The Plague Year
newyorker.com
newyorker.com
By this time, Taiwan had already started quarantining travelers from China (starting Dec 31). They were bitten by the lack of transparency and paranoia of the China government with SARS in 2003, so had developed a focus on outbreaks in China so as not to be caught unawares again.
The US CDC failed to learn from SARS and we're paying the price now. No one should trust that China will be forthcoming and transparent about these matters. The CDC needs to learn to "trust, but verify". They didn't verify, and they trusted a source with a long history of not being truthful or timely in divulging information.
Also, by this time, Dr Li had been hauled down to the police station and forced to recant his warning that this was human transmissible. So, the wheels of CCP governance were already grinding the truth under foot.
What were the actions that Taiwan took that could be replicated in a much larger scale liberal democracy on a large continent with a diverse globally engaged population?
In case you hit the paywall: https://archive.md/on1X2
As a New Yorker myself, the article in the May 4 issue [1], contrasting the responses of Seattle/WA and NYC/NY was a gut-wrenching read.
We should be grateful that journalism like this exists, to boldly contradict the political spin-jobs.
If your opinion even slant rhymes with "it was rough in the beginning, but we did as much as we could as early as we could, thanks to the courage/leadership of Mr. Cuomo / De Blasio", and you care about the truth, I encourage you to read.
[1]: https://www.newyorker.com/magazine/2020/05/04/seattles-leade...
I think the biggest mistake of this whole pandemic was none of the things listed, it was banning all vaccines for almost a full year. The FDA was granted far reaching powers by congress multiple times to ensure they can approve vaccines quickly in a pandemic. The FDA instead forced. So as badly as Trump handled the pandemic (and he did handle it badly), at least he wanted a fast vaccine. You might blame the first 100k deaths on the disease, but everything after that is due to the ban on the vaccine.
Now, as the vaccines are distributed they are requiring them to go through an ineffective CDC, who is holding back 50% of the vaccines, to the states who aren't able to distribute more than 30% of what they get yet.
The FDA, CDC, and states need to just stop banning people from getting a vaccine. Let private industry help.
Should Trump have proposed legislation to fix this? Yes, but so should Democrats and Republicans. Our beaucracies failed, both parties failed. Even Biden is coming in with goals like "vaccinate 100M in the first 100 days." What a low bar, since we have already bought 200M doses for delivery by the end of Q1 (70ish days into his term). So Biden's goal seems to be "not approve any more vaccines and try not to lose most of the vaccines we have." His goal should be vaccines for everyone that wants it within 60 days. That is achievable with existing supply+ Astrazeneca and if J&J looks good too then that makes it a slam dunk, unless the government gets in the way again.
Even if they’d guessed right, how many people would have taken an untested vaccine?
And what if a lot of people had, and then side effects show up. That would probably cost more lives over the next decade by public distrust of the drug approval process.
Yes, it seems like the success rate may be higher than for "regular" drug development. But, crucially, nobody knew this. There haven't been a whole lot new vaccines developed in the last few decades.
Besides, as far as I know production capabilities were being built and stockpiles created while the trials were ongoing.
The FDA is addressed in the article, mostly when talking about the botched tests in February.
>You might blame the first 100k deaths on the disease, but everything after that is due to the ban on the vaccine.
That's a reckless way to approach vaccination. From TFA:
"Like COVID, [RSV] is dispersed through particle droplets and contaminated surfaces. In the nineteen-sixties, a clinical trial of a potential RSV vaccine made children sicker and led to two deaths—a syndrome called vaccine-enhanced disease."
Potential vaccines can make things worse, which is why we have three test phases. Even if you want to let people get an untested vaccine, which ones get approval? Do they need to get multiple? Will they interact badly?
>Even Biden is coming in with goals like "vaccinate 100M in the first 100 days." What a low bar, since we have already bought 200M doses for delivery by the end of Q1 (70ish days into his term).
Forgive me if I'm wrong, but this is because the approved vaccines require two doses per recipient. Factoring in logistics and public outreach, that's a reasonable goal.
This article is also a nice microcosm of the whole American situation
So for this, something like: $("video").playbackRate = 2
or whatever. It's nice even for players with controls (like YT) if you want more than 2x speed
Also you can just look at the video tag's internal URL and just download and play however, offline :)
At 2 or 4 times the speed I think is a simple step, just omit every two or three of four samples.
Anyway, this gives different distortions. I am Deaf so I don't hear the distortions but I understand sound in a mathematical way. At a sampling rate of 44.1k the highest representable sound is about 22kHz. At 4 times the speed this is only the fourth of it, about 5500 Hz. If higher sounds aren't filtered they will wrap around and re-appear as low frequency sounds. I imagine that this sounds very weird.
And for n not being a power of two or at 8 times or more, you need to resample sound. Transform the samples into the frequency domain and back into the time domain but sped up. This is quite a mathematically heavy operation and probably there are other limits I don't know of.
