California sets Covid-19 daily record, Bay Area cumulative total passes 20k
eastbaytimes.com
eastbaytimes.com
I always thought, based on what I've read/heard, that one of the big reasons, maybe the biggest reason we're doing all this is to flatten the curb so hospitals don't get overwhelmed. For some reason headlines always seem to be number of cases or positive test results, and maybe then the number in the hospital is mentioned. The article does say "hospitalization and deaths are also believed to be a lagging indicator." so maybe that's why, but I don't get why (from what I've seen) hospitalizations don't seem to be all that important when reporting on COVID numbers in general. Could it be the people getting the virus now are less likely to end up in the hospital so that number won't keep going up to the point of causing trouble? Another headline on the site says "17+ students test positive for COVID-19 after beach trip".
This was my understanding as well, and it is what is shown in Wikipedia:
https://en.wikipedia.org/wiki/Flatten_the_curve
The bigger thing that I have chatted about with several other is that the area under the curve is the same, i.e. the same amount of inidividuals will still get sick.
https://calmatters.org/health/coronavirus/2020/05/health-car...
With the assumption that every vaccinated person counts towards herd immunity and isn't likely to die, you can plug in your own numbers to the equation above. Even with really conservative estimates, it's easy* to get into the millions when you consider the entire planet.
*Barring some highly effective treatments that may or may not surface.
You need the lower IFR, not the CFR, here.
At this time we don't know how effective any of the vaccine candidates will be.
kids and young adults have less than 1/100,000 chance of dying of COVID. The vaccine needs to be better than that. There is an ethical issue at hand of vaccinating people that are not at risk to save those that are at risk.
For reference after administering 3.1 billion vaccines the US paid damages in about 3,000 cases thus across all vaccines the rate of serious side effects is about 1 in a hundred thousand (considering about 10 vaccines per individual).
There is no vaccine that we currently mandate for the sole reason of protecting someone else.
The fundamental requirement of the Hippocratic Oath is "First, do no harm". If you are vaccinating someone, you better cause less damage to that person than the disease itself would do.
I have a kid, I am not an anti-vaxxer by any stretch of imagination: the whole family gets flu shots every single year.
But will I rush to get my kid vaccinated with a new thing rushed to market during a exaggerated hysteria, a vaccine not properly vetted for long term effects ... uhh most certainly not. I am going to wait a couple of years to see how others will fare.
(FYI I work in life sciences and I like to believe that I understand the inner workings of a living cell better than overwhelming majority of the population)
And as far as COVID vaccinations go, you're trying to have your cake and eat it. Either COVID-19 isn't risky/dangerous for young people, (meaning we can safely vaccinate them), or it's dangerous to them. If you're trying to say that a vaccine for COVID-19 would have worse effects than the disease itself, I think this would be extremely unlikely, since it doesn't occur with other vaccines.
If a COVID vaccination has a 1 in 100K rate of deleterious side effects (up to and including COVID-19) in the general population, then vaccinating the US population (330M) would result in 3300 cases of COVID (or bad side effects). The benefit of this would be saving roughly 2M people from death, and countless others from hospitalization and long term complications.
As for the other content, it just shows you don't understand what kind of problems an insufficiently tested vaccine could cause. You should educate yourself better:
https://www.sciencemag.org/news/2019/04/dengue-vaccine-fiasc...
Of course no one wants to take a vaccine that didn't undergo proper clinical trials. The argument was whether a vaccine that had typical side effect ratios would be ethical.
I don't think we disagree about the new vaccine risk level, since we don't have a vaccine, nor know anything about its side effects.
If a vaccine is has differing risks based on age group, then I would hope that we vaccinate the lowest risk group; assuming the risk variance is significant.
As a society, vaccinations are naturally government infringement upon individual rights. But a well-functioning society routinely infringes on individual rights. We place children in protective services when their parents don't care for them properly (in the mind of the government). We (in extreme times) invoke a draft for military personnel. As my dad used to say, your right to swing your fist stops at my nose. Rights are not inviolable; though care should be taken to limit infringement.
As SC Justice Robert Jackson once said, the protections afforded by the Constitution "must not be discredited by an interpretation to mean liberty without law."
I don't feel that you answered my questions directly, but if I understand correctly, it appears that you would hypothetically favor compulsory vaccination of children for the greater good, even if the personal risk outweighs the benefit.
I wholeheartedly disagree, as I do with the draft. Similarly, I 'think the right not to be punched, is analogous to forcing someone else to vaccinate for your benefit.
As a society, we get to decide what impositions we impose on individual liberty. Where would you draw this line?
I draw the line at criminal charges for failure to vaccinate.
infection fatality rate is the observed death rate based on all (known+undetected) cases
the Swedish report indicates of infection fatality rate of 0.1%
That's incorrect. The IFR in Stockholm (the epicenter for COVID-19) in Sweden is .6% currently [0]. Only if you exclude anyone above 70 do you get an IFR of .1%. According to [1] 20% of the population is 65 and older, roughly 2m people.
[0]https://www.folkhalsomyndigheten.se/contentassets/53c0dc391b...
[1]https://www.indexmundi.com/sweden/demographics_profile.html
FWIW the IFR is getting tiny as for younger people so using the the same preventive measures for low risk people that we use for high risk ones does not make much sense
Do you have a specific source that can explain it?
Basically, the number of infections peaks at the point where - due to some combination of immunity and measures like social distancing - each person infects at most one other person on average. However, there are still a whole bunch of infected and susceptible people spreading the disease, meaning that quite a lot more people then become infected than is actually necessary to end the outbreak. If you assume no attempt to flatten the curve, then a lot more people become infected than the herd immunity threshold, and that's what the NYT and co have focused on. However, one consequence is that flattening the curve without fully surpressing the outbreak reduces overall infections and deaths - the peak is lower and happens after fewer total infections, making it possible to build a whole bunch of herd immunity without all the extra infections and deaths from massively overshooting it.
I have never been able flattening the curve. If people would just stay home for a month and take precautions this would be over as it wouldn't spread and those who have it get over it. The details of living like that are tricky but too many people didn't try.
You flatten the curve to buy time for medical advancements, which will reduce the total area under the curve. It can be any or all of:
1) flattening the curve enough to make contact tracing viable, which can eradicate breakouts before they take hold
2) finding a decent anti-viral treatment so that number of deaths or "permanent damage" cases decrease, even if # of cases does not
3) developing a vaccine
This thing about "area under the curve remaining the same" is only true for calculus, it has no bearing on real life because we are making medical advances.
Aside from medical advancements, if the health care personnel is not overworked, overstressed, overtired, patients have a better chance to survive.
Flattening the curve means lives saved.
Not to mention hospitals usually shutting down elective procedures once the amount of infected patients in their care crosses a certain threshold.
If we had taken decisive action in January or February, we would have had enough resources for contact tracing, and really limit the spread. Instead we'll see at least 200K deaths from this before it is over.
Looking at the new case counts for the USA vs. the EU makes me sad and angry.
When 2 Mother's Day gatherings account for 50% of the cases in Santa Cruz county, what can you do short of saying "You're a moron."
It probably also doesn't help that a lot of Arizonans travel to California at this time of year to escape the heat.
* Forcibly testing people regularly
* Forcibly quarantining people who test positive
* Mandating contact tracing regardless of personal preference
* Imposing travel restrictions on hot spots with actual blockades
* Restricting any gatherings that aren't essential, with "essential" actually meaning essential (grocery stores, pharmacies, hospitals, etc) rather than politically necessary.
* Mandating correct wearing of masks
* Closing borders or requiring quarantine upon entry
In effect, we need to do what China did. We absolutely lack the political will to do that in the US for a variety of reasons, and so we will not be able to approach containment until we get a vaccine.
most people do not want that at all
I most certainly not want to be forcibly tested or mandated to "correctly" wear the mask and you can fuck off you do
Look for example at Norway and Sweden. Norway took drastic measures early and were able to stop the spread to such a degree that schools opened up again after Easter and everything is almost back to normal now. Sweden did not take very drastic measures early and have had massive spread and 20 times more fatalities than Norway and now they have in many regards stricter social distancing rules than than Norway.
After a certain point it seems like you have to either shut down society for a long period of time (Italy) or just let it run its course through society somewhat controlled.
Austria and Italy, share a border, have ski lodges in the same Alps. Austria got off easy even though they had a one of the first outbreaks, Italy got hammered for two months. Yet Italy locked down harder during all this time.
I don't know in what way is Norway different from Sweden, Norway looks and feels a lot more rural and sparse. Sweden more cosmopolitan.
You could also compare Sweden to Denmark which is more similar than Norway. Denmark took drastic measures quite early and were able to get it under control.
Further to that I agree it's too early to say what is the best strategy long term. All epidemiologists in Scandinavia basically agreed with the Swedish approach in the beginning of the outbreak, but politicians in Norway and Denmark thought otherwise. I guess epidemiologists didn't think it was an option to basically lock down a modern country for several months and maintain social distancing rules for months on end. If this works until the end I assume the books on the subject will be rewritten ...
150 cases out of 150 tests? Yikes! 150 cases out of 150,000 tests? Yawn.
California has been increasing raw number of tests but the positive tests percentage has been holding relatively steady around 4.5%
https://coronavirus.jhu.edu/testing/individual-states/califo...
Florida is a much different story, as their cases have increased the testing has not kept up, and the positive test rate has gone from 2.3% at the end of May to 12.2%
https://coronavirus.jhu.edu/testing/individual-states/florid...
