We're in for 2 Months
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It seems to me that what we’re really doing with the lockdown is buying the time to “mobilize,” in the military sense, our healthcare system. If we had the testing capacity to test everyone and contain only the sick, this would be less serious. If we had 10x as many ventilators, and 100x as much protective equipment, this would be less dangerous. If we had an effective treatment (like a Tamiflu for Covid), then this would be less dangerous. Etc.
It seems to me unlikely that we will be locked down less than 2-3 months. But after that, I doubt the public will be willing to endure another global lockdown of this magnitude. Thus I think everything we’re doing now is really about delaying the inevitable long enough for us to get a coherent response in place.
To the extent that anyone is a “winner” in a pandemic, it certainly appears to be Taiwan and South Korea, who responded fast enough to the first wave to keep it from requiring an authoritarian response (or, at least thus far).
Only up to some point, then you run out of specialized personnel who know how to properly treat each patient (including controlling said ventilators). (Re-)training personnel probably takes months to years.
The people on a nasal cannula of oxygen probably only need limited skilled intervention and supervision, but once they're intubated it's pretty intensive.
Also, the US's lockdown seems liable to be more porous than China's.
Would you have instituted a statewide lockdown when there were 1-2 cases in California?
Would you be willing to trade certain unemployment and economic unproductivity for 2+ months, in exchange for the possibility that you might end up like Italy instead of Taiwan/South Korea? The last datapoint we had was SARS-Cov-1, which ended up not becoming a huge pandemic. Of course, the disease characteristics for SARS-Cov-2 are different, but without the benefit of hindsight, was the decision really that clear?
Incompetent US administration aside, the financial markets - which can be thought of as an expensive forecasting computer - certainly did not price in what would happen, so I'm not sure we can expect policymakers to arrive at far-superior decision making.
Considering that China is not completely out of the woods yet either, and the US/Italy lags about 1 month behind them in pandemic progression, how would you advise the US act now, with the knowledge of what China is doing?
We didn't know how much it was spreading in the US because we weren't testing cases that didn't have a nexus to China/SK. So we had no idea what the spread was like and there was no data to go on to inform decisions to lock down. Seattle only got there early because some local flu researchers disobeyed their own IRB rules and tested cases for the virus without approval.
California seems to have gotten the lockdown about as early as was practical and has done much better than NYC, so they're actually doing well, all things considered.
Pretend for a second that you're Andrew Cuomo on January 1, 2020. What information would you have to justify this crash program?
Pretend that you're Andrew Cuomo on April 4, 2020. You're aware of what stage China is in. What would you do differently?
I would not make cuts to Medicaid, for one.
https://www.washingtonpost.com/investigations/2020/04/03/cor...
That wasn't true of SARS which made people very sick so it was able to be contained (it's possibly that the novel coronavirus is just far more contagious but I don't know that for sure).
By mid to late January we all knew this. It was happening in China in full view of the world. The question was whether it could be contained, we didn't know that at the moment. But without extreme intervention it was just simple math that this would happen, and it did.
The U.S. should have started ramping up supply production in the early days, not because they had some guarantee that this particular virus would wreak havoc in America, but because two things should have been readily apparent:
1) The stockpile of essential supplies was apparently abysmally low, both at a state and federal level
2) That if this specific respiratory virus didn’t end up arriving on U.S. shores, it was just a matter of time before one did.
Aggressive production should have begun long ago, with the assumption that supplies may be needed for this outbreak, and if not, it ought have been treated as a wake up call and at least the country would be more prepared for a future outbreak that could happen at any time.
Not only production, but aggressive public messaging about reasonable social distancing, hand washing, etc. should have begun much earlier.
The inaction was, in my view, bizarre and indefensible, and few elected officials exhibited the true qualities of leadership that are needed to foresee the risk and act swiftly to hedge against the risks that were readily apparent early on.
Singapore starts screening inbound travelers January 3:
https://www.moh.gov.sg/news-highlights/details/precautionary...
China locks down epicenter of Wuhan outbreak January 23:
https://www.reuters.com/article/us-china-health-who-idUSKBN1...
The initial response in China was to try to cover it up, only after it was out of control did they start locking things down.
But it matters that you'd have the choice.
For example
- a treatment might be found which reduces the fatality rate, making it a less dangerous disease
- widespread testing might show that a significant portion of the population already had it and were asymptomatic, thus we have herd immunity sooner than expected in places like New York and Spain/Italy
- antibody testing might become mainstream, so if there was a certificate for people who have already gotten it, that subset of the population can return to a normal life.
