How many does Seattle receive?
The current state of both cities has nothing to do with what they did or didn't.
Same thing with Europe. The most affected countries are the most visited ones. Which also makes me question about the effectiveness of lockdowns.
Lockdowns are definitively, absolutely effective in curbing spread. It is backed by solid evidence of reduction is spread in places where lockdown was implemented, AND we have logical scientific reasoning to explain why. The only debatable aspect is whether they are the best solution, given all the trade-offs. And that is a difficult choice. But given no other solutions, if you can afford a lockdown, it is the right first step while you figure out other options.
Countries have been able to avoid a lockdown if they have sufficient quarantine facilities, contact tracing and hospital capacity. But in the absence of these, lockdown is the most effective way to navigate this.
Real number is less than that and could be way less than that.
Lockdowns create their own form of havoc, but I think they were the right decision at the time until we had more information.
Now we need to figure a low risk way forward
Not overwhelming hospitals.
The why, as Washington State Governor Jay Inslee said, "The penalties are you might be killing your grandfather if you don't do it."
It's innocent others; our grandparents, those with known compromised health conditions, and those, even young and likely uninsured, with unknown health conditions, that are being saved.
Putting this another way, I don't care if someone is a smoker in isolation. That's their choice. I care when it spreads and affects others, including myself. The balance of freedom must be considered when conflicts exist, with a bias towards preventing tragedy of the commons.
- There is a deadly virus out there that is spreading very quickly.
- People who are not showing symptoms are spreading it.
- Community transmission has started
Given these data points, if one leader decided to lockdown sooner and another decided to wait it out, I think it is fair to say that the leader who picked lockdown made the right decision. Yes, if you add an additional data point that 50% of population is already infected, sure, you could argue that maybe it is doing more harm than good. But there is no evidence for this, and this almost certainly was not true when the lockdown decision was made in Washington and California.
_If_ is the key part of this sentence. We simply do not know, which is why - as you point out - testing is key!
If we were strict on lock-down and on testing, we can be very effective with this:
After a few (say 6 or 8) weeks if lock-down we can know with high likelihood who is and who is not sick. Now test all the sick people (and their friends), and start testing the general public for anti-bodies. Then start tracing any new infections.
That requires folks following the lock-down and health measures and the mass availability of virus and anti-body tests.
https://www.bloomberg.com/opinion/articles/2020-04-24/corona... "in the most severely affected regions only about 10% to 15% of the population had been infected"
So, um, no, we are nowhere near the 50 percent, at least according to any data we might have. And, depending which expert do you heed and what is the definition of "herd immunity" they're after, we need 70%, 90% or 95% before this is over.
50% would lower a 2.0 R0 to 1.0. 66% would lower a 2.5 R0 to 1.0. And this ignores that we may have permanently changed behaviors (e.g. handshakes) that facilitate spread, so we may not even need this fraction to curb tramission.
New York City is presently somewhere past 23%, so that's a big chunk of the way to a 1.0 Rt without controls.
If you read the article you'll see that doesn't matter. By the time Seattle took action the disease was already widespread in the population at large.
Other factors, like size, density, and use of public transport, are discussed in the article.
> The most affected countries are the most visited ones. Which also makes me question about the effectiveness of lockdowns.
The countries we have the best data on are developed countries. Again, read the discussion on the different tactics and approaches -- lockdown is only one of the issues.
Looking at 2019 passenger statistics for the big 3:
JFK[1] = 62.6 MM
LGA[2] = 31.1 MM
EWR[3] = 46.3 MM
Total = 140.0 MM
Equivalent 2019 metric for SEA[4] puts it at 51.8 MM.
So as a ballpark measure, greater NYC process 3x more than SEA.
The CDC[5] reports ~13k cases in WA, whereas NY alone is at ~267k cases; add another ~102k for nearby NJ.
Extending the benefit of the doubt, that's ~20x positive incident for 3x flight activity. Even if we pretend that WA is under-reporting by a factor of 2, and half of NY cases are false positive, the argument still falls flat on its face...keep in mind, NJ isn't even being accounted for in this thought experiment.
[1] https://www.panynj.gov/content/dam/airports/statistics/stati...
[2] https://www.panynj.gov/content/dam/airports/statistics/stati...
[3] https://www.panynj.gov/content/dam/airports/statistics/stati...
