What Happens Next? Covid-19 Futures, Explained with Playable Simulations
ncase.me
ncase.me
I live in NYC, and this is something that still feels like a gaping hole. My wife has been job hunting since before we were on lockdown in February, and its been truly horrifying how many businesses COVID-19 hiring plans have been along the lines of "work from home until the very fist day the governor says we can go back to office". These aren't just "old school" BigCorps either, most have been small tech firms. Even worse, she finally ended up with a "offer" from a government agency I won't name that refuses to give her a start date yet because, even though the rest of the office workers are WFH, they refuse to hire remote because of "taxpayers" (who are ironically funding her to not work via NYS unemployment benefits).
It's become quite clear to me that we can't trust businesses to do the right thing here. The desire for "butt in seat at office" from folks making decisions at employers here is going to end up flooding our subways with commuters who have no choice but to come in because they don't want to lose their jobs. Theres no reason office workers successfully working from home shouldn't stay there as long as they feel comfortable, and not make it terrible for folks who truly do need to commute (retail, food service, medical, etc). Maybe I'm just biased because I work for a remote company already, but I'm seriously worried what the big cities in America will look like once the initial restrictions are lifted.
Are you sure you're not reading too much into this? If I was running a company, new hires would be among the first people I would want in the office. Traning them and getting them up to speed would be so much faster in person, whereas most other employees are already set up to WFH. Just because they want new hires to come in asap doesn't mean all employees have to come in asap.
I'm curious why this is the case. Is it because of existing processes? Any sort of onboarding that involves pairing / sitting over the other persons shoulder / breaking social distancing sounds risky anyways. As I said earlier, I'm probably just biased due to my current employer being remote where I onboarded just fine; even my in-office "training" was like 6 weeks after I started and batched with 3 months of other new hires, and not at all helpful for my day to day work. I can't remember a single in-office job where I felt like I was onboarded fast, most of them I sat around reading code and docs while everyone else was busy doing their normal job.
Btw, I regret any mention of the rest of the country in my original comment. The thing that really scares the hell out of me is the mass transit / subway system here in NYC and opening that back up to office workers (many commuting from outside NYC), new hires or otherwise. I think its an extraordinary situation compared to the majority of the driving to work US and should force companies to adapt in ways others might not have to.
The inability to change the parameters is a major problem with the simulation and invalidates a number of conclusions at the end.
What we can observe so far is that CFR is heavily skewed towards the old and frail with significant co-morbidities. Most likely there is another, not yet fully identified, medical cofactor that makes this virus particularly difficult for a very small number of people of any age. Outside of those groups the virus doesn't seem to be very symptomatic for the majority of infected people. Note that symptomatic in the medical sense and common usage is not the same. The latter having a way higher subjective threshold.
The simulation should also account for the "weak tree" effect in that the majority of the susceptible will succumb to it on the first contact. In the following years the number of susceptible will be much lower and only go up with the remaining people going into ill health and becoming susceptible, if they haven't developed any immunity from the previous encounters.
A simulation to draw real conclusions from must have an adjustable IFR, CFR, the corresponding hospitalisation rates, and the age and health distribution of the population for a region to be modelled.
We need models that consider the details. We need models that consider that the virus preys on the weak (i.e., elderly and pre-existing conditions). Taking these profiles and applying them across the entire population is inaccurate ans misleading. It might even be dangerous.
The oldest people also die much faster so the ratio of deaths depend on rate of spread.
For example, I heard a new report that said the Bronx NYC has the highest per capita C19 infaction rate of any community nationally. Freightening? Maybe. How many other communities are similar to the Bronx? Similarly, how many living situations are similar to assisted living facilities. Taking edge and atypical cases and extrapolating that out over 330 million isn't a good model.
Yes. C19 is highly contagious. But we also know - from data - it is more likely to kill the weak than the strong.
If it's something bad,it's bad. You have to take precautions to it. But panic and fear is the things you have most likely not to on most of the situation. Because it'll lead you to the poor allocation of the resources. Although, these are just my opinions :)
Some countries can do it, some others cannot even at gunpoint because skills and discipline are not there, and you can not create them out of thin air.
No fatalities among the 200-odd employees. But around 2% became very ill indeed, and they still can't breathe properly weeks later.
Deaths are not the only problem. They're the most visible and the most shocking, but there will be 5-10X more serious illnesses, and it's not yet clear if these people will ever recover fully.
Characterizing this demographic as "old and frail" is a bit much. And there's no science limiting this analysis to "significant" comorbidities. I hate to pick on one adjective, but it really seems like you believe that everyone who dies from this disease is at death's door already. There is absolutely no science to support that.
