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kmlx

And Italy, Spain, France, Germany, Sweden, Turkey, Iran, etc etc

Does anyone know of any large country that managed to:

- not lockdown

- keep the disease under control

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Taiwan.

The country has 23M inhabitants, most of them are clustered in a few densely populated metro areas (Taipei, Kaohsiung, Taichung–Changhua, Taoyuan–Zhongli, Tainan and Hsinchu). Taiwan had many daily flights to/from China, including daily directs from Wuhan (stopped 31 December 2019). Taiwan is one of the world's older countries (median age ~43). Taiwan permitted the docking of the Diamond Princess [2] and allowed passengers to disembark in Keelung (near Taipei), on 31 January, before the ship left for Japan. The ship was subsequently found to have numerous confirmed infections onboard. In reaction, Taiwan's government published the 50 locations where the cruise ship travelers may have visited and asked around 600k citizens who may have been in contact with the tour group to conduct symptom monitoring and self-quarantine if necessary. None were confirmed to have COVID-19 after 14 days had passed. (The only advantage Taiwan had was that facemasks were widely used and even expected on public transport for years.) For all those reasons, Taiwan was at unusually high risk from Covid.

Yet, no lockdown.

No country managed the disease better than Taiwan. We should learn from Taiwan. See [1] for an analysis of Taiwan's response from early March 2020.

It is interesting to reflect upon why most countries ignored Taiwan. The World Health Organization's locking out Taiwan on China's request is probably one reason. Is it the only one?

[1] C. Y. Wang, C. Y. Ng, R. H. Brook, Response to COVID-19 in Taiwan: Big Data Analytics, New Technology, and Proactive Testing. https://pubmed.ncbi.nlm.nih.gov/32125371/

[2] https://en.wikipedia.org/wiki/Diamond_Princess_(ship)

The Taiwanese have been practicing wearing face masks since the early 90's. My first time there in 1991, up to 30% wore face masks when in crowded spaces. My last time in 2018, up to 80% wore face masks when in crowded spaces.

??? Last 3 times I went to Taiwan I didn't see 80% wearing face masks in crowed places. I have pictures from this last December 2019 as well January 2018. Walking around shopping centers, being on the subway, going to night markets, no one is wearing any masks. At least no in Taipei or Dansui

Large country: Vietnam

- More than 2x population of California

- Next to China geographically

- Zero death from COVID so far [1]

- Has a very active campaign on raising awareness for COVID, including the famous COVID song.

[1] https://news.google.com/covid19/map?mid=%2Fm%2F01crd5

Vietnam has used targeted lockdowns. Overall Vietnams strategy was very aggressive on all fronts.

https://www.snopes.com/news/2020/04/21/vietnam-has-reported-...

Given that almost nobody suggested doing nothing, I imagine that a targetted lockdown is really the opposite of a country-wide lockdown. Without elaboration "lockdown" is usually understood as referring to a country-wide lockdown.

AFAIK Germany has done much better than the other ones on your list.

Anders Tegnell, some say the head of Swedish plan against COVID was recently on BBC HARDtalk. You can hear his views on the plan they implemented.

Like the British numbers, the Swedish ones have yet to peak, and they are at 0.4/1000 fatalities (ie four times the German numbers I cited in my sibling comment).

If your primary goal was prevention of loss of life, the Swedish approach doesn't look so hot either.

The primary plan was to keep the load on the health care system within capacity. Preventing loss of life due to insufficient availability of health care. Which according to the models looked like the major contributing factor that could be controlled.

The primary plan was to do the absolute only thing available against the virus: social distance. We have no other way to fight it than to starve it out with 14 day quarantines and other social distancing tactics. No other motive is needed when you’ve only got “one bullet in the chamber” that’s the bullet you’re going to fire.

There's another method: masks. Making them mandatory seems likely to have real, significant effects. It seems almost impossible to make them mandatory in western countries without absolutely massive cause, though.

That’s what I thought too but michael osterholm‘s recent comments led me to believe masks are ineffective.

You can’t know whether the lockdown saved lives until after you see whether countries that locked down have another wave of deaths after reopening.

It’s possible that Britain only delayed deaths by a few months, which is why they currently look better than Sweden.