One thing that everyone should keep in mind, even if you could attribute all of the increase in confirmed cases to testing, tests don't give anyone the coronavirus. The only thing increased testing can do is give you a more accurate picture of how bad the situation is, it can't make the situation worse.
Well, the curve had somewhat flattened (but was still trending upward among the noise) before reaching the point of overwhelming the system before we started reopening and it unflattened. I think it was premature to say that it had been flattened enough to avoid rather than delay that outcome, though it's kind of immaterial anyway since we abandoned the effort to keep it flat and are heading straight for overwhelming the system.
Prolonged lockdowns have costs too, it's just not politically correct to compare them to peoples' lives so people like to ignore them.
Can people really go 18 months with no employment? Can students miss 18 months of schooling? Can people go 18 months without other medical care? Can housing go 18 months without upkeep because the landlords have no money since they can't evict rent nonpayers?
A lockdown that extended is not feasible, even before you get to any discretionary economic activity.
The fire department was able to get that room where the fire started mostly put out, there's still a little bit of fire in the hallway, and they start putting the hoses away.
"There's much less fire than when we started, and people were getting really angry about the water damage to the surrounding buildings. We are all done here!"
Would you be happy about this situation, wouldn't you point out that even if there is less fire, nothing else has changed about the situation. Fire still spreads, it can still catch the building on fire, and that fire could still spread to the surrounding buildings.
The problem isn't over yet, and if the whole point of suffering the water damage was that my building wouldn't burn down, well now I have water damage and it might still burn down.
What sources of information lead you to this conclusion?
Different people have different goals.
One goal would be to reduce the rate of new infections to a level that hospitals can handle.
A different strategy is to reduce the rate of new infections to a much lower level, so that contact tracing and containment is possible, and then open things back up.
If a vaccine is available at some point in the next year, the latter strategy saves many lives. It requires a sharp, relatively short (4-6 weeks) shutdown. Afterwards, it requires a high level of testing, quarantine for infected people, widespread use of fever checks in public places, a ban on large events, and extensive contact tracing. Many countries have now successfully deployed this strategy.
The US is stuck in limbo. Some states locked down hard, others didn't lock down enough. Things opened up too quickly, without the systems in place to contain the epidemic, and people are largely acting as if SARS-CoV-2 didn't exist any more. The consequence is that new infections never went down to a level where contact tracing is possible, and the rate of new infections is on the rise again.
I've never understood this fascination with fever checks. I've never had a fever where I couldn't tell I had a fever -- everyone with a fever perfectly well knows they have a fever. The problem is people trying to hide it, I guess? And if they suppress it with medication, your forehead scanner will be useless anyway.
The solution for that is to make quarantine less painful. Here's a list of grocery delivery services, here's a guarantee your employer can't punish you for taking time off work, here's a nursing service that'll call you to check in daily, etc. Enjoy your vacation.
The real reason though is people tend to think it ain't that bad and go out. Fever checks stop those people before they infect your shop.
If you want proper temperature checking you're going to have to get into oral checks, which nobody is willing to do. The forehead scanners are a placebo -- this has been known for a very long time: https://www.reuters.com/article/us-thermometers/accuracy-of-...
Umm, I think you mean the world. the nordics can't decide what do do with Sweden. New Zealand will be perpetually close to zero cases, but be sealed off from the world. Obviously US/Brazil tourism is good to go.
> Some states locked down hard, others didn't lock down enough.
On the world scale, India locked down hard, but failed because arguably, the hard lockdown created more problems. I think Sweden had fewer cases per capita at the peak than the UK, despite avoiding a formal lockdown, but Norway had even fewer. A lot of factors you'd think would be meaningful haven't been, and the ones we're left with is developed East-Asian countries did OK, isolated developed countries did OK, countries lead by populists haven't done so well, and North Korea still claims to have zero cases.
Not most of Europe and East Asia, and a smattering of countries that have had effective responses. They have suppressed the epidemic to the point where they can reopen most things. They have to be vigilant and monitor the R value, but as long as it hovers around 1, they're okay. The levels of their epidemics are also low enough that they can do effective contact tracing (see, for example, what happened in Beijing recently).
In the US, by contrast, there are tens of thousands of new cases every day. Contact tracing is impossible at that point, and parts of the US will probably have to go into lockdown again, unless the US is willing to accept hundreds of thousands of additional deaths. A sharp lockdown lasting about 6 weeks would have put the US in a much better position.
> the nordics can't decide what do do with Sweden.
Because Sweden refused to lock down. This is the fault of Swedish politics, not the other Nordic countries that took effective action to suppress the virus.
> I think Sweden had fewer cases per capita at the peak than the UK, despite avoiding a formal lockdown
The UK has had a particularly bad epidemic because early on, the government pursued a "herd immunity" strategy. They waited far too long before locking down.
I think more significantly they're driven by total cases. Are you suggesting we test less?
Also you seem to have a very black and white view of outcomes. It's not clear cut between alive or dead. There's many things that we still don't know about this virus and the harm it causes. https://www.bbc.com/future/article/20200622-the-long-term-ef...
Of course this is a case where no long term effects are something we are only sure of after currently young people die of old age.
Or do you work with the concept "long term = next quarter"?
That depends which numbers you follow. "Cases" is different than "clinical cases". A clinical case will show some sort of symptom. While asymptomatic spread is almost certainly a thing, symptomatic patients spread much more readily than asymptomatic. So rather than look only a total cases, look for data on clinical cases because those are the ones that are most likely to spread to others. That will normally be patients under treatment rather than the larger number of people who have tested positive, show no real symptoms, and are sitting at home waiting for another test.
If you aren't sufficiently worried, John Campbell has a video about the clinical presentation: https://www.youtube.com/watch?v=U7BbXEOB1gk
edit: thanks!
The CFR for coronaplague is ~ 1 %, comparable to the Spanish Flu in Germany. The impact was catastrophic, the High Command had to decide between sending young men to the front or keeping them at work in coal and steel. In those days there was little automation, the infection would spread like wildfire through the workforce at any large employer. The only reason we aren't seeing the same now is that people adhere to some form of social distancing - work from home, no going out to bars, no gym, no church, kids are not in school, but as soon as guard is dropped infection rates jump up again. We are seeing this as well. Israel had new cases down to 1 per 100000 people until they opened up the schools and cases increased by two orders of magnitude.
We shut down cancer screening and gyms for 3 months in Ontario; that’s almost certainly going to kill more people than COVID did.
If there are ~1 million gym patrons in Ontario, then the gym lockdown (which is still ongoing) only needs to decrease a gym patron's lifespan by 10 days on average to be worse than COVID.
Also, I claimed cancer screenings + gyms combined. Hundreds of people get diagnosed with malignant tumors every day in Ontario and those tumors are now 3 months more advanced than they should be (and will be for a long time after the lockdown until the queues for medical care clear up).
At an avg lifespan of 78 years, 100 kids is ~68 million hours. 30 minutes saved a day / 261 days / year for 75,000 people is ~9.7 million hours a year, so after 7 years, it basically free. Except we would never do that because we don't measure human value in hours because the people in power would be free to make some really terrible optimizations.
You are right though, you did include cancers and I ignored it so we can call it a tie.
Edit: and it's not just the gym obviously, we've removed any incidental exercise one might get from work or leisure activities that were locked down too
https://www.ft.com/content/6bd88b7d-3386-4543-b2e9-0d5c6fac8...
Those are absolutely moving deaths forward by a couple months at best.
I'd be willing to put money on a fair amount of the rest of the deaths also being people who are pretty ill. Not all, of course.
Maybe not even most of the rest.
But enough to not be a rounding error.
The fact that the numbers don't seem that dramatic yet doesn't mean that measures to slow the progress of the virus aren't important.
[1] - https://www.latimes.com/california/story/2020-03-20/newsom-c...
[2] - https://www.sanjoseinside.com/news/san-jose-braces-for-2000-...
You've made a classic converse error.
The US didn't devolve into mass graves and people dying waiting for hospital care yet, it doesn't mean that the fearmongering is misplaced and the more you doubt it the more you will be part of the problem.
No, we are not setting death records day after day. Deaths worldwide have held steady since mid May; deaths in the US have been trending downwards since May.
The logic behind this is that people are going to the hospital whether or not they have been tested, they are not going to stay away because they haven't been. I don't have easy access to numbers of hospitalized patients, so I watch the number of deaths. Right now they have been flattening out or decreasing, as you pointed out. When that changes I'll get worried more. In either case, I am playing it safe by social distancing and wearing my mask and reducing the amount of time I'm in the office.
White people under 50, to be specific. As many as 50% of new hospitalizations in Texas are under 50.
The problem will be if they infect higher risk groups, potentially in catastrophic numbers, and the deaths surge along with cases.
Also, deaths remaining somewhat flat is concerning considering the low risk population getting infected.
But that's not the only driver. And when you increase testing and the percentage of positives you find goes up from 5% to 20% (as it's happening in some states) instead of going down you really have a problem.
> The people getting infected now, the out-and-abouters, are much, much lower risk of complications.
But the people that will now be infected by them (relatives, coworkers, customers) will be closer to the general population and have higher risk.
Young people are generally on the front lines now. Both voluntarily through outings, bars, etc, and front-line jobs, so they are a leading indicator that "things are getting worse."
And while that doesn't guarantee that most "at risk" people will get sick and require hospitalization, it's a safe assumption that the probability of that occurring is increasing.
It's the same reason you get a mole checked out. Might be nothing now, but it could be something much worse in the near future.
The number of reported or confirmed cases is correlated with testing.
