people worldwide who were infected with HIV by their partners might beg to differ.

Even there, the spread has not been rapid or in a short period of time, which are both part of the definition of epidemic which I mentioned above. AIDS has taken decades to reach its current prevalence.

AIDS was not easily avoided. The blood supply was not screened early on. Many people early in the epidemic were infected from simple transfusions. Famous American tennis player Arthur Ashe contracted it and died in this manner.

It's not possible to screen for certain if someone has just acquired HIV, so to this day, they try to exclude people with risk factors from donating blood. Which then is treated as a human rights issue by some.

I am from Europe so it seems a little weird to me - is donating blood your right in the USA?

No, there are a series of screening questions that rule out high-risk donors (gay men, IV drug users, and travelers to high/risk areas are disqualified from donating). All blood is tested regardless.

However, not everybody agrees that all of the questions are necessary or appropriately worded.

That is the same as here, but how is it a human rights issue?

If you are gay, they don't want you to donate blood. The problem is that if you are, say, at work and they do a blood drive and you say "I can't. Sorry." that potentially outs you to your coworkers that you are gay or have some other issue that disqualifies your blood.

In practice, they will let you donate and then mark it for destruction so you can hide the fact from your coworkers that you don't qualify. (Or they did at one time.)

This was a big issue in the US military during the "don't ask, don't tell" era where they would throw you out if they knew, but official policy was to encourage you to just remain closeted. Being outed as gay was career ending if you were career military at that time. Blood drives are common in the military. They had to have some mechanism to honor the "don't ask, don't tell" policy and let you keep hiding your sexual orientation.

I never heard about anything like "blood drive", or that my medical details could be shared with my employer in the USA! Makes more sense now.

It wouldn't be directly shared with your employer. But if everyone is there and you decline to participate in giving blood, it can point to information about you that you don't want people to know.

Whether you did or did not have some procedure done is definitely private medical information in Europe. There is no way for them to know whether I did or did not participate - maybe through the on site doctor if that is the one doing the procedure, but they're bound by very serious regulation to keep their mouths shut. Regardless, me not wanting to go would be a perfectly normal thing as well.

Blood donation tends to not be treated in the US as a medical procedure. It tends to be treated as a feel good community event. I'm a bit weirded out to have that reflected back to me as a medical procedure, though it certainly is. We don't quite seem to get that fact in some important way.

We're basically savages in huts over here about some things.

When I had a corporate job, lower level employees were instructed to keep their mouths shut and not tell everyone they were being promoted or whatever until it could be officially announced. Meanwhile, it was common for more than one middle manager type to drop by their cubicle to loudly congratulate them and make small talk, clearly trying to get in good with someone whose skills and such they might need.

I guess we were all supposed to be stupid or something and be incapable of inferring they had been promoted or something.

This was at a Fortune 500 company, so "the best of the best, sir." And it drove me crazy for so many reasons.

My mother is a German immigrant who came from a family of twelve kids. I am routinely shocked and appalled at how bad so many people are at thinking about the larger social landscape and how this will be viewed by others and what knock on effects it may have.

That type of thing seems to be shockingly common in the US and probably plays a large role in a lot of our social issues.

> I'm a bit weirded out to have that reflected back to me as a medical procedure, though it certainly is

This is not US-exclusive. This is also true in a lot of European countries.

I am from the central/eastern part (CZ). Which countries do you mean? I assume this to be typical of formerly communist healthcare systems.

"The problem is that if you are, say, at work and they do a blood drive and you say "I can't. Sorry." that potentially outs you to your coworkers that you are gay or have some other issue that disqualifies your blood."

I never heard about that as a concern, and I have to dismiss that as silly, given the many reasons why you can be disqualified. I mean, you could just have low iron or some other minor health issue.

What I was alluding to is that some people feel it is not acceptable or just to have a blanket exclusion of men who have sex with men. I can't imagine that your answers to the questionaire are allowed to be shared with anyone though.

I've never heard of anyone being offended by the exclusion of people who have spent time in Africa or Europe though.

Isaac Asimov is another.

In addition to AIDS, there were major American flu pandemics in 2009 and 1968. 1957 too, depending on how old you consider to be "living memory" - many federal leaders were teenagers at the time.

So basically nothing on this scale.

For years, all diagnosed AIDS patients were expected to die within 12 months. It wasn't spread as broadly, and the flu pandemics weren't as deadly, but the general concepts that pandemics can strike hard and fast were definitely within leaders' personal knowledge.

But you don’t have to shut down the economy to deal with AIDS because it’s sexually transmitted. That’s my point: the vast majority of people have never had to make serious changes to their behavior or lifestyle to avoid contagion before.

That I agree with, but as far as I can tell the degree of measures we're trying to take are unprecedented even in non-living memory. School closures and public gathering bans, sure, but those measures happen pretty frequently during lesser scale outbreaks. If anyone tried to ban social calls during the Spanish Flu, I'm not aware of it.

They didn't. That's why it killed tens of millions of people back when the global population was about 1/4 of what it is today, and mobility was much more constrained. No jets in 1918.

The expected death toll from Covid, assuming an overall mortality rate of 1%, would be about 75 million people. So far the death toll worldwide is about 13,000. That's a big number, but only about 0.02% of the expected total without intervention.

> as far as I can tell the degree of measures we're trying to take are unprecedented even in non-living memory.

This is exactly my point. Nobody in the west has ever lived through something that has necessitated these kinds of measures. People thought this kind of thing only happened in the movies, Asia, or Africa. That it couldn’t happen to us. And that lack of personal experience is why, in my opinion, our response was probably always going to be slower than it needed to be.

But my concern is, are these kinds of measures actually necessitated? The entire argument for doing them appears to be that China did them; in fact, I'm not sure I've seen anyone make an argument, rather than just silently assuming "extreme social distancing" must mean Wuhan-style authoritarian control. You say "Asia and Africa", but before 2020, is there any precedent at all for controlling a pandemic by mandatory universal lockdown of its healthy citizens?

In other words, what are the chances that we look back in a decade, and realize that we inflicted a month of trauma on the country because we assumed authoritarian China must have a good reason for it?

I mean, there’s the basic logic that reducing human interaction will inhibit the virulence of something which spreads by human interaction. My personal opinion is that we probably could have avoided blanket shutdowns if we had ramped up testing capacity in late January and February. Now the hope is that we avoid becoming Northern Italy. I think the Chinese have demonstrated that it’s possible to avoid an outcome like that. Whether we’ll be severe enough in our lockdowns to pull that off is another story. Doesn’t seem like people around me are taking this seriously enough. But I’ve been self isolating since late February.

IIRC, I was a teenager when AIDS came out. It was not classified as a global pandemic.

It's quite hard to catch and was mostly limited in the US to IV drug users and gay men. It became a human rights issue because both of those populations were generally deemed to be sinners and people tended to not care if they died.

The fight was not just against the disease itself. It was very much against prejudice and the threat of draconian measures aimed at specific populations.

Non drug using heterosexual populations in the US mostly didn't care. It was largely deemed to be irrelevant if you weren't one of the "sinners" that most folks wished would drop dead anyway because we're so loving and Christian and all that.

I don't think we've ever had a global pandemic in my life. SARS was the closest and it was mostly in Asia, IIRC.

Why the downvotes on this? Yes, what parent post has to say is disgusting by modern sensibilities, but it's historically pretty accurate.

Maybe it needs a "/s" somewhere? You would think my disgust and contempt would be clear from context, but maybe not.

It was absolutely clear. I suspect a few of the downvotes are coming from some of those "loving christians" you mention.

Please don't take HN threads further into religious flamewar. We don't need that here.

https://news.ycombinator.com/newsguidelines.html

I agree, but my guess is the last sentence. It did become a global pandemic. Today 0.8% of people age 15-49 are infected.

> the "sinners" that most folks wished would drop dead anyway because we're so loving and Christian and all that.

That is why you got downvotes, I would imagine.

>>> It became a human rights issue because both of those populations were generally deemed to be sinners and people tended to not care if they died.

My father was a medical doctor at the time, specializing in diagnosing and treating brain cancer, and told me that although docs were scrambling to treat a growing flood of AIDS patients, there was a quiet resentment at the need to reallocate scarce resources for a disease that was largely preventable (except for tainted blood transfusions). Cancer was (and is) a much larger problem, killing hundreds of thousands of people every year; then there's heart disease which kills 647,000 Americans every year.

To say IV users and gay men were "generally deemed to be sinners" who didn't deserve to be cured is a vast exaggeration. Certainly there were and are people who think this way, but the general population, both lay and medical, certainly didn't. That would include the general non-fundamentalists among the American religious community.

The fact is that thousands of unsung researchers worked long hours, first to understand HIV's structure and mechanism, then to figure out how to prolong life, and most recently, how to actually cure it. Unfortunately, some gay activist groups such as ActUp felt these efforts were insufficient, and showed up at medical conferences to chant "killers!" at the scientists who were presenting findings. This created more resentment.

Look, everyone's feelings are inflamed in a time of crisis. It's important to let cooler heads prevail, and not descend to name calling or deriding this or that group. Especially in the current situation, we're all in this together, and we will sink or rise together.

there was a quiet resentment at the need to reallocate scarce resources for a disease that was largely preventable

This is all too often how prejudice gets expressed. The resentment and hostility towards the group in question gets justified on some reasonable grounds other than racism, homophobia, etc.

I believe people suffering addiction are self medicating in the most literal sense for either medical or mental health issues that are going largely unrecognized and for which they aren't getting appropriate care. I think blaming them for "getting something preventable" is not significantly different from blaming those who got AIDS via transfusions for being so awful as to be in need of blood.

Gays were often living in the closet. The need to hide their orientation had a lot of real world negative consequences with serious implications for their health choices. Blaming them for getting something "preventable" is similar to telling women their abusive husband wouldn't beat them if they just didn't piss the guy off so much.

For the record, let me apologize to Christians and to the mods. I'm not anti-Christian and I've spoken in their defense before. I was in no way trying to start a religious flame war. My disgust with homophobia and with society's attitudes towards people suffering from addiction wasn't intended to impugn Christians or the Christian religion.

In the 1980s, the general population absolutely reviled gay people and gay men in particular. Don't downplay the deep stigma that gay people experienced at the time.

> To say IV users and gay men were "generally deemed to be sinners" who didn't deserve to be cured is a vast exaggeration. Certainly there were and are people who think this way, but the general population, both lay and medical, certainly didn't.

This just is not true. The sidelining of AIDS as someone else’s problem is well documented in Randy Shilts’ book. People were still making jokes about AIDS in 1983 when people had been dying for several years. Ronald Reagan, President throughout this whole time, did not publicly acknowledge AIDS until 1987.

No one cared about aids because its really easy to avoid.

The closest thing that people in the US might have a living memory of is the polio epidemic in the US in 1952. [0] Granted anyone who is old enough to have lived through that and remember it is probably on lock down in a nursing home right about now. The people in power now would have been children around that time so who knows if it would have a made an impression on them.

[0] https://www.npr.org/sections/health-shots/2012/10/16/1626708...

Mitch Mcconnell, the person who sets the legislative agenda in the Senate, wrote this in his memoir:

It’s one of my life’s great fortunes that Sister’s home was only about sixty miles from Warm Springs, Georgia, where President Franklin D. Roosevelt had established a polio treatment center and where he’d often travel to find relief from the polio that paralyzed him at the age of thirty-nine.

My mother took me there every chance she had. The nurses would teach her how to perform exercises meant to rehabilitate my leg while also emphasizing her need to make me believe I could walk, even though I wasn’t allowed to.

I bet it left an impression.

Apparently not enough of one.

It made a huge impression on many children in the 50s still - there were still tens of thousands dying and being paralyzed each year until the late 50s, and by this point they were predominantly small children being affected. My parents are in their early 60s and they remember it well - when she was five her friend was partially paralyzed for life by it. https://www.historyofvaccines.org/content/us-polio-cases-195... had friends who died. They were given behavior restrictions.

H1N1 in 2009.

AIDS? Legionnaire's disease? People forget the panic these caused until they were understood.

In addition, we have had some horrible flus over the years. 1994(ish) and 1977(ish) stick out in my mind.

Anyone who says: "Oh, it's just a nasty flu" has never had a bad flu. I can't imagine being more sick than being stuck in bed for two solid weeks not wanting to move because it hurts so bad but you have to make yourself some food and then choke it down only to throw it up.

And Covid-19 is WORSE THAT THAT! Holy hell, people, I'd do ANYTHING to avoid that.

I had a couple of weeks paralysis as a result of a bad flue in my teens. Scary as hell.

Guillan Barre syndrome (paralysis) can be seen after vaccines or viral infection

Yes, but that usually lasts a lot longer. My stepdad had that and nearly died from it. Spent a long time in a ventilator and the remainder of his life in a wheelchair.

Urgh, yet another auto-immune disease ? I really hope that a massive breakthrough in medical knowledge will happen regarding that general subject. Unfortunately the matter seems to be more complex than anything I, as a developer, can imagine…

>>As far as I am aware...

Doesn't really matter what you are aware or not. USA and the major countries have thousands of people that do just that, monitor epidemics. https://www.cdc.gov/coronavirus/2019-nCoV/index.html That's their job and they have ways to notify leadership. Other look out for steroids, others for hackers hacking power plants, others look out for terror threats and so on.

It turns out that out intel services knew about this and its potential since January but civilian leader more or less ignored it. https://www.washingtonpost.com/national-security/us-intellig...

> It turns out that out intel services knew about this and its potential since January

I would hope they knew about it since January because I knew about it since January and likely so did you.

And since the beginning of February I've been warning people in ever more concrete terms.

Here it was, right here on HN in January:

https://news.ycombinator.com/item?id=22146446

There may be even older ones, for instance, this one:

https://news.ycombinator.com/item?id=22000761

Which linked to:

https://www.bbc.com/news/world-asia-china-51047576

which in turn links to:

https://www.bbc.com/news/world-asia-china-50984025

Which is the oldest western article I've been able to find. Are there older ones?

On HN, the oldest I was able to find is

https://news.ycombinator.com/item?id=21926713

linking to

https://www.dw.com/en/china-investigates-sars-like-virus-as-...

from Jan 1st, which is 8 days earlier than your second link, but with only 3 points and zero comments, I'm not sure how much that counts.

The BBC story that you linked to is from Jan 3rd, the AP had a story[1] on the 5th, so the public had opportunity to know about it in early January. I can't get Reddit's search to cooperate, so I can't say if there's an earlier mention there (plus Google's dates about Reddit don't agree with Reddit's). Wikipedia has an early timeline page with a lot of details.[2] Public statements were made on December 30th about pneumonia of unknown cause.

If there had been a US pandemic response team, we could have started mobilizing December 30th. Hong Kong did.

[1] https://apnews.com/7cfe53b9e7c7509c1f61c6c09e6fc4e6 [2]https://en.wikipedia.org/wiki/Timeline_of_the_2019%E2%80%932...

Excellent sleuthing, so even earlier.

That DW article is pretty poor, dating sars 1 to around 2009/2010 - confusing it with swine flu perhaps? A later comment, presumably from another source since the article is tagged AFP/AP/Reuters, gives a correct and more precise dating to sars 1. Yet the editor/collator didn't notice the discrepancy.

I am pretty sure H1N1 (aka swine flu) was declared a worldwide pandemic by the WHO.

Fatality rate similar to the normal flu.

In Case you think I’m making this up, here’s what I said elsewhere in this thread:

> According to this Wikipedia page about the 2009 flu pandemic (which is what the term “swine flu” references, as best as I can tell), worldwide fatalities are estimated at 575 thousand (upper bound) and worldwide infections are estimated at 700 million (lower bound). Given those numbers, the worst case fatality rate is 0.08%. Then there is this quote:

> A follow-up study done in September 2010 showed that the risk of serious illness resulting from the 2009 H1N1 flu was no higher than that of the yearly seasonal flu.

> Wikipedia page: https://en.wikipedia.org/wiki/2009_flu_pandemic reply

Literally "just the flu bro"

At the time it was happening, no one knew that. The media was comparing it to SARS.