I am struggling to reconcile "the british numbers have yet to peak" with stories like that:

https://news.sky.com/story/coronavirus-disappearing-so-fast-...

As for deaths, they have peaked in early April in England (see first spreadhseet "COVID 19 total announced deaths"):

https://www.england.nhs.uk/statistics/statistical-work-areas...

I provided links plotting daily numbers for various countries in my other comment. Just compare

    https://covid.observer/gb/#daily
    https://covid.observer/se/#daily

to eg

    https://covid.observer/it/#daily
    https://covid.observer/de/#daily

There's also the possibility that numbers will essentially stabilize, eg

    https://covid.observer/fr/#daily
    https://covid.observer/es/#daily

We don't know yet which way the UK will go, as the number of active cases is still growing.

And it doesn't strike you that zero people recovered in the UK based on your chart...?

It's the Johns Hopkins University CSSE dataset, and recovered cases are indeed not properly tracked for some countries. But you can just look at the crude numbers of confirmed cases and fatalities to see that the situation in Germany and the UK follow different dynamics (cf this plot[1] of the new confirmed cases, though the difference is of course in part due to the testing rates),

However, from looking at the daily fatality rates, you're right that the UK might indeed be already past the peak as well.

[1] https://i.imgur.com/6YJ6op8.png

All you are measuring with your chart is the late ramp up in testing in the UK. Deaths is a much more reliable indicator.

From your spreadsheet:

"This file contains information on the deaths of patients who have died in hospitals in England and have tested positive for Covid-19. All deaths were reported during the period specified below and are recorded against the date of death rather than the day the deaths were announced."

It doesn't include people dying in nursing homes. It doesn't include people dying in care homes. It doesn't include people dying in supported or sheltered accommodation. It doesn't include people dying in prisons. It doesn't include people dying in their own homes.

From research we think care home deaths are a significant fraction of the total (between 30% to 50%), although we need more information.

We stopped transferring people from care homes to hospitals. We put them on palliative pathways instead of transferring them to ICUs.

Why do you think Swedish numbers has yet had to peak? As far as I can tell they peaked in first half of April when the infection peaked in Stockholm and since then it has been bad but stable. We might see a smaller peak now in the end of May when it peaks in Gothenburg.

Yeah, your list kind of lacks nuance. Eg compare

    https://covid.observer/de/#daily

    https://covid.observer/gb/#daily

and

    https://covid.observer/de/#per-capita

    https://covid.observer/gb/#per-capita

The German numbers peaked 2020-04-06, the British numbers have yet to peak. The former are at 0.099 fatal cases per 1000 citizen, the latter at 0.54

Looking at cumulative graphs like that is misleading. It's also impossible to conclude anything about peaking in the UK from the total figures, as the baseline for testing has been changing as the number of tests has increased rapidly in the last few weeks. Fortunately there is one dataset that has remained constant throughout. In the government's daily releases https://www.gov.uk/guidance/coronavirus-covid-19-information... there are "pillar 1" statistics. This number is the hospital admissions that test positive, and it's the only data set that has been gathered in a consistent way throughout. The pillar 1 stats peaked at 5903 new cases on April 5th. Yesterdays pillar 1 new cases were 1277, so the UK cases indeed have peaked and have declined significantly since the peak. They're being a bit stubborn at decreasing below 1000 per day though.

Japan maybe but it's unclear why at this stage.

One important aspect is that in Japan, there were no huge clusters in old folks homes.

There are many others, but this is one of the most important.

Naively, could a factor be that in Japan wearing masks all the time was already normal practice, long before this pandemic?

No, people did not wear masks "all the time" nor did even "most" people wear masks. Go to any image search. Find images before February. (Search Hardly a mask in sight. They are common enough no one finds them strange but they weren't remotely the norm either.

https://www.google.com/search?q=tokyo+crowded+before:2019-12...

https://www.google.com/search?q=tokyo+station+crowded+before...

By "all the time", I mean take any given adult in Tokyo and there's a good chance they have experience wearing a mask for a couple days every year.

In Japan it's not only the immunocompromised or healthcare workers who have ever donned a mask: it's nearly everybody.

You'd be hard-pressed to ride the metro and not see a handful of mask-wearers on any given Tuesday in recent years.