That's a significantly different statement, and also tautological and essentially vacuous.
Average time to death after confirmation of disease is around 13 days, so the death rate today has essentially nothing to do with the number of cases confirmed today. The death rate today has a lot to do with the number of cases confirmed a few weeks ago.
One of the reasons the US is doing so incredibly poorly is the incredible sloppiness of the analyses in so much of the media. I don't know if it's willful -- an attempt to pretend that nature will bend to political delusion -- or if it's simple innumeracy.
Daily case numbers in Illinois, at least, have no correlation with the increase in testing. I'm certain all we've found with the extra tests is people who never had it.
Then you break active cases down by area (read: hospital) and carrier profile (e.g., age, pre-existing conditions, etc.). The point is, not everyone who tests positive is high risk. Not everyone who shows symptons will end up at hospital. Not everyone who ends up at hospital will need a ventilator. And so on.
As it is, this whole event has been a text book case of how not to use data and statistics properly.
To an extent, by the time the hospital numbers are going up sharply, it's too late, and the hospitals will inevitably be overwhelmed, so it's not a good guide of policy. New case count is the only vaguely timely indicator we have.
If you need to pick a metric on which to reinstitute lockdowns, hospitalization isn't really very useful; it's better than nothing but if you use it you're probably going to overshoot.
The only reason the hospitals aren't overwhelmed is that we kept the total case count low enough. Now that the case count is going up, we're seeing the same problems.
Yes, we don't seem to have quite the same equipment shortages as we had in March. That's good. That was part of the reasoning behind the lockdowns.
Yes, we seem to be doing better at keeping people dying, that's good ... but it's going to take up more hospital resources for longer periods, that's going to exacerbate shortages.
The problem is that if covid doesn't kill you, stopping the economy will (or at least will make it worse for a large part of the population).
There might be a right trade-off of making heavy use of masks and preventative measures, but this is not currently the implied strategy of the government (as masks are not really enforced).
The difference with SARS-CoV-1 from 2002-2004 was that symptoms were much more aggressive and quick, and thus it was much more easy to trace and quarantine people. With the current one we have a mix of issues: lots of asymptomatic people or symptoms take time to develop.
https://www.bbc.com/future/article/20200622-the-long-term-ef...
So definitely not something to get infected with, especially as it is still not clear if surviving an infection gives you immunity.
If it does not - you might get infected repeatedly until it "rolls the dice" just "right" and damages your health and possibly even kills you...
I think the other, possibly just as important, reason to lower the infection count is that medical professionals are yet unsure of the long-term, chronic health impacts of this disease and that there appear to be some preliminary signs of significant respiratory and pulmonary issues that can effect many age groups - perhaps even in those not necessarily requiring hospitalization.
It would appear that medical science has a few additional treatments in their toolbox now (as compared to, say, March or April) that lower the severity of the disease and helps prevent death in some populations, but still, many concerning unknowns remain.
At least that is what I have seen here and there from several medical professionals that I have seen on Twitter over the past few weeks...
Then halfway through the article it randomly changes to a different combination of cases, tests or deaths or a different time frame and different larger or smaller area.
And then finally it switches again, but about a totally different country or worldwide statistics.
Now you can procedurally generate multiple articles all day!
"Wow engagement is so high", said the Product Manager. "Our KPIs are through the roof, keep doing more of that our customers must love us."
Sure oxygen can be given at a hospital, but if we are overwhelmed, you can easily do oxygen at home.
Anyone have a different understanding?
It's not as simple as "welcome to Wendy's, would you like the oxygen today, or can we supersize you to a ventilator?"
There's a very short period of time between when a patient starts drowning in their own fluids and when they die. So you need to be oxygenating in a clinical setting because you need people immediately available to intubate in case your oxygenated patient starts drowning in their own fluids, which they do often. That's why it confers a 12% survival rate. If you've progressed to the point where supplemental oxygen doesn't work then you're pretty close to dying. I'll take 12% over 0% any day of the week.
As always you should look past the statistics to what actually needs to happen in those situations. Statistics provide very little assistance in determining whether an individual patient needs to be hospitalized or not. You can't look at someone and go "oh this guy is one of the X% that will eventually need a ventilator." You have to assume that any one patient that needs supplemental oxygen may be one of that X%.
So sending people home with supplemental oxygen should be a last-ditch effort if the hospitals become completely overwhelmed, not a routine activity. And to facilitate that, we should absolutely be trying to keep people from getting sick so our hospitals remain open for the unavoidable cases.
as for those that survive - most have serious breathing problems for the rest of their lives -
https://www.webmd.com/lung/news/20200415/ventilators-helping...
Kidney problems are popping up in some folks post-infection; that's also better dealt with in a hospital.
1) we want to eradicate the virus from our population => total cases matter and should be 0 sometime soon, I think that was and is China’s goal
2) we don’t try to eradicate the virus, but we want to keep the stress on the health system manageable => total cases don’t matter that much, bed capacity is the relevant indicator. This seems to be the goal of the “flatten the curve” thinking
3) we don’t care that much, let the virus spread like wildfire so we will have herd immunity asap => I am not sure, but from outside it seems like Brazil is trying to do this
I think the reason you and I are confused is because it’s seems to be unclear if we are trying to achieve 1) or 2). It’s not communicated. Maybe it’s unclear to policy makers, too.
Without that, then we shouldn't be too worried about getting the disease as long as we keep transmission rates low enough so hospitals don't get overwhelmed. But if some people end up with long-term respiratory issues after contracting the disease, now there's a reason to keep people from getting it, period, regardless of hospital capacity.
But it would be nice to hear these goals actually articulated by public health officials. I'm not sure if my above paragraph is actually what any public health officials are thinking or are worried about (I'm just guessing), but it would be nice to know, because I agree with you that there seems to be a lack of "goal clarity" at this point.
That is, we want to minimize infections, just not at all costs (to society/economy/...). And similarly, we want to minimize impact on society/economy/..., just not at all cost (to health).
Keep in mind that every infection bears a risk for long time health impact or short term (death), no matter if a hospital bed is available or not.
Finding this compromise is a matter of opinion and therefore a political question. It's not as easy and black-and-white to formulate as it would be to say whether we do 1 or 2.
Eradication in the US seems unreasonable, and just keeping hospitals less than overflowing not enough.
Most places just aren't being transparent. Wearing a mask has turned into a political or moral statement without being driven by a goal. Leaders aren't really selling any goals, though CDC / various health departments probably have goals, the technical details are not being communicated. Instead all you see is vague information and seemingly arbitrary action from leaders and virtue signaling from the population.
In Trump-led America, I think the goal is pretty obviously positive political outcomes for Trump. CDC and others might have goals but I haven't seen them.
Part of the problem is people are generally so stupid about failure that any goal setting sets you up to be a target for people angry about not meeting your goal or not setting an aggressive enough goal so being vague is seen as the best strategy, even though I think it leads to the sort of "fake news" vs "moral crusade" problem.
Eradication seems possible when there's a small number of cases, and effective border control (being an island nation helps a lot). In the US it's going to be difficult to eradicate, because people can move about the country easily and the case load is high.
I haven't looked at other states, but Washington state has fairly clear metrics for opening restrictions at a county level. We'll see how well that works, I guess. Other states will be doing their own thing, as well as other countries, and maybe we can figure out which methods are more or less effective and either switch or know for next time.
I'm not saying it's not achievable. Just that you need to evaluate if it is achievable before you focus on it and it certainly doesn't seem like its "obvious" that it is to me.
Not surprising after COVID burned through their population (quarantine or not) the case numbers have subsided. If anything NYC demonstrates that quarantine was entirely ineffective, and that the biggest mistake was not focusing on protecting the people actually at risk.
The most interesting takeaway from COVID is that “both sides” were right. It is much more deadly than an average flu (for the elderly) and also much less deadly than the average flu (for those under 50).
Are you serious? How do you even come up with misinformation like this and not even bother to back anything up with any sources? How do you seriously look at the case charts and pretend like going from 10k cases/day to 500 cases/day was an inevitable outcome resulting from burning through nursing homes? It would be funny if it weren't completely insulting to their herculean efforts in containing everything when so much of the rest of the country is going in the opposite direction. https://www.nytimes.com/interactive/2020/us/new-york-coronav...
1) NY has the highest cases per capita and death rate per capita in the country. [1] [2] This is what I mean by burned through their population. Serology estimates about 20% of NYC population was infected. [3]
2) NY’s policy blunder in shipping COVID positive patients into nursing homes is well documented. [4]
#2 did not lead to #1, nor did I claim it did.
Their “herculean efforts” to contain COVID notwithstanding, NY is in the process of phased reopening, just like pretty much everyone else.
[1] - https://www.statista.com/statistics/1109004/coronavirus-covi...
[2] - https://www.statista.com/statistics/1109004/coronavirus-covi...
[3] - https://www.governor.ny.gov/news/amid-ongoing-covid-19-pande...
[4] - https://abcnews.go.com/Health/wireStory/ap-count-4300-virus-...
Keeping it under control but not eradicated means averaging exactly 1 over time, which seems like a much harder balancing act.
Focusing on the rate as the metric of attention seems very much like the right thing to be at the center of public policy.
Just put the control rods - I mean open restaurants - on a control loop driven by number of number of hospitalizations.
Helps if you have prompt and delayed transmission modes, so you can regulate at the slower speed.
The USA definitely does not. I'm starting to wonder if "not knowing what we want" will be the root cause for the end of American hegemony.