Okay, but my original point is that nobody in the West has gone through something like what we’re going through. You’re actually making my point even stronger: not only has no one in the West ever actually lived through a pandemic that took a bunch of lives and requires societal level sacrifice, we’ve all had false alarms that have made us less likely to take potential pandemics seriously.

which is maybe why the west has been so slow to react to this pandemic - we were mostly unaffected by that one.

H1N1 mostly affected people under 25.

https://www.cdc.gov/h1n1flu/surveillanceqa.htm

Obesity, according to this NIH document https://www.ncbi.nlm.nih.gov/pubmed/28292617 on Pubmed:

> Obesity pandemic: causes, consequences, and solutions-but do we have the will?

> Abstract

> Obesity has become pandemic owing to an obesogenic environment (inexpensive calorie dense food, technologies and structure of communities that reduce or replace physical activity, and inexpensive nonphysical entertainment) and excessive emphasis on low fat intake resulting in excessive intake of simple carbohydrates and sugar. . .

Until we find an infectious cause of obesity, calling it an obesity pandemic is a rhetorical act it grounded in the widely accepted meaning of the word.

Wikipedia's page on Adenoviridae lists these human adenovirus types that cause obesity or adipogenesis: HAdV-A type 31; HAdV-C type 5; HAdV-D types 9, 36, 37

One of the references:

Voss JD, Atkinson RL, Dhurandhar NV (November 2015). "Role of adenoviruses in obesity". Reviews in Medical Virology. 25 (6): https://zenodo.org/record/1229348

So yes, obesity can be caused by contagious disease.

Obesity can be caused by a infectious disease is not the same thing as obesity, in general, being caused by an infectious disease. It would have to be caused by a contagious, in general, to be able to describe the widespread prevalence of obesity as a pandemic, since the term pandemic is concerned with infectious diseases.

A pandemic is a form of epidemic (according to Wikipedia's definition, which you have referred to).

An epidemic is an outbreak of a disease (according to Wikipedia's definition, which you have referred to).

A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not due to any immediate external injury... A disease may be caused by external factors such as pathogens or by internal dysfunctions. (according to Wikipedia's definition, which is included by link by its definition of epidemic).

There is no requirement on the definition of epidemic that you have referred to that requires it to be infectious.

Please pick a definition and stick to it. You want a pandemic to be a global outbreak of a disease to which the overwhelming majority of the population is susceptible and which is spread via a pathogen without physical contact. If there's an authority that uses that definition, find them and cite them. Otherwise please stick the definitions you've already cited and move on.

The wikipedia definition of epidemic that I cited uses the phrase "rapid spread of disease". I think most people would agree that for a disease to spread it must be communicable in some way.

The HIV/AIDS pandemic, not only recent but also one of the most destructive in human history as well. [1]

[1] https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5531a1.htm

Please explain how a disease transmitted by unprotected sex and IV drug use (once the blood supply was screened) is in any way comparable to an airborne illness.

It’s not, the vast majority of western society (hell, eastern too) has never been at risk of contracting HIV/AIDS. The vast majority are at risk of COVID-19.

HIV/AIDS is technically a pandemic, but not one that affects all populations/demographics. Completely different.

You do realize there was a time where HIV/AIDS wasn't at all understood right? HIV/AIDS is not "technically a pandemic" it is a pandemic period. Pandemic is a geographic relative term it does not need to to "affect all populations/demographics." That is not a qualification. That appears to be some something you made up. The role of epidemiology is the same whether something is a flu pandemic or some other disease. The reason Dr Deborah Birx is qualified in her current role is because of her research in the early days of the HIV/AIDs pandemic. Nobody is claiming she is not qualified because that wasn't a flu pandemic.

From another reply of mine in this thread:

> AIDS is not a pandemic. Pandemic requires epidemic, which requires rapid spread in a short period of time. AIDS has been slow. Calling it a pandemic is, IMO, motivated by politics (it mostly affects male homosexuals and sub-Saharan Africans). Ctrl-F for my discussion elsewhere in this thread.

So you're stating that AIDS was never an epidemic? Right. And that's based on your opinion I guess? Well there's actual facts too:

"In late 1983, the global presence of the mysterious virus motivated European authorities and the WHO to classify the growing number of diagnoses as an epidemic. In addition to the outbreak in the U.S., patients with similar symptoms were documented in 15 European countries, 7 Latin American countries, Canada, Zaire, Haiti, Australia and Japan. Of particular concern was an outbreak in central Africa among heterosexual patients."[1]

[1] https://www.publichealth.org/public-awareness/hiv-aids/origi...

I mean, I’m just pointing out that it doesn’t match the definition of a pandemic or epidemic from Wikipedia unless you restrict the population in question to male homosexuals or sub-Saharan Africans and ignore that fact that it didn’t spread that quickly (an STD kinda cant spread that fast). But I’m not surprised that people classified it as an epidemic when it’s cause and mode of transmission was unknown, since all they saw was a rapid increase in diagnosis. But of course, given the way it spreads, it had been spreading, undiagnosed, for a while (probably years) in most places.

Since epidemics are indeed specifically bound to a particular population, especially a geographical population, there can be no doubt the AIDS is an epidemic if it only epidemic in sub-Saharan Africa.

The question then is whether it is also epidemic in a greater region, for instance multiple continents or world wide. Since there are subsets of the population in all areas where it is widespread, it seems fair to say that it is pandemic.

Cause and mode of transmission are not relevant to the definition of epidemic or pandemic that you have selected.

So your argument goes like this:

P1. An epidemic is the rapid spread of a disease to a large number of people in a given population within a short period of time. (definition)

P2. AIDS has spread rapidly through people in sub-Saharan Africa and male homosexuals worldwide. (observation)

P3. People in sub-Saharan Africa are not a population. (assertion)

P4. Male homosexuals worldwide are not a population. (assertion)

P5. AIDS spreads sexually, via blood transfusions etc. (observation)

---------- (by P1-P5)

C1. Therefore, AIDS is not an epidemic.

P6. A pandemic is a widespread epidemic, spreading through multiple populations e.g. multiple continents or worldwide. (definition)

----------- (by C1 and P6)

C2. Therefore, AIDS is not a pandemic.

But from this, P3 and P4 are obviously false and P5 is not relevant since mode of transmission is not referred to in P1.

I don't feel like I'm at risk of getting AIDS, so it's a little hard for me to worry about AIDS as if it's a pandemic. But that doesn't mean AIDS isn't a pandemic. It's definitely epidemic according to the definition you picked - I'm just not part of the relevant populations through which it is spreading. You're definitely arguing poorly, since you demand we hold premises that are obviously false and you introduce irrelevant points that have nothing to do with your case.

My objection to labeling AIDS as a pandemic is the "rapidly" part of the definition of epidemic. I don't think AIDS spread all that rapidly. It took decades to become a problem in sub-Saharan Africa. And it was probably spreading for years among male homosexuals before anybody noticed anything. That would put it on the slower end of the continuum when measured against most communicable diseases that I can think of.

>"I mean, I’m just pointing out that it doesn’t match the definition of a pandemic or epidemic from Wikipedia unless you restrict the population in question to male homosexuals or sub-Saharan"

Since wikipedia seems to be the only bar for your argument. Here's two wikipedia entries where it's clearly stated they are both epidemic and pandemic.

https://en.wikipedia.org/wiki/HIV/AIDS

https://en.wikipedia.org/wiki/Epidemiology_of_HIV/AIDS

And of course more authoritative sources such as the CDC and WHO have also classified HIV/AIDS as both pandemic and epidemic:

https://wwwnc.cdc.gov/eid/article/24/3/17-1797_article

https://www.who.int/global_health_histories/seminars/present...

I qualified my statement by stating “after the blood supply was screened”, which rules out the period where it was not understood.

I’m not here to argue semantics, you win. HIV/AIDS is a pandemic and epidemic.

My point is that COVID-19 can infect anyone that has lungs, and breathes in the virus contained in the air.

HIV/AIDS is contracted via IV drug use, unprotected sex, or mother-to-child transmission.

Notice how one of these is incredibly easy to catch, and the other you have to try and catch? That is my point.

It has nothing to with semantics. If you reread the OP's original comment they state:

>"The problem is that the west has nobody in power with living memory of a pandemic."

And that is not true. And this HIV/AIDS is particularly relevant because Dr Deborah Birx was chosen as response coordinator for the White House Coronavirus Task Force because of her work on a previous pandemic, that of HIV/AIDS.

It was barely 10 years ago. Between April 2009 and April 2010, H1N1 (swine flu) sickened 60.8M people in the US alone. [0]

[0] https://www.cdc.gov/flu/pandemic-resources/2009-h1n1-pandemi...

OK, so... how does that explain Taiwan or Korea, who had the same "living memory" we do and managed to get this under control without breaking their health care systems?

I mean, your point is true, but the lack of action wasn't the fault of the average citizen or their living memory. The decision-makers should have had access to better info, and of course they did. Doctors from China and Italy told us long ago that PPE equipment was a bottleneck. Epidemiologists could see what was going to happen with the rate of spread. Local health officials in states knew at the outset that they needed more tests. Hell, the federal government has a whole departmental center dedicated specifically to the control of disease; they've spent decades modeling out how to respond to crises like this.

Yet... no decisions got made. That wasn't for a lack of "living memory of a pandemic".

Taiwan is ethnically Han, has lots of ties to mainland China, and is an island just if the Chinese coast. Korea is a peninsula attached to mainland China. They both had to deal with and care about SARS in a way that the west did not.

> Taiwan or Korea, who had the same "living memory" we do

They faced SARS, which never took off in the West.

There were 44 deaths in Canada

https://globalnews.ca/news/6458609/looking-back-toronto-sars...

An interview with a team in Ontario, Canada that dealt with SARS, including the Minister of Health (Clement) at the time:

* https://www.youtube.com/watch?v=OPOkpIc2Z7U

So basically none. Not trying to be dismissive but this is going to kill way more than 44 in canada. Likely 100s if not thousands. Completely different order of magnitude.

Also they are sitting near adjacent to the original epicenter. It was more real to them along with the previous outbreaks.

I would like to ask people to not to attach "Asianness" to having a working government.

Even back just 2 decades ago, in every Asian country, a typical saying would've been "When will we live like in America?"

The West was the envy of the world in its best years, and it can be again.

If you can fix your societal problems, you will be, if you can not, you will not.

This is one of those uncomfortable truths that require introspection to be resolved and that's in very short supply.

Western commenters often see the strengths of Asian countries as stemming from their governments, but much of what goes well in Asia has to do with civil society.

I think much of what went well in America had much to do with civil society. I believe we collectively figured out there’s likely no god and mistakenly assumed everything that went along with the whole community & church system was to be thrown out. Not sure what to do about it because I think the weekly meetings with recognizable families was important but the Olstein style self help pastors isn’t.

Sport was originally a form of discipline and training - not just of the body, but also to be a good loser and a good winner. I think we need to abandon, for the most part, spectator sport, and create a social norm where people actually physically meet up weekly to play the sport of their choice at an incredibly amateur level. Imagine if every Sunday almost everyone in your community turned up to play - some people playing chess, some people playing football, some people swimming. Whatever their mind is interested in and their body can cope with. This would be completely different than the current system of sport, where those who want to do it fit it into their weekly schedule at a suitable time. One person goes to yoga on Thursday afternoon in an office building, another person rides their bike on Tuesday morning, a team meets to play netball on Wednesday. The would, of course, be permitted to do whatever they want. But there would also be an expectation.

Unfortunately I don't know how to get there from here - for the time being, there's no support of anything amateur. We're basically told to be a pro or go home. Not just sport, anything and everything.

There is a good intuition here. The arts, too, once served a primarily communal function. Most of the steps that later became the ballet are drawn from folk dancing, which at one time was common to all communities.

In Tokyo sometimes, you walk through a neighborhood where the people have blocked off an intersection for circle dancing in a relatively simple style.

Maybe the easiest thing to get tech people to do would be live CounterStrike. One half of the office is "guarding the VIPs", the other half is rescuing the hostages. People spend hours and hours on these kinds of games as it is. Bringing it into the real world would harness some of that engagement for health and community.

I didn't want to put too much forward but truly I'm interested in starting a secular church to capture new parents returning to the church. The main issue is the base organization would have to change. Sermon's would have to become a sometimes activity and we'd have to go back to the small gatherings of "Sabbath school" being the central activity...

But WOW oh Wow is your insight about sport deep and well said. I think that could be the central focus of the group activity. And perhaps communal art and dance could be the primary replacement for the sermon.

There's something there and I can see how focusing on sport makes the idea more palatable to people who aren't naturally open to meditation, yoga, or Buddhism.

Other commenters mentioned SARS, but specifically for Korea, they faced a MERS outbreak in 2015 that resulted in deliberate policy changes that made their response to COVID-19 rapid and effective.

> The problem is that the west has nobody in power with living memory of a pandemic.

Doesn't help that the WH pandemic response team was disbanded (fired/resigned and not replaced).

The President, with unlimited access to the best public health advice in the world, has zero excuses.

This is wishful thinking. It is doubtful that there was even a concensus from public health officials 8-10 weeks ago.

There are way too many people using what they know now to criticize decisions that were made 8 weeks ago when the information/evidence wasn't obvious.

It still isn't clear to me if the severe economic shutdowns are going to not have secondary affects that are just as bad as the virus. I think we should all be a little more humble about what should have been done until we are on the other side of this crisis.

> The problem is that the west has nobody in power with living memory of a pandemic.

Irrelevant. It's why we have things like (history) books: so that we don't have to relive past events to learn from them and repeat every mistake done in the past. It's cheaper to learn from other people's mistakes than your own.

The Trump Administration was specifically warned about pandemics before they even took power:

> “Health officials warn that this could become the worst influenza pandemic since 1918,” Trump’s aides were told. Soon, they heard cases were popping up in California and Texas.

> The briefing was intended to hammer home a new, terrifying reality facing the Trump administration, and the incoming president’s responsibility to protect Americans amid a crisis. But unlike the coronavirus pandemic currently ravaging the globe, this 2017 crisis didn’t really happen — it was among a handful of scenarios presented to Trump’s top aides as part of a legally required transition exercise with members of the outgoing administration of Barack Obama.

* https://www.politico.com/news/2020/03/16/trump-inauguration-...

Trump could have done something between 4-6 weeks sooner per briefings in January:

* https://www.washingtonpost.com/national-security/us-intellig...

When H1N1 appeared in April 2009 the response was swift and decisive:

> The CDC's summary report[1] of the 2009 H1N1 pandemic outlines how tests were administered at the time. The virus was first detected in the US on April 15. The CDC informed the World Health Organization about initial cases April 18. A test to detect this strain of swine flu was developed by the CDC and cleared for use 10 days later, on April 28, and the CDC began shipping tests across the US and around the world on May 1.

* https://www.cnn.com/2020/03/13/politics/fact-checking-trumps...

China's lack of transparency did not help matters:

> 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. However, if NPIs were conducted one week, two weeks, or three weeks later than they were, the number of cases may have shown a 3-fold, 7-fold, or 18-fold increase, respectively.

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

* Study: https://www.medrxiv.org/content/10.1101/2020.03.03.20029843v...

But all the "technical" knowledge to do the right thing was there. There is nothing new to this situation that we didn't already understand from an epidemiological perspective.

No one should be downvoting such a high quality and well researched post. Hacker news truly embarrasses me sometimes

It's not high quality or well researched. It uses biased sources. Trump took action in January, despite the ongoing impeachment circus, but the post contains a sentence ("Trump could have done something between 4-6 weeks sooner per briefings in January") that implies otherwise. The house even voted to undo the action Trump took against the virus.

> The house even voted to undo the action Trump took against the virus.

Citation needed.

My guess is you're referring to the travel ban issued at the end of January for people who had recently been to China, and the No Ban Act. If so: the No Ban Act would not undo the coronavirus ban if it were passed. It would undo Trump's earlier travel bans targeted towards Muslim countries, which are of course what the bill was intended to address. Although those bans and the coronavirus ban were imposed under the same authority, the bill would not remove that authority entirely, merely put limits on it. Regardless, the bill was not actually passed or voted on by the full House, only voted out of committee.

> Trump took action in January...

That's a strange way to put it. He took exactly one executive action: he restricted travel from China. This was very important and probably bought us some precious time. But for the next month and a half, Trump squandered that time with complacence, misinformation, and bureaucratic paralysis, all while downplaying the disease and vilifying reports of its severity as a hoax.