- the public support for the lockdown evaporates if it goes on for too long and unemployment skyrockets, so the government might move to a more moderate measure - e.g.: only lock down the people at risk, and let everyone else return to a normal life.
- rapid and cheap tests because widespread, so perhaps you can just get tested before boarding a plane, or entering a shopping mall, etc.
What if we don't find a cure and a vaccine takes 3 years?
Cheap, fast testing is almost there but I don't see how that actually helps... What do we do with people who didn't yet get the virus? Should they stay at home? Since they're a majority, it's not very different from the current situation. Or should they go out and "chance it"? Are you willing to do that in the absence of a cure?
If you have a difficult time putting this in perspective, just swap COVID-19 and social distancing for HIV and condoms.
I think this is a dangerous myth as till now infected people are infecting a lot of the people they come in contact with. Had the virus already passed through a lot of people already the spike in number of ICU cases would not be happening now nor keep increasing at the same rate
We get it, we are going to have to shut down the main street economy for months, and potentially on and off for years.
OK, we aren't rioting yet.
So, elites, what's the plan to keep people from starving and being thrown out in the streets? A one time $1000 check at some point in the future isn't a plan.
People who swarm criticize anyone saying "this is crazy" need to start presenting feasible economic plans, or they are gonna see fully operational crazy in a month or so.
Many of our nations higher paying jobs are either essential (doctors, nurses), or remote friendly (developers , to some extent lawyers and real estate agents).
Even if 25% of our economy is not working, we can make near 90% of our GDP.
Which isn’t ideal but it makes the lockdown perhaps less dire than it appears for the economy.
Especially for FB and Goog, as they use second-price auctions, so anyone who measures their results will see performance improvement, make more money and thus (theoretically) invest more in advertising until it is no longer profitable.
They'll lose some revenue, but it won't be anything ridiculously large; and even if it is, some of the previously priced out advertisers (less profitable mobile games, for instance) will return.
Advertising is a hell of a business, especially online.
Airlines are heavy advertisers and their industry is crushed. We’ll see the next quarterly results. I bet at-least 30% revenue quarterly loss compared to last year.
The economy is very intertwined. Especially when people start defaulting on mortgages en-masse. The 2 trillion stimulation hasn’t yet started sending out cheques to those who need it. Banks haven’t figured out how to loan to businesses that need it.
The worst death count / day of virus is still to come.
People can may be weather one or two months, after that. Shit will really hit the fan.
Nontheless,they have a good business model and will most likely be fine (even if they show no revenue growth, they make a lot of money).
If you're suggesting 30% revenue loss relative to last year, that's probably flat to -10% revenue for each of them, which in the midst of a global pandemic is pretty good.
Like, things are going to be really bad for a whole lot of people, on that we agree.
However, i continue to believe that Goog and FB's businesses will weather the storm a lot better than most other technology companies.
Dire is a matter of perspective.
Edit - your math is also counting babies and kids. Not many babies or kids lost jobs in the past month.
What because 90% of GDP isn't that dire?
(And hopefully this is an over-reaction: https://www.usatoday.com/story/news/politics/2020/04/04/coro... but if it takes months for that federal money to be disbursed, then in a lot of cases is may as well not come at all.)
A "high percentage" seems like a comical overstatement.
> remote friendly (developers
The layoffs in software engineer world are still yet to come and we've already seen quite a few. Sure, not nearly as many layoffs as low-wage workers, but you've seen the layoff threads here on HN, right?
This is only the start of the downturn if the US stays shut down.
https://www.cnbc.com/2020/03/31/coronavirus-stimulus-checks-...
> That could change if the Treasury Department decides to alter its guidance.
> That could include some kind of declaration form where you could provide evidence that your 2020 income has dropped, such as an unemployment insurance claim.
Some speculation: a big part of why lockdown takes that long to work is that it seems to take that long for people to start taking things seriously enough for lockdown to work. A few weeks ago in NYC there were still people coughing on each other in public and laughing about it, and my observation of a lot of people's behavior over time is that for some people, they need someone proximal to them to die of it before they will start complying.
I don't say this judgmentally. Personally, I probably didn't take things seriously for about a week after I probably should have, and looking back at why, it wasn't because I didn't care, it was a fear reaction--one very human reaction to something scary is to downplay it or pretend it isn't happening.
Depression, loneliness, suicide, addictive behaviours (alcohol, tobacco, recreational drugs), high stress due to varying economic factors, panic (media induced) etc ...
[0] https://www.bloomberg.com/news/articles/2020-03-31/divorces-...