* China lied about the virus. They banned investigators from outside the country and tried to cover everything up. Experts knew they'd lied previously about SARS, but rather than assuming the worst they more or less assumed it probably wouldn't be a big deal.
* The FDA completely dropped the ball on testing kits and it took an incredibly long time to resolve the issue. Its unclear that people in power even realized this. Back in January and February when we were hearing about a case here, a case there there was almost certainly rampant community transmission and death occurring.
* CDC leaders were very slow to consider that the virus might transmit through the air. This led to the early advice being misguided (6ft of distancing and washing your hands protects you) and just flat out wrong (wearing a mask does nothing).
* Inside the executive branch, people who gave bad news were forced out and people who gave good news got promoted. Predictably this made things much, much worse.
I would also emphasize that, in terms of personal culpability, Secretary Alex Azar of the Department of Health and Human Services comes out looking very poor. (Mnuchin was also the speaker of some, in retrospect, appalling secondhand quotes).
The article points out that Azar is the director of both the FDA and the CDC, and should have played a more active role in orchestrating their handshakes in February.
Misunderstanding and miscommunication between the FDA and CDC were responsible for the absurd delay in widely-available testing, which otherwise should have been available in med-February.
Not only was he aware of problems early on, he didn't properly communicate them up (to Trump, which contributed to Trump's belief that the whole thing would blow over), or manage them down.
This is my reading, as a disclaimer, not an explicit statement from the article. I recommend people read it for themselves.
Fauci and (sidelined and silenced) career officials at the CDC, FDA, and NIH are the only ones who came out looking okay.
But I don’t know how accurate his portrayals of the intentions behind the CDC and the FDA officials are. There aren’t a lot of ways to cross reference his analysis of the quoted meetings, since the CDC and FDA both declined to comment for the piece.
This is as close to a “full story” as we’re going to get before a hypothetical “COVID commission” congressional investigation, but it’s still quite two dimensional.
They shared the genome quite quickly. Scientists got working on it ASAP, around the world. Chinese hospitals and medical experts were also pretty quick about sharing detailed information about what they knew of symptoms, disease progression, and their local best practices for keeping healthcare workers safe. (Sadly many hospitals around the world did not follow those...)
Independent epidemiologists, virologists, etc. in the West immediately started issuing urgent warnings, begging governments to take decisive action. Neighborhoods in Western countries with significant Chinese expat populations were paying attention and started masking up and staying in their houses by the beginning of February.
What outsiders could objectively see in January was that China shut down the entire national economy and transportation network, instituted unprecedented public quarantine/curfew measures (blocking off neighborhoods, only allowing occasional trips out of apartment buildings, stopping all inter-household gatherings, locking domestic immigrants out of their own apartments, forcing people into temporary isolation facilities, etc.), shifted massive numbers of healthcare workers to Hubei province, vacuumed up whatever PPE supply they could, started building temporary hospitals at ludicrous (probably structurally unsound) speed, etc. There were videos online of people getting welded into their own apartments or forcibly shoved into vans by the local police, falling down dead in the street, large-scale public disinfection of streets by armies of workers in hazmat suits, etc. etc. It was like a post-apocalyptic horror movie.
The provincial government clearly screwed up by wasting time and covering things up in November–January, but after the national government took over the response was swift and decisive. (I think some steps were clearly an overreach and some of the implementation was sloppy and disorganized, which ended up hurting a lot of people. But it is easy to criticize from afar, and at the time there were many unknowns.)
Sure the aggregated public statistics put out by the Chinese government of cases and deaths in the Wuhan area were obviously a massive undercount (partly because getting reliable data of a new disease that nobody understands yet and can't perfectly test for is always extremely difficult; there were also dramatic undercounts in Italy, Iran, the USA, etc. a couple months later), but anyone paying even the slightest attention could see that this was a huge serious threat coming for the world. Certainly by mid February it was abundantly clear that this would be a pandemic requiring large-scale coordinated decisive action by governments around the world.
Some governments (e.g. Taiwan, South Korea) took their own decisive action, mobilized a national response and spun up PPE, testing, isolation, quarantines, contact tracing, etc. ASAP, and saved countless lives.
Other governments (e.g. England, USA) were disorganized, avoided taking prompt action, sidelined local experts, and ended up with many avoidable deaths and economic devastation. Attempts by leaders in the latter countries to deflect blame to China can be rationalized by saying that China was not as forthcoming as they should have been, but frankly that is a cop out, with at least some racist undertone. It didn't take any brilliant insight to see that the Chinese government considered the epidemic to be a catastrophic national crisis, and that there was significant risk for a severe worldwide crisis.
However, this does not excuse the Chinese Government's active (and ongoing!) attempts to downplay what they knew about the initial severity of the outbreak. I don't think it's fair to blame the botched first two months of response on the provincial government.