Contrast this with S. Korea and Taiwan. The U.S. and South Korea both reported their first cases on the same day -- January 20. The S. Korean government listened to the experts and took quick and decisive action, and they are rapidly getting their outbreak under control without draconian lockdowns.

We have a leadership vacuum at the federal level.

> despite the ongoing impeachment circus

This is supposed to be an excuse? If I remember correctly, Trump told us he was a strong leader who could easily handle more than one task at a time.

The US response was abysmal. Trump's China ban was effectively a racist strike to his trade war. Hardly a sufficient response to the disease. But it was a response to the disease.

You describe the difference between the West and the peri-Chinese liberal wealthy states - not the difference between the US and everyone else. So Trump did something. He didn't do enough. Morrison did something. He didn't do enough. Merkel did as little as she could. She didn't do enough. Johnson eventually acted - and actively tried to get as many British residents infected as he could. If the US failure to take quick and decisive action is Trump's unique failure then every western state has a leadership vacuum.

Yes, there are symptoms of the US partisan malaise in this. Somehow a public health emergency of international concern became a political divide. But that doesn't explain the similarities in the initial US response - the response that meant the disease became established in the US.

It's far, far more likely that all Western leaders relied on the same advice - given to them by advisers who experienced an official pandemic. Swine flu was widely regarded as an overreaction and sowed its seeds of apathy in our experts. We're reaping that crop today.

I don't really agree with the gist of this, but your response is reasoned and well articulated, and your analysis of our collectively poor decision making is spot on I think.

Trump did far worse than almost any other world leader. He didn't merely underperform. He spent nearly two precious months actively mocking and attacking efforts to try and inform and prepare us for the pandemic.

Only when Trump figured out he could try to spin himself as a "wartime president" did he start to put on an air of concern. Angela Merkel for example was obviously, clearly waiting to be convinced on a scientific basis -- weighing evidence, currying expert advice, waiting for more data until the last possible moment before putting a gun to the head of the economy and pulling the trigger.

To Trump, this is, as with everything single thing he does, primarily a sales and PR mission.

> Trump took action in January ...

* https://www.snopes.com/fact-check/timeline-trump-covid19-res...

Snopes is not legitimate.

In this case, they give a "mostly true" rating while barely acknowledging that the anti-trump timeline is missing some events.

Those events, of course, are not minor. They make the timeline into what we call a "lie by omission".

Most importantly, the entire Snopes article neglects to mention that Trump's ban on travel from China was issued on the last Friday of January.

This is typical for Snopes.

> The problem is that the west has nobody in power with living memory of a pandemic. [...] there hasn't been a pandemic in the west in over 100 years...

Recent counter-example:

https://en.wikipedia.org/wiki/2009_flu_pandemic

https://en.wikipedia.org/wiki/2009_flu_pandemic_in_the_Unite...

Key stats:

* global cases: 700 million - 1.4 billion

* global deaths: 150,000–575,000

* US cases: 60.8 million

* US deaths: 12,469

A few more counter-examples can be found here: https://en.wikipedia.org/wiki/List_of_epidemics

(Edit: added key stats)

Do the math on the death rate. Same as normal flu. Not the same thing as this pandemic.

At the time, no one knew that. There was mass panic and surgical masks were also being bought out.

Also just to point out, for 2009 Swine flu pandemic, we had vaccines (effective 43%) and antiviral treatments can significantly help. This time since COVID-19 is a novel virus, we have nothing.

> So it was never going to be clear to most people that this was a problem until we had waited way too long.

Sorry, but we knew it was serious. On January 25th, we closed down and evacuated the US consulate in Wuhan. That was 2 months ago.

Unless by 'most people' you mean Trump and the Fox News audience.

FYI for the down voters, Fox News was up in denial till last week

https://www.youtube.com/watch?v=ifKbwDf51bA

The Trump administration greatly mishandled the crisis.

There is a theory that Trump's mishandling of the crisis is somehow what sets the United States or the west as a whole apart from the wealthy liberal East Asian states of South Korea, Taiwan, Singapore and Hong Kong.

The problem with this theory, though, is that it doesn't explain why countries like Germany, Italy, the United Kingdom and Australia all dragged their feet every step of the way. (At the beginning, Germany seemed to respond extremely well, but once it became epidemic in other countries, they gave up.) People were not tested if they showed signs of the disease; they were only tested if they were connected to a known case. Travel was not restricted till the disease was already present in the target markets. When travel was restricted, it was too often done on effectively a racist basis. If you're Chinese, you're banned. People acted as though we would somehow be immune from this disease since our political/health system/language is just so.

In China and in the West, the response was always F-grade. Trump and the US deserve extra comment, but they are not the unique failures. It's the difference between 15 and 45. A huge difference, but a passing grade is 50.

>"The problem is that the west has nobody in power with living memory of a pandemic. An unfortunate failing of human cognition is that most humans discount that which they have no direct experience of."

What about the HIV/AIDS pandemic? Lots of folks in the HHS have living memory of that. In fact Dr Debbie Birx the WH Coronavirus response coordinator has spent decades fighting on that front.

And the CDC has a presence in 40 different counties through various partnerships and has had first hand experience with SARS, MERS, H1N1 and EBOLA.

AIDS is not a pandemic. Pandemic requires epidemic, which requires rapid spread in a short period of time. AIDS has been slow. Calling it a pandemic is, IMO, motivated by politics (it mostly affects male homosexuals and sub-Saharan Africans). Ctrl-F for my discussion elsewhere in this thread.

I believe the next pandemic response after this one should better take into the sentiment that there is sometimes no good answer to viral outbreaks that does not tank the economy.

This outbreak is a litmus test for the competency of many world leaderships. It's a sad fact that it takes a death toll in the course of a few months to cause it, but that's reality. Look at how wrong some very powerful people were in addressing the scale of the crisis. There is still a lot of unfounded optimism going around. This could potentially be highly damaging to their credibility. Maybe we will learn to be more pessimistic when it counts next time, prioritizing reality over individual liberty.

Like other natural phenomena, viruses have no qualms about diplomatic red tape, the efficiency of medical supply manufacture, or personal belief. They will keep infecting regardless.

What happens when another outbreak occurs, more deadly and/or transmissable than this one, when notions of social distancing become even less effective, and self-isolation is actually the only viable option to prevent mass deaths? Will our best-case manufacturing rate always be able to outstrip the infection rate enough, and if not how would we respond? There will probably still be many people that hang on to the belief that something can be done to save the economic structures underlying society, in the face of reality. Given even more dangerous diseases, at what point does this become false? I'm not hopeful that economic measures will always be able to solve economic crises without an economic cause, because nature doesn't care about economic models. If the only solution to prevent societal collapse in the future would be mandatory self-quarantine, regardless of whether or not we'd know this, will world leaders ever be prepared to make that call, and swiftly? This outbreak will probably not lead to the collapse of humanity in general. But with the mindset we currently have of never reacting until it's too late, which outbreak will become the one where we finally run out of options?

I sincerely hope enough of the world has embedded this into their minds and will spread this memory to future generations, and be prepared, to be in time for the next, more severe crisis.

Why would you need experience with a pandemic?

The previous team of CDC made sure that Ebola didn't become one.

They were pretty successful untill Trump wanted to put inexperienced "allies" in place.

I think the problem is that the west has people in power with living memory of a pandemic - Swine Flu - which was widely criticised as a complete overreaction, to the point that there's no such category as an official pandemic any more.

The reaction here was a significant counter-reaction to the swine flu overreaction.

If it is any comfort Spain, UK and Italy also failed responding to the crisis, so it is not like the American authorities are obviously worse?

Also France and the Netherlands....

To some degree it is because (1) they had an even longer lead time and (2) they pissed even more away.

The united states responded before the united kingdom and contemporaneously with spain.

Yes. Much. Too. Late.

It makes China’s failure to respond understandable.

To what (honest) standard are you holding the United States to? Curious, given the totally black swan nature of the event and the wildly different geopolitical, cultural, legal, cultural, and even geographical differences between, say, Taiwan and the United States.

We have a long history of bringing our B-game until we realize it's time to bring our A-game, make it happen, and almost entirely without meaning to, reshape the global order: https://news.ycombinator.com/item?id=22658475

"You can always count on Americans to do the right thing - after they've tried everything else." A classic Winston Churchill quote. Even if he never said it, it sounds like something he would have said.

I wish you luck with that strategy. Almost every historical US rival was smaller was isolated (no solid allies), from about 1880 until 2010.

China is not smaller and it knows better than to become isolated.

Note: I'm not rooting for China.

Nitpicky point: The USSR was larger geographically and in population than the United States.

If you combine the “Communist block” in 1955, it was significantly larger than the “free world.”

Of course, the “Communist block” quickly turned on itself. But still.

The US has taken on larger powers before, but we had the advantage of strong social institutions.

Our own social institutions have been decaying, but when I think of China’s strengths, “strong institutions” doesn’t come to mind.

Geographically, at some point it doesn't matter. Everything else being equal, Canada is equivalent to the US, to Brazil, to India, to China, to Russia, etc. The difference boils down to population and economy. The USSR was slightly ahead in population and significantly behind in economy.

The "Communist block" was the USSR plus subjugated/unwilling allies. The US allies were much, much better, since:

1. They actually wanted to be part of their block.

2. Their resources, populations and economies were definitely far ahead of the "Communist block" ones. After all, the UK and France were still colonial empires in 1955. While Poland and Romania... yeah... You could count China, but China basically only got involved in wars near its borders: Korea, Vietnam. It was never going to join the USSR in an all-out, nuclear war against the West unless directly attacked for some reason. It was part of the reason the split happened between the USSR and China (China wouldn't fall in line like Hungary or Czechoslovakia).

The US could still be ahead, but it's alienating all its allies right now.

A lot of our allies in the Cold War were former Axis powers, not to mention some fishy ex-neutrals (Spain, etc.).

I don’t think they really liked the US as much as our interests were aligned and we had a gun to their heads.

Did they “like us”? It didn’t really matter.

France and the UK were, depending on how you count them, still the #3 and #4 economies in the world at that time. Ravaged by war, but still backed (though not as solidly) by colonial empires or at least neo-colonial institutions (Commonwealth, Francophonie).

Who did the Soviets have, that was worthy of being mentioned as an ally? China? That was about it.

And fear of Communism was much higher than fear of the US. Therefore making a lot of countries natural American allies.

“China? That’s about it.” China is freaking massive. Both in terms of geography and population. Russia + China is enough to vastly outnumber and “outgun” the US.

I don’t think we’re really disagreeing on much. My original comment was pretty nitpicky.

> write a blank check and fire up mask, ventilator, and test production the second it was clear this was a global problem

I think part of the problem is that we instead specifically prohibited pricing the masks in accordance with the extra costs associated with ramping up production.

We prohibited price gouging i.e. increasing the price of masks that were already produced.

> one of the nastiest challenges the world has ever faced

Unfortunately, Covid probably will not be in the top 100 nastiest challenges. Our global history has some truly terrible things in it

> it definitely feels like we're bringing our B game to one of the nastiest challenges the world has ever faced

That B game has been years in the making and predate the current administration since we exported our ability to bring our A game. Hopefully after this, these past short-sighted decisions are sharply corrected.

I will say that almost every national or state level decision so far (other than San Francisco) has a very tangible tardiness to it. Washington state started with 6 cases, in 2-3 weeks NY has over 4K. Is Texas on lockdown yet? They sure will be in exactly two weeks (tangibly tardy).

God forbid a state pre-emptively goes on lockdown to shorten the overall downtime vs waiting too long, having to lockdown anyway, and dragging the whole mess out.

The US always does this. Consider the response to World War I and World War II.

My observation as well, it's China's dream coming true unfortunately

I don’t see why this was downvoted as it is certainly an interesting discussion- will this crisis prompt the wealthiest nation in the world to enact a suitable response to a viral pandemic?

My opinion is a strong no. After hurricanes and floods, we simply rebuild houses where they once stood and forget they ever happened. Our modern hurricane response is nothing to be proud of.

Before WW1, Britain was the wealthiest nation in the world. They controlled the seas of the entire world and despite having one of the smaller populations, could bend huge populations to their will (e.g. India). It took only 4 years for an enormous transfer of wealth to take place from the British Empire, which had itself been sucking up the wealth of the world for centuries, to the United States. The financial hub of the world moved from London to New York. I could certainly see it moving again, and right now the most likely candidate is Beijing.

> They controlled the seas of the entire world

In their heads. But meanwhile, the Dutch, Portuguese and Spanish had more than their fair share as well. This whole re-writing of history is what enables 'MAGA' and other idiotic revisionist trends, please don't contribute to them. It only gives more credence to the kind of exceptionalism and nationalism on display.

It's romantic to speak in such absolutes.

It depends what era you're talking about, but the period leading up to WWI the UK was pretty dominant. Neither the Spanish or Portuguese challenged them during that period.

https://en.m.wikipedia.org/wiki/Pax_Britannica

Huh? I lived through hurricane Andrew. Building codes were updated. People were significantly more ready for the string of hurricanes that came through 1999-2005. Miami is still gonna be underwater due to climate change but the response to hurricanes was dramatic. People know how to deal with hurricanes in South Florida.

Agree with you on this, like I mentioned above I was uninformed - happened before I was born :) Thank you for the information.

It’s really striking how many metal roofs have been installed in Florida. Everywhere else they’re seen as an unobtainable luxury.

Even the non-metal roofs have changed. The shape used to be 2-plane, like a book opened face-down, with a spine running from one end to the other. This made two walls of the house pentagonal. Those pentagonal walls typically had the upper portion just sitting there, barely attached. Now the building codes require internal diagonal bracing for that portion, if it even exists. Insurance companies charge more if it exists, so most roofs are more pyramid-like, composed of 4 planes, with the edge of the roof being the same height from the ground all around the house.

So, hip roofs are preferred over gable roofs?

Yes. Because some people built poor-quality gable roofs, we all pay more for insurance if we have them. Never mind that the pentagonal walls could be made of steel or poured concrete. Insurance companies just don't want that type of roof.

I've lived in California my whole life. The state has been continually been beefing up it's building codes since 1906 to resist earthquakes. I'm pretty sure when this is over California is going to make some big changes.

The wealth shifted because the British Empire lost it's navy and thus it's force projection which made it lose it's way to control it's colonies and it handing it's colonies to the US in lend lease. That was combined with a guarantee of global seas protection from the US navy. CCP has zero force projection even over their local area of the world and are wholly dependent on imports from the rest of the world for its economy. The US could shut down the economy of China and send it in to millions of people dying famine by just putting some blockades up between the middle east and China and China would cease to be a country.

> "right now the most likely candidate is Beijing."

Beijing is not even the financial hub of China. That would be Shanghai.

Interesting to learn this, thanks for the information.

To a (very) rough approximation counterparts are: Beijing: Washington, DC, Shanghai: NYC, Shenzen: a mix of Detroit/California. China has lots of ports, seven of the top 10 worlds largest container ports are Chinese.

The British Empire was the pivot of world power through to 1947. Yup, then it dissolved and Britain was bankrupt, but the transfer of wealth didn't go from London to New York, the continental power of the United States made all the wealth anyone needed. Bismark said it “God has a special providence for fools, drunkards, and the United States of America.”

This is a great point and love the quote.

Evacuation orders are given almost a week ahead of hurricanes now. Updated building codes after Andrew have made wind almost a non-issue for houses built in the last 20 years. Expanded flood zones have forced more houses to be built above the 100 year flood line. Local utility lines have mostly been moved underground to avoid wind and falling trees. The last time we received hurricane force winds we didn’t even lose cable.

Clearly we have learned nothing from hurricanes.

Thank you for the information, my opinions were largely formed by contemporary news articles - had I been more informed I would not be so negative about hurricane response.

One of the big building code changes was actually very simple.

https://en.m.wikipedia.org/wiki/Tie_(engineering)#Hurricane_...

But ties changed the entire survivability of a building in high winds.

Americans have a strong scepticism of prognosticators.

Just look at children stories like chicken little and the boy who cried wolf.

