Crimson Contagion
en.wikipedia.org
en.wikipedia.org
My home country (Switzerland) has a conscription army. ~160k people, each with either a pistol or an assault rifle at home, receiving regular training for a few weeks a year while the government compensates their employer for the loss in productivity. There are tanks, fighter jets and massive alpine fortifications. It's expensive. Most countries have an army and they are usually sized for an unlikely worst case scenario.
One would think maintaining a stockpile of PPE that would allow the authorities to recommend (and even provide) masks for the general population without risking a shortage in health care would be a relatively minor expense compared to that. And yet, all over the western world, PPE is in short supply, and that is without the general public wearing masks like they do in many asian countries.
They should have gowns that can be boiled and reused.
Surgical masks that can be boiled, etc.
Disposable PPE is used for convenience. It's easier and cheaper to throw away an N95 mask than to clean an P100 mask, except when you can't buy N95 masks.
If you have re-usable gear, you have to make VERY sure that what you think is clean is really clean. That means cleaning procedures have to be extremely thorough, and you have to make sure that you NEVER mistake a soiled unit for a clean one. In addition to designing things to be clean-able (which is much harder than it sounds), you need to make sure that they are designed in such a manner that they can be doffed safely. Taking off PPE sounds easy, but when you are guaranteed to come into contact with biohazards, you have to be extremely careful about how and what you do.
Simply put; desiging, manufacturing, and safely using re-usable PPE for use in biohazardous environments is much harder than it sounds.
We're now forced to reuse disposable PPE due to the shortage. It would have made a lot more sense to be reusing PPE designed in the first place to be reused.
I design some non-medical mechanical assemblies (various types, for use with electronic equiment), and have no idea how I would design (reliably manufacturable) re-usable PPE for use in a biohazardous environment. As far as I can see, the problems would mostly be in the joints and fastening features between different materials. Some features (such as filters) will likely need to remain at least somewhat disposable, as I believe that all biofilters have a limited lifespan.
https://en.wikipedia.org/wiki/Johns_Hopkins_Center_for_Healt...
In recent years, the world has seen a growing number of epidemic events, amounting to approximately 200 events annually. These events are increasing, and they are disruptive to health, economies, and society. Managing these events already strains global capacity, even absent a pandemic threat. Experts agree that it is only a matter of time before one of these epidemics becomes global—a pandemic with potentially catastrophic consequences. A severe pandemic, which becomes “Event 201,”
> Event 201 simulates an outbreak of a novel zoonotic coronavirus transmitted from bats to pigs to people that eventually becomes efficiently transmissible from person to person, leading to a severe pandemic. The pathogen and the disease it causes are modeled largely on SARS, but it is more transmissible in the community setting by people with mild symptoms.
That's almost exactly what happened. Except for the jump through pigs.
And the "growing number of epidemic events" is arguably caused by increasing human contact with previously isolated habitats, driven by population pressure.[1]
0) https://www.centerforhealthsecurity.org/event201/scenario.ht...
1) https://www.scientificamerican.com/article/what-11-billion-p...
https://www.centerforhealthsecurity.org/event201/videos.html
This is exactly why we can't have the government move like molasses. We had several months, needed to react with urgency and failed.
“The proposed budget also cut the CDC's discretionary budget authority by $1.3 billion in fiscal 2021 compared with fiscal 2020 -- a 19% cut -- including $25 million from public health preparedness and response outlays.”
That's a rewrite of the actual history that occurred and what people understood along the way.
They had a realistic four to six weeks max to start production of ventilators. A herculean feat in fact. Even less time if you were going to judge it based on understanding the severity and particular intensive-care heavy effects of the virus.
It was not a certainty to the outside world that it was human to human transmissable until the end of January. There was a lot of confusion due to the total lack of access to China and its data.
From February 1st (China's reported numbers begin to spike here) to the point where you understand it's a high global risk, capable of a large scale outbreak that could threaten the US, it's another 1-2 weeks minimum based on the rate of expansion in China's reported numbers and their inability to contain it properly (and better yet, with China you watch what they do more than what they say; during that first and second week of February, China took what seemed like wild action domestically while playing down the danger of SARS-CoV-2 to the rest of the world, including regarding travel restrictions).