[1] https://www.france24.com/en/20200330-france-to-put-domestic-...
The interesting thing is that in previous situations deaths attributable to these things was offset by a decrease in deaths due to automobile accidents, workplace stress-related incidents, etc. That doesn't make it ok at all, and it's possible this time around is worse socioeconomically so things aren't offset. But it might not show up in overall trends if you just looked at general disability or death.
So it even could take a few more weeks to get to the same low point again. Plus China had an extremely aggressive strategy, accumulating the measures, and even Italy did not use all of them. And France does less than Italy (non essential production has not been stopped by the government in France).
On the other hand I doubt we are going to eradicate the disease (at least not in the immediate future and not only with worldwide lockdowns), so we might want to use another lifting strategy than what they did in China (if we manage to develop means to control the spread at a very low rate)
2 months is still a reasonable approximation, given all the unknowns. But I will not even be surprised if it ends up being 3, and 4 is not out of the question.
I asked as I see everyone use them to compare against but then I see articles popping up talking about reporters who reported difference numbers just vanish over night.
https://www.who.int/classifications/icd/covid19/en/
Simply classify the cause of death to be the virus only in tested and confirmed cases (U07.1 COVID-19, virus identified).
That's what my country's (Poland) government is doing and lo and behold - our numbers are relatively small.
https://www.pzh.gov.pl/wp-content/uploads/2020/04/wytyczne-d...
If you are seeing these articles "pop up" then you read fake news btw
I don't trust the Chinese government but I think if they were lying then their opponents would be able to build a more persuasive case by now.
That being said, it does still speak to the point of the Chinese government and their attempts to control the narrative. At least for me, that makes me start from a point of distrust over anything they say.
Moreover, Radio Free Asia is quoting named residents, so this cannot plausibly be described "anonymously sourced US propaganda" or "fake news". [1]
In general, I think one should be skeptical of any statistics produced by a totalitarian dictatorship for Western consumption.
[1] https://www.rfa.org/english/news/china/wuhan-deaths-03272020...
I don’t think the great firewall will let the bad news come out
For my money, I don't trust the US intelligence community but I still think that the Chinese numbers are somewhat implausible.
The charts show an identical dropoff in almost every region at the same time. We can see, from the European experience, that there's a lag between lockdown and case saturation. This does not appear in the Chinese data, which makes me somewhat sceptical.
Note that I'm not an epidemiologist, so it's possible that there's something else driving those numbers that I'm missing.
On the other hand, there's probably an opportunity if not now than soon to start modeling the plausibility of Chinese reports. That is, a lot of them use China as a sort of baseline, but at some point things are going to get flipped on their head and the aggregate of other country's trends are going to start affording the ability to ask questions like "given what we know about the distribution of trajectories in other places, how plausible is it that data from country X is valid?"
There's complications due to heterogeneity in population networks, healthcare, response, etc. but I think quickly we're going to start seeing things being sorted out empirically. You can only hide things for so long.
This is also happening in hospitals, in nursing homes, in homeless shelters...all are also "families" for this purpose. If your "lockdown" was truly no contact between any two humans, the cascade would stop quicker. But that's not the case.
Comparing the US to China is wrong, because the US isn't doing MOST of what China did to allow the lockdown to be lifted.
I don't think that's the curve they're talking about flattening.
I think 2 months is just the lower bound.
And 2 months is probably not back to normal (international travel, etc). China is still fearing a second wave coming from the rest of the world.
Note that I think other countries will also play the blame game. I don't plan to buy into the finger pointing as it doesn't really solve anything.
We're in this for many, many months. Somehow a lot of people have forgotten that "flattening the curve" greatly lengthens the time period of the curve.
Also, the thesis behind flattening the curve is still that the same number of people eventually get it, and it's only once you get broad population immunity that the spread stops.
We will be fighting this with social distancing until there is a vaccine.
Take the extreme example of Taiwan. If reports are accurate and they maintain their current situation, the literally flat curve there will lead to a few thousand people getting infected out of 23 million.
Or compare this outbreak to the first SARS, where asymptomatic spreading was much less of an issue. Very few people globally got SARS, exactly because interventions to stop the spread were effective.
But SARS was also much less contagious than this virus, especially during the asymptomatic phase. SARS also was much more lethal, meaning people that got it had less of a chance of transmitting it, because they were dead.
This virus is kind of the worst of all world's, in that it's very dangerous but only for a relatively small portion of the population, and that it can be spread by asymptomatic people much more easily. This means that it's very easy for any "embers" burning anywhere to eventually flare up into huge blazes wherever there are large number of people that still don't have immunity.