That’s great when prognosticators are wrong: https://science.sciencemag.org/content/157/3791/914.2

Unlike America, China didn’t ignore Paul Erlich and his ilk. They responded by implementing the one child policy.

Originally intended to preserve their resources, they kept it because it aided in industrialization.

And so China is now a major polluter, is stripping away its resources at a massive scale, and about to hit a massive demographic cliff.

And in the process violated human rights on a massive scale.

California especially has a lot of really great people in disaster management, from CalOES on down to the various county-level agencies that they coordinate with. That's not to say that things don't sometimes go upside-down; the destruction of the town of Paradise was an event that nobody had trained or planned for and there were a lot of relatively little things that got mishandled in the process, which slowed down some of the bigger things.

But then it was all used as a case study over the next year and became a training drill with new operations manuals for all the agencies involved.

So yeah, I get what you mean. New York seems to be taking the right steps here in the absence of a functioning federal government. I hope we don't get to see California in action, but if we do, I expect it will be a very fast, competent response.

They should be responding already surely?

Thats one of the things about americanism, we have little reverence for tradition or authorities - we culturally value results more than process to achieve them. It has some downsides yes, but in times of crisis ie means that, we all just pick up and do our part - and frankly the best ideas usually float to the top.

It looks sloppy as hell too. Which is partly why there's always so many complaints about how the US responds to any event.

It does, but it's mostly effective, just slow to get started in the absence of someone priming the pump.

> we culturally value results more than process to achieve them

Frankly, that was not my impression from American management or institutions. The most important was rule following, then appearance of effort, results largely unimportant.

Every culture has toxic subgroups that veer in this direction. It likely says more about your experience than the culture in aggregate.

I would not necessary say they were all toxic as a persons. More that the whole culture pushes them to be that way and select people like that as leaders.

> we culturally value results more than process to achieve them.

You do? Seems to me that there are some areas that this very much doesn't apply too. For example: market processes are preferred over functioning healthcare system. The right to bear arms is preferred over limiting mass shootings.

Capitalism is the ultimate authority in america. It's just so ingrained it's not seen as such.

Limiting mass shootings isn't the target result of the right to bear arms. Allowing for self-defense, precaution against drastic government overreach and the such are the objective there. Mass shootings are just a side effect.

> And I think one of the strongest virtues of the United States is being proven by Trump

Strong military logistic?

I think it is such a strong side of US military, that if you compare the entire logistic capacity of the rest of world's militaries taken together, it will still not surpass the US.

Relevant article:

https://news.ycombinator.com/item?id=22658475

Yeah it’s true and when America does wake up to global warming, it’ll be a juggernaut on so many fronts. I genuinely believe that when America decides to act on global warming there will be zero room for negotiation by others.

It’s not in America’s short term interest though so this won’t happen any time soon.

It is certainly more comforting/assuring to see more actions take right now. Once mobilized, US starts to impress more.

But I fear what has been done is not enough, because it only feel necessary, but the virus is an exponential growing crisis, our capacity can not possible catch up with it.

Strict lockdown right now. Take the short term pain, but better for long term.

I’ve heard the opposite.

Locking down only works as long as people lock down. Once the lockdown ends, the virus re-emerges. The repeated lockdowns continue until a vaccine is created.

Taking less serious measures - only locking down the elderly - creates heard immunity, albeit with a higher death rate.

The absolute lockdown we are doing now means the crisis will go on longer.

The short term pain solution would be accepting the higher fatality rate for heard immunity.

For the sake of my elderly parents, I’m glad we’re starting with a lockdown.

The short term pain solution would be accepting the higher fatality rate for heard immunity.

But it's a much higher mortality rate without the social distancing since the hospitals will be overwhelmed so the mortality rate will approach the hospitalization rate if 15 - 20%

Yes, the wheels of production are starting to turn. Right now, there's a virus test shortage, a toilet paper shortage, a mask shortage, and a hand sanitizer shortage. Production of all those small items has already gone way up, and most of those shortages should be solved in a week or two.

Bigger items like ventilators, ICU suites, and hospitals take longer.

As for levels of government, that's very real. People outside the US often don't realize it, but the states have more power than the Federal government in many areas. I'm in San Mateo County, California, and we're in lockdown because the County Medical Officer and the county supervisors decided it was necessary. They didn't have to ask permission from any higher authority to do that. Action by the state governor came later. Action by the Federal government came even later, and was mostly advisory.

California has wildfires, earthquakes, and floods routinely. So the state's Office of Emergency Services is large and well-funded, and their emergency operations center is usually dealing with something. Most large cities have emergency operations centers.

It won't be enough at first. But this is going to be a months long problem, if not a year or two. The support facilities will catch up.

> People outside the US often don't realize it, but the states have more power than the Federal government in many areas.

Especially when a local or a statewide emergency is declared. At that point, all bets are off and authorities can do pretty much whatever they want until someone gets a judge to issue an injunction, which they're a lot less likely to do in a state of emergency unless its gross abuse of civil liberties. Even then, if it goes on long enough, executive power at all levels of government becomes even harder to curtail.

There is a retail level toilet paper shortage due to hoarding and swine reselling it at massive markups. The supply continues to flow however

Show me evidence that the mask shortage and the ventilator shortage will be resolved at any point in this pandemic please.

Military releases 2,000 ventilators, up to 5 million masks for coronavirus response

https://www.mcclatchydc.com/news/coronavirus/article24127936...

Plus tens of thousands in the Strategic National Stockpile.

The bottle neck will be low margin consumables items as we are seeing now with nasal swabs, plastic cups, pipet tips running out.

2,000 ventilators and 5 million masks is nothing.

Thinking that the pandemic will blow over before a sufficient amount of ventilators are available may actually be too optimistic.

Car factories and similar manufacturing plants can probably be turned around in a matter of months, and will be able to produce millions of respirators over a year or two.

The virus, unless properly contained, is likely to be a threat for at least 1-2 years, and that is assuming no significant mutations to restart the cycle.

During WW2, the US started ordering Essex class carriers in 1940. Even though they were not present during the critical months of early 1942, they did turn the battle of the Pacific in 1943.

> Bigger items like ventilators, ICU suites, and hospitals take longer.

Doctors and nurses take even longer.

> I mean this kind of should have happened weeks ago, and the executive branch is a bit of a panicked joke.

And I feel like these sorts of virtue-signaling remarks makes it harder to focus on what to do now. It isn't even clear that anyone would have listened to the federal government weeks ago. Look at the criticism that was made when Chinese flights were restricted in January.

The CEOs bit got an audible laugh out of me! Wash your hands of all sarcasm too.

The US always lags on a major crisis and then surges over time. It happens in every instance. It's because of the scale and nature of Federal -> State -> Local as a system, mixed with human rights and democracy (no authoritarian switch to throw, so to speak). The US has to put a lot of things in motion to mobilize at all levels and it's extraordinarily expensive, so you don't want to do it unless you must.

As recently as mid January the WHO was still repeating Chinese propaganda about the virus not being transmitted from person to person (China had known at that point for at least 30-45 days that that was a lie, they were trying to keep the world from isolating them and hammering their economy, hoping they could stop it quickly).

Trump's delays cost the US three to four weeks of additional prep time. From the first week of February (closer to when the US should have began to prepare nationally), versus the end of Feb / first week of March. It was also entirely unclear how infectious it was and what the mortality rate was likely to be, until well into February.

Trump probably burned approximately the amount of time he bought by shutting down flights too and from China before everyone else.

“Men and nations do behave wisely once they have exhausted all other alternatives.” - Abba Eban

Note though that such things are usually done by some department of the US army - and that's no accident given that it's the most well funded and some of the most well prepared of such organizations in the world.

Murica!

> The Army Corps is expected to immediately begin work to construct the [four] temporary hospitals. The Governor is also requesting FEMA designate four field hospitals

NY is creating EIGHT temporary hospitals total. I can't imagine the logistics, staffing, materials, etc. A few days ago I wasn't terribly concerned, but it continues to look worse and worse for the US.

from the article: > The Governor is also requesting FEMA designate four field hospitals with 250 beds each for the state, intended for use in the Javits Center in addition to the temporary hospital to be constructed by the Army Corps.

I think putting 1000 beds in a conference centre sounds a lot less dramatic than 4 new hospitals.

I wonder why Wuhan authorities opted for new construction over using available spaces that surely must exist in a 10M city when everything is shut down?

Available spaces were most probably not fit to serve as hospital for airborne infectious disease. Water/air ducts, isolation rooms, medical equipment and so on.

Wuhan wanted to put the hospital away from city center. And did not want to contaminate existing spaces.

In NYC, there is very little space for something new. And the existing structures are poor locations for actual hospitals.

If the economy is going to be down for a while, might as well use a public space that is shut down for that purpose.

Perhaps it was to enlist the unemployed. Lots of people losing jobs because of the epidemic + need for hospitals to mitigate epidemic effects = build hospitals?

That was least of China's worries. They clearly focused on pandemic resolution at the expense of everything else.

There were convention centers converted to isolate patients in Wuhan too. Basically, Wuhan needed both more hospital beds for people requiring intensive care, and more beds for isolating infected patients with mild symptoms. Only the second kind can be in placed in conventional centers.

PR reasons, probably. It gave a big, visible, livestreamed 24/7 impression of progress towards doing something against the disease in a way that other countries wouldn't be able to match.

It seems you’re not familiar with the situation.

Those new temporary hospital units that they built in 2 weeks, are specialized, negative pressure rooms, that sucks the air out of the room, and runs it through a scrubbing filter, before safely expelling it outside into the atmosphere.

They learned their lesson from SARS, and built these special care units, to treat pulmonary infectious diseases.

These negative pressure rooms will help minimize infected air, such as when you do an intubation, and the virus get aerosolized, then it helps to vacuum the virus out of the air inside the room.

These hospitals were built to treat their most critical cases. Then, they later built general facilities in sporting stadiums, for milder cases, to keep these infected patients away from their families and the public, while they recovered. In retrospect, they should have built these two types of facilities in parallel. This appears to be a lesson learned for them. They underestimated the magnitude of the infection rate, and later realized that milder cases can be triaged and treated separately.

Granted, not a whole lot of information about this was shared in Western media; since most of the effort, was spent smearing China, and their terrible authoritarian government.

And whatever was reported was dumbed down for western audiences. This was frustrating when you wanted to find actual information, and you had to dig deeper, to find actual useful information about what was happening on the ground.

Note: As typical of HN readers, I’m expecting to get docked -4 points for this post, because I actually wrote something positive about China’s efforts to contain the coronavirus. In the end, apparently, it worked.

Why are they not using college dorms instead? There's already beds there and there's a modicum of isolation.

I have no actual idea, but would venture to guess that all dorms in NY are old buildings with HVAC/Electrical/Elevators/Hallway sizes that aren't good enough for medical care.

Lived in the international house in NY many years back. I would add bedbugs to the list!

Here in New York, they're building a facility at one university, though the dorms are going to be used to house workers rather than patients.

https://riverheadlocal.com/2020/03/22/as-suffolk-coronavirus...

I saw an image of the rate of total diagnosed cases per day of Italy vs the USA and the curves appear to overlap suggesting were going to see a similar swell and they're preparing for it. I've not confirmed any of this but everything else I've read seems to suggest that this may be the case.

I live in NYC with elderly family members as well as at-risk family members. I also have family in CA. My Friends are also in the same boat.

Unfortunately my business is critical so it will remain open though they are taking this very seriously. They have a rigorous cleaning policy as well as split shifting a crazy schedule to minimize people in the building at once yet moving production along. All office people who can work remote (not me, im tech) are home with laptops. Thankfully I have my own microwave and fridge in my pretty isolated office so im hunkering down there by myself. Only bringing food prepared at home which I have a little stock of. They also said I am free to hide all I want unless it's an emergency which is usually once a week when some old machine decides to throw a hissy fit.

NYC is the epicenter of the epidemic in the United States right now, they essentially doubled overnight in the number of confirmed cases. Pretty grim given the absolute numbers involved.

> NY is creating EIGHT temporary hospitals total. I can't imagine the logistics, staffing, materials, etc. A few days ago I wasn't terribly concerned, but it continues to look worse and worse for the US.

I think the logistic complexity of building 4 field hospitals is like nothing compared building 30-40+ FOBs, MOBs, firebases, landing grounds, airfield, and other field logistic elements in the warzone, during an invasion.

Saying that, one need to think how shockingly bad the showing of American state apparatus been in recent years despite such an enormous resource at its disposal, unless the actual army is involved.

The military is the only governmental organization that genuinely practices and puts into play its planning and training.

The rest of government generally only plans but never stress tests those plans. And the few times they do get practice, we rotate them out of those roles every time a new administration is voted in. Any SRE working at large tech companies like Facebook and Google probably have more experience responding to crises and correcting the shortcomings than many of the people on the civilian side of government.

The acoup blog just did a piece on chemical weapons and their dis/use in modern times. Part of that analysis was a dive into Modern v. Static armies.

Static armies are what Saddam, Assad, and the Iranians have. Though their weapons are pretty up to date, they still get squished when fighting Modern armies like the US or France. That is because their 'doctrine' is Static, mostly to be coup-proof. In Static Armies, you don't give field commanders a lot of lee-way or control. You send orders, they execute. They don't get to play jazz. This is due to regime issues that don't translate into up to date warfare.

In Modern armies, you have terribly expensive weapons too. But the training is what makes it really work. You have to train field commanders to play jazz and improvise. It's a constant blitzkrieg of movement and mechanized/digitized warfare. There is no sitting around. That takes training people to think for themselves; a big no-no in regimes.

The US is the example of a modern force, complete with fancy gadgets and fancy training.

We should expect that NYNG could get eight field hospitals going in hours. That is the entire basis of our military, to move really fast and get things done. Imperfectly? Oh hell yes. But fast is the entire name of the game.

https://acoup.blog/2020/03/20/collections-why-dont-we-use-ch...

I promise you, there is very little improvisation or "jazz" in the U.S. Army and a lot of micromangement and bureaucracy.

The experience is more akin to being in a massive company with tons of middle managers who are always looking to self-promote and cover their a.

The army has many great men and women in it, despite the bs, but let's not pretend it's some "dynamic" entity.

Don't believe me? Read Bob Gates' memoir, where he recounts how as SecDef he had to fight the Pentagon brass just to get MRAPs that would save lives. And he was in charge of the department!

Isn't this exactly the point of OP?

>In Static Armies, you don't give field commanders a lot of lee-way or control. You send orders, they execute.

If we had a Static Army, the Pentagon brass would have immediately yielded to SecDef and executed his orders. The fact that there had to be immense debate around the issue means that everyone is granted the right to do their thing and improvise in the meantime. You can bet troops were trying all sorts of wacky things to IED-proof their Humvees.

I think the point is that, there is a bureaucracy to fight. Sometimes units can simply do what needs done, other times they'll need resources and get them, and other times then need resources and not get them.

But you can bet no high ranking officer in Saddam Hussein's army was successfully "fighting the bureaucracy" to get things through.

acoup's post goes into much better detail and I'll point any readers to it.

One tid-bit I did find interesting was :

"Likewise, armies with weak organization, training and discipline will find chemical preparedness – which involves a lot of training on how to get those gas masks and NBC suits on fast – very difficult; actually getting all of the fidgety equipment to the right spots will also prove hard (but is second-nature to a modern system military which has nothing but fidgety equipment)."

I think that acoup's point extends to most aspects of the military and to parts of civilian life as well. The complex, murky, and seemingly insane rulesets of command systems in Modern militaries is a feature, not a bug, though most people in it understandably disagree and are screaming at their screens right now. There's that old apocryphal quote that goes something like: war is chaos, which is why the Americans do so well in it, as they practice it on a daily basis.

Econtalk had a great bit on chaos in potato chip sales. Brendan O'Donohoe of Frito-Lay mentions that he randomly makes people take vacations, pulls them on to other projects, jazzes things up, so that his team can better sell potato chips. I've no idea of their internal numbers back in 2011, but based on his current LI, he's done alright enough since then (maybe, I really can't judge here)

https://www.econtalk.org/odonohoe-on-potato-chips-and-salty-...

What happens when those workers all get Covid-19? This is an invisible enemy that's already on our soil and growing exponentially with the ability to spread by asymptomatic carriers. I hope you are right....