We entered 2 wars without clarity on what it would mean to win. This was the #1 post-mortem on Iraq and Afghanistan from basically every general involved over 15 years: they never had mission clarity.
On the back of that tough lesson, we immediately entered a trade war with zero clarity on what it would mean to win.
And before we could learn the lesson a third time we're now up against a pandemic and apparently can't decide what it means for us to win.
I'm starting to wonder if "not knowing what you want" is even worse than wanting something dumb.
https://en.wikipedia.org/wiki/Sovereign_democracy
https://en.wikipedia.org/wiki/Vladislav_Surkov
https://www.economist.com/europe/2013/05/11/an-ideologues-ex...
The long-term goal of the trade war with China is... QoL that costs low six figure salaries plus a pension and union protection for every high school grad in the midwest willing to work in a factory, even as the rest of the world surpasses us in labor productivty. In other words, a literal pipe dream.
We always have some pipe dream. We just never have an actual sober-minded mission with realistic expectations.
Maybe America needs a war on the drug of American exceptionalism. idk. I know war is always the answer, though. :-\
If we weren't drunk on exceptionalism, we would be containing the virus and we would have a Manhattan project-level investment in vaccine research. We don't. Calling a spade a spade literally sounds like trolling these days.
Maybe not the best way to phrase that these days.
Until the 20th century phrase had exclusively the meaning I always thought it had, and that meaning dates back to the 1500s (spade = gardening tool).
In the 1920s some people started using "spade" to mean "person with dark-toned skin" (because spades are black in a deck of cards, so spade the gardnening tool => spade the suit in a deck of cards => poc). I've never heard "spade" used like that before, and the article suggests that use of "spade" remains fairly esoteric, but it's apparently in wide enough use that dictionaries have picked up on this meaning.
The article doesn't ever establish that the phrase itself is used as a double entendre. In a quick saerch, I can't find any in-the-wild uses of "Call a spade a spade" that evoke the double meaning.
TBH I think the article's advice is sound but also extremely jaded ("Rather than taking the chance of unintentionally offending someone or of being misunderstood, it is best to relinquish the old innocuous proverbial expression all together"). I'll stop using the phrase, but doing so feels like assuming the worst of my interlocutors' intelligence and intent.
This has never been the goal of the United states
US Presidents typically have a lot of problems with democracies/democratic movements in Iran, Venezuela, Haiti, Egypt etc but very much liked the dictatorships in Saudi Arabia, Egypt, Chile, Brazil, El Salvador.
I judge governments and people by their actions and not their words.
Does that really sound like a conspiracy theory now we know that the regime deliberately and knowingly lied about Weapons of Mass Destruction?
If you think that possible then perhaps the "long-term goal" wasn't really what the liars were lying at the time? There are those who believer endless war was the precise goal. There hasn't been a lot of anti-corruption impetus in washington since that distraction was launched - save for Trump pretending he was anti-corruption at the last minute before the lasrt election. That last minute inspiration might have won it for him too.
Anyway if you have an unclear goal you can just move the goalposts and declare success, which is the kind of the point, right? And why the goals are unclear because otherwise America might lose and you'd be the loser president.
Out of interest how do Americans feel about the Vietnam war? Did America lose that war?
Pretty sure of all of most of that for both, though not the same parts for Iraq and Afghanistan. The political imperative for Afghanistan after 9/11 is pretty unmistakable. The long-term neocon objective with Iraq also was unmistakable. There's also pretty solid indication that factions I. The Administration wanted to use 9/11 as a pretext to execute the latter but were delayed by the political imperative for the former.
> Does that really sound like a conspiracy theory now we know that the regime deliberately and knowingly lied about Weapons of Mass Destruction?
Yes, the ascriptions of the motives cited to both Afghanistan and Iraq still sounds like a conspiracy theory. And I’m not sure what you mean by “now that we know”; that the claims were being advanced were false and that the administration had the information which showed them to be false was widely reported in the major media at the time the claims were made.
> If you think that possible then perhaps the "long-term goal" wasn't really what the liars were lying at the time?
No, but in the case of Iraq, it's what the leading figures of the neocon movement were telling the truth about the desires for right up to the moment the whole gang became the defense and foreign policy apparatus (and hyper-empowered VP) of the Bush 43 administration.
> There are those who believer endless war was the precise goal.
“There are those who believe” is not an argument that makes your position sound less like a conspiracy theory.
> There hasn't been a lot of anti-corruption impetus in washington since that distraction was launched
There wasn't a lot in the two decades before that, either. So unless the distraction was as effective backwards in time as forwards, I don't think it was really a significant factor.
> Out of interest how do Americans feel about the Vietnam war? Did America lose that war?
Most recognize that we lost the war; there are those who cling to loudly propounding the fact that we militarily defeated the VC before the NVA took over the main fighting as if that somehow negates losing the war.
They probably expected to see light at the end of the tunnel last month, like other countries. Now, maybe next year?
We are not being treated by robots and the longer the pandemic lasts the more healthcare professionals suffering (physically and mentally) we will see, the more churn we will get and less care capacity we will have...
If vaccines will also be available in ‘waves’ as they are produced, then that must mean testing is some kind of a prerequisite to know who to give the vaccine to that needs it most - and who also may already be immune from exposure?
It seems like the total cases —> 0 option is virtually unattainable in the near term (probably into 2021). Maybe with more cases being reported, we are aiming for 2) but actually going through 3).
I agree, and with the recent outbreak, I don't think it's possible, at least not for China. New Zealand has a shot at it.
I think rather than it being "unclear" to policy makers, it's rather that there's a short-term economic imperative to go for 3), or if not, then 2), while 1) upfronts economic cost. This means that while the general desire might be to go for 1) from an ethical/expert/academic-advice perspective, policy makers are doing their best to hedge (while not wanting to appear as if they are).
What other country do you think of that doesn't have clarity?
The problem is that in a lot of places, the information about hospital use isn't available, isn't timely, or isn't reliable.
Hospital owners and their lobbying groups have blocked some states and county health departments from reporting such information, claiming it's "proprietary information."
One of the Las Vegas newspapers had a series of articles about it. The hospital lobbying group actually somehow "prohibited" the state from releasing the information, as if hospitals have some kind of authority over the government.
It is certainly true that survival rates have improved as treatments have changed based on experience. I think folks know better how to manage things at home, to some extent. Earlier testing also allows earlier intervention, which allows treatment that may avoid ventilator usage. Vent usage corresponds with pretty poor outcomes, although that too is improving.
It could. Or it could be simply getting out of control (though specifically California is in much less trouble than Texas, Florida or especially Arizona at the moment). The point is that (1) it's fundamentally impossible to tell the difference until the bodies are counted and (2) the boundary between "well under capacity, we're fine" and "well over capacity, tens of thousands needlessly dead" represents just a week or two of growth.
We don't have time to wait and see, we need an answer now. And we can't get it until the demographics is done postmortem. So what is supposed to happen is that we all behave conservatively until the outbreak shrinks to the point where it can be contained via contact tracing.
And... that almost worked. It worked in Asia and Europe, It almost worked here, at least in the hardest hit areas with the early outbreaks. But... it didn't take. Half the population decided they didn't need to bother with this stuff (largely because of reasoning like yours) and walked back into enclosed indoor spaces.
And now we're right back where we were in March. Effectively no progress. While the rest of the industrialized world is finishing this off and coming back to life, we're having to talk about new lockdowns. It's so deeply frustrating.
In my state, Oregon, we locked down when there were only a handful of cases, and not much community spread. Most spread was either in long-term care or familial. But we locked down _hard_ and had pretty good compliance. I am talking, standing in the middle of I-5 at noon compliance. Sure you'd have to keep an eye out for trucks from time to time. But still.
We set up surge capacity. Hospitals in Portland set up triage tents and cleared out other beds for a surge...... that never came. A few weeks in, the tents were taken down, the staff was laid off. We sat in our cocoon waiting for something, not sure what. Eventually the pain of being closed started to tick away, and we started reopening...
But nothing materially _changed_ between then and now. We just stopped community spread of an infection nobody really had. We've had less than 6k infections in Oregon. Now we are opening up and guess what? Cases are increasing! We didn't flatten the curve we crushed the curve. So there was no controlled spread, it was just us all feeling proud of ourselves for three months while the poor suffered.
The sneaky lie was that, in a country as big as the US, a flatten the curve strategy was never going to work at a national level. We need community level response.
We locked down Oregon over what was happening in NYC. That is akin to Northern Ireland locking down because of Moscow. That isn't an exaggeration. If anything, it is an understatement.
All of the European countries that we are saying "why can't we be more like them?" all had orders of magnitude more cases than Oregon. So if Oregon quadruples in cases over the next month we are still better off than a lot of nations.
To flatten the curve, there needs to be a damn curve to flatten. Had we waited until there was known, uncontrolled community spread and _then_ shut down, we would have a lot more political will. Now if it gets to that point after three months of being shut down, I doubt anyone will give a shit what the Governor says. Goodwill has been burned through and then some.
It was never going to work and people were screaming that at the top of their lungs in March. We were called ghouls or accused of supporting genocide. I am not kidding.
Or maybe the real answer was a coordinated national response.
Why wasn't the NYC cluster confined to NYC or NY state? If the initial lockdown succeeded in killing community transmission in Oregon, how did it start growing again? Most likely from external sources.
Only a national strategy could have made these individual state-level lockdowns worthwhile. Since we didn't have that, the states implemented a haphazard, patchwork of lockdowns that weren't coordinated.