My family is in New England. Massachusetts has 10x more deaths per capita than New Hampshire even though, if anything, Massachusetts has been a bit ahead in terms of closures and interventions.
No one who's been to NYC can miss the fact that it's one of the filthiest places in America, from the perspective of disease possibilities. Many parts simply pile their trash on the curb and there are rats are everywhere. People pack into subway cars like sardines, and there's no way to avoid droplet transmission. During my time there, I saw several people vomit in public and just walk off.
There are plenty of great things about the city, but lacking a real culture of cleanliness (e.g., Tokyo), density breeds disease.
COVID-19 is spread principally by breathing, which is unaffected by cleanliness.
And if you think people are packed into subway cars in New York... have you been to Tokyo?
I'm not saying New York is a paragon of cleanliness, but you will have to show some scientific evidence that curbside trash pickup or the occasional subway rat has anything to do with the prevalence of modern-day diseases. Because they simply do not as common knowledge suggests.
Modern diseases like colds and flus are spread through close contact in schools, office buildings and subways the exact same as they are every other major city on the planet.
I haven't been to Tokyo, but I have sat and watched groups of rats feast on curbside trash in Upper Manhattan. Many times. (And the roaches--ugh.)
Masks?
> I'm not saying New York is a paragon of cleanliness, but you will have to show some scientific evidence that curbside trash pickup or the occasional subway rat has anything to do with the prevalence of modern-day diseases. Because they simply do not as common knowledge suggests.
Initial reading: https://en.wikipedia.org/wiki/Rats_in_New_York_City#Disease,...
Diseases carried by NYC rats: https://www.ncbi.nlm.nih.gov/pubmed/25316698
Hong Kong and literal SARS: https://pubmed.ncbi.nlm.nih.gov/12932393/
"Urban Norway and black rats (Rattus norvegicus and Rattus rattus) are the source of a number of pathogens responsible for significant human morbidity and mortality in cities around the world.": https://doi.org/10.1089/vbz.2012.1195
Yes, we all know rats can carry disease, and that this has been a historical problem (e.g. the Black Death).
But it's not like coming into physical contact with a rat, or even their droppings or anything, is a common occurrence in NYC.
In 10 years living in New York City, I've seen a rat maybe 50 times total? Every single one was on the subway tracks (i.e. inaccessible), except exactly once I saw one at the end of the deserted platform, but far away from people.
Now I'm sure there are rats elsewhere, I'm just a single data point.
But nevertheless, to put it simply, getting diseases from rats is not a known public health problem in New York City. You cannot extrapolate a risk here simply from the presence of rats.
If you're up for a more disturbing experience, go sit on those benches at the south end of Riverside Park--the ones next to the ivy or whatever. Listen for the squeaking. Guess what? Those are rats. Lots and lots of rats, like in Jurassic Park or something.
Your argument would basically be saying at that point "China has much more cases even though they have stricter restrictions, which means restrictions don't work!"
Saying that New York's approach wasn't science based is absurd. The most notable screwup was the delay in school closures due to the dependence that many have on getting breakfast and lunch at school. IMO, at the time I don't think awareness that asymptomatic "super spreaders" may exist was known. (Assuming that is true, much of the data known to CDC is now classified so it's difficult to really know!)
A tiny number compared to NYC or Seattle. Yet, the state hasn't issued stay-at-home orders, and now they have a major outbreak.
So far, they've had 10 deaths. The total projected number of deaths through August 3rd is 93.
New York is projected to suffer 23,232 deaths for the same time period.
https://covid19.healthdata.org/united-states-of-america/sout...
--
'More subway' doesn't really capture it. NYC has ~70x the daily ridership on metro rapid transit.
https://en.wikipedia.org/wiki/List_of_United_States_rapid_tr...
Overall population density is much higher as well:
https://en.wikipedia.org/wiki/List_of_United_States_cities_b...
NYC also has the lowest car ownership in the nation, so you're basically left with walking or uber/taxi/public transportation just to get to the store/doctor/etc.
https://www.governing.com/gov-data/car-ownership-numbers-of-...
Also ~25% more airline traffic hauling bugs in from everywhere.
https://en.wikipedia.org/wiki/List_of_busiest_city_airport_s...
Combined with a long transmissable dwell time before symptoms, wouldn't surprise me if 90%+ of the people in NYC were materially exposed.