Some will have mild cases and be able to continue caring (with less need for PPE, even). Others will recover. Not everyone gets hit at once.

My dad’s a doc (not in NY) and got sent home so he can be second wave.

Not to be heartless, but many militaries are fairly experienced in rapid reductions in manpower resources.

Also, acoup's blog post does a really good job of going through the differences in Modern and Static military doctrines. Much better than my TLDR of it.

I wonder if there are any historical accounts of military warfare during a global pandemic affecting both sides at the same time.

There are MANY examples, here's a good starting ref:

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

WWI[1] - the pandemic ended up being called "Spanish flu" because Spain was the only country publishing accurate statistics since it was neutral in the war. The belligerents were heavily affected, but were muzzling the press due to wartime censorship.

1. https://en.wikipedia.org/wiki/Spanish_flu

Being prepared to defend against and then defeat an intelligent, organised enemy with a strong industrial base requires the maintenance of an incredibly expensive logistical apparatus with massive stockpiles of reserve materiel and operating capacity.

This is one of the few respects in which military wastefulness is useful, since those capabilities are repurposable for zero-sum games played against nature.

More like for NYC. NY is reporting more than half the cases in the US.

I really don't think they are doing enough. The virus is still growing at an exponential rate, and when you look at the other countries that managed to get things under control vs. the ones that didn't, the actions that NYC and the rest of America are taking fall squarely into "this looks like the ones that didn't get things under control."

Public transport needs to be disabled. People need to be required to wear a mask when they go out. Police need to enforce people staying inside.

Italy got the growth rate down to 15% per day. That's still enough to hit the whole population by early May.

> People need to be required to wear a mask when they go out.

Well, you can’t do that here because those masks don’t exist. We don’t have enough for healthcare workers, much less everyone else.

I think in this case any piece of cloth will do - we're not talking N95s. Basically, it reduces the likelihood of spittle etc. and so it reduces spread.

That said Taiwan, S. Korea, Singapore are all riding the Subways, going to Restaurants, going to work.

They're more aggressive with testing and tracking.

It also keeps your hands away from your mucus membranes. Just tying a bandana around your face is absolutely a useful mitigation. But staying home is better.

If anything it makes you touch your face more -- masks are weird and itchy, and they need to be adjusted when they slip.

There's good reasons why the CDC, Public Health England, The World Health Organisation, etc etc all say that masks don't work. ANd that's because they don't work.

> Just tying a bandana around your face is absolutely a useful mitigation.

This "protective" mask will helpfully absorb any moisture droplets and hold them in place in front of your mouth and nose, and you will breathe in the virus as these droplets dry out. https://twitter.com/MedtechMustKnow/status/12412950342860841...

The CDC actually says masks work if you dig down to details.

https://wwwnc.cdc.gov/eid/article/10/2/03-0730_article

During SARS, they reduced risk by 70%, and that’s among the general public, not healthcare workers. No reason it’d be different here.

The Instagram and Etsy crowd need to popularize fashionable home-made masks like the ones the new Slovakian president wears.

https://www.reddit.com/r/europe/comments/fmeyis/corona_fashi...

And day before https://i.redd.it/njkm2on8kwn41.jpg

It's probably not surprising to anyone who knows how industrial production works, but to a layman like me it's really surprising how hard it seems to be to produce more suitable masks in a short time. I didn't expect the supply chain and machines for such simple products to be that complex and hard to set up.

It's probably not hard to increase production, but it's definitely hard to increase it 100x.

I have no clue about softer materials, but setting up the tooling for making the simplest of plastic parts is a multi-step process where each step takes weeks. And, for roughly the same reasons as in software development, making that shorter is likely to be both expensive and drop some quality. With medical equipment you generally don't want to drop quality. So, if making these masks is any similar to the only industrial process I know about, we might have the needed capacity just in time for the autumn rebound.

Not surprising at all. First off you need screens, molds, and other one-per-machine equipment that has to be fully custom to whatever product you want to build. When expedited, these things can still take a week or more to create.

From there you need to assemble a pipeline and do an enormous amount of tuning. Your first runs are generally going to completely unusable products because of a large number of mistakes in the manufacturing process. It takes time (also generally weeks) to find all the places where errors are happening and make the appropriate adjustments.

When you are making 10,000 (or more) of something per day, no product is "simple".

That's what happens when manufacturing is outsource to China. They were able to ramp up by 20x and produce 200 million mask per day. As a comparison, 3M makes 300 million per year and said they will increase by 30%.

https://www.npr.org/sections/goatsandsoda/2020/03/16/8149292...

And the response is to tell people "don't worry! Masks don't help. They only work for doctors!"

See: https://www.nytimes.com/2020/03/17/opinion/coronavirus-face-...

Like inkjet cartridges, masks have a DRM chip: if they detect you are not licensed to use them, they stop working!

I don't think this is necessarily contradictory. Masks need to be worn correctly and not be reused. There's a good chance that a lot of people are wearing them incorrectly, and most people aren't going to have a sufficient supply on hand to avoid reuse. As such, they might give some people a false sense of security.

This article gets into some of the potential issues: http://blogs.hcpro.com/osha/2009/05/ask-the-expert-n95-respi...

It at least seems plausible that for the average person masks won't do much good and that it's much more important for health care and public safety workers to have access to them.

Since my N95 respirator supply is limited, I have been removing it in the car and spritzing it with 91% alcohol inside and out until moist. It is usually dry in minutes, and should be sterile for the next use.

I've been baking mine in a 350 degree oven

Interesting, hadn't considered that one...how long and are the 'rubbers' holding up? Also cheers on that article...I've been finding it confounding that both masks and disposable gloves are NOT being preached in all media, if one must go into confining public spaces.

The "rubber" seems to hold up fine. It's in a convection oven, I bring it to temperature, with a dish of water in it, and then bake it for 10 minutes. I have no idea if it's clean or not, of course.

That study is great, but why no UV-C tests? I’ve been using a UV-C decontamination box I made cheaply. It seems safe and effective for a couple of rounds of decontamination.

https://www.nebraskamed.com/sites/default/files/documents/co...

Was just studying on Far-UVC (222nm) as being much safer than C, yet more effective (literally second(s)) to kill virus..I suspect we will see vast deployments of this light coming to public spaces near you.

https://www.laserfocusworld.com/lasers-sources/article/16555...

https://journals.plos.org/plosone/article?id=10.1371/journal...

This study tried several methods of decontamination including soaking it in alcohol or bleach or even baking it in a rice cooker.

TLDR baking damaged it only slightly but alcohol and bleach significantly damaged it

https://www.researchgate.net/publication/320361295_Filter_qu...

which masks are we talking about here? cloth masks used throughout the population effectively reduce the transmission rate

Who is driving all the essential workers to work without public transport?

How can it still be spreading like that if people are staying indoors away from each other? I read that grocery stores even limit the number of people shopping at one time. Is it spreading though essential-type workers?

The typical latency between being infected and testing positive is quite long, I’d guess around two weeks. The new cases being reported now are from before the shutdown measures started in earnest.

There's a period of days between exposure and symptomatic infection. The social distancing started ~a week ago Friday (and ramped up over the next several days).

We are only beginning to see the impact from that, and it will be quite a few more days until we see the full impact (and with some states taking longer to put the measures in place, even longer).

Unfortunately social distancing in some states didn't start until two days ago.

> Italy got the growth rate down to 15% per day. That's still enough to hit the whole population by early May.

We won't know the lockdown's effect until all the severe cases from people who got sick pre-lockdown have shown up at the hospital. That will be in the next few days. If the number of new reported cases starts to drop from day to day, we'll know they succeeded.

If not...

It's hard to accept that Italy hasn't even been under water for a full two weeks yet, it feels like months.

But I guess you are right, Italy didn't really crack down until early March.

Do you have any data or is this idle fear mongering? We're living through a man made disaster and you say we aren't doing enough?

Look at the (higher quality) data from Germany and SK. Very low mortality. 99% or more do not need medical treatment. Yet the societal devastation is already immense and harming much more than 1%. It's uniquely bad in Italy. Not entirely clear why. But even there the vast majority of affected people are elderly and have other co morbidities. So let's put it in perspective when we're cancelling our children's future.

I agree with masks. That just makes sense. Martial law keeping folks inside? You're living in a fairy tale.

I don't think we should do nothing, even though the worst case scenario of doing nothing is less bad than what's already happening. But what we are doing is totally wrong headed, rather than "not enough". We need to focus on protecting vulnerable groups, not indiscriminately turn everyone into a victim.

> It's uniquely bad in Italy. Not entirely clear why.

Aging population that generally lives in multi-generational housing or at least in close proximity. The US, especially in blue states, is unique in how separated different generations are physically.

Also a hypothesis that seems plausible as a factor: Smoking. Italians have more of a history of smoking than any other affected area as of yet. Smoking could also explain why the mortality skews more to men over women.

Oh yea, smoking too. That would also explain what we observed in China. Almost everyone who smokes in China is a man because there is a stigma that the only women who smoke are prostitutes (or at least that was the case when I lived there over a decade ago). Something like 30% of China smokes, but almost all of those are men, making it over 50% of men smoking.

"In 2015, smoking prevalence was 27.7% (52.1% among men and 2.7% among women)" ref: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6546632/

> I agree with masks

The problem in germany is that we don't have enough masks to give them to everyone. Right now we have to acquire enough so that our healthcare-system doesn't suffer. It's being discussed, but is seems that there's currently no way to make it work here.

Why are people forgetting they can get infected through their eyes? We need protective eyewear in addition to N95 face mask + gloves.

According to

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

the NY numbers have more than doubled today (from ~10k to ~22k). What is happening? Are some belated test results coming in?

EDIT: Numbers were just corrected, are now at total ~16k with ~5k new cases. Still high growth, but more reasonable.

New York state has been increasing testing pretty rapidly. A few days ago they were at 10,000 a day.

They started testing in mass the last couple of days, so you see the spike...

New York is now testing more daily per-capita than South Korea and China, so naturally due to the higher test rate (which gives ability to find the clusters) New York is going to pull ahead of the rest of the country because it will have the ability to actually show the cases that are active but weren't able to be tested.

I think there was a typo. Earlier this day, NY had +5k. Then it went to +12,345 (which looked like a suspicious number to me). And now, the number is back to +5,429.

It's still growing fast though.

I think generally the case numbers reflect more how much testing is being made in the country than how many people are infected. I think I got infected, called a relative of mine who is a doctor and followed UK guidelines which is to self isolate. So I appear in no statistics whatsoever. As the vast majority of people with none or mild symptoms. I think you can pretty much ditch the official case numbers as meaningless.

The numbers seem to update in a weird staggered way; for example right now for New York I see 15801 + 5429, which is right about the +33% the US has been seeing since Mar 1.

There is a lot of noise in the data but the general trend is more than clear.

In Massachusetts we were told the numbers would go up quickly because there were a lot of results backlogged at the CDC.

I wish I knew where the official numbers were coming from. For a while we’d hear about “presumptive positive” cases, where a person had tested positive according to a state test, but it wouldn’t be counted until confirmed by the CDC. I don’t know if that’s still the case.

It's a reflection of improved testing, but it is also an indicator of how bad things really are. The reason for the huge jump is that the virus has been spreading unchecked and undetected for much too long.

I am very curious about the "technical issue" that is preventing NY from receiving aid in the relief bill.

https://www.syracuse.com/coronavirus/2020/03/loophole-in-fed...

Apparently, it prevents states from making changes to Medicaid this year, but NY already did.

Honestly, if this goes through, New York should just bus people to the closest states that got the coronavirus bill money.

This should ensure that people get the proper care and definitely won't cause large amounts of spreading outside of New Tork.

I know I may sound naive asking this, but wouldn't it just be easier to change the Bill? If the bill doesn't help New York, what good is it? It should provide Coronavirus relief for everyone in the nation who needs it.

But I'm not a political type, so if I'm thinking about this wrong I'm open to being corrected.

This didn't just happen... someone wanted to screw one of those liberal states in this democrat hoax...

If that be the case, I mean, yeah, just, no words.

I'm disappointed I guess.

I've always had limited faith and political and economic leaders, but this crisis has really just cratered the little faith I did have.

Let's screw the liberal states?

Let's make a few bucks on the stock market?

Just, wow. Can't even be angry really, I don't deserve any better. In a democracy, you get exactly the leaders you are deserving of. I guess I know how much we rate. Lesson learned.

Also keep in mind the proposed $1000 check has a salary minimum in order to qualify, not just salary maximum.

I suppose the poor cannot vote you out if they are dead.

Wow. Didn't know that either.

Just, yeah.

To not only do all the stuff that our politicians, of every political stripe, are doing, but then to screw over the poor at a time like this as well?

I think I'm done here for the day. I'm pretty sure I don't want to know anything more about what the politicians are doing.

Yeah, $75,000 maximum, $18,000 minimum...

If you make $75,000 in New York, you're probably homeless... but in the red states that's fuck you money.

New York votes for Democrats. Making them suffer and look bad is part of Trump's campaign.

Cuomo addressed this in the press conference. I believe it relates to Medicaid. New York modified some Medicaid rules in January and the relief bill won't grant money to states with modified Medicaid rules. He didn't get into specifics, but said that the bill needed to be updated.

I am as well, but overall I’m very frustrated by the lack of coordination and leadership overall. This combined with de Blasio’s proven inability to lead is making the situation much worse than it needs to be.

This is a pandemic. Across country and state lines.

Any response that is not federal is going to struggle.

The buck stops solely at the white house and congress for failing to see the warning signs and properly respond.

I think they saw the warning signs. [0]

[0] https://www.opensecrets.org/news/2020/03/burr-unloaded-stock...

Cuomo OTOH has been quite effective at working with the administration to ramp up testing to the highest throughput in the nation, as well as enacting other measures, and getting FEMA involved, while DeBlasio's response was pretty much only to point out that "orange man bad", and dragging his staff around with him to infected areas. As of 2 days ago, he went to the _gym_.

If you listen to WH pressers, you will see that federal government wants the governors to do what they can to procure stuff and enact measures for their states, and step in when the governors feel their response will be inadequate. Which is what we're observing in CA and NY as the governors of those states chose to put politics aside for the time being and actually engage.

The reason for delegating frontline response to the states is that if the federal government steps in to buy medical supplies for example (which BTW it still does from time to time - they ordered $500M worth of N95 masks yesterday), such a purchase would first soak up available capacity, and then it'd have to be disbursed to the states, instead of going to them directly, adding delay and confusion.

FWIW, I have not seen this level of coordinated response to _anything_ and I've been in the US for 20 years now. I did not know some of the things that are being done are even possible. FEMA and Army Corps of Engineers started to step in massively over the past week. Companies are starting to make ventilators. Drugs and testing equipment are approved for use in weeks instead of years. The list goes on.

>Cuomo OTOH has been quite effective at working with the administration to ramp up testing to the highest throughput in the nation

Let's be honest, Cuomo just went out and outbid everyone to get the materials his people needed. He didn't work with the admin to do a thing, he waved money around in the global marketplace. Not hating on him, that's his job. He's supposed to look out for New Yorkers. But a lot of states out there don't have New York's bottomless checkbook. Nor do they have New York's influence.

Easy to look good when you're not really depending on the federal government for testing throughput. Again, guy's done a great job. But he's done it by circumventing the limitations set by the administration not really by living with them like the rest of us have to.

Anything to back up your claim of him out bidding everyone else? I believe right now there are restrictions on price gouging for necessary supplies.

"Cuomo also urged the federal government to nationalize the effort to acquire protective medical supplies — including masks, gowns and gloves — that are in short supply. He says masks that used to cost 85 cents are now priced at $7 as states are forced to bid against each other for limited supplies."

https://www.npr.org/sections/coronavirus-live-updates/2020/0...

Now imagine an entity which can literally print money outbid _NY_ and sent a substantial part of that capacity to WA (which initially was the epicenter, but where there were no new cases in the past 24 hours) and CA (which seems to have much less of a problem), as well as to the remaining 47 states where the number of cases is pretty low. Imagine what that'd do to NY and their case load a week from now. I'd like to also remind you that the three states hardest hit by the virus have some of the deepest pocketbooks in the nation. CA and NY have huge economies. WA has two of the richest people in the world who they could "ask" to "share their wealth" as it were.