> I doubt anyone will give a shit what the Governor says. Goodwill has been burned through and then some.
Unfortunately you're right about that.
I'm not an expert, but that doesn't seem to be the case.[1]
> interstate commerce clause
I thought that just gave Congress the power to regulate interstate commerce. Again, I'm not a legal expert.
1. https://www.claimsjournal.com/news/national/2020/03/18/29607...
I am probably wrong about the law used. IANAL.
So if you gave them relief preemptively they'd be OK, right?
In any case, you don't need border closures. Even things like suspending or massively reducing domestic air travel, introducing compulsory self-quarantine upon arrival in a new state etc. might be better than doing nothing. I'm not an expert, but it seems like we never even tried.
The viable model is the Swedish model, schools are open, restaurants are open, nobody wears a mask. What they do is voluntarily keep more distance between people. That's it. that will do it.
The sky has not fallen, they are exactly on the same track as the US.
Or India? 4x the population, 1/5 the deaths so far. Although they'll catch up eventually - this disease is simply too contagious. But they have a national strategy, everybody is making plays from the same playbook.
> nobody wears a mask
Why not though? If it's been proven to reduce transmission, it seems stupid to not do it.
> that will do it.
All that's done is take the US to the top in lives lost to this disease. If that's where we wanted to end up then mission accomplished, I guess.
> The sky has not fallen, they are exactly on the same track as the US.
See above.
Hoisted by our own petard.
Only 1 death attributed to COVID, making Burundi the country with the fewest deaths per population.
The US is at the top for two reasons, huge and extremely varied country, lots of testing and accountability.
China most likely has had more deaths than the US, they just simply chose not report it, ergo they are all good (and that's what Trump wishes the US could do).
Deaths on this scale is hard to hide, even in a state controlled environment. Large cities outside of Wuhan have no seen this. I have colleagues and friends in the big cities and I haven’t heard of anyone catching let alone dying of covid.
I said they've had a plan and they've tried to fight. Exhibit A: https://www.theguardian.com/world/2020/may/14/the-coronaviru... It'll ultimately overcome India, but it won't be because they waved the white flag like the US appears to have done.
> China most likely has had more deaths than the US,
China would have to underreport deaths by 20x to approach the American death toll. Covering up that many deaths doesn't seem possible. It makes me feel like you're just arguing in bad faith.
And even if China had exactly as many deaths as the US, they'd still be 3.5x better on a per capita basis. Despite being more densely populated, poorer, and likely having a population with more pre-existing respiratory issues due to more pollution. That's how poorly the US has performed in this whole affair.
Sweden's seen way more deaths than its neighbors, and being on the same track as the US should be an embarrassment here.
Also, no, that will not do it. That will see a huge fraction of the population infected. Adding masks would help a lot, though.
Maybe the ability to control people coming in and out is more of a commonality than their responses? That is considering their responses looked _nothing alike_. NZ and Japan are basically as opposite as you can get in regards to a response.
How did they do it? All borders closed. Quarantine at home? Well, we’ll post someone to keep an eye on you. Not following the rules? We have a quarantine camp that will work better.
Someone infected on the same floor of your apartment building? Everyone is locked down for 24 hrs (can’t leave your unit). Floor is disinfected and everyone tested.
Vietnam just basically went full throttle using every public health measure they could.
I think the OP’s point is that your goal is immunity and Sweden will get there before NZ will (absent a vaccine). Sweden’s economy will be humming while NZ stays isolated.
Give it a year and we’ll see who did best
NZ somehow always comes up...
HK never locked up as hard as NZ or Spain or Italy even thou it's a city almost double the size of the country NZ with 420 times the density.
It is only a matter of time before we see community spread a second time, and as in Oregon nothing has materially changed since November. We still have no vaccine or immunity, and we can reasonably expect to see a second outbreak before either appears. The only difference is that Kiwis are unwilling to tolerate a second shut down, and Kiwi businesses don't have the funds to weather another financial hit. Neither does the NZ government, realistically.
Locking down the country was an understandable response, but it does not appear to have achieved anything valuable unless a vaccine becomes available before the next outbreak.
Sweden and Czech Republic has about the same population, there were strict lockdown measures in the Czech Republic and not much at all in Sweden.
So far 336 people have died in the Czech Republic due to Covid-19, daily cases are ~50. For comaparison Sweden has 5053 dead with daily cases about 500-600.
That does not look like something viable & I'm not sure how are they gonna get out of this with some many daily case & how many more people will have to needlessly die.
If you want to protect old people (and everyone of us will get old eventually) is to make sure they won't get infected, simple as that.
To achieve that, many care homes here locked down much earlier than the state wide lockdown (and in some cases were already in annual flu related lockdown, same thing for many hospitals). In quite a few cases, the care personnel even volunteered to basically camp out at the site to eliminate any possibility of getting the infection in from their homes.
This has been quite effective. The few cases where the infection did get in were pretty brutal, which validates the rather drastic steps taken.
The US is not like that at all.
What is appalling that the CDC seemed to be completely clueless to these basic observations, as if it weren't their job to make sane recommendations beyond the "everyone everywhere immediately shut yourself indoors for a few months" (a recommendation imported from China FWIW)
I tend to agree with your point, though. Many many areas could likely have been just fine by only restricting large gatherings (concerts, etc), requiring masks, strongly encouraging WFH, and so on. But keep open hair salons, local shops, restaurants (with precautions), etc.
Even in the Bay Area, I can't help but think we shut too much down.
Now that it is raining in the Atacama, we have no political will to do anything.
Edit: I was sassy before I saw your edit :D. High-five on agreeing in principle!
This is tough and it's a bit of a lose-lose situation. Like you said, there's not enough patience or personal savings to stay like this for another 8 months, and any course of action will be highly criticized, regardless of outcome.
Since we "crushed the curve" we've learned what masks are good for, and how they should be used. We've developed a lifesaving protocol for the most sick patients. We've gotten into the summer which plays somewhat in our favor.
In fact, it looks like universal masking and a bit of care is sufficient to get R0<1. Problem solved, eventually. Unfortunately... leadership matters.
How many people died from other, preventable things, while we learned that masks work? Something we knew then, by the way. Just ask any country that dealt with SARS Ver. 1.0
Because they shut down. They observed community spread and they acted appropriately. https://www.newyorker.com/magazine/2020/05/04/seattles-leade...
Scientific knowledge is slow and hard to come by, and we didn't know that in February. What we knew was this: Masks don't work for every disease. They don't even work for all coronaviruses. Cloth masks worn by the public can increase transmission of some diseases. SARS-COV2 is not the same as SARS-COV1.
'If it looks like you're overreacting, you're probably doing the right thing' -Fauci https://www.washingtonpost.com/outlook/2020/03/17/overreacti...
If it had, it would have had about half the deaths it eventually did.
Also, NY is about as dense as the US gets, and has way more shared, multi-generational housing than the rest of the US. Also NYC has way more transit usage than any other area in the USA, which was one important vector.
Everyone keeps pretending like the lockdown is the only variable. It isn't!
Seems to have worked fine, as the average number of cases has been around 50 daily for a couple of weeks, all that while most of the restrictions have been lifted.
So where is the difference ? I think in two aspects: - all the neighboring countries did similar strict lockdown and achieved similar levels of success - we closed our borders to everyone, including preventing residents from going out - the Prague international airport was deserted for month and a half, all international bus and train connections have been shut down & border crossing were guarded by police with army helping out, letting only trucks through
I think this really helped as each country could apply their lockdown separately for a limited period, without worrying about international travel bringing it right back in.
While from what I've read and even been told by people in the US - even is a single US state did a very strict lockdown with potentially huge economical cost - the neighboring state (or in some cases even the next city!) will do hardly anything at all. Combined with no state border lockdown, the strict state will get infections back in from the less responsible areas.
The Czech Republic border is no longer closed, buses and trains go over the borders again & local flights have been reestablished. Still, a version of the border lockdown is still going on, with the Czech Ministry of health maintaining a list of "red" countries, such as for example Sweden or Portugal, that you should not visit but if you do you should go to quarantine and get tested.
Looking back, it would have made more sense to do the lockdown in phases. Ask every company who can have their employees work from to do so. Track the numbers!
Ok, is it still spreading quickly? Well identify the next round of business that should shutter.
We basically did it all at once and like Oregon, CA was pretty adherent, but I just went for a walk this afternoon and it looks no different than per-Covid.
We basically went from on, to off, to on again.
Yep, this right here is the problem. Unfortunately, social media and the 24/7 news cycle (that magnified 100x by social media) has meant that people react strongly to events that have no effect on them, and then go and do things which have no effect on the underlying cause, just because they saw people doing is thousands of miles away.
This is what happened with the COVID lock downs. People panicked when they saw NYC, but there was no reason for most place to lock down (when they did). Far better to wait for a more effective time. But no, you had people slamming governors for doing nothing in states that had very few cases.
This extends to a ton of other causes and problems. See the BLM movement. You have people protesting in countries that have nothing to do with George Floyd and a very different police force, risking their lives and others by spreading covid, because they saw people on the news in another country protesting. Utterly absurd.
It seems fairly successful so far in China/Korea/Australia etc. Maybe it was never possible with a fractured America filled with selfish idiots. I've completely lost hope in my country for the first time in my life I don't have confidence we can our system can fix itself
How many people had covid, self quarantined, and never spread it ... unbeknownst to anyone?
The way exponentials work maybe nobody was saved, or maybe a whole nursing home or a city of old people.