Taking the decision to push billions of dollars in spending to jumpstart very early production of PPE and ventilators, is a big decision that you better be right about when you make it. You were going against the behavior of the entire developed world by producing ventilators in February, so now you need to be prepared to look like a paranoid lunatic, along with being called a racist and xenophobe while you restrict travel and close borders.
It's February 7th and you need to coordinate with domestic industry, local governments, international agencies, and companies around the world.
It's February 14th and you've got your first partnership together, they've agreed to produce ventilators.
It's March 7-14th by the time they are able to produce their first ventilator after preparing a factory for it, preparing any necessary design changes to accomodate rapid scale production, and putting together a supply chain that can scale for the hundreds of specific parts in a ventilator.
You need to build a scheme that can produce more ventilators than the present total global annual supply.
It's mid to late April before they have consequential volume of production. Assuming things go well.
Having closely followed all the ventilator efforts around the world, please show me a faster timeline that is realistic. You're only going to beat our present timeline by a matter of weeks, and that's if you aggressively jump out in front of prevailing 'wisdom' at the time.
It's an extraordinary short amount of time to accomplish the ramping up of producing ventilators.
The big failure was preparation rather than reaction with urgency to produce (that part is exceptionally difficult to do in such a short amount of time, it's setting yourself up for failure, as we've seen in most industrial nations).
Throw into the mix the fact that the world's biggest manufacturer of PPE gear was the center of the pandemic. Meaning they needed all of their own supply and would not be able to export properly so the rest of the world could build up their own supplies. So you're on your own to make your gear (something many nations around the world have had to suffer miserably through; most nations are screwed in this situation, they simply can't make such gear quickly under any scenario). This rapidly broke global supply chains, something never before experienced during the post 1970 high globalization era where supply chains became very complex, more fragile and global.
I'm not arguing that we shouldn't have had more ventilators in stock - we should have. An extra tens of thousands of ventilators in our stockpile would not have been unreasonable. That's another preparation failure spanning decades into the past.
For example by legalising 'hoarding' and 'profiteering'. Then some enterprising speculators could have bid for the PPE in the hopes of selling them for higher prices later.
Singapore started screening incoming travelers Jan 3, based on the pneumonia cluster in Wuhan growing in size.
Xi found out about it and took aggressive measures ~Jan 21.
It was an obvious risk on Jan 3. Maybe not a high probability risk, but obvious enough for a country to make sure they had the first couple of steps of their response at least figured out. Human to human spread was pretty clearly the case when the Chinese government started taking aggressive lockdown measures.
So your timeline is pretty friendly.
And then the focus on ventilators is odd. How about masks and other PPE and testing and so on?
What? The US intelligence community was watching before the first person was infected? Man, they've gotten a little too good.
> "As a matter of practice the National Center for Medical Intelligence does not comment publicly on specific intelligence matters. However, in the interest of transparency during this current public health crisis, we can confirm that media reporting about the existence/release of a National Center for Medical Intelligence Coronavirus-related product/assessment in November of 2019 is not correct. No such NCMI product exists," the statement said.
It doesn't seem likely that they were watching in mid-November when according to
https://www.theguardian.com/world/2020/mar/13/first-covid-19...
China "may" have retroactively found the first patient to be some guy on Nov. 17. That part could be entirely made up as well, I don't trust anything they say.
It would be absurd to ramp up production of ventilators early on because if you're taking action that early, you're taking completely different action.
There is one example of a nation that did what South Korea specifically did, and it's South Korea. They had several attributes unique in combination to South Korea that enabled the speed, cultural response, tech, testing, tracing and manufacturing to come together so well.
Nearly every country on the planet similarly failed to follow precisely what South Korea did. For good reason: they couldn't under any circumstances, realistically, because there are few countries like South Korea.
There are only about a handful of nations that can, for example, rapidly do the testing (tech, scale, manufacturing, distribution, results, reaction) that South Korea pulled off and so quickly. A mere ~4-6 out of 195 nations can do that on the timeline they did it (and that's in a good scenario).
It would have been an extraordinary accomplishment indeed to have such amazing forward-sight to know exactly what was going to happen and to pick the one country to copy the behavior of - and then to move at a lightning speed of manufacturing and cultural behavior the US hasn't seen since the 1940s, based on 20k-40k cases of an infection in China that we didn't know much about.