Well, not really. We can also fight it by producing more needed medical supplies, developing better treatments and expanding hospital capacity. We aren't just trying to influence the curve, but also the line we are trying to keep the curve under. And some nations have had luck flattening the curve using testing and tracing (but the US does not seem to be interested in this approach for some reason). It's also worth considering that the level of social distancing is not fixed. There is a wide range of options between universal quarantine and business as usual.
If your answer is no, you're still worried about the consequences of infection including death and permanent disability, then the public is still going to want to avoid infections even if ICU beds were completely unlimited.
I haven't read the whole thing, but here he's defining "rate of growth" as the number of new cases. If there are 0 new cases each day, then eventually the number of total cases goes to zero.
A solution seems to be selective lockdowns by area backed by a huge amount of testing.
That implies we are trying to make the virus extinct, which we are not. We want the virus to spread, but at a manageable rate.
Otherwise you'll just end up with a new trend of locking down things for 2 months, then opening up, only for a new patient 0 to lock down everything 2 months later.
(I wish I could believe that contact tracing and partial lockdown were sufficient but even Singapore, which by all reports was doing these things, is now SIP with 1/4 as many cases per capita as the US. I think our best case if we can't eradicate is going to look a bit like SK, where schools are shut down and life is very different from what we would typically expect. But that is a best case scenario assuming competent and diligent institutions, which I'm not sure we have.)
(a) most people already caught it and are immune
(b) we develop a vaccine
(c) we develop a cure that is easily mass produced and easily distributed.
Until one of those happens we're in lockdown. No? And that means 12 to 24 months.
This strategy has worked in China and South Korea, where life is now slowly resuming, but most other countries haven't caught up with their testing numbers yet.
The reason we're all quarantined now is that there's presently no rapid reliable way to tell who needs to be quarantined and who doesn't.
Really? Because I have heard of no plan at the federal or state level to implement a wide-scale test and trace program to contain the virus. This seems like a very good idea, but not one being implemented in the US.
We have already taken measures to contain the virus. So why aren't we preparing these needed resources for testing and tracing while the lockdowns are in effect? Two months will pass and we will be no better prepared than we are today because no government in the US is working towards this. The containment will be for nothing, just a temporary measure that will have to be repeated over and over because we aren't even trying to implement a better solution.
For most countries, the month before lock down was one where people acted as they always had. The months after lock downs are relaxed will not have people acting the same way, and there is a lot of middle ground between lock down and buffets at international conferences.
Enormous deployment of serological tests and rapid RNA tests can also change the way we approach day to day activities.
1) a social and economic pressure to also get infected and ignore the risks
2) a control problem: Suddenly, many people are outside and socialize. How should the police differ between the two kinds?
3) even after the symptoms have gone away, the virus is still contained, e.g., in the stool. So you would need vast and repeated testing to check who is not infectious and immune.
I think what is really going on here is world leaders assume China is most knowledgeable about this virus, because goodness knows its labs probably have been studying it for 15 years, they don't have confidence that China is forthcoming about what it knows, and in a few nations globally the effect borders on catastrophic so it's not something to be ignored. So, governments have copied the more knowledgeable actor, which happens to be an autocratic communist government, in hopes that it's approach is the best informed and effective scientifically .
Thus, the answer to 'when do the lockdowns end' really is: when we feel more knowledgeable about the virus than the nations that resorted to placing their populations under house arrest, and therefore feel confident enough to stop following China's example.
One such account which is purportedly doing this is https://twitter.com/truthabtchina. To summarize this, among other rumors:
- lots more people have died that communicated (there's an estimate of ~22m due to missing cell phone contracts)
- riots are happening between regions where lockdown occurred, and regions next to them)
- lockdown isn't practically over in areas where resurgence of infection is happening (pending other containment approaches)
I do think it's quite reasonable to assume some areas of China are getting back to normal.
I also think it's quite unreasonable to assume info _isn't_ being censored and controlled, especially post journalist-eviction.
I communicate pretty often with people living in China and with family and living in China. Things, even close to Wuhan, are returning to normal. People are going out, eating out, socializing more.
From all of the everyday people reporting there is no obvious or visible things not being reported. By and large people in China are primarily worried about America right now.
It wouldn't shock me if there was some important information not being reported, but this conspiratorial "If real information where to leak out" is nonsense since you can very easy interact and talk with actual people living in China.
However, could be this was a one-off genuine mistake (things are hectic). I'd love to know more