> the majority of the susceptible will succumb to it on the first contact.
And that's not correct at all. Even the most at-risk groups have a 90%+ survival rate.
>NOTE: The simulations that inform policy are way, way more sophisticated than this! But the SIR Model can still explain the same general findings, even if missing the nuances.
This is a much simplified model for the purpose of education. So not including everything the real models include isn't really a flaw in my eyes.
From the article's source (https://www.sciencedirect.com/science/article/pii/S019665530...): "None of these surgical masks exhibited adequate filter performance and facial fit characteristics to be considered respiratory protection devices"
Well, what's "adequate filter performance and facial fit"? For filter performance, they measured how good the surgical masks were at blocking tiny latex spheres that approximated an aerosol, and found that masks ranged from less than 1% penetration (best) all the way to 80% penetration (worst). For facial fit, they told subjects who "were not screened for previous use of masks or respirators" to wear masks and then sprayed an aerosolised bitter substance on them, and found all of the subjects could taste it after their first try.
The article is making the claim that masks don't stop you getting sick, based on a source that indicates some masks don't filter aerosols completely and that nobody wears masks correctly anyway. This is a bit of a stretch - their source says nothing about larger droplets, it says nothing about side effects like touching your face less, it says nothing about masks encouraging other people to socially distance, it says very little about how masks reduce the viral load that reaches you.
I don't think there's enough evidence to categorically state that masks do not stop you getting sick. I think it's irresponsible to make such a firm statement without better evidence.
I feel like the masks don't work rhetoric is political maneuvering born from the fact that governments had little to no reserves of them and that health professionals desperately need them.
Whilst I'm sure some seasoned bureaucrats or advisors think the (subjectively) white lie is the right thing to do; because health professionals need them more. The fact is if we all supported EVERYONE wearing masks, large scale domestic production would have to begin in every country and health care professionals would be swimming in masks. Not to mention it could play a part in reducing transmission.
Masks for everyone is a win win.
Lying to people erodes trust. When leaders then order subsequent weeks-months of lockdown, people don't trust them, ignore their orders, and protest.
It's not just the masks, though. Leaders failed to lay out plans and exit criteria fast enough, weren't fast enough to address arbitrariness in their orders, and have downplayed knock-on effects.
https://today.rtl.lu/news/science-and-environment/a/1498185....
Whether masks protect the person wearing them is still very important, firstly for the protection itself, but secondly because some people are motivated more by self-interest than altruism. If you tell everyone that masks don't stop you getting sick, when in the balance of probability they do prevent some cases, then fewer people will wear them.
> Around 1 in 20 people infected with COVID-19 need to go to an ICU (Intensive Care Unit).
That statistic is contingent on infection rates. No one has these due to lack of testing. Therefore, the statistic is misleading at best, and wrong at worst.
> However, pandemics are like poker. Make bets only when you're 95% sure, and you'll lose everything at stake.
This is highly alarmist. Pandemics aren't like poker because you're not going "all-in" on a 95% bet. Awful analogy, and just bad rhetoric.
> (Rant about the confusion about pre-symptomatic vs "true" asymptomatic. "True" asymptomatics are rare.)
Let's be real. In the study cited, N was like 900 (with asymptomatics = 4; 1.9%). We have no idea how "rare" asymptomatics are, and citing this study is just bad science. I don't understand why not just be honest.
The 'masks protect others from you, and wont protect you from others' illustration is very useful, too.
the problem with this simulation is as with all models, it treats everyone equally likely to need medical care (this is how the ICU bed capacity is drawn). That is not the case a least bit. Millions of people have recovered with minor discomfort and they have all predictable traits (say age) that clearly indicated their preponderance to risk.
Show me a model that accounts for this, then I will take it seriously.
Unless of course you want to assert that we should care more about some deaths than others. But that is a political statement, not an epidemiological one.
That said, I'd love to see a model that does assume the population cares more about some deaths (notably their own, and those of their close friends and family) than others.
The starting point for epidemiology and public health is that all life is sacred and worth the same, and we should protect life at all costs. There's pretty ample evidence that much of the general public doesn't actually believe this, though they'll publicly profess to because there's immense social stigma against wishing other people dead. But note how many people make comments in the vein of "It doesn't affect young people", "This is only a big-city disease", "It only affects Asian people", "Yes, yes I hope Trump supporters do drink some bleach", "I hope he dies of coronavirus", or "Good, Darwinism in action." The mods of r/coronavirus had to make a blanket policy against wishing people dead, and regularly lock threads because of it.
