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Comment by coffeefirst | Hacker News Reader

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.

View on HN

> 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.

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.

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.

> 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.

> 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

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.

> 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.

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

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

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.

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