Looks like you have a possibly important point:
If so, then they would be well on the way to herd immunity and, thus, essentially at the end new cases and the end of the epidemic.
So, for your point, at
https://www.breitbart.com/politics/2020/04/23/andrew-cuomo-1...
is in part:
"Andrew Cuomo: 13.9% of New Yorkers Tested Positive for Coronavirus Antibodies; 21% in NYC"
The 21% is huge.
So, it looks like the virus spread much faster than symptoms indicated and now ballpark 1/4th NYC has been "exposed" to the virus and is either infected without symptoms or recovered without ever having significant or any symptoms. Amazing. So, if want to accept the usual situation for viruses, then the 1/4 of the population soon can't get or transmit the virus.
Ah, but wait; there's more: As at
https://www.msn.com/en-us/news/us/in-four-us-state-prisons-n...
is, call it an exploitation of a captive audience,
> When the first cases of the new coronavirus surfaced in Ohio’s prisons, the director in charge felt like she was fighting a ghost.
> “We weren’t always able to pinpoint where all the cases were coming from,” said Annette Chambers-Smith, director of the Ohio Department of Rehabilitation and Correction. As the virus spread, they began mass testing.
> They started with the Marion Correctional Institution, which houses 2,500 prisoners in north central Ohio, many of them older with pre-existing health conditions. After testing 2,300 inmates for the coronavirus, they were shocked. Of the 2,028 who tested positive, close to 95% had no symptoms.
> “It was very surprising,” said Chambers-Smith, who oversees the state’s 28 correctional facilities.
and the article has more such data.
Then if want to accept an estimate that 50% of the population immune means herd immunity, NYC is ballpark half way to herd immunity which would be close to the end of the epidemic. E.g., even people in NYC so far never exposed to the virus would not get infected even from infected new arrivals before they were recovered or dead.
So, a guess is that the virus SARS-COV-2 is very strange in two respects: (1) It is astoundingly communicative, that is, spreads very easily and (2) has some huge fraction of people with the virus but without symptoms.
A guess at an explanation: In NYC, the virus was often getting spread just via the air, e.g., via building central HVAC systems?
The good news, if want to believe all such evidence and related common assumptions, is that we can get to a fraction of the population with immunity large enough to have herd immunity and, thus, essentially be well on the way to the end of the epidemic, all surprisingly quickly.
Only, there's no evidence that folks who recover from COVID are immune. Herd immunity might never come, so lockdowns remain beneficial in reducing hospital crowding.
https://www.npr.org/sections/coronavirus-live-updates/2020/0...
Yup. But the usual assumption, experience, history, situation, whatever of viruses is that recovery means immunity at least for some significant time, say, a year or so.
Also, I stated
> So, if want to accept the usual situation for viruses,
I didn't explicitly repeat this qualification just before your quote but went for fewer words.
>> So, if want to accept the usual situation for viruses...
You're saying that we should assume "normal situation" in the face of evidence that your assumptions do not hold. Anything you say based on this faulty assumption is hardly worth consideration.
Folks don't develop immunity to this virus. They can get re-infected immediately after recovering. Herd immunity is a phenomenon observed elsewhere, but not here.
This is an extraordinary claim without evidence.
There's a few case reports of "reinfection", but they are rare. In all cases A) symptoms were mild, and B) researchers were unable to culture SARS-CoV-2 from them. Many viral illnesses have people shed virus again a few times after "recovering", and this seems no different.
A bigger concern is, humans seem to lose antibodies to coronaviruses with time-- this is how we get the common cold again and again. But infections after the first time seem to be less severe, thanks to longer-lived immunity from memory t-cells, etc. And at least for SARS-COV-1, immunity lasted quite a bit longer than typical for other human coronaviruses, with decent antibody titers at 3 years (no followup past then).
Not really! As you say, this virus is new. Soooooo, we are short on info. So, we should entertain several possibilities.
I didn't say "should" and, to entertain more than one possibility, only said "If"! Biggie difference.
Yup, we don't know. If we do a lot of very well designed and executed statistical trials, controlled, double blind, randomized, simple random sample, stratified sample, etc., then maybe in five years we will know enough to be sure on all the major points, across seasons, ages, other medical conditions, reinfection, spreading via HVAC systems, therapeutics with dosages, side effects, and contraindications, vaccines with number of shots, contraindications, etc. Ah, just wait five years!!!!