I recall the y2k problem and the hysteria. In the end, nothing happened. But... was it an overreaction, or was it an appropriate reaction seeing that all these companies didn't meltdown financially?
A couple of weeks ago, the number of Latino cases in San Mateo was about the same as the Asian and white groups. It is now over triple.
https://data.sfgov.org/stories/s/fjki-2fab
https://www.smchealth.org/san-mateo-county-covid-19-and-othe...
I think it's like Gay-Related Immune Deficiency (GRID, before it was AIDS). There's no inherent reason that it showed up predominantly in the gay male population, except a) the first superspreader was a gay airline steward (so he had lots of contacts with the gay community all over the country), and b) gay men were enjoying the fruits of their sexual revolution.
If you think about it, monogamy is basically an extreme form of "sexual distancing", and so a non-monogamous community is much more likely to have an outbreak of an STD. Other non-monogamous communities heavily promote wearing masks (condoms), but as this had been viewed primarily as a way to prevent pregnancy, the gay community did not think it was necessary.
Many outlying areas of Mexico appear to be out of control. Chihuahua, for example, has a 21% fatality rate.
The county has by far the state’s highest case numbers on a per capita basis, 3,414 per 100,000, as well as a positivity rate for tests that’s more than four times the state average.“
https://www.technologyreview.com/2020/06/30/1004696/theres-n...
The focus on absolute numbers of positive cases (without normalizing by testing rate or population) pretty dramatically distorts the national discourse on COVID-19. California has been slow to reopen — although it is reopening — and has been criticized by the right as experiencing surging cases regardless. But that's largely inaccurate: CA is just much, much larger than any other state, and it's been reliably ramping up testing. As counterexamples, Florida and Arizona are places where the surge in cases is actually reflective of significantly worsening community spread: Arizona's positivity rate has tripled from a low of 6.5% in May to nearly 20% today [2], and Florida's positivity rate has grown 5x from a low of 2.3% in May to over 12% today [3]. Texas, another state that reopened quickly, had its positivity rate double from a low of 4.7% — approximately similar to the rate CA has managed to keep itself at — to 11% today. [4]
1: https://coronavirus.jhu.edu/testing/individual-states/califo... 2: https://coronavirus.jhu.edu/testing/individual-states/arizon... 3: https://coronavirus.jhu.edu/testing/individual-states/florid... 4: https://coronavirus.jhu.edu/testing/individual-states/texas
Californian cities are actually not dense at all, which may explain why it isn't even worse. LA at 7.5k /mi2, San Diego 4.4k/mi2 etc.. compare that to New York at 27k/mi2, or even Paris 54k/mi2, Barcelona 41k/mi2
https://en.wikipedia.org/wiki/List_of_United_States_cities_b...
And if you look at entire metropolitan areas, rather than just cities, LA is actually the second-most dense metropolitan area in the country.
Meanwhile, Phoenix, Arizona has a population density of 2k/mi2, and is having a massive outbreak.
Public policy appears to be the determining factor in flattening the curve of COVID outbreaks, not density.
[1] https://ig.ft.com/coronavirus-chart/?areas=usa&areas=chn&are...
Or put more simply: We would be a lot better off if everyone would just shut the fuck up for 10 minutes.
Healthcare is a political issue. Pretty much everything is a political issue. To pretend otherwise is to bury your head in the sand.
It literally means politician politics, or politicians' politics (a politician is a political figure, like an elected official), and it very derogatorily qualifies all the noise, the blablabla, the unimportant chatter in politics — Wherein politics speaks of egos, not ideas; the part that seldom leads to actual or worthwhile "policy".
When a leader is said to be making “de la politique politicienne”, it basically means that's degree zero of intelligent discourse, and solely aimed at tackling political opponents. Cue false claims, supporting opinions you provably don't believe yourself (but party line prevails), etc.
It's an old expression, before my time (1980s). It's fallen out of flavor. Probably because 99% of politics has now become de la politique politicienne...
Compare the states of New York and New Jersey to the country of Italy. That is a more fair comparison. Not USA -> Italy.
One more thing. Italy didn't beat it. As soon as free movement is restored to the EU, it will spread again. The only thing that would prevent that is the ballyhooed theory that there is latent immunity in 40-60% of the population. If that is the case, than yes Lombardy is in the clear.
But if that is the case, then we also ruined the economy over a disease that was only going to infect a quarter of the people feared, and kill even less. Changes the math, doesn't it?
Edit: Fixed my stupidity about regions of my own country.
To be fair, in my opinion neither region "defeated" the virus - they just ran out of people that could be easily infected.
The seropositivity in NYC is probably pushing 30-40 percent now.
I will say that being susceptible is not evenly distributed across a population. This is why prisons, meat packing and old people homes are more likely to have outbreaks. The corollary to that is that R0 is not consistent in a population. The R0 for people who live in old folks home is far higher than a bachelor who works from home.
So when the person said that they ran out of easy people to infect, that is absolutely true.
The goal should be to minimize spread among the most vulnerable.
NY/NJ are not part of New England. And what's your definition of "uncontrolled community spread"? [Other places like Louisiana surely qualified. Edit: never mind, I didn't parse LA as Louisiana.] Would you say it's now "uncontrolled" in say Arizona or South Carolina?
I lied! NY and NJ are not in New England. The USA is annoying.
New York and New Jersey are mid Atlantic states.
Maybe they should be more careful with their choice of name, New England has been used for over 400 years to refer to something that definitely doesn’t include Manhattan or New Jersey.
The name even has a precise administrative meaning today, as does Middle Atlantic: https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us...
In other contexts New England is usually used correctly, though I have seen people include NY and/or the original 13 colonies as "New England"
That said I didn't know about the mid-atlantic administrative region, thanks for that info. It seems really weird to call NY, which borders Canada, mid-atlantic and have it stop at the south of NJ, especially when east north central goes further south. South atlantic looks about 2-3x bigger than mid and definitely goes way past the north-south halfway point of the east coast.
We can minimize it somewhat, but lots of people are going to die. If we locked down completely, lots of people would die of a litany of other things that would have normally been prevented in an open society. Fucked either way.
See my point?
For the US to still cry about China is embarrassing.
I am not crying about China. It is the truth. The only way to prevent uncontrolled spread would have been to stop it before it became uncontrolled. The fact that the first cases were in Cali. in December shows how impossible that really is for a non-island nation (caveat only because NZ)
The main point I was making is that it isn't possible! By the time China had enough data to detect a novel virus, it was too late. It would have always been too late. China isn't to blame. This could just have easily of jumped species in Canada or the US. The point is that we can't be gods no matter how much we tell ourselves we are just that.
Would you like to have the same death rates as Italy (much higher than US)? No.
Is the disease eradicated in either country? No.
The story of who did better remains to be written.
If anything California shut down way too soon. That's the problem that no one seems to talk about.
What?
UK: 642
Spain: 576
Italy: 575
France: 441
US: 365
Netherlands 340
EU Average: 208
Germany: 107
I dont have an easy way to adjust for demographics, but the median age of most of the countries listed is 2-3 years greater than the US. Italy is ~ 6.
Italy is also not the richest country with the highest per capita ICU bed availability with a ridiculously expensive healthcare system which while terrible for general welfare was excellently places for an emergency like the pandemic.
And if California shut down too early, it was still not a bad decision because you did not know what a good decision was at the time.
The fundamental problem in the US has not been shutdowns. It’s been shutdowns which have involved absolutely no planning for the reopenings.
That’s the fundamental disaster in the US handling of the situation. The northeast could maybe be forgiven for not doing planning for reopening because they were actually dealing with a crisis during the shutdown. But the rest of the country had no excuse. And unlike the northeast they weren’t the first to be hit, so they had time to see and prepare.
Instead, they declared it a Northeast problem as if the virus could tell Jersey Shore residents from South beach residents, and decided to go on with their lives without any planning or preparation anyways.
Don’t know what you guys are seeing on the media but I’ve been in China since February and the response has been pretty reasonable and very effective, at least from where I’m sitting. Before I came back in early Feb I thought about fleeing to the US, but haven’t entertained the idea since.
We decided that staying home and socially isolating was just to hard. The rest of the world must be looking at us in horror.
There were hundreds of people packed together looking at and touching art.
There was a big sign that 'we'd get through this together'.
They're also opening up farmers markets.
I think we're going to see the number of cases rise again.
Nothing about the photographs I have seen of the Huanan Seafood Wholesale Market suggests "outdoors".
Looks like prime batcave-like conditions for coronavirus spread.
The one near me in downtown San Jose just re-opened a couple of weeks ago. I walked through to see what it was like. Not too bad, they require masks for patrons and also the people working the vendor stalls. Also, customers aren't allowed to touch produce at all and contactless payment is preferred.
So all of that looked relatively decent. My issue was I would see patrons walking around or about to pay and they'd be lowering their mask to talk, not covering their nose with the mask, wearing their mask on their neck, etc.
I'm not sure how to correct issues like that.
EDIT: Additional context: https://www.worldometers.info/coronavirus/usa/california/
If a county’s active case number equals Total Cases Minus Deaths, then they’re not reporting recoveries. Los Angeles is the largest county not reporting recoveries. In just the Bay Area, Alameda, Santa Clara, San Francisco, San Mateo are the 4 of the 5 largest counties in the Bay Area by population and are not tracking recoveries. Contra Costa and all the North Bay counties appear to be tracking recoveries.
I think at some point soon, people are just going to give up.
We could’ve bit the bullet, and did a hard lock down for 4 weeks. This would’ve killed the virus in its tracks. But instead, we didn’t take the hard actions. And now, this virus is going to take its toll.