South Korea has a far more nimble system and society than the US does, for all sorts of reasons. The US is a lumbering goliath, South Korea is a faster start-up. It would be impossible for the US to do what they did, on their timeline, at scale. The best you were likely to get out of the US, is much higher scale testing earlier on, we could have done that.
However it's brought about, reducing transmission and flattening the curve is key. Every country had a variety of means to do so--South Korea's wasn't the only one. The regions that did so early and aggressively were successful at massively reducing the body count in comparison to countries like the U.S. that slow-rolled any and all measures for six weeks--thus, the U.S. will have, at best, 60k deaths instead of the 5k it would have had if it had enacted the measures it did eventually take just two weeks earlier.
That’s exactly what Taiwan did for instance - maxed out their own factories and ordered more machines to make PPE in January.
Meanwhile, in mid-February, the largest American factory for making surgical masks was running at less than full capacity as the owner complained to the media that no one would make a long-term contract with him and he and his employees were burned last time he ramped up production for H1N1. https://www.washingtonpost.com/business/2020/02/15/coronavir...
> “ In an interview, Bowen said he could make 1 million masks a day if he ran his machines around the clock, a huge quantity for his firm but an amount that would barely make a dent in global demand. He’s hesitant, however, to ramp up production at the facility [. . .]“
Besides, isn't one of the core tenants of Capitalism that those who are able to adapt and overcome will prosper?
Why should we continue to prop up and bail out companies who have clearly mismanaged their finances?
What exactly is wrong with bailouts? Moral hazard is the main one. I don't think my neighborhood coffee shop will take its payout as a license to start breeding bats.
Inefficiency can be a concern. Maybe the economy would perform better if all the real estate and capital equipment made its way to smarter managers, who would not make such stupid mistakes as... business models that involve physical presence in any way?
The survival of the fittest thing is about competition. Capitalism is pretty quiet on the issue of shocks that hit all the competitors equally. That's why we've had monetary and fiscal policy for a while now. This would be a hell of a time to give them up.
So I'm not sure we'd want them to move faster. Perhaps make them move better, or at least abstain from moving so badly, first?
It turns out that a few early mover states were more willing than expected to institute rigorous lockdowns, other states followed on more rapidly than expected, and the population as a whole (even in states with less effective responses) was... actually fairly well informed and took appropriate action.
Basically, we stayed home and beat this. Now we need to finish the job, of course, but absent some kind of crazy change in public behavior we're not going to see the doomsday numbers that everyone was worried about.
I thought this doctor explained the idea better than I could: https://medium.com/@jbgeach/eight-reasons-to-end-the-lockdow...
But I’m just winging this like everyone. I could certainly be wrong.
No, it's not time to ease up. Unlike in February, we have effectively zero buffer in many areas. A sudden increase in cases (which is what "easing up" means!) would push us right over the edge.
We ease up when the outbreak can be sustained. It can't now, and won't for several weeks, maybe two months more. Stay home.
I know in Florida we had to furlough a lot of medical staff because they didn’t get as many cases as expected and elective procedures are banned.
I dislike citing news articles, I'd prefer to cite real research, but here's a crappy source: https://www.usatoday.com/story/news/health/2020/04/02/corona...
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When I first started hearing about the Coronavirus and figuring out the situation, my initial reaction was that we need to foster herd immunity, and avoiding exposure is near-impossible over the long run therefore we should just "get it over with" - not going out of our way to get infected but also not hiding.
Then as we heard about Italy, France, etc, my view shifted, and I viewed the lockdown as a necessary evil.
I've now swung back the other way. Time will tell, but I really think that subsequent research we'll show that we took a huge problem - a covid pandemic - and turned it into two huge problems - a pandemic along with significant swaths of our economy getting destroyed.