Whereas in countries like the United States you'd rarely see masks outside of a serious medical setting, and you wouldn't be able to buy masks for a dollar at literally every corner shop within 100 meters of your home.

> And Italy, Spain, France, Germany, Sweden, Turkey, Iran, etc etc

This assertion grossly misrepresents the facts.

Italy and Spain were one of the first countries after China to be massively affected by covid19.

They endured a fast and entirely unexpected rise in infection rates during a period where WHO was still repeating the Chinese regime's claims that covid19 didn't spread among humans.

Still, once they started to track the disease and register hundreds of of deaths in patients infected with the disease, they acted decisively. Not only regarding quarantine and social distancing but also putting up massive field hospitals like Madrid's IFEMA hospital.

Spain and Italy's government did not overreacted or downplayed the threat. The UK, US, Brazil and Russia's government started by either pretending it did not existed, assumed they could ride the wave while doing nothing at all, or that everything would just kill off a bunch of people and vanish without any need to worry. Arguably, the government of Brazil is still in the denial stage.

That approach to an epidemic is world's apart than the approach taken by either Spain or Italy or France or Portugal or Greece or Germany or any other country in the world whose government decided to act responsibly and looking after their citizens best interests.

>They endured a fast and entirely unexpected rise in infection rates during a period where WHO was still repeating the Chinese regime's claims that covid19 didn't spread among humans.

Do you have any evidence from that? China locked down 11 million people in Wuhan on January 23[0] which was a whole week before the first cases showed up in Italy[1].

[0]: https://www.reuters.com/article/us-china-health-who-idUSKBN1...

[1]: https://www.corriere.it/cronache/20_gennaio_30/coronavirus-i...

There is some current US right-wing propaganda that China was lying to (in some versions, paying off or running) the WHO to intentionally spread the virus. It's effective because most people don't know the difference between "no confirmed spread between humans" (which the WHO said early in the pandemic) and "confirmed no spread between humans" (which they did not, but is what the propaganda claims was said).

1. You yourself are muddling facts, and 2. the left wing seems to parrot it as well.

The fact is, there was some some oddness between china and the WHO, be it influence, manipulated data or just the appearance of such, it is still not ignorant for the layperson to be suspicious. The problem lies where suspicions become vile forum fanfic, and others start taking it seriously.

The answer is not to point at any side, but at ourselves for promoting the division of our humanity.

I agree about Italy, but I don't agree about Spain.

By March 8th 2020 there were 366 deaths in Italy and over 7000 registered infected, according to: https://www.worldometers.info/coronavirus/country/italy/

The same day the Spanish government let hundred of thousands take part in the 8th of March International Women's Day rallies all over Spain: https://www.reuters.com/article/us-womens-day-spain-idUSKBN2...

According to the Reuters article there were already 589 confirmed cases in Spain at that time, 202 of them in Madrid.

Since Spain did not react earlier I don't think it is right to say the following about Spain (not referring to Italy here): "Spain and Italy's government did not overreacted or downplayed the threat".

Spain was following the indications of the OMS at that point. The pandemic was not declared until March 11th, three days after Woman's Day.

By default, anyone can rally in Spain at any point. They don't seek authorization for the government, they have it by default. It can only be revoked and not granted. While there probably was some thought given to preventing the rallies, given what the OMS was saying at the time it looked like an over reaction. It was, of course, an error in hindsight, but I don't think it's indicative of a big failure of leadership.

The Spanish government did little or nothing before Saturday the 14th of March when the government decided to lock down the country, starting Sunday 15th of March. By that time there were 193 dead and more than 6000 cases in Spain according to: https://www.theguardian.com/world/2020/mar/14/spain-governme...

So even when WHO (OMS) had declared a pandemic March 11th, there were no policies taking effect before March 15th.

Even I, that has never had any interest in epidemic diseases, started to follow the Sitraps from WHO almost daily from February 24th (even mentioned it in a comment on March 2nd, https://news.ycombinator.com/item?id=22464056). Professionals for much longer I assume.

Saying that Spain didn't downplay the threat, as parent 'rumanator' was saying, is therefore not something I can agree with.

I'm afraid politics have been a big part of bad decisions. There were enough cues to stop the rally and they still encouraged people to go there.