But, no worries. The stock market is doing all time highs.
But like most things, once you are accustomed to it, the amount of fear people feel declines. As fear declines, apathy increases.
It's like gang violence, child trafficking, or casualties of war. At first it is shocking, but then people get used to it and go on with their lives.
LA and Riverside Counties are about 1/3 of California by population, so while it is somewhat disproportional for most of (whatever) to be there, it's not anywhere close to what it might seem when you name 2 out of 58 counties.
Somewhat related to the OP's post, what really drives me crazy is focusing on cases since beginning of time. California has 174k cases in this case. What really should be looked at is week over week increases and number of new cases, and only of active cases, old cases shouldn't really be included but newspapers love sensationalism. In addition states are combining antibody test positives(person had covid, recovered) with active positive tests(nose swabs, person is infected with covid) [1]. Basically testing and presenting digestible results have been a disaster. In addition finding decent dashboards for this info is surprisingly hard. Local ones like santa clara counties one are good [2], but step up the state and national level and its hit or miss.
[1] - https://www.beckershospitalreview.com/public-health/this-is-...
[2] - https://www.sccgov.org/sites/covid19/Pages/dashboard.aspx
We could face another wave, which of course would be bad. Lockdown fatigue and protests could easily bring it back. But if we've brought one wave under control, at least we know what it takes to do it and we can try to react a little faster for the next one.
"But seven EU countries (including Belgium, France, Italy, the Netherlands and Spain) currently rank above America in their mortality rate. So does Britain, where the official rate is a shocking 559 per million"
This article is ridiculous, the author is simply upset that many sports are closed for a season, and is looking for any justification to reopen. Yes the media blows things out of proportion, but the author even has a graph in the article that shows covid19 kills old people more effectively than flu and pneumonia!
The last few days have seen global upticks in infections, maybe they'll get their chance to write another article about the media being fearmongers once a few hundred thousand more people die and the death curve hits another flat spot.
Absolutely absurd.
Are you sure it’s not any of these:
1. The most likely to die have already died
2. The virus has mutated to be less lethal
3. We are learning how to treat it better
4. Higher vitamin d levels in the summer
5. A younger population is now getting it
6. Some level of herd immunity especially in Europe and NY.
(Im probably missing some)
The leaps from your suggested causes are much more complicated.
If the second wave doesn't result in more deaths, then maybe it was one your proposed causes, and it'll be interesting to see how they contributed.
If deaths do spike again, then could you please stop spamming Hacker News with anti covid "skepticism"? Because if you continue to post and share these things in spite of a pile of dead bodies, you'd be complicit in the deaths from the third wave (if any).
I was at a sit-down restaurant packed at capacity with live music a week ago about 100 miles from Bay Area. That should not be possible.
Close the state border to all interstate traffic. Test truck drivers at weigh stations near the state border. There should be sufficient capacity of the 5-minute Abbott test for this. Test other interstate travelers at mandatory checkpoints with a test that shows results no later than 60 minutes.
Close county borders. Mandatory testing at each county border. Issue a photo + ID card to each person tested. Mandatory verification of negative result before public transit boarding. Mandatory door to door testing in resisting areas. Deny all walk-in service to anyone not able to verify current test results with at-door scanner. Assume they are infected and serve them curbside. Have them scanned by a mobile dispatched unit at their if unable to travel to a testing location.
Annoying? That's what "essential" activity means. We are not making it inconvenient enough to not do non-essential activities.
Sounds extreme? That's what EU did to contain Italy and Spain. They closed internal borders and localized efforts.
Sounds expensive? Abbott will make a lot of money. Lives will be saved. The entire state could reopen and resume operations once strict testing protocols are in place and the curve is properly slammed.
We do not have an effective CDC to set national policy. Compare the real guidelines [1] leaked to press to the softened guidelines[2]. There is a reason why schools are rejecting[3] the official guidelines.
Finally. Want to host a church gathering? Your entire congregation is welcome to stay quarantined for 14 days on your premises.
P.S. The current CDC document has been updated. It was far less prescriptive earlier. Some sense prevailed. The entire section related to churches has been deleted.
Counties with zero infections should be allowed to open, but border protocols must be enforced. [1]https://www.documentcloud.org/documents/6889330-Guidance-for... [2]https://www.cdc.gov/coronavirus/2019-ncov/downloads/php/CDC-... [3]https://www.usnews.com/news/education-news/articles/2020-05-...
Even now with most of the wide area lockdown lifted, there are local clusters being isolated by locking down towns or whole regions, as at the moment with the German slaughter house cluster and the Czech and Polish coal mine clusters.
Or are you saying that the ones who would normally call that out are the Republicans, and they won't because they want Trump's rallies to happen? That's quite plausibly true. But putting it the way you did makes your view sound quite slanted.
It can take weeks after infection to start showing symptoms, weeks more to be sick enough to need hospitalization, weeks after that to die.
These days, many people won't even go to hospitals, even when they're dying, and when they die at home they may never be tested for the virus at all, so won't necessarily be counted as having died from COVID-19.
The direct repercussions of the highly irresponsible mass gatherings that have been taking place over the last few weeks may not be evident for some time.
All this doesn't even take in to account all the people who did not attend any gathering but got infected by someone who did, and yet further infections from the first-order indirect infections, and so on.
Those later, indirect cases (which will still be the result of infections spread during these gatherings) will take even longer to be noticed.
But cloth masks work very well if used by a large percentage of the population. Manufacturing them would have been a very fast win, possibly cutting the infection rate in half, and a corresponding cut in fatalities.
My daughter was sewing cloth masks by March 15 when it was almost impossible to come by an N95 mask. She's made over 20 reusable masks. How hard would it have been for the rest of the country to do something similar, had we been given effective leadership?
They did this without having any detected cases.
The numbers are crazy in some areas, not in others. Texas has 254 counties, and probably 200 of those counties have had less than 75 cases each. many of them have reported 0 cases, and 0 covid-19 related deaths. Even some of the counties around Dallas are doing just fine.
This whole thing is bizarre.
If masks work this well and protesters aren't spiking, I'm not really seeing a good case for allowing more fans at outdoor sporting events.
The virus doesn't hang around outside at the open bus stop. It goes with the people.
then Americans like their rooms numbingly cold so the AC goes full blast
so there, it actually makes perfect sense
these states got few cases in the winter because the weather was warm and sunny and they spent more time outside, now they are inside all the time in the cold, you get more cases
This is the expected outcome by the recent "black lives matter" events. Right actions but really bad time choice.
I wonder why people expected other results.
Lest you think it's a typo, the number of symptomatic tests is a critical number to know.
It's not about whether the individuals beings tested have been harmed, it's about whether testing shows us the infection rate in the population or not. If 100% of tests were of symptomatic patients, the numbers tell us almost nothing.
https://www.cebm.net/covid-19/covid-19-what-proportion-are-a...
In general the world is too connected, and populations too mobile, for a virus like SARS-CoV-2 to be contained, save for special case island nations that are willing to keep borders closed or visitors quarantined and ensure compliance until a vaccine becomes available.
For the rest of the world, what is abundantly clear in countries that are willing and able to perform the requisite testing, is that this is a virus that spreads easily and rapidly but thankfully in those under 50 is vanishingly unlikely to kill if it is symptomatic at all.
With over 10 million confirmed cases worldwide, likely in excess of 100 million actual infections, COVID could burn out in it’s own before widespread vaccination is available. Not due to containment measures, but due to enough people gaining immunity.
In my non-expert estimation, the public health response to COVID will ultimately result in about an order of magnitude more deaths, or roughly an order of magnitude more years of life lost, than due to COVID itself. The longer we continue lockdown-type policies, the greater the damage done.
COVID spread anyway, COVID continues to spread, although now it seems to be mostly in less risky populations as case counts surge and hospitalization and death rates remain constant. Some of this is of course simply sampling bias now that testing is more available for lower risk populations. We also see people who know they aren’t at any real risk willing to be exposed in order to live their lives. Most inexcusably is that the most vulnerable populations (e.g. in nursing homes) were not adequately protected and even directly harmed by policies while the general masses bore the economic and social brunt of the involuntary enforcement measures.
In general every person who gets COVID and is asymptomatic or minimally symptomatic is basically someone getting an early access vaccine, and this can only be regarded as a positive in exerting a downward effect on R.
I think that speculating about long term effects in largely asymptomatic populations is an academic exercise which misses the forest for the trees. We need to reopen emergency rooms for the cardiac patients, reopen oncology departments for the chemo patients, reopen primary care clinics for health screenings, and reopen gyms, all to reduce/prevent well known and proven morbidities that cost millions of lives a year, not just continue to incur increase death in our most prevalent causes of death out of fear or politics.
I am wondering if these commenters are discounting the possibility of a vaccine? There is a strong possibility that we will have a vaccine before we can safely reach herd immunity.
Semi-related note, I think we haven't properly socialized the basic numbers behind the disease. I hear that Covid-19 is more contagious than first thought, with a "natural" R0 of 5.7. I also hear that it has a doubling time of around three days, originally thought to be more like 5-6. I also hear that the contagion period is 8-10 days. These three numbers do not make sense together. The R0 number needs to be reached during the contagion period. The average contagion period is likely far longer, or, it's way more contagious than 5.7 (which would mean the herd immunity threshold goes higher).
Also, if the illness is more contagious than we first thought, it means that the lockdown was even more effective than we first thought.