This is likely true, but he would be the first to admit it. Cuomo has been publicly begging the federal government to step in for a while.

There are so many unfair takes against politicians these days it’s hard to tell who is actually right anymore.

It’s good people are holding them up to a high standard (elections are regularly presented as choosing the lesser of evils) but when all of them seem to be getting killed it makes you wonder if it’s just the nature of the beast. Especially in the west.

The few who have gotten praise (South Korea) were the ones that were more likely to ignore WHO and bypass other typical established political processes, allowing them to react quickly - and are by far the rare exceptions, not the rule.

‘Government’ and ‘moving quickly’ are rarely things you see in the same sentence in normal times, nor would ‘good’ politicians typically be defined as the ones who ignore the recommendations of international organizations, but yet it’s something everyone thinks can immediately be fixed on demand like flipping a switch.

> There are so many unfair takes against politicians these days it’s hard to tell who is actually right anymore.

Here is a handy guide:

- If they are angry at the media, they are confused and should be muzzled for a time

- If they are exercising insider trading, they should be removed from office

- If they are coordinating and appear to be going to too much of an extreme regarding lockdown and response, they are actually well informed and should be granted additional responsibility and leadership, if capable

- If they are offering help to business but not individuals, they should be muzzled for the extent of the crisis and not allowed to submit amendments or legislation

- If they are deliberately slowing down responses, they should be muzzled for the extent of the crisis and their decision powers be given to their deputies

- If they are ensuring the public nothing is wrong they are incorrect and should be muzzled for the extend of their crisis, and their decision and executive powers given to their deputies.

These heuristics would ensure incompetence is kept in its place -- away from the lives and livelihoods of individuals, and ideally removed from office during the next election cycle as incompetent politicians have no business executing the will of their constituents during wartime or peacetime.

> "The Governor also issued an executive order temporary closing the Department of Motor Vehicles for all in-office visits. Online transactions, including for license renewals, are still be available."

It seems a bit dated to even have in-office visits for things like driving license renewals. The UK equivalent, DVLA, closed all their office counters a few years back. Now everything is done online and by post.

There's still things like driving tests that need to be done in person how do they do those? Most things can be done online but they keep the locations open for things like RealID and driving/vision tests.

Driving test centres still operate as before. You register, book, and pay for your test online, then go to the test centre at the booked time.

But routine things like vehicle taxes, license renewals, updating addresses, etc, are all done online.

That's basically the same for me in North Carolina, only a few things /require/ you to go in to the DMV. We do have the complication of having many states and having to support people getting a new license in the state they move to so there's a constant need for people getting new IDs which needs in person to gather the info and documents about the person.

On the contrary, I wish we'd be more aggressive about drivers licensing. The whole process is fairly meaningless.

My mother-in-law barely has enough motor control to turn the key to start the car, yet somehow she just renewed her license. People like her need to be taken for a test drive, not allowed to renew online.

That more of a retesting requirement than a renewal problem. We can have both, easy online renewal for most people and an age cutoff for people where they require periodic retesting.

You can do a lot online with the DMV, but not everything.

That said, the DMV is probably one of the most archaic, bureaucratic and dysfunctional government services in the US.

Ripping on the DMV is a part of US popular culture for a reason.

Here is the very informative briefing Cuomo gave today [1]. Quick facts for the state of New York:

1. ~15,000 cases of confirmed COVID-19

2. 114 individuals have died from COVID-19

    a. 70% of deaths were ages 70 and over and "majority" had underlying health conditions.

    b. ~80% of those who died under the age of 70 had underlying health conditions.

3. 18-49 years old represent 53% of all confirmed COVID-19 cases.

4. hospitalization rate of 13% which is very good, flattening the curve works. Stay inside.

Cuomo has mandated the City of New York to hand over a plan in 24 hours (as of today) to outline how exactly the local governments will curtail overcrowding in parks and other public places. When asked why Cuomo can't do this himself, he stated in a fair manner that while he does have the power to do so, he would not be as apt to devise the plan as the local governments are. This is the right move.

Gov. Cuomo made a similar judgement when pressing the federal gov't to curtail fed regulations and to allow him to open over 200 labs available within the state of New York to provide faster testing than what the federal government was able to do.

This opening of state-wide labs is why NY has nearly 15x the number of confirmed COVID-19 cases when compared to the next highest, the state of Washington. NY also has a more accurate hospitalization rate because of this, which is a very important number to be tracking when figuring out how to "flatten the curve" which currently sits at 13%.

Governor Cuomo is following the playbook of South Korea as effectively as possible in this current political climate and has successfully deployed every move available to him and helped push federal barriers down to allow NY to attack this virus faster than any other state. He is showing leadership that everyone wishes to see at the Federal level.

Having all of these laboratories in the state of NY makes me grateful every time I think about how much I pay in state taxes. But I can't help to think about how all of the bloodshed is a direct result of the failure of leadership at the federal level to be proactive about the situation. There is nothing of greater importance than every individual human life. The federal government sacrificed these people and all the people who will suffer and die in the future in the name of better polling numbers, placating a fan base, and keeping stocks afloat for a mere month longer than they would have.

Edit: Moved 53% statistic into its own bullet. Don't know know why I had it as a sub-bullet of the deaths statistic.

[1]: https://www.youtube.com/watch?v=RjbIVnnMT18

Perhaps residents of WA will now contemplate the wisdom of higher taxes.

I suspect Washington will have an income tax roughly around the time we've got a functional self sufficient colony out on Ganymede.

WA resident here, I am quite happy with the response here relative to many other places.

UW has been running 2-3k tests per day for much longer than the NY testing apparatus has been spun up, we've actually run more tests per capita than NY (though I expect things to look more normal soon), with additional capacity coming online soon. Those tests have maintained a ~7% positivity rate, which is good news.

We were some of the first to report community transmission thanks to the hard work of our research community.

In addition, the business community in the Seattle area worked to push people to WFH long before other places, keeping hundreds of thousands of people from being potential vectors for spreading COVID-19.

Frankly I don't think now is the time to be making remarks like this. WA is not perfect, but it does not boil down to tax rate.

I took a covid test on Tuesday. Still haven't gotten a result :/

The state tax rate in NY has nothing to do with this response (that seems quite good) to the COVID-19 pandemic. The labs that will be performing these extra tests are private labs, not labs funded by NY state taxes. I wish people could separate their criticism of the different governmental responses to this pandemic from their preferred stance on domestic tax policy.

AFAICT the State of New York is contracting out these labs directly and paying for all of the testing.

The expenses involved in the response to the pandemic aren't in any state's budget. All the states are going to petition the federal government for aid and the Fed is going to print money to cover it. In other words, we're all going to pay for it through inflation. Honestly, that's probably not the worst outcome, but there's no way any individual state, high tax rate or not, was going to be in a position to respond to a severe pandemic like this.

The California and New York legislatures were already seriously looking at funding single payer healthcare in their states, largely pending a cooperative federal government. Covering the cost of hospitalization for at most 15% of their states would be a drop in the bucket. I wouldn't be surprised if California, Texas, and New York would be able to raise $100+ billion each in state bonds on rather favourable terms for healthcare expenses and direct stimulus despite the federal liquidity injections (or because of them, I can't figure whats going on there right now). It's not enough to keep the economic regions from collapsing and taking the rest of the country down with them long term, but it's probably enough for the people there until the federal response is adequate enough to take over.

If we're talking about the massive bailouts that'll need to happen for national security's sake, then I agree fully. There is no way any state can go it alone and at that point at least inflation spreads the pain a little bit more fairly, considering how bad multiple metropolitan regions collapsing would be for the rest of the country.

We have a well-funded state university system paid for by tax dollars which provides these labs with competent, well-educated employees. But yes, these labs are not directly funded by state dollars.

yes private universities like stanford and harvard would have no way of creating competent well educated employees. do you have proof the employees even when to state schools?

> Having all of these laboratories in the state of NY makes me grateful every time I think about how much I pay in state taxes.

Those labs paid for by federal money?

Nope most are private labs! But what do you think drew these labs to New York? Possibly a well-educated populace driven by a successful state university system funded by tax dollars? You better believe it!

2.c is not related to the 114 who died, is it?

No - sorry for the confusion.

18-49 year olds represent 53% of all confirmed COVID-19 cases in the state of New York.

Thanks for clarifying!

It’s interesting that you are “relatively” optimistic about the situation in New York. I’ve been watching Mayor De Blasio in the recent weeks, and, he seems to have become more and more nervous over the course. Almost desperate. Maybe he is just playing it or he is not as cool as Cuomo, who, granted, does a good job so far.

> But I can't help to think about how all of the bloodshed is a direct result of the failure of leadership at the federal level to be proactive about the situation.

I feel like this is hindsight thinking and it is also a waste of energy and divisive at this point in the situation. We should all be focusing on what to do next. There will be lots of time for retrospectives afterwards.

> a. 70% of deaths were ages 70 and over and "majority" had underlying health conditions.

> b. ~80% of those who died under the age of 70 had underlying health conditions.

Underlying health conditions is a very broad metric. It could mean something as simple (possibly I don't know for sure) as 'high blood pressure'. I think we'd like to think of it as more severe than what that category includes.

It's similar in a way when their is a fire and the local papers say 'had several building code violations'. Without knowing what the violations were (and if they even mattered to the fire) I don't think many conclusions could be drawn.

And this assumes things are even categorized correctly in the first place.

Of course 'age' is age so that is most likely an accurate metric.

I agree. I don't like having underlying health conditions listed as a statistic. I think it leads to people thinking "oh it only really affects people who are sick" and then those people go about their day as usual and spread the disease further. I didn't want to skip over it though out of fear of someone saying I tried to frame the stats to fit a narrative or something.

The NY governor in your video cited that 40-60% of people are going to get it (20 min mark) and the same thing was said by CA governor a couple days ago too (56%): https://news.ycombinator.com/item?id=22633570

So it seems like there's a consensus within the top-level leadership that containment is impossible. I still don't understand why we've given up when China managed to do it.

My understanding of containment is that it is only effective when testing and tracing are radically pursued. There just are not enough resources at the state level (at this point) to do this with the effectiveness China has managed to do it. So we are left with one tool to fix this which is flatten the curve to not overwhelm the healthcare system and lead to further deaths. South Korea has been doing a lot of tracing and they are starting to see this as a great success, but mostly due to south korea's ability to track phones of people diagnosed positive.

We could do that too, if there was enough social trust to make it politically acceptable (the tracking, that is).

I think they mean over the next few years. This virus is in every city in the world, we can't contain it everywhere. Eventually its just another endemic disease, but one we can vaccinate for and treat at a steady rate.

I don't get the "NY is testing more" claim. Based on the data I have seen https://coronavirus.1point3acres.com/en/test NY tested 61401 so far with 15168 positive for a positive rate of 24.7%, while WA tested 27121 with 1793 positive for a positive rate of 6.6%. NY testing seems very restrictive. CA is now limiting tests due to shortage of swabs and PPEs.

A couple of observations:

First, most of what’s out there in the media and popular discussion is nothing less than ignorant. Sometimes I feel people watch too many movies and think they are real.

Under normal conditions it can take over a year to go from nothing to making something as simple as a certified N95 mask at scale. Under normal conditions component lead times in electronics can easily be in the 8 to 16 week range. Not to mention such things as manufacturing tooling, molds, test systems, etc.

Making hardware is hard for a reason. It takes time, and money can’t always accelerate the timeline.

And so, reporters pounding away at test kit, mask or PPE is ignorant and counterproductive. Making 100 million masks in haste could result in ineffective masks that provide little protection.

This problem is exacerbated by a supply chain that has been the subject of major disruption.

The sad reality is, when you don’t control the entire supply chain you can only accomplish so much. This is surely a lesson that might change the world post COVID-19.

Aside from that. It seems to me converting cruise ships to temporary hospitals might be the quickest way to expand capacity. They are self-contained little cities with rooms for thousands.

This effort should be commended. However, I'm wondering, where are all the billionaires and corporations when the world needs them? I'm not even asking this flippantly. Seriously, how come they're not doing anything? Just for the past few months Bloomberg spent half a billion essentially to achieve nothing.

Couldn't he repeat the feat and build a few hospitals to help out his home state? Or his country? How about everyone else?

I believe he could repeat that feat 120 times and still be a billionaire.

Indeed. Maybe we should demand it of him and of others in his position.

Regular people are placed under a tremendous burden all over the world and they are expected to cooperate and to sacrifice.

The very least the rich could do is shoulder part of the financial burden.

* 1 billion...

Does anyone know if it is possible to volunteer for the Army Corps of Engineers?

All of those shipping container to modular homes should be working on making mobile hospital wards.

Doesn't need to be fancy, just functional and better than being in a tent.

Need someone to coordinate it though.

At current pace the whole US will be infected by May (I wonder, whether the market have priced that in already).

To be fair, the market isn't pricing deaths of old and sick people. It is pricing the suppression of economic activity as a result of the lockdown. If the whole of the US were really infected by May and if by June the lockdown would be off and the virus in the rear mirror, you would see a big market rallye.

This blog post covers the math of why this is necessary

https://medium.com/@donnellymjd/covid-19-nyc-should-brace-fo...

Why didn't we start a month ago? 6 weeks ago?

The United States jumped from position 20 or so on the world ranking for the number of cases to spot number 3 in a manner of days. NYC doubled overnight. There was an article published all of seven hours ago that claimed the US was #4: https://www.newsweek.com/u-s-now-has-third-highest-number-co... it has already been made outdated by developments: https://www.worldometers.info/coronavirus/ .

Wonder what degree of revisionism the 'it is just a flu' crowd will engage in where they are on the record.

Very important:

1. Gov. Cuomo announces trial of hydroxychloroquine and azithromycin to start in NY

https://www.cnbc.com/2020/03/22/coronavirus-ny-gov-cuomo-say...

2. CDC: Healthcare workers OK to use homemade masks (bandana,scarf) as last resort.

https://www.forbes.com/sites/tjmccue/2020/03/20/calling-all-...

“Healthcare personnel (HCP) use of homemade masks:

In settings where facemasks are not available, HCP might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort. However, homemade masks are not considered PPE, since their capability to protect HCP is unknown. Caution should be exercised when considering this option. Homemade masks should ideally be used in combination with a face shield that covers the entire front (that extends to the chin or below) and sides of the face.”

Although NY is probably seeing an explosion in infections, this doubling is probably not a true growth in number of cases overnight, but instead representative of massively increased testing in NY.

That's true.

But an actual doubling, measured by the number of people who can't breathe in a hospital currently takes 3-4 days.

Is there a reliable link to the number of people on ventilators? I've only been able to find time series data for number of deaths. Which is helpful, but way too much of a lagging indiactor.

The 'critical' column on worldometers is a starting point. The general consensus is that the deaths are the most reliable, the criticals are somewhere in the middle and verified cases the least reliable due to lack of tests. But it is hard to fudge a death.

For the US that critical column as been way out of date (just from what I knew of one hospital vs what it was reporting for the country several days after; I don't know if it is still far out of date).

> But it is hard to fudge a death.

Not that I think the number of cases is grossly overstated, but Italy lists deaths from coronavirus if the patient dies for ANY reason while they are afflicted by the coronavirus. This would be the source of some "fudging" of the numbers.

> But it is hard to fudge a death.

One country (Germany, I think?) doesn't or wasn't including people who weren't tested before dying, so had a really low rate.

Yes, absolutely. Even so, and even if there is a lot of noise in the data the trend is alarming to put it mildly. With earlier testing and a more transparent picture people may have taken the warnings more serious. Now they are partying like it is 1999 and the results of that will only become visible two weeks from now. By the time tests will be more common across other populous states the USA will likely be the #1 country in the world regarding case count and the delayed response means they'll peak a lot higher than China.

This is far from over.

The rate of spreading is still >> rate of testing

How do you know the rate of spread if you can’t test?

Increase of testing is 300% a day at times. For infections to increase greater than that you would need each infected individual to infected 3+ people a day. You may mean that the number of infected is still higher than the number of tests available

The only way to stop the spread is to have accurate testing and a population willing to abide by quarantine measures on a voluntary basis when tested positive as well as immediate tracing of contacts. Anything less than that and the spread will continue.