The argument to flatten the curve, beyond preventing exceeding hospital capacity, which is absolutely a critical goal, was also that those of us who are not at serious risk could spread to those who _are_ at risk, and therefore everyone needs to act in lockstep. Well, if you take a systems-level view, absolutely the best thing a non-at-risk person can do is get exposed to covid, fully quarantine themselves, and then return to daily life. Having a huge swath of the population with immunity is the best way to protect our at risk population. (In a perfect world, we could culture sars-cov-2 and voluntarily expose ourselves - basically a vaccine except you're exposing yourself to the real deal and not a virus rendered inert)
Also, back on the "exceeding hospital capacity" point, it is precisely those at-risk who are filling up hospitals and needing intubation or ventilation. So we can have a huge portion of the population who is not at risk still living their lives (with some adjustments), and the effect on hospitalizations would really not be that bad as a result.
I'll be closely following Sweden's data over the next months. I'm very curious how their strategy pans out.
The problem with this kind of "systems-level view" is that individual humans are not cogs in a system. What you propose here is asking every non-at-risk person to take an unknown, but possibly as high as a percent or two, risk of dying. I doubt many people will take you up on that. I certainly won't.
I think the best you're going to get along these lines is to find out, once widespread antibody testing is available, how many people have already been exposed to the virus without knowing it. If that number of people turns out to be large enough, it will be a lot easier to get things back to something approaching normal.
This is a complete farce. 1-2% of dying in not-at-risk individuals? We know that the diamond princess, the cruise where we tested everybody, had around a 1% mortality rate, and that was with a bunch of at-risk individuals (the elderly, in this case). That basically gives us an upper bound IFR, and other data coming out from places like Germany is putting us closer to .2-.6% IFR.
But yes, if someone has extreme anxiety that they are going to die from covid, even despite evidence to the contrary, they should absolutely stay at home. No one should be forced to go outside, but unfortunately in many parts of the world people are being forbidden from going outside practically at all.
The important thing here is the individual needs to be empowered to make an informed decision based off their personal risk tolerance. If someone decides that the unknowns are too overwhelming and they want to remain at home until a hypothetical future vaccine is hypothetically released, that's totally fine. But critically, I don't want to be living in a society that is forcing me to stay inside for reasons that are not based on evidence-based public health policy. And unfortunately so much of what we've seen (e.g. closing public parks, banning jogging, disallowing drive-thru church meetings until the decision was overturned) is not grounded in sane policy, but instead in panic-driven reactionism.
This seems like a highly disproportionate response.
> other data coming out from places like Germany is putting us closer to .2-.6% IFR.
Which is not that different from 1% if you're talking about people deliberately exposing themselves to the virus. If I'm not going to do that at 1%, I'm not going to do it at .2% either. So the term "complete farce" seems way over the top. To me, if you seriously think a significant number of people are going to be willing to deliberately infect themselves and take a .2% risk of dying, or even a considerably lower risk than that, that seems like a farce.
> The important thing here is the individual needs to be empowered to make an informed decision based off their personal risk tolerance.
I'm generally in favor of the idea that people should be given the best available information and then should make their own decisions. In this particular case, I just think you are way, way off as far as your apparent estimate of the average person's risk tolerance when it comes to deliberately infecting themselves with a virus.
Also, if we're going to talk about evidence-based public policy, we need to look at the evidence regarding how well people make decisions when they are empowered to do so. I think the evidence of the last couple of months shows that many people are very bad at that; a lot of public places continued to be crowded with people well after the point where there was plenty of public information telling everyone that close contact with other people in crowded places would spread this virus.
Further, our current public policy regime holds public officials responsible when things go bad, regardless of whether it was actually their fault. That creates a huge incentive for public officials to impose restrictions on people, whether or not they actually make a difference. If we really want to be empowered to make our own choices, we need to stop expecting our public officials to automatically protect us from bad things happening, and take the responsibility for protecting ourselves.
Where is this number coming from?
(Also, .007% is 7 per 100,000.)
Those numbers came from https://esb.nu/blog/20059695/we-kunnen-nu-gaan-rekenen-aan-c..., but given it's in dutch it's probably easier to use this table that a redditor compiled:
https://old.reddit.com/r/COVID19/comments/g4tqvk/dutch_antib...
My bad on not including the source originally; I was on mobile and couldn't track it down (and therefore probably should have just not commented)
> we have effectively zero buffer in many areas. A sudden increase in cases (which is what "easing up" means!) would push us right over the edge.