Here's a fun mental exercise for whoever's reading this. Say that you have a bubble of 100 people, and released a disease that infected 50 people and killed all of them; 100% fatality. Then say you discovered that it actually infected all 100 people, but only 50% of them died. Is the disease less dangerous than you first thought?
I think those are outside of the range of any recent estimates I've seen. Natural R0 is generally believed to be higher, and IFR is believed to be in the 0.5% - 1% range.
I also hope we won't hit 350k, but if we stay below that number, it will be because of a combination of continued lockdowns and finding an effective treatment/vaccine before we reach herd immunity.
https://www.medrxiv.org/content/10.1101/2020.02.10.20021725v...
This is before considering overshoot, which can occur just as in the homogeneous case (and is a reason to slow the spread as much as reasonable, even if you expect/fear that the end result will be herd immunity from recovered patients).
Reported IFRs are now calculated from serostudies testing for IgG. The best studies are on the high end of your 0.5-1%, but there's reason to suspect they're significant overestimates. Sensitivity for the blood tests was established from cases severe enough to seek medical help, and may be much lower for mild cases. There's also evidence of mucosal immunity in patients who test negative for IgG, and recently of T cell response in such patients too:
https://www.medrxiv.org/content/10.1101/2020.06.21.20132449v...
And the number of coronavirus deaths is greater than the actual number of excess deaths, since they're disproportionately elderly. All these second-order effects are uncertain, and difficult to incorporate into a final number; but they're real, and to ignore them completely risks a gross overestimate. Maybe people know that, and think of the overestimate as "conservative"; but considering the tremendous costs of both the coronavirus itself and society's response, I strongly disagree.
Finally, since you said "lockdowns"--if you credit lockdowns (which are always vaguely defined; but government-imposed restrictions on movement and assembly, broadly) with all of benefit to the USA, how do you explain Japan? They're sitting at 8 deaths per million, they never significantly locked down, and their contact tracers are missing ~80% of cases. Maybe it's the masks? Even in California, use is waning. No one seems to have the political appetite to enforce the order coercively; NYC just stopped enforcing theirs entirely after an incident.
Maybe it's the contact tracing anyways, since missing 80% of cases might be fine if you catch the 20% who are super-spreaders (which you will disproportionately, since each person they infect is a chance to find them tracing back)? I could imagine big public campaigns to explain the importance of cooperating with contact tracers, or websites to help people anonymously advise their contacts (which have been tried for STDs, which have at least as much stigma). But I've seen almost nothing.
To be clear, I agree that restrictions on movement and assembly were and are a good idea in some cases, and New York and Lombardy surely wish they'd locked down earlier. I just don't like seeing them discussed as if they're responsible for all the difference between our current situation and a first-order model that we know is significantly wrong.
So my suspicion is that you've skimmed my (long) comment, assigned it to some "template" that you've seen before, and made quick and inaccurate assumptions about my beliefs instead of reading what I wrote. I don't see how you could otherwise believe in good faith that I was "arguing in favor of ending all lockdown-ish behavior, letting the chips fall where they may, and relying on herd immunity to save us".
To start, I'm arguing that the first-order death calculations using 1-1/R0 and IFR from IgG are probably significant overestimates. Do you disagree? If yes, why do you think heterogeneity and evidence other than IgG of prior infection are negligible?
And again, how do you explain Japan? They found a way to continue mostly operating society, while American schoolchildren without attentive parents fall behind their classmates a day at a time. Wouldn't we be better off trying to understand and emulate their success instead of arguing about "lockdowns"?
I've seen you ask about Japan in other threads, using much of the same words, without the various counterpoints seeming to register to you, and now you're making the same points here. It just seems weird. Why are you bringing Japan up as if it's some sort of counterpoint, when it's a counterpoint to something that you apparently believe in? Why are you bringing it up if you aren't in favor of ending mitigation and aren't in favor of acting more like... Japan? I don't care if (R0-1)/R0 is off by some negligible percentage - it would still mean there's a huge difference in death depending on whether we do or don't stop mitigation. I'm arguing against the people that don't even seem to have a rough mathematical sense about this, and also the people that seem content to be like Thanos and shrug their shoulders at a million, 350k, or 200k people in the US dying as long as it's not their friends.
I mean, back to your first comment, if you think herd immunity maxes out at 30%, and that IFR of 0.5 - 1% is a "significant overestimate", then you're pretty close to projecting our current death toll anyway. 0.25% IFR at 30% would be like 250k in the US, which we'll probably hit with our half-hearted mitigation. But since you're in favor of mitigation efforts, you clearly don't believe the estimates to be that low. So... again, what is the relevance of what you're saying? Are you just being sophist? What's the syllogistic connective tissue in your points? What's your therefore? You believe the R0 and IFR estimates are overestimates; therefore what?
Why do I need to explain Japan? I mean obviously something must be happening in Japan that is consistent with what is happening elsewhere, it's not like they are an alternate universe. It's not like Japan is a counterpoint to NYC or Lombardy; they're in the same reality somehow. How do you explain Japan? It's probably some mixture of culture and bad stats in a way that doesn't really have any bearing on what we should do - we already have sufficient data to know that mitigation saves lives, and we're stupid enough that we're about to learn it all over again for the first time over the next six weeks.
Both harms seem tremendous to me, neither so obviously larger than the other that we should disregard information that helps make the best estimate possible. Do you disagree? If yes, how did you convince yourself that the costs of the lockdowns were definitely smaller? I agree that some of the people arguing against lockdowns are ignorant of the likely death toll, or indifferent to human life; but some of them just think you're underestimating the cost of the lockdowns, just as you think they're underestimating the cost in human life.
In any case, we certainly both agree that the government should take actions to mitigate the coronavirus. In your reply above, you've switched freely between "lockdown" and "mitigation", when the latter is a broader category. Japan is surely undercounting some (like everywhere), but you can't miss NYC-scale mortality. I see basically no question that Japan has many fewer deaths, despite the near-absence of lockdown-type mitigations there. As you say, the Japanese aren't aliens--so if something in their culture is saving them, why can't we find out what and adopt it? Whatever they're doing, compared to the USA, it let them operate their society almost uninterrupted and avoided about 46,000 deaths. How can you dismiss whatever they did as non-actionable, when we don't even know what it was?
Was it all the masks? I don't know, but maybe. So why haven't we tried actually enforcing their use, and a big public education campaign on how to wear them properly? How many Americans have dismissed masks because they tried a fabric mask made from too many layers of high-thread-count fabric and found it hard to breathe through? Masks made from meltblown material are easier, and back close to normal prices. Do Americans know that? I didn't until recently.
Or maybe it's the contact tracing? I doubted that before because Japan is missing most of its cases, but I read a paper observing that heterogeneity meant the most important cases (super-spreaders) would be found preferentially. So maybe it's their cooperation with contact tracers? You could spend more than Coca Cola does in a year advertising the importance of that, and it would cost less than a day of strict lockdown. Why haven't we tried that? Or hygiene in general? Are Americans just bad at washing their hands? Major ad campaigns for basic public health measures have been successful in Africa. Why couldn't they here?
Or maybe it really is something non-replicable? I liked the humidity theory, though the trend in Florida goes against that (though Japan also tends to run the air conditioning hotter and more humid than American tastes; should we advise people to do that?). Something genetic? But even if it's not replicable, I'm amazed by the incuriosity most people--on either side of the "lockdown" debate--show at this massive unexplained difference.
I'm afraid you're trying to interpret my comments as supporting or opposing a small number of well-known, hardened, binary political positions. The result is confusing, because reality is a poor fit for either side of those positions. To the extent I have any goal in writing this beyond procrastinating, it's to show that, and to encourage people to spend their time exploring all the (messy, uncertain, self-contradictory) information available, instead of just arguing a position.
Just to highlight one point that I think is often missed. Comparing the "additional cost of covid if lockdown is ended" to the "cost of lockdown" is a frequently abused argument - partly because of bad faith, but in other cases because people legitimately miss that "ending the lockdown" doesn't mean that people will all of a sudden leave home. There is a portion of economic cost, and I won't engage in trying to size it right now, because I tire of this, that will remain just from people being rational self-actors. Restaurants will still close, schools will be reduced attended, etc. Because of the virus. So the comparison is to compare "additional cost of covid if lockdown is ended" (and we know there are sufficient idiots out there to drive spread in this case; it doesn't take a lot to have large effects) to "saved marginal cost if lockdown ends".
Those policymakers were trained professionals, so I doubt I'm any better at picking and choosing what truths should be spoken. So especially in a forum of moderately sophisticated readers, I'm not inclined to limit myself. I understand that may sometimes superficially look like things people often say in bad faith, but I hope readers expend the effort to distinguish.
In any case, I certainly agree that the coronavirus has tremendous societal and economic cost independent of the mitigations. That doesn't mean we still can't make it worse, though. I'm perhaps more optimistic than you are that Americans can do the right thing after exhausting all other possibilities, and actually wear masks properly and cooperate with other mitigations short of lockdown, with the right (perhaps coercive) guidance. I hope you weren't too close to the earthquake, continuing the apocalypse bingo.
10% will be hospitalized = 19.8M
10% of those hospitalized will die = 1.98M
Even if the IFR isn't 1%, say it's half that, almost 1M deaths.
And if you think 350k surplus deaths isn't catastrophic, you must have been nodding your head while watching Chernobyl (3.6 Roentgen? Not great, not terrible).
Any evidence for this? Singapore has 35k recovered and just 26 deaths, because the vast majority of infections are working-age migrants. A disease that kills less than 1/1000 working age people is not going to have a big effect on the economy.