Well, nope, to paraphrase, we go to war with the info we have and not the info we want.
So, for the info we have, from the history of viruses, once recovered, then likely immune for a long time; for now we have to take that seriously and maybe are in effect forced to act as if we believe it.
Yup, there are reports of "reinfection" from maybe China or South Korea -- I didn't pay much attention to those reports due to concerns about, call it, data quality. But, net, yup, maybe in some cases, maybe even in all cases, recovery does not mean immunity.
At high cost, we will be finding out with some relatively good data, and in less than five years! Did I mention high cost?
Here in the SF Bay Area, I'm seeing a 40% decay weekly in hospital admissions. If you assume infections outnumber hospital admissions by 20x, it's going to be months before we reach the low case counts (1 per million) needed for contact tracing and suppression efforts amid semi-normal activities. And that's assuming we keep the 40% decay rate, and don't encounter subpopulations with higher Rt's that keep the virus circulating much longer or even growing.
I disagree.
Specifically, Deblasio took forever to close the schools. I don’t live in NYC, and I remember when before they closed the schools wondering why they hadn’t done it yet.
So some actions matter more than most.
https://www.theguardian.com/world/2020/apr/21/boy-with-covid...
The Paediatric Intensive Care society put out an alert (weirdly using Twitter to do so): https://twitter.com/PICSociety/status/1254508725227982848
https://www.hsj.co.uk/acute-care/exclusive-national-alert-as...
What's your source on that though?
The Northeast US is, at least in parts, some of the worst in the world that is known about and, other than being pretty dense, it really doesn't map to especially poor government response by reasonable definitions. Perfect hindsight doesn't count.
If you read the article, they largely discuss NYC's inability to arrive a decision promptly, which allowed things to spread. Also, resistance to the idea of social distancing looks like it made things much worse.
It's like everyone who is commenting here didn't even read the article and is just spouting opinions.
The long term effect is arguable since we don't know if we can prevent the majority of people from getting infected.
That's why the phrase "slow the spread" makes sense. Even if we can't prevent people from getting infected eventually, we can slow the spread enough that hospitals can handle incoming patients. If everyone gets infected at the same time, there won't be enough ventilators to treat everyone.
More visitors may kick off more chains of infection (so higher numbers) but that's just linear growth. Stopping exponential spread is what prevented something far worse than what we have seen.
Some Italian scientists did an RNA analysis on samples from infected people from Italy, and confirmed they descended from the first German case.
Basically, if this hypothesis is true then German quarantine and/or exposure tracking failed. Had they played it safe and properly quarantined the entire staff of the office building , Europe's coronavirus pandemic might have gone entirely differently.
According to virologist Dr. Drosten, this idea has been mostly disproven. Some scientists believed it initially but after more debate, the consensus has emerged that both Italy and Germany got their virus directly from Wuhan or Shanghai.
Source (in German language): https://www.ndr.de/nachrichten/info/coronaskript174.pdf page 79
It might well be that containment failed, and that a single person caused hundreds or thousands of the deaths in Italy, much like patient 31 in South Korea.
On the other hand, without those extra deaths, authorities would simply have waited a bit longer with a lockdown, people would have acted as usual for longer, and the end result might just have been very similar with a delay of a few weeks.
That other 99% really don't seem to know for sure lockdowns are effective; the only arguments I've ever seen them present are "my model says they're effective" or "it would be strange in principle if they weren't". (Some laypeople draw dishonest comparisons to control measures for the Spanish Flu, but epidemiologists know that these measures didn't include orders to stay at home or close all businesses.)
Sweden did start much more slowly that switzerland but they clearly are vastly underperforming in saving their citizens.
You took Switzerland as an example, but if you would have taken Belgium, Sweden would do actually very well. Still, Belgium took quite strict lockdown measures and in a pretty early stage.
What really seems to have had a significant result on keeping the death rate down, is testing: countries like Germany and Switzerland are testing often and early and have done so already in an early stage of the outbreak. This way they were able to treat patients early and to protect vulnerable patients against others in their surrounding that were infected.
The US would probably be at over a million deaths by now if life had continued normally without lockdowns.
I also think we have many different ideas about what's best. (Again, all people I assume are smart.)
This is just a hard scenario. There is no obvious 'best' answer. There may not even be a 'right' answer.