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I think that this is not the best way to think about it. We need to contrast the benefit of lockdowns (decreased transmission of the disease) with the economic costs. And just to be clear, this isn't about investment returns, the stock market, etc, it's about the very real fact that poverty, stress, and economic uncertainty all eventually lead to deaths in their own right (either indirectly due to being reluctant to seek medical care, or directly through suicide).
If you're willing to discuss further, can we see if we agree on these points?
(1) This is a highly transmissible respiratory virus, and thus eradication is impossible
(2) Given (1), the purpose of lockdowns and other measures is primarily to prevent us from exceeding our hospital capacity, at which point the number of deaths would go up dramatically
(3) The vast majority of the globe will be exposed to this. Avoiding that is not possible, so it's just a matter of when
Therefore, we should work to mitigate the _impact_ of Covid (NOT with the goal of eradicating it, which is impossible), but there is a point where the economic damage will far exceed the cost of lifting lockdown.
BTW, it's not like ending lockdown means everything goes back to normal. We would still be banning large gatherings, at least for a short length of time, and we would still be advising at-risk individuals to self-isolate (and for a country like the US, I don't have any hard numbers here but that could easily still be 30-50% of the country who's considered at risk).
Last point I want to make. Many of us here work jobs that allow us to work from home, and so we kept our jobs during this. We need to recognize that not only have tens of millions of Americans lost their jobs, but a significant chunk of those jobs will not be "coming back". Real value was destroyed. And those who lost their jobs are exactly those who are likely to be in lower socioeconomic classes and thus are much less equipped to weather events like this.
(Sorry, the above was pretty rambly, so I hope there's still some value you can get out of it :P)
Yes, because debt is the only thing that causes stress.
Being cooped in a tiny apartment away from friends and family can be very difficult for those with severe depression and anxiety. In some cases it will and has lead to suicide.
> than force everyone back into the mix and risk a new outbreak
Just because a lockdown is lifted doesn't mean anyone is forced back into leaving home.
The problem with the lockdown is it forces the same solution on to every individual. Individuals have different needs, risk factors, priorities, and appetite for risk. People should be able to these make decisions for themselves.
Yes it is, without proper economic support. It's go back to work or risk poverty. It's not a fair choice if people can't safely stay home without going broke.
> The problem with the lockdown is it forces the same solution on to every individual. Individuals have different needs, risk factors, priorities, and appetite for risk. People should be able to these make decisions for themselves.
That's framing this as an individual choice when it's a societal issue. If people can do whatever they want, it's just the tragedy of the commons. People will do what's good for them instead of what's good for public health. In this kind of scenario, individualism often just translates to selfishness.
Life's not fair bucko.
You want to release lockdowns at the very moment where we are at peak outbreak size? How is that not the worst possible time to do it? The very definition of "releasing lockdown" is that the rate of spread will increase. Since the exponent now seems to be very close to zero, that means it will rapidly become higher than zero, and we will be growing exponentially again.
And we will start not from a dozen cases, but from hundreds of thousands. How does the math work on that?
Also, to pick on some of your postulates:
> (3) The vast majority of the globe will be exposed to this. Avoiding that is not possible, so it's just a matter of when
The fact that we're peaking now, way under universal infection, proves this wrong. We've beaten it, the war just isn't over. We didn't all get Ebola or HIV, which were similarly novel. The world never acquired universal herd immunity to polio either.
Some pandemics, like the 2009 H1N1 ("swine flu") outbreak, do work like that and spread effectively uncontained. And it's bad when they do. Swine flu killed a quarter million people, and COVID-19 is about an order of magnitude more dangerous. So it maybe made sense to let one spread where we want to contain the other.
Details matter, basically.
Please define "peaking". Really what you mean is that the curve of new infections is starting to flatten, but by definition, we are going to hit a new, higher peak if we lift the lockdown, because we haven't exposed enough of our population yet.
It is very important that we either agree on the 3 postulates I provided, or can convincingly explain to each other why we disagree on point (3). The vast majority of the globe will be exposed to this.
> We didn't all get Ebola or HIV, which were similarly novel. The world never acquired universal herd immunity to polio either.