Public health interventions only work if people follow them, which implies that a.) the citizenry needs to trust public health experts and b.) their goals need to be aligned enough that citizens think it's in their best interests to comply. There's a very common failure mode for other system-design efforts in assuming that the stated goals of the project are the actual goals. I'd love to see a model that assumes people are self-interested actors that respond to fear and greed, rather than one that takes as a given that they'll act for the common good.
You misunderstood GP's statement. For example, this statement from the article: "Around 1 in 20 people infected with COVID-19 need to go to an ICU (Intensive Care Unit)." is grossly misleading as it's dependent on having reliable infection rates (which no one has).
There are no reliable tests, governments are not doing a lot of testing, most cases are asymptomatic.
How do you even know the death rate, and how many people need ICU? The animation says 1-20, seems crazy.
Am I right ?
Your hospital would now when you ask them for a year, same as they know when they process it.
Short answer, if the immunity is as short lived as current seasonal coronaviruses, it would be expected to recur in 2022 (hopefully with milder symptoms, but we can't know that yet).
The best Strategy is to do nothing
The best Tactic is the complex array of shutdowns, mask, social distancing, pharmaceuticals.
https://en.m.wikipedia.org/wiki/Antibody-dependent_enhanceme...
That said, approaches are kind of different compared to traditional vaccine development. If efficacy is demonstrated, there will be a huge pressure to scale up production to get it around ASAP.
That's why institutions like the Jenner Institute in Oxford (which develops one of the vaccines further ahead in the race) is seeking partnerships everywhere (at risk, because for now no one knows if it works). No single entity can make billions of doses.
P.S.: All these measures and reasonings seem to forget the eventual availability of effective pharmacological treatment, which might reduce the medical impact of this disease.
His questions got creepy quickly until I had to tell him to ask someone else because I felt uncomfortable, but let's just say Office 365 can quickly turn into a mighty tool for the ill intentioned.
One of the great shocks in my life was finding out the sheer number of employees to which this applies. The most obvious places were the various BigCo's I worked at, but it applied almost anywhere.
Now just the drudgery and pointlessness of much of their work made me sympathetic to their slacking-off, but it was the constant anxiety of appearing busy that made it seem truly miserable.
At some point in my early twenties I'd had both the high-pressure, still-smelling-of-fries-after-a-shower type of experience of working at McDonald's or various restaurants, as well as the experience of sitting in the office with various just-below-board-member managers of one of the major insurance companies here.
Aside from the possible issues resulting from the physical strain, and having to live more frugally, McDonald's struck me as preferable to the latter (but neither seemed like any kind of world I want to live in or actively maintain, if possible).
I don't know if this is a personal thing, but I would go for a job where I need to focus and work over a job where I need to pretend to focus and work anytime. And most office jobs seem to have more of the latter than I can imagine anyone tolerating.
Most people need to feel useful on some level or they lose motivation and their brains go sour. There are exceptions to this rule, and those people should definitely dedicate their lives to finding a cushy office job. I would literally rather drive rideshare, and I have. [Not since March 12th, though-- fortunately my S.O. is able to cover bills until I can go back to driving and/or try to find a software job worth showing up for again.]
I just wanted to point that out, because I find it extremely frustrating to discuss these matters with various friends who are all in agreement, but then somehow believe this is just a government thing, and as a result seem to be drinking more and more of the 'corporations and the free market optimize this shit away and socialism is bad' kool-aid. Which strikes me as both a simplistic and ineffective conclusion to draw, if we're thinking about better ways to do things.
Oversimplifying, but in my experience the private sector, at scale, is often just as inefficient and bullshitty and mind-numbing and depressing as a government entity, just with less job protection, higher pressure, and perhaps often less of a meaningful societal value, however inefficiently achieved.
And perhaps worst of all, you get managers/bosses who are not just content to do an okay job at their current position, but actively employ a ruthlessness and ambition that makes their stupidity all the more problematic.
This is a great point. Having worked at several large companies in addition to both state and federal government agencies, I mostly agree. I hated not being efficient in government work, but at least there was less B.S. pressure and some sense of 'greater good' decoupled from profit incentives (although there were definitely still budget constraints).
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edit to add:
I worked at Google as a TVC for a couple of years and somewhere in there I became convinced that (at least part of) what was going on was that they were sequestering talent. Hiring people and parking them in idle tasks to keep them from becoming competitors.
It's probably not true, but it was slightly more reassuring than believing that they were just that wasteful.
(I.e. our five-years-and-counting project and team of dozens could have been replaced by about three people and finished in a year. But nobody wanted to hear that. In other words, the situations was "works as intended".)
This seems to be the argument against UBI, as well.
You can replace American with German/Indian/Korean/$COUNTRY.
Lots of managers are just doing BS jobs and are totally useless and the only way they can justify their necessity to those above them is to put on a show and have a tight grip on those beneath them.