I'm amazed they managed to scale testing.

I was wrong. Been in isolation now for 9 days.

From what I can tell (even here on HN by a few bad actors), they seem to have pivoted to a “we simply can’t do this to the economy; it’s not an option for a disease that only kills old and sick people”, without the faintest hint of a plan for what they’d actually do given what we know and the resources that we have.

We can all wish for the culture, test availability, and competent government that South Korea and Singapore and Taiwan apparently have, but we don’t have those. So their “plan” is effectively a plan to just let millions of people 60+ or with pre-existing conditions die without much effort to save them. It’s not only unconscionable, it’s incredibly stupid. Do they think we’re just going to go back to work and restaurants and on vacation while millions of our loved ones take their last gasps in a converted convention center somewhere? The economy grinds to a halt either way, and there’s no moral or political path forward for what they want to do. Which is why they don’t have the courage to even spell it out, it’s just some magic handwaving about how we must do something different.

And all this against the backdrop of them and people like them downplaying this from the start and putting us in this position.

> We can all wish for the culture, test availability, and competent government that South Korea and Singapore and Taiwan apparently have, but we don’t have those. So their “plan” is effectively a plan to just let millions of people 60+ or with pre-existing conditions die without much effort to save them. It’s not only unconscionable, it’s incredibly stupid.

Why we had to wait until a crisis like this for this to be rendered bare for the wider population?

As I've said countless times before, the West has been on the downward trajectory for a very long time, both as a society, and as state entities.

What I call an "ultrapopulism" has been an ever growing trend in the West since around mid-nineties.

The Western nations are not just weak as societies, and nations, they are diseased (sorry for having to use this word now.)

The reasons for me moving from comfy life in the West to China is not because I so much enjoyed it, but for me having a realisation that this accelerating downward trend will have very real consequences in my lifetime, and that even money alone no longer favours the West.

Well, lets not forget that this whole mess started in China. It was the chinese government which decided to hide information and pretend everything was under control while allowing it to spread all over the world.

> Well, lets not forget that this whole mess started in China.

Yes, China is a patently dysfunctional society. This is what I can say as person whose life and career depends on it, and who actually lived there.

I'd say the "good" performance of Chinese state looks like that only in comparison to catastrophically bad showing from Western nations.

20 year ago, I would've said that what China did after the monumental screw up at the start, would've been an expected level of response from an upstanding Western nation. Now, the West can not do the same what it could've done 20 years ago easily. That's the only message for that particular point.

Is Chinese society a healthy, functioning society? No, but at least critical parts are still coasting on inertia from the time China had half sane political leadership.

Is the West a healthy, functioning society? Some things there work, but the most important, critical parts are failing in broad daylight, and people don't damn care.

The response to this from the western world has indeed been disgraceful. China's was too. They managed to contain due to their authoritarian policies but the real examples of good responses from asian nations are SK, Japan, Singapore, Hong Kong, Taiwan. They've managed to contain it much better than anyone else without the need of massive government overreach.

This crisis was a very good slap to the face to Chinese establishment. It was very much needed for a long time.

I heard even most hardcore communists starting to question Xi's mandate to rule now, and how much such a weak leader is costing them.

What I heard myself was pretty much a question "What if it was a war?"

Were Xi to hide in a bunker when the military can't do anything without his explicit approval, they would've been screwed.

Isn’t the South Korean government known for massive amounts of corruption between itself and entities like Samsung? The good does not wash away the bad, nor the bad the good...

This is the point worth talking.

I'd say that even overt corruption is not necessarily a white or black determinator on the overall health of the institute of government.

South Korea is not only known for "Samsung bribing *," but also countless successful cases of corruption prosecution, including 2 Samsung CEOs in a row going to real jail.

In overall, a health on the very top of society stems from strength at the bottom.

Another counter-point to the inhumane position you're rebuking - one which speaks to people's self-interest - is that as the healthcare systems become overwhelmed they will eventually stop treating conditions and accidents which afflict everyone including young people.

Not all Americans are doing that.

I am actively trying to promote work from home options and mostly being ignored.

I am actively trying to talk about home health care options. It's been extremely controversial, so I am reluctant to push too hard.

There's a lot of disinterest or active blow back against any attempt at a grass roots movement in the absence of sufficient leadership from the top.

Given how powerful America is, it's not unreasonable for the world at large to be concerned.

Doreen, your home health care options are good, and I appreciate your comments! You're not making ridiculous claims or pushing some off-label drugs.

I told several friends about your advice to prop up your head and back in bed when feeling shortness of breath.

Cautiously I also recommend tonic water for a cough - not because of a medical benefit, but because the bitterness makes sputum in my mouth and that soothed my sore throat. Also wasabi for a blocked nose. Normally I think cough medicine would be better, but I know that pharmacies are overloaded right now. I also think the placebo effect is very real - doing something positive might help, instead of just sitting and worrying.

Please don't recommend things for a cough that you clearly know nothing about.

Tonic water absolutely has a medical history. It's not hard at all to find that out by reading the label and doing a little online research.

It makes me extremely uncomfortable for you to talk about tonic water for a very long list of reasons.

Because it contains an actual for serious drug -- quinine -- you can get serious side effects from overusing it. These include vision problems, headache and nausea similar to migraines. IIRC, you can cause yourself permanent vision problems.

Because it's a powerful alkaloid, overuse can cause your stomach to become too alkaline. This can cause you to be unable to digest food and can result in vomiting.

The name "tonic water" is medical in origin. The bitter flavor you speak of was common to a class of medicinal herbs typically referred to as "bitters."

Quinine is a drug related to the drug currently being tested as a possible treatment for covid19: Chloroquine. So casual and uniformed use of it could create resistance in the virus, making actual medical treatment less effective in the future.

I highly recommend you keep a journal and actually read up on anything you are finding personally helpful.

I'm not here trying to tell people what to do with home remedies for casual use. My consistent framing has been "If the shit really hits the fan and doctors have nothing for you, there are other options that may make sense to gamble on if your options are take a chance or die."

I know a helluva lot about medical stuff. My mother wanted to be a doctor and she personally changed the practices of two cancer clinics when she kept my dad alive after they wrote him off for dead. I have another relative who works at the CDC and has for years.

I've been surrounded by medically knowledgeable people my entire life. I also absolutely don't hawk home remedies.

I've spent a lot of years trying to figure out if there is any way to effectively share what I know about CF and other health issues to either be helpful or to somehow get actual medical professionals and scientists to do studies.

I would love to finally have credibility and be taken seriously in the world and have actual respect.

And it matters vastly less to me than avoiding potential harm to potentially millions of people because I'm cute and charismatic and people want to be my fwend and it goes amazingly bizarre places and always has.

I know you mean well. I know you think I'm pathetic and sad and a social outcast and a poor person and you think you are doing something nice by publicly patting me on the head.

I absolutely don't see it that way. I'm extremely uncomfortable with you and other people here clearly desiring some kind of feel good emotional attachment to me personally as your primary goal of engaging me, very much at the expense of best practices for disseminating medically useful information.

The tonic water that is available without prescription is too dilute to matter as a drug. You would get the permanent vision problems after using it daily for about 500 years, except that you are unlikely to live 500 years anyway.

Historically, a gin and tonic was developed to be used as a prophylactic against malaria for British soldiers stationed in areas where malaria was a problem. So it was a medicinal drink. This is easy enough to verify:

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

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

https://flaviar.com/blog/gin-tonic-history

http://activehistory.ca/2012/08/gin-and-tonic-a-short-histor...

I've done the math. I know how much tonic water you need to drink to be roughly equivalent to being prescribed quinine as a drug for medical use.

It's a lot, but not so much that you can't consume that much in a single day. I'm not posting the figures I remember here because I'm not interested in encouraging people to do something like that.

That tonic, used by British soldiers, is not available. You can get something with less than 1% of the concentration.

I am actually terrified about home remedies regular people provide without deep understanding of human physiology and medicine.

Please refrain from providing advice to people if you're not in the position to do so unless you're a medical doctor. It sounds good hearted but this is exactly the kind of things we shouldn't be perpetuating. You can cause inadvertent loss of life in worst case.

My parents are forwarding all kinds of shit from social media from fake vaccine news to completely insane home remedies such as going to a sauna when you have fever to "kill the virus". I am not suggesting you're doing this, but just to illustrate extreme case of misinformation.

Yes, I know. I've actually been around this block before.

I have a form of cystic fibrosis, as does my 32 year old son who still lives with me. I left all the CF lists years ago because people with CF live in terror and mostly don't want to take chances on trying anything not prescribed by a doctor, even though they are facing certain death.

Doctors don't know how to fix them. When I was diagnosed in 2001, life expectancy in the US was age 36.

Like anyone who has CF or who has a loved one with CF, I know quite a lot about germ control and daily home management of potentially deadly lung problems. Unlike most people with CF, I'm currently drug free. My condition is managed with diet and lifestyle.

I think it's outright irresponsible to say nothing at all in cases where I know a thing and no one else is speaking up, even though I surely an not the only person who knows X. I've mostly spoken up to say, essentially, "If there aren't enough ventilators to go around, airway clearance techniques have been around forever and some of them are non invasive and don't require mechanical intervention. You may still have options, even if the worst comes to pass, the medical system is overloaded and you are trying to survive a deadline epidemic while locked down at home."

If you want to see my past remarks, I've added the link to that discussion to my profile. I'm disinclined to do too much cage rattling on HN in discussion.

I'm currently working on developing a blog in hopes of putting together useful information about best practices for simply avoiding germs in day-to-day life.

I think I know a lot of useful information. I don't think I'm behaving irresponsibly.

I'm still trying to sort out for myself what I think works going forward. I don't think there's anyone on the planet who can tell me what that is.

Please don't do any of this. I beg you.

If you want to help, volunteer in a hospital.

I absolutely cannot volunteer in a hospital. Cystic fibrosis puts me in a high risk category. That's like asking me to intentionally become the Typhoid Mary of covid19.

I see, perhaps you can then you can:

- Spread information about hygiene, CDC recommendations on how to prevent spread of Coronavirus and reiterate/ephasize the importance of washing hands/cleaning public spaces.

- Donate money to medical research, who knows, some of these home remedies may be useful. But not without getting the research done first.

You don't see the danger of providing medical advise to others? I've been wrong many times of something that I thought was intuitive to me but ultimately there was a "oh..." moment when I saw experimental results or some concrete evidence.

There is also a network effect - you say X to person Y. Person Y tells X to 10 other friends who then tell 1000 other people. The misinformation that started from you could potentially affect a lot of people and then you start having deep thoughts such as - I tested X on myself and it worked. But now 100,000 people are doing it - is it safe?

This is why you should stop from providing medical advice to others. I am saying this with respect to you and your earnest intentions from heart.

Cystic fibrosis is supposed to cost up to a quarter of a million dollars per year for medical care per patient. Two members of my household have it. I've supported us all on well under $20k annually for at least eight years and we were homeless for nearly six years.

I often have insufficient money for food. Yet, we are still alive.

I respect your genuine and valid concerns about giving advice in situations where you don't know what you are talking about. Trying to give me advice to do things like volunteer in a hospital or donate money I don't have falls in that category.

Maybe take a few minutes to at least look up cystic fibrosis before commenting further about what you think I should be doing.

They aren't wrong about the sauna.

The whole point of a fever is that the higher temperature harms the disease organism more than the host organism. It is in fact to "kill the virus".

The sauna supports that. The same goes for anything else that would enable the fever of course. You could instead eat hot soup, wear a jacket, or adjust your thermostat.

Going the other way, cooling yourself to suppress a fever, blocks a natural response to infectious disease. Don't do that unless your body has overshot the proper fever temperature by a long ways, to the point that you are at risk of brain damage.

It seems to be happening everywhere:

Netherlands: TOTAL CORONAVIRUS CASES QUADRUPLE IN A WEEK TO 4,204; DEATH TOLL REACHES 179

https://nltimes.nl/2020/03/22/total-coronavirus-cases-quadru...

We can’t build temporary quarantine centers, hermetically sealed units, gas mask or ventilators. We could predict all this and did, but incompetence. We could had made a coronavirus vaccine that could had potentially worked now, years ago. We could have general tests or fast tracked specific tests months ago.

All this seems like a much bigger problem than the virus itself. Our system is incapable of being efficient, effective or proactive.

> We could had made a coronavirus vaccine that could had potentially worked now, years ago.

That isn't really true. Some viruses are more susceptible to vaccination than others but all have one thing in common: about 12-18 months between the first confirmed sighting of a virus and the time to make a vaccine if one is possible. And for plenty of Viruses we have not been able to make a vaccine and some of those are coronaviruses.

And they are entirely ignoring the impact of this virus on our healthcare workers. Due to high exposure levels to the virus, they are at much higher risk of not just getting infected, but also developing higher severity of the disease.

We need to make "Support our Healthcare Workers" a bigger part of the messaging strategy. They are on the front lines of this battle, and when we fail to implement control measures, we are putting their lives at risk.

US was delayed with the onset compared to Europe and the rest of the world. This is not some competition that lowest number of cases wins. If anything else, you need to account for cases/capita. Furthermore, India, a country of 1 billion+ citizens has less than 1000 cases. Why? Because they haven't got enough testing capacity.

Please stop this ranking nonsense. It is not helping in anyway. If we want to assess how effective each country will fare - look no further than totalitarian and authoritarian states. Also, wait for all of this to be over with and then we can assess who did better and who did worse. Amidst the crisis, I am frankly concerned about comments such as this.

Ranking by cases/capita (per 1M)

1. Iceland: 978

2. Switzerland: 864

3. Spain: 612

4. Norway: 417

5. Austria: 396

6. Germany: 297

7. Belgium: 293

8. Iran: 258

9. France: 245

10. Netherlands: 245

11. Denmark: 241

12. Sweden: 191

13. Ireland: 183

14. S Korea: 174

15. Portugal: 157

16. USA: 98

Ignoring smaller countries such as Estonia, Vatican City, etc Source: https://www.worldometers.info/coronavirus/

Even the aforementioned ranking is useless because the onset is staggered. It is like taking a slice of a timeseries data in the middle of highest rates of changes and saying "Here! Look. We have some definitive answers."

I am in no way opposed to spreading the message to folks in deep south states who are largely ignoring this crisis. But using misleading data to alarm them is not the right way to go about this. The press should be doing their job of communicating what exactly is going on in hospitals, pressuring leaders of the states to consider the warnings, and generally taking an objective, scientific approach in informing the public.

These rankings are important because it helps us get a feel for what type of quarantine action is getting the virus under control.

Any country with sufficient testing that's managed to bring the growth rate below exponential is worth an enormous amount of attention, because we seem to have many countries who have taken action yet failed to stop exponential growth.

Then use cases/capita. US has 330 million people and comparing it with #2 spot (Italy with 60 million) is completely insane, not to mention that the worse is yet to come to US.

I am all for taking a critical look at American systems and their effectiveness of the response, but the ranking by the case numbers is naive, misleading and unproductive.

Every country starts with (let's say) 1 imported case. From there, it grows. Cases/capita doesn't really mean anything until you get into the millions of cases and start thinking about what the upper bound might be.

And so ranking countries by size of outbreak seems reasonable to me.

I edited my comment with some data. The onset is staggered, the entire ranking thing is useless until the pandemic is over. It is simply a tracker, not an objective measure of the efficacy or the effectiveness of the measures each country is taking. It is too soon.

I've seen plenty of graphs where people plot the epidemics correcting for start date in each country, that seems pretty useful.

Edit: Here you go, here's one corrected for day of 100th case.

https://twitter.com/levelsio/status/1241149458089418752

This is nice but still has major confounding effects that could completely change the story:

- Amount of testing

- Sampling process of testing - i.e. Policies that govern whether someone should be tested or not. Each country has their own policy.

- Demographics, especially age

- Still shows total cases, should be cases/capita

- Some effects of weather/humidity

I agree except for cases/capita. I dont see how that is relevant during the initial phases of an epidemic, as explained above.

> we seem to have many countries who have taken action yet failed to stop exponential growth

Remember the virus has an incubation period of around 2 weeks. China's numbers appeared to be increasing exponentially for 2 weeks after the lockdown, but those were mostly people infected before the lockdown.