Hmm. This is just incredibly wrong. It's not the "novelness" that determines whether the majority of the globe will be exposed. You have to look at how the disease is spread and how fast/easily it spreads. HIV is not a respiratory infection. So it's a total red herring. Same thing with polio. It should be really obvious that a disease where you need to be exposed to semen/blood/other fluids of someone infected (HIV), or exposed to fecal matter entering your mouth (polio), is going to behave differently than a disease that spreads via respiratory droplets (covid).
Look, the entire world agrees we cannot eradicate influenza, and we also agree that the majority of the world has some level of immunity to these diseases. Whereas with a completely novel virus, we do not have widespread immunity.
Any infection that spreads easily enough (which tends to exclusively be respiratory infections since they spread the most) is impossible to eradicate, doubly so if there are natural animal reservoirs as their are with H1N1 and sars-cov-2.
> So it maybe made sense to let one spread where we want to contain the other.
We cannot contain either of these diseases. It is infeasible. This is another point we really need to agree on to be able to have a productive discussion. Tell me, is there any respected health organization that is advocating a policy of _containment_ towards covid? I am asserting that there is not.
Containment has virtually nothing to do with lethality of the disease, except insofar as a disease with a 50% mortality rate will tend to burn itself out. It's all about the transmission rate.
I agree that details matter. Which is why I think when the facts of how this virus operates are examined, it is extremely clear that we will neither contain nor eradicate the disease.
The approach you are advocating for will lead to the so-called "second wave" that will crush us, and we'll have to close our economy down again to avoid widespread infection, except (a) we won't be able to because we already damaged it too much to have that headroom, and (b) as I believe this "first wave" will show us, economic shutdown is just a bad policy across the board except in areas where we are near peak hospital capacity.
Not sure if you're interested, but my thoughts on a "second wave" are that it's an indication that a society totally mishandled the initial outbreak. We need to try to maintain a steady rate of new infections, such that we are near our capacity but not exceeding it. Now, due to how exponents work, it is really easy to mess up that balance. But we have to work towards herd immunity. (BTW, it's not something that you have to "work" towards, it's really a natural process that we can only interfere with by trying to foolishly contain rather than practicing targeted mitigation.
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> Do you have a specific policy you're trying to advocate for?
Yeah, I'll give you one to chew on. All at-risk individuals are encouraged to voluntarily self isolate, and hunker down until we have a possible vaccine. Those who are not at risk live life as normal, minus some large gatherings. While those at-risk quarantine, everyone else is developing herd immunity. BTW, it saddens me that "herd immunity" has been turned into a dirty word. It is a natural consequence of the way immunity works in a population, and so the idea that building herd immunity is "callous" or ineffective is just a total disregard of reality.
We need to build immunity in as much of the population as possible. That's the only way, and it's what we've done for every Influenza outbreak, because herd immunity isn't even something you can avoid developing without containment. But what we can do via misguided lockdowns is needlessly delay the formation of herd immunity while also destroying our economy (I am using strong language but if you look at the jobless claims, medical workers being furloughed, etc, you realize we are truly _destroying_ tremendous sources of value).
This is sort of the pareto principle. We get 80% of the benefits of a mass lockdown, with only a small increase in costs. In fact, I would go one further and say that any policies that prevent the development of herd immunity are actively causing harm since we're postponing the reconciliation into the future while damaging our economy in the present
Oh, and just to be clear, I advocate total lockdown in any areas that are nearing medical capacity. New York is the quintessential example here.
BTW, New York will be a great example of herd immunity. Their death toll is staggering right now, because massive quantities of people have been exposed. It's hard to know how many, particularly given that the death figures are a little untrustworthy, but I would assume that every death has something like 200 corresponding infections (somewhere around a .5% IFR). Give it another month, and we will see a dramatic dropoff in infection, even if we lift the lockdown, because there won't be many vectors left for covid to spread through.
Last thing I'll say is, it's very telling that you have not made any references to the economic impacts of lockdown. A rational decision requires comparing the benefits of lockdown with the costs to our economy, and by not even mentioning the latter, it seems to imply that you're not performing a rational cost/benefit analysis here, but rather are relying on very dubious reasoning.
We should probably look for mitigations that are not economically harmful and keep them in place. Mask wearing seems to be one of them. Then we can use the time that gives us to look for treatments and maybe even a vaccine.