Once CV19 blows over, it'll be back to clogging up the streets and offices for most of us.
Yep - this whole thing is upsetting middle-management. When they're not able to do the whole "manage culture"/butts-in-chairs thing their worth goes to near-zero outside of harassing workers and slinging office documents around.
Regardless of if it's workers/managers, work remote does one thing: it cuts the performers from non-performers because the best metric to measure success is output. THIS is why people are freaking out - if they can't APPEAR to be working it'll become very apparent that they're a net-negative to the company they're a parasite of.
But good point. Just we shouldn't be applying aggregate performance reviews based on this episode which don't account for the varying burdens being experienced
Empathetically I agree, but as a realist you can't expect that burden to be shouldered by American businesses who are already hurting. If I kept employing someone that was a net-negative I'd be penalizing those who are keeping their stuff together by keeping them on the payroll during a market downturn... pandemic or not. You don't stay in business by accepting extraneous risk over people's personal problems.
This is why I'm supportive of a livable UBI - most of the American corporate environment is make-work and it shouldn't be looked down on for non-market-performers to exit the workforce and exist doing whatever. Leave the work to people who want to work... simple as that.
Engineer: "Can't you see we are all very smart and working harmoniously to your goal? Just leave us alone already!"
Manager: "Well Fred is bullying Steve about this aspect of the product, because he doesn't like his way of doing it and thinks he can do it better. This puts way too much pressure on Fred who will crack trying to do two jobs, and resentment from Steve, who is actually doing a fine job. I need to talk to Fred about this."
"Also Mike is slacking, working on his side hustle while only contributing the bare minimum to the project. People are noticing and are getting mad at him, cutting him out of the loop more and more."
I don't think management as a role is appreciated much, but it can be vital. It can also be very bad, but the abuse doesn't abolish the use.
You bring up very good points and that’s exactly what management is supposed to be about. Enable everyone to perform at their best as best as possible. It’s just that it’s hard and people resort to indirect markers. “Does she come to office on time?” “Does she spend enough time at work?“
Not many managers try to find out - “is she doing the best she can?” “What’s preventing her from that?” “How can I help her?”
How many managers have a real good relationship with their team that the team shares their real issues preventing them? How many team members feel judged or not heard?
All these have nothing to do with working from home or remote btw.
Hell as a pair I had to send a coworker home because he was so embroiled in day trading. At one point I closed his laptop and said "your either here to work or you can go home and panic about the markets". He got real huffy and then went home. He apologized a week later (he was relatively introspective it just took him a day or so)
In a similar vein, over-reliance on analytics of past data to make future decisions seems inversely related to the ability of a leader to lead. It shows how lazy their thinking is. Consequently, it shows how weak leaders are.
Prior pandemic case fatality rates were 10x what we’re seeing with COVID-19.
Also, in 1918, shelter in place contributed to a W shaped pandemic, where the second wave was much more deadly, and also killed lots of kids and young adults.
If more people in those age groups had been infected in the first wave, many fewer people would have died in total.
Reducing the amount of virus in aerosols won't reduce the number of infections by the same amount. If a cough produces ten times the infective dose, then with the mask that's still three times.
Masks are still likely to help (and maybe having a smaller dose will make the disease milder if someone does catch the virus), but it's not possible to make a statement like this about the effect on R.
https://www.ijidonline.com/article/S1201-9712(08)01008-4/ful...
I think your argument is that it’s just not scientifically proven, but we have to make decisions today with the best information we have. Wearing masks still appears to be a good idea, has very low cost, and has been shown to help for a long time for all kinds of respiratory diseases.
https://www.the-hospitalist.org/hospitalist/article/221558/c...
The Swedish Medical Products Agency (Läkemedelsverket) said on April 2nd that chloroquine/hydroxychloroquine should be used for the Covid-19 indication within clinical studies only, otherwise only for the approved indications (arthritis, lupus and similar). This is because the available data does not offer robust conclusions on efficacy and safety. [1]
This is in line with EMA recommendations, which defer use within emergency programs to national authorities. [2] And in Sweden's case they say "no".
[1] https://www.lakemedelsverket.se/sv/nyheter/klorokin-och-hydr...
[2] https://www.ema.europa.eu/en/news/covid-19-chloroquine-hydro...
See: https://www.cnn.com/2020/04/21/health/hydroxychloroquine-vet...
Seems to me the Remesedevir is the better option, and may be the first silver lining.
I've told my wife, if I can't make the choice do not let them put me on that chloroquine no matter what. Also no ventilation without sedation/paralytics (in case of shortage, I'd rather die than be vented and wide awake).