Be concerned all you want, but look at it this way: without the most populous nations (for instance, the USA) at the top of a list like this politicians can downplay the seriousness of the threat. HN has a small army of people who do nothing else than trying to make it seem like this is 'just a flu', or something slightly worse.

All of that taken together translates into people simply ignoring the danger and continuing their life making things much worse in the long run.

Viruses don't have legs, they need people to transport them. And as long as we're willing it gets spread around and some people will die. If rankings like these send the message loud and clear that this also concerns you then I'm all for the rankings, even if they are a bs statistic without taking into account the total population size. People find it much easier to relate to 5000 people dead than they do to 2000 people per million infected.

Agreed that we need to spread the message far and wide. Just slamming down on people that are doing their best to cope with this situation isn't very productive, if not discouraging and harmful. In these times, Solidarity is needed. Just the way we support Italian crisis, we need to do the same to the US and the rest of the countries.

Slam governments, take it up on the streets to address issues after this pandemic is over.

> without the most populous nations (for instance, the USA) at the top of a list like this politicians can downplay the seriousness of the threat

That doesn't make any sense. First, it's not desirable in any way for the US to be near the top of that list. That's a per capita list (for obvious reasons it's better for small nations to dominate that list) and the US has a spread out and very low population density compared to most nations in eg Europe. Having a high population nation doesn't inherently correlate to being near the top of the per capita infection list.

Population density is not your friend when it comes to a highly infectious virus spreading in the population.

Countries in Europe vs the US on population density:

The Netherlands 12x, Belgium 11x, UK 9x, Germany 7x, Switzerland 6x, Italy 6x, France 4x, Poland 4x, Spain 3x.

The US also has no primate cities, whereas Europe has ~25 of them (hyper population concentration). Most nations in Europe have a primate city that dominates the nation in terms of population, acting as a massive potential infection supercenter.

It's entirely unsurprising that smaller European nations with high population densities vs the US would have higher infection rates per capita.

This list is meaningless unless you factor in the geographic sizes of the countries and what percentage of the land passes some density threshold.

If you split up the united states into regions, we definitely would not be 16th on the list.

You should rank in cases per test instead. Otherwise countries that simply don't test look very good.

Now many people need to be hospitalized vs reported cases? Last I heard here in Los Angeles county we had like 270 reported cases and like 40 people hospitalized. This is in a county of around 10 million people.

Roughly 20% of those infected required hospitalization.

> Wonder what degree of revisionism the 'it is just a flu' crowd will engage in where they are on the record

Just check Elon Musk's twitter apparently

I’m pretty doubtful that this is much worse than the flu. But I am self quarantined, stocked up on food etc. my level of doubt is not nearly strong enough to counter the severity of consequences if I am wrong.

My wife has asthma, and my parents are elderly. I’m middle aged. I’m much more concerned about hurting other people.

That said, flu statistics aren’t great. I’m pretty sure I’ve had the flu, due to severity of illness. But I’ve never been tested for it. I don’t know anyone who has. When people die of pneumonia etc they Aren’t automatically tested for flu.

Well, the flu doesn't infect 100 million Americans in the same quarter. Just to mention one way in which Covid-19 is clearly worse than the flu.

100 million Americans have been infected with covid?

50 million Americans getting the flu in any given year is pretty typical, although flu season is a couple months longer than a quarter.

The CDC numbers I found are slightly more than half that for influenza.

Without significant mitigating precautions, which was the context for this discussion, the USA would very likely have more than 100 million Covid-19 infections in the next three months.

Yes, it's technically a logistic process rather than exponential. But there is no pre-existing immunity, so it won't hit the inflection point until it bumps up against the natural limitations. Meaning herd immunity due to a large percentage of potential victims already infected, or limitations in how many people will likely meet a sick person. The latter won't happen without the mitigations I'm talking about.

A third of the population infected seems as reasonable a ball-park guess as any for when the first point would be hit. But I really, really hope that the mitigations prevent this.

We wont know the extent until 1-2 years from now when statistical studies are done to show the true danger of the Chinese coronavirus. It could very well be the flu, a 10x flu, or worse, or better. It’s the uncertainty that’s killing us, for lack of a better term.

There will be no revisionism, because that would require respect for the value of speaking truthfully and standing behind your words. Rather, bringing this up will just be met with shallow denials that it wasn't important at the time, that nobody could have known, that the questioner is part of the problem, etc.

You can already see the narrative of the ignorance club is shifting to "we're doing a good job" - focusing on current nascent actions and completely ignoring the month long head start given to the pandemic in the US by inaction, incompetence, and outright lies (eg masks).

Not that it makes sense to waste energy bickering about these things when there is still a major problem to be addressed, but the point is that the month or two long societal shutdown we're experiencing is best attributed to a failure of our institutions rather than the force of nature.

https://news.ycombinator.com/item?id=22657717

I very much admire Gov Cuomo - he is perfectly straight forward in his approach, putting aside partisanship and truly care about his state and the New York City. I encourage everyone to watch his updates to see for yourself. We need more leaders like him. In his presentation, he is telling how to run the Federal goverment and recommendations - which just illustrates the competance of the executive branch of the US Govt. Same thing with Gov Newsom of California.

Latest update: https://www.youtube.com/watch?v=dlZeKTlpcqU

This article sums up the feelings of many New Yorkers, myself included:

https://www.nytimes.com/2020/03/16/business/media/cuomo-new-...

In normal times he is utterly infuriating and represents some of the worst qualities you see in a politician. In a crisis... well, you need a solid pair of hands and a leader capable of making big decisions effectively. And he is definitely that.

Churchill was the same way. Great wartime leader. Rubbish in peacetime.

Seconded. I can’t stand the guy, but contrast his leadership to that of our Mayor and he comes out looking like a hero.

I am not ready to change my assessment of him. There were ample situations in in "peace time" for him to push harder but he didn't. DeBlasio may be more inept, but Cuomo only pushes things hard after they become very popular. That's still not leadership.

There's a difference between leading with ideas and such and executing well. The latter is more important in a crisis.

I'm not even asking for ideas, though. Subway, weed, rent, cannabis, etc didn't need ideas.

I'm not asking for Good Robert Moses, I am asking for Good Robert Moses's Oddjob.

Except New York has roughly 50% of all cases in the U.S --- ~15k of the 32k total as of this writing. Newsom at ~1.5k seems to be doing much better if we’re judging by that metric

https://coronavirus.1point3acres.com/en

NY is doing far more testing than anywhere else. That's why they have more confirmed cases.

the death stats aren't subject to that effect. today it was +58 in NY and the next highest state was GA with +9.

Germany has the lowest death rates on record even though the population of infected per age group was similar to Italy, but they are being very selective on testing dead people, so it could be a very misleading statistic - we may not know the true data, Germany may be doing something better than Italy or it could be worse and we just do not know, same as with all the states in the USA, if something is not being measured, all bets are off without a representative sampling or full sampling.

> Germany may be doing something better than Italy

been curious about that super spreader story we have been hearing about italy. they probably need to study what happened there so we can all learn from it.

maybe italy has a life style that made it easier for the virus to go around?

The shape of social graphs is likely very different across countries, but I don’t know of studies checking this. However, there are anecdata aplenty. My hometown in Spain has a lot of part timers in senior living facilities, so you will find, for instance, physical therapists working 2 or 3 facilities over the course of a week. We have confirmed examples of one therapist who contracted the virus somewhere, and now it’s on every facility he visited: Over a hundred people tested positive with him as the only link.

There is also how common it is for adult children to live with their parents, who might be retired already. Different networks do seniors and millennials that go to different places and have different links, but help the infection travel fast.

Given the low ICU capacity, a single case like this can overwhelm a local hospital system, with predictable results.

When the dust settles, it will be interesting to not think in term of absolute number of deaths, but in term of additional mortality over a normal year. I understand that something like 99% of people who died of this virus had pre-existing conditions, in many cases serious ones. Logically, a fraction of the victims may have died of something else that same year.

I've seen this claim around a lot - is there a handy link that shows the testing that NY is doing and/or their true positive rates as compared to other regions?

https://covid-19.direct/state/NY

great resource! thanks!

Well yes, but they also almost certainly have it the worst.

Their testing rate is not even particularly high - Washington State has tested more per capita and has a drastically lower positive rate

https://covid-19.direct/state/NY

(If anything Washington, which is facing roughly linear case growth without a shelter in place in effect, is arguably handling the best of anywhere in the US. But I recognize NYC being so dense is intrinsically in a bad spot in a pandemic)

Any idea how they got a negative number of tests on Mar 8?

I don't really know, but I'll guess. Maybe the estimate is done by taking the total for one day and subtracting out the total for the previous day? If the data were a bit messy and revised down, this might result in an occasional negative value.

Some places don't even test at all so they have zero known cases. They must be doing something right.

My wife likes him but I get quite infuriated at how slowly he moves. The NYC mayor is doing better with the little he can do. And Cuomo keeps overruling NYC mayor.

In comparison to Trump, he is less partisan and more decisive. But overall, his press conference is very little material.

Still in this difficult time he is a beacon of hope.

So what changed in the last few days? What is playing out is EXACTLY what epidimiologists, scientists, mathemeticians, the US intelligence agencies, and the WHO have been saying for over a month at this point. This has ALL been predicted and no one fucking cared or listened until it is BY DEFINITION TOO LATE.

I've even been saying this for weeks now, and I get challenged on it. Even though every single day we continue to just follow or beat the worst trend lines from the worst affected countries BECAUSE WE'RE NOT DOING ANY OF THE THINGS WE KNOW WORK.

What's going to be different next time? Are we going to have a global conversation about our inability to plan more than 2 days out? Our inability to grasp truly horrific facts and accept them, instead of letting fearful human brains go "That could never happen in America" (lol) even in the fact of raw statistics? Or is this just another thing I'm going to be eye-rolled at and told "it's just how it is". A global pandemic and economic slump (I'm metering my predictions here because this site doesn't seem to be able to handle realistically gloomy predictions for the future) still isn't enough to get us to ask how we got here?

I today saw the number of infected for US jump 8k (it seemed to have been reduced from 14k, which was really alarming). https://www.worldometers.info/coronavirus/

A quite worrying turn that rate of cases is ramping up so quickly in US. Don't know what else to say. And there isn't really that much you can do as an individual, if the other people are not taking it that seriously. Just yesterday I saw a child with his parent cough with a rattling sound in a supermarket without covering his mouth. It is these types of small actions of neglectedness that compound, making this virus so hard to stop from spreading.

Hopefully you at least build antibodies when you get sick. Otherwise this will never stop spreading until we get a working vaccine.

> I today saw the number ... https://www.worldometers.info/coronavirus/

Note that the number for the current day isn't yet necessarily complete. For example, as of this writing, Washington and Illinois were not yet in the table [1].

Washington numbers get released at 3pm PST [1] and Illinois numbers don't specifiy an update time [2]. It looks like the number should end up around 8.5k today, so better than yesterday's 14k.

Of course, with all the back-and-forth on test availability, comparing numbers day-to-day is challenging, since more testing is likely to reveal a higher absolute number of cases.

[1] https://www.worldometers.info/coronavirus/country/us/

[2] https://www.doh.wa.gov/Emergencies/Coronavirus

[3] https://dph.illinois.gov/covid19

> until it is BY DEFINITION TOO LATE.

There could surely have been faster responses (testing, movement restrictions...)

But hospitals? They are by definition too late when people die from lack of Hospital capacity. Doesn’t hurt to have some margin, but from what I have heard it doesn’t sound like NY has run out of capacity just yet.

Please don't use uppercase for emphasis. If you want to emphasize a word or phrase, put asterisks around it and it will get italicized.

https://news.ycombinator.com/newsguidelines.html.

Nobel laureate and Stanford biophysicist predicts a quicker coronavirus recovery: 'We're going to be fine'

https://news.yahoo.com/why-nobel-laureate-predicts-quicker-2...

Interesting life lesson for those who are not familiar is the concept I think it's called 'don't spit into the wind'.

By this I mean all of the politicians who constantly gave Trump a hard time at each and every turn. I don't mean any in particular investigation and I don't mean they needed to agree and not criticize him at all at any time. But maybe they should have thought that this person 'The President' has the ability to give their region (or their state) what they need 'greenlight' and yes he should do it because 'it's the right thing to do' but human decision making and interaction is more than that. And people are people. This is no different for any political process or politician. Sometimes you have to simply (to use the phrase) 'not be a dick' if there is a person in power who can give you things you need to play the game. Doesn't mean you should like the game and doesn't mean it shouldn't be that way but in the end it is the way life often is.

Wow, ok, finally.

I keep having this crazy, irresponsible, dangerous... hopeful idea: virus cruises. Take one or more available cruise ships, equip it with ventilators, tests, supplie, ask for volunteer crew, passengers, and medical staff, and send everyone off for a two week cruise to get deliberately infected with the virus, study its characteristics, and start to build herd immunity. Seems like it'd be a way to get started fighting back.

I don't think you realize what the severe cases look like.

This isn't chickenpox.

This is people drowning in their own fluid-filled lungs, having to be physically restrained to keep from pulling out their tubes, with a surprisingly rapid progression from mild symptoms to requiring a ventilator to being declared dead.

You willing to sign up for that?

You'd be murdering people. That's an un-ethical medical experiment. About as unethical as what already happened to those on the Diamond Princess. 8 of them are dead now, there are still another 15 in critical with some of those expected to eventually die.

Just to punch it in a bit more: The ship was quarantined about a month and a half ago. This isn't a week-or-so sickness.

If this is not peak HN I don’t know what it is.

You're getting a lot of downvotes...but this is how the eradication of Smallpox started...through inoculation.

https://www.nlm.nih.gov/exhibition/smallpox/sp_variolation.h...

It gets interesting if you start people on the anti-viral medication before infecting them. That should make the disease very mild. There might not be anybody who gets severe illness.

> Over the past days, an inspection team led by the Army Corps of Engineers, and including state officials from the Office of General Services, the Dormitory Authority of the State of New York

Huh? What? How was this not already done? YEARS ago? What if this was something _fast_ moving?

We knew a pandemic was inevitable. No stock pile of mask? No plan for ad hoc hospitals? If they're making it up as they go then what has FEMA, the DoD and the CDC been doing with our money? Using it for TP?

We have plenty of space (churches, meeting halls, school and university dormitories) to use for temporary hospitals w/o the Army building temporary buildings that will cost a fortune and later be torn down all on the taxpayers' dime. Charitable organizations, universities and institutions should be willing to donate those resources.

I don't want to pay the army for building: I want their doctors doing research on a cure/fix for Covid-19 and I want their soldiers alert and ready. It would be cheaper to hire immigrant Mexicans to build temporary hospitals.

Using the army to build hospitals when better space is already is a waste of time, a waste of money and little more than a boondoggle for the suppliers who are chosen.

And isn't this possibly a violation of the posse comitatus Act?

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

> We have plenty of space (churches, meeting halls, school and university dormitories) to use for temporary hospitals

Making these spaces fit the physical needs of these hospitals (massive power requirements for equipment, hallways and elevators with certain amounts of clearance for transporting patients, extremely well-controlled ventilation systems, sanitizable surfaces everywhere, rooms laid out with central access for doctors and nurses) would take so much time and effort that it would be more money- and time-efficient to build new buildings with the expertise of a group practiced in building new, reasonably high-quality buildings as fast as possible... like, say, the Army.

These need to be modern hospitals, not 19th-century sanitariums where patients just get dumped into a bed and left to die or recover on their own.

> It would be cheaper to hire immigrant Mexicans to build temporary hospitals.

Right, and I'm sure hiring random people to construct temporary buildings as fast as possible would result in something that won't fall in on peoples' heads immediately.

> And isn't this possibly a violation of the posse comitatus Act?

The Posse Comitatus Act applies to the use of the military as law enforcement, so, no.

Posse Comitatus doesn't really apply they're not enforcing a law or acting as a policing force which is all that law actually cares about. The Army Corps of Engineers does a lot of projects like this, it's part of the reason they exist at all. Lots of the flood control along the Mississippi for example are COE works and they come in during emergencies to do stuff like this. For example during Katrina they were the ones repairing the dykes that had failed around New Orleans.

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