I wonder if you are giving any consideration of the economic consequences of the virus? Those are going to happen regardless of imposed lockdowns. There's a tweet about reservations at restaurants in Seattle declining 60% prior to the lockdown. That's plenty.
BTW, New York is nowhere near herd immunity. If you assume 1000 cases per death, they would have ~1 million people that have been infected. For a virus this contagious, you want 50-60% for herd immunity, not ~12%.
Absolutely.
> I wonder if you are giving any consideration of the economic consequences of the virus? Those are going to happen regardless of imposed lockdowns. There's a tweet about reservations at restaurants in Seattle declining 60% prior to the lockdown. That's plenty.
Yes, I have given consideration to that, and I think your point is an important one. Basically, I draw a distinction between unavoidable economic impact due to covid itself (your example with restaurant reservations) versus self-inflicted economic damage (forcing closures rather than letting businesses decide for themselves, discouraging elective surgery in areas without a huge outbreak which has led to incredible job loss/furloughs in the medical sector)
> BTW, New York is nowhere near herd immunity. If you assume 1000 cases per death, they would have ~1 million people that have been infected. For a virus this contagious, you want 50-60% for herd immunity, not ~12%.
Right, hitting the "herd immunity" threshold is great, but the important point is that any marginal increase in recovered cases leads to reduced transmission, even if it does not lead to containment the way "full" herd immunity does.
Per your point, if we stick with that 1000:1 estimate (which honestly I think is within an order of magnitude of the true number), that implies we're only 2, maybe 3 "doublings" away from herd immunity in New York. (Let me know if you see an issue with that logic).
By comparison, in my home state of California, we currently have 1000 deaths which we would expand to 1 million cases using that same 1000:1 ratio, whereas our population is about 40 million, so we have an implied 2.5% herd immunity
We also don't know the degree or duration of immunity previous infection provides; we have both analytical reasons to expect and early expiremental evidence that prior infection provides some immunity in the near term, but one quote I've seen is that the level of information we have isn't enough to give us confidence beyond that it probably usually provides some degree of immunity for some period between 6 months and 60 years after infection, without knowing either the degree of protection or where in that range the usual duration falls.
Also we need real-time mass testing capabilities.
Without all of these I can pretty much guarantee that the only weapon we have is lockdowns and there will be another one come flu season, possibly through Christmas until February/March. This is mainly because we won’t be able to tell the difference between the flu and Covid-19 fast enough.
That was going to be the policy of the UK government, until (apparently) modelling based on data from Wuhan showed that it would lead to ~250,000 deaths in the UK.
I do not agree on any single one of your numbered points.
1) "eradication is not possible" just does not follow from "this is a highly transmissible respiratory virus". "Eradication will be difficult" follows; but several countries have shown us that "eradication is entirely possible if proper measures are taken"
2) The purpose of lockdowns is to eradicate the virus. https://medium.com/@joschabach/flattening-the-curve-is-a-dea...
3) See 1.
So my position is that eradication is possible, and - given the possibility of multiple waves if the virus becomes endemic (large virus population --> increased chances of dangerous mutations) - it is vital that we give it a really good try.
The discussion should re-focus on how we go about eradicating the virus, while minimizing the damage to the economy. This article outlines an appropriate path forward: https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-th...
https://apnews.com/8ccd325c2be9bf454c2128dcb7bd616d
It's also not the case that reducing government mandated restrictions will just snap the economy back. Plenty of people are going to avoid sitting in restaurants and the like, regardless of what the government says.
And hopefully businesses will keep lots of people working from home, so that we can limit the spread as much as possible while working towards better treatments and a vaccine.
Yes. And that's a good argument in favour of gradually lifting government restrictions: the private sector will do some of its own lockdown as necessary.
Also, folks shouldn't be smoking or even vaping right now (what's the point of making your possible lung complications from COVID worse???) Just make edibles.
life is risk, and so risk is not a reason to forgo life.
I'm not saying we should "forgo life," I'm just wondering why so many people are rushing to get back to driving Ubers, flipping burgers, etc. in the midst of this pandemic. It's not worth the risk of COVID, which is much, much higher than the baseline risk of everyday life.
And I know it’s quite the contrarian viewpoint but it remains to be seen if the cure is worse than the disease. How many small businesses and livelihoods have we lost? How many suicides? How much unemployment?