Not that the other side isn't being as idiotic now, asking for raising the restrictions immediately.

But there's no excuse for March 8th. Different agencies had clearly warned what was happening and were ignored.

Edit: for fargren, what I mean encouraging:

https://www.youtube.com/watch?v=9Juy7YnqCTQ

For extrangers: it's the vice-prime minister saying on tv that all women should go to the rallies because "it's a matter of live or death" to them. Indeed.

There are many facts that have been arising later, like ministry of health forbidding doctors to attend conventions, police acquiring masks massively and several medical agencies and organizations advicing against the rallies.

It was a typical case of management discarding what every technician under them was telling them for politics.

Edit 2: please don't adopt the typical partisan position with "the opposition was also organizing rallies". No they weren't. There was one party that had its national convention around the same days. Still, it isn't comparable. The government had the direct access to the official sources of information and ignored and hid them.

This isn't a right vs. left matter. More to the left is labour minister Ribera and she was correct to inform the public of how lockdown scenarios would affect workplaces. No good deed goes unpunished, everybody attacked her from all sides... until a few days later it became obvious that what she said was unavoidable.

In the right wing, Ayuso was correctly willing to wait a couple of weeks more to open Madrid, when her coalition partner Aguado forced her to ask for immediate unlock. Central government didn't consent, so change of position was useless, but now there's a left for lockdown, right for unlock division, that's it.

I won't go into the masks issue. It's too painful to just recall.

What do you mean by encouraging? I was out of the country at the time so maybe I missed something.

To be clear, I think the 8th was a mistake. But at the same time, the opposition was organizing rallies and those were not stopped either. There were also massive football matches. At the time, I think the government simply underestimated what was going on, in a large part because the OMS guidance wasn't prudent enough. The fact the 8M aligns with the government may have entered into it, but it's not clear given other events that happened around those dates.

> There were enough cues to stop the rally

This is blatantly and shamelessly false. On the day of the rally there were zero reported deaths by covid19 in the entire country, let alone Madrid. By then the total number of confirmed cases in the entire country barely reached 1k.

There isn't a single nation or government in the history of humanity that decided to lock down an entire country just because there was 1k cases of what was described by then as a mere atypical form of viral pneumonia.

By March 8th, they had been 3k deaths in Wuhan. It was blatantly obvious by that time that Covid-19 was dangerous, and also that the testing situation was such that no one knew how widespread the virus was. Since the strict Spanish lockdown started just 6 days later, it seems clear that not halting the march was a big mistake, although it seems unclear how many were actually infected there.

On the day of the rally there were zero reported deaths by covid19 in the entire country

But the situation in Italy, our neighbours, was clear enough, no need to be Nostradamus.

There isn't a single nation or government in the history of humanity that decided to lock down an entire country...

You're very good attacking a strawman. Between encouraging massive rallies of hundred of thousands of persons packed in the streets and locking down an entire country, you know, there's a whole lot of intermediate points.

...just because there was 1k cases of what was described by then as a mere atypical form of viral pneumonia.

https://www.marketwatch.com/story/coronavirus-update-107758-...

> The same day the Spanish government let hundred of thousands take part in the 8th of March International Women's Day rallies all over Spain: https://www.reuters.com/article/us-womens-day-spain-idUSKBN2....

On March 8th Spain barely registered 1k cases, and counted zero deaths due to covid19.

The first confirmed death in Spain due to covid19 was registered on March 9th.

https://en.wikipedia.org/wiki/COVID-19_pandemic_in_Spain

It makes no sense to criticize a democratic government to impose emergency measures a kin of totalitarian and oppressive regimes just because there were barely 1k cases of an atypical pneumonia which even the World Health Organization claimed that wouldn not spread between humans.

Italy had 79 total cases on 22nd Feb, a full month after China confirmed H2H and went into full lockdown. China had 10k+ cases by 31st Jan, confirming the exponential growth of the virus. Countries had ample time to come together and act. They were caught blind because they were actively looking away. Look at the entire South East Asia, Taiwan, South Korea to see what proactive measures look like.

Italy began engaging similar proactive measures on 23 Feb, including lockdowns of towns with confirmed spread. We just don't remember it that way because their proactive measures didn't work.

Japan, Sweden, Taiwan.

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