Never mind that what kind of economy would we have had with 2M deaths and bodies buried in Central Park?
Also note that Sweden isn't exactly "not locked down" anyway. They didn't institute the hard rules in the same way that, say, Missouri did. Yet the population did it anyway, because they watch the news and see other areas shutting down. So restaurants are open, but empty. Theaters are closed. People are working from home. (Schools are open, which is one difference from most US states). Sweden is absolutely not unaffected economically.
Also recognize that Sweden, like other nations in scandanavia, had a much smaller and somewhat later outbreak vs. the ones we saw elsewhere in Europe. They had warning that the Italians didn't.
So it's a spectrum thing. They chose to accept some lessser economic impact (how much less isn't really measured yet) at the cost of some number of deaths vs. similar data in Norway and Finland. The policy you are arguing for via "open up the economy" almost certainly doesn't look like Sweden.
That's just speculation, of course. But if you look at someone like Trump, I don't claim to understand his thinking super well but he seems like the type of person that would be extremely opposed to a lockdown, not because of the economic impacts themselves but because the impact on the stock market. So, the fact that he accepted the recommendation to lockdown basically implies to me that he saw the level of panic and saw that, if he shutdown, very few would blame him for following advice of medical professionals, whereas if he didn't shutdown and we really did have 2 million deaths, that would absolutely be held against him. So really just some basic game theory.
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Also, I totally agree that the cure is absolutely worse than the disease. (Or more accurately, I am not sure but am highly confident, and will be following the data over the next months)
It's already happening with protests in several states.
If anyone has good ideas for encouraging the types of societal/cultural changes necessary to (eventually) properly incentivize politicians, I'm all ears.
It's not "the populace," it's lobbyists that are funded by massive corporations that are trying to protect their revenue streams. What's the solution? Get the money out of politics. Make it illegal for government officials to take comfy six-figure corporate jobs after they finish their term, overturn Citizens United, put a limit on campaign spending or at least try to level the playing field in some way. That would be a great start.
Regulatory capture means all of this is borderline impossible, though. We live in a world where even 100M people will have a hard time fighting the collective power of billions and billions of dollars. Money makes the world go 'round baby.
How do you feel about the citizens united ruling, which (I am paraphrasing, perhaps poorly) found that by disallowing one to spend money on poltiical speech, that freedom of speech was impacted?
I think it's actually quite a sensible point. Speech costs money. Therefore limits on the money an organization can spend is necessarily a limit on speech.
("Overturn citizens united" is the classic liberal/democrat view, but I really question how many have thought deeply about the implications of what they are proposing).
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BTW, as you probably know, regulations quickly get co-opted by corporations/lobbyists for their own ends. So, if there is a true desire to funnel money to politicians, they will find a way. Now, that does not mean that we shouldn't try to make that harder, if that's what we think is the right move (I think Citizens United was a great ruling. I assume you disagree based off of the above)
I think there are at least three partial solutions that need to be pushed simultaneously:
* Reduce the amount of money in politics
* Mechanisms to reduce the impact of the money that remains
* Mechanisms to help voters see through short-term promisesThe populace casts the votes. We have corrupt politicians that can be bought by lobbyists because we vote for corrupt politicians that can be bought by lobbyists.
The damage here isn't about left/right. It's about a few people in a position to bungle it, doing so with grade B cinema effectiveness.
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I guess, my question is, can you point to some actions that the Obama administration took, relative to the timeline of when the WHO issued the warning, and compare that to the Trump administration's coronavirus response?
(BTW, it's not relevant, but I will say that I do agree that Trump is a total idiot and will put his ego before...well, everything. He has completely mischaracterized our testing capacity, along with tons of other issues. But I'm suspicious of blanket claims that administration X did a better job without a little more substance than you provided)
Even those that took it seriously would not have any sense of urgency to get things ready right away. You need to budget for it, etc and that takes months/years.
To draw a similar point, all of the N95 masks in stockpile were used up in 2009 and never replenished by Obama. No one in 11 years and 2 presidencies took it seriously since then, so I would assume the same with this simulation as well.
[1] https://mobile.twitter.com/marvindanig/status/12520293225898...