But concretely the provincial government did what it could to hide and cover up the epidemic, silencing local doctors, cooking the statistics, etc., hoping it would go away by itself and they could avoid blame or conflict.
The Chinese government completely dropped the ball on providing an objective warning of the situation.
The US federal government completely dropped the ball on preparing an adequate and timely response, even granted the handicap of officially sanctioned misinformation coming from Chinese Government.
I agree that the first problem does not make the second problem any more forgivable, and we should disregard narratives that try to push that idea. Neither misdeed should be tolerated or go un-shamed.
Whatever the Chinese government might have been "saying" (in press releases?) their signals were abundantly clear to everyone paying attention, and should have been even clearer even earlier to folks with access to CIA reports etc.
Feel free to criticize the Chinese government's statements per se all you like, but it is absurd for other governments who didn't take action for months despite an obvious need to blame the Chinese government for this. Especially when those governments have done plenty of their own lying (in the US case, arguably more). Frankly, I don't think more transparency from the Chinese would have made too much difference in the USA. The Trump administration would still have been calling the situation a Chinese hoax or deliberate biological warfare or whatever conspiracy theory.
We can see clearly how e.g. South Korea mobilized the entire country, spun up nationwide testing at unprecedented speed, implemented a huge and very effective contact tracing program (if they had waited an extra few weeks and not caught the Shincheonji church cases in time, they might have ended up with uncontrollable spread), did detailed case studies for every case they could find and published all of the details, made sure every resident had access to masks, etc. etc. There is no inherent reason why much stronger responses couldn't have been made in the US and Europe.
The US is among the best inherently prepared countries in the world for a crisis like this: little reliance on public transit, lots of jobs that can be done remotely, relatively few intergenerational households, a world-class public health agency, one of the richest healthcare systems in the world, world-class universities and research facilities, many large pharmaceutical companies, a national constitution and legal structure that gives the federal government broad powers in a health crisis, a position of international power and leadership with many strong alliances, a central position in the world economic order, a huge industrial base, ability to shift human resources from one place to another in response to local crises, a relatively self sufficient domestic economy, universal access to basic communications infrastructure, ...
And yet we had among the worst responses in the world, due to abject failure of federal leadership, total lack of coordination, and rampant misinformation by GOP-aligned media and others.
You think foreign governments who didn't take the virus seriously after seeing China's response to it would have taken it seriously if China had told them to?
FWIW, while the article does note, correctly, that China were largely unhelpful with providing information or access, it seems the focus is more on how and why the US government and agencies mostly failed to act appropriately to not being able to get the data they wanted.
The lab that sequenced and shared the genome apparently did this without authorization from the central government. Shortly afterward, the entire lab was shut down for "rectification."
The Chinese government also repeatedly refused requests to share a sample of the virus. It refused to allow any independent scientists to enter the country to investigate even up to today, and even the WHO commission that has finally been assembled can only contain members that are approved by the Chinese government.
From January 1 schools can now apply for funding to improve their ventilation systems and it will probably arrive around June. And we still have not started vaccinating and won’t start vaccinating the elderly for at least a month.
And only very slowly the media finally is starting to notice that the government has messed up. But still most reporting is just copying the press releases, shifting the blame around, jealously pointing fingers at supposed transgressors and blindly defending policy.
It’s truly sad.
Here is the most recent time it was posted (5 months ago) https://news.ycombinator.com/item?id=24101712
https://www.pbs.org/newshour/show/the-intrepid-journalist-wh...
And here's the book, "Fallout: The Hiroshima Cover-up and the Reporter Who Revealed It to the World" https://www.amazon.com/Fallout-Hiroshima-Cover-up-Reporter-R...
Diarrhea probably ended up killing more people than SARS-CoV-2 in 2020.
"Diarrhea kills 2,195 children every day—more than AIDS, malaria, and measles combined."[1]
"In 2016, diarrhoea was the eighth leading cause of death among all ages (1 655 944 deaths, 95% uncertainty interval [UI] 1 244 073–2 366 552)"[2]
1: https://www.cdc.gov/healthywater/global/diarrhea-burden.html
2: https://www.thelancet.com/journals/laninf/article/PIIS1473-3...
https://www.nytimes.com/2021/01/02/world/africa/africa-coron...
Tl;dr: Reporting of deaths is incredibly irregular across Africa, and counting excess deaths is likely impossible as a result. The population is younger on average, which likely helps, but we probably don't know the real numbers there.
> “The mortality due to Covid in the African continent is not a major public issue,” said Dorian Job, the West Africa program manager for Doctors Without Borders.
The rest of that article is just speculation that there might be an outbreak that isn't being recorded, with little evidence.
The Spanish flu killed 50 million people. That’s 5% of the word population at the time. Now 50 million would barley be over half a percent.
Meanwhile almost everyone I know in tech has had the best financial year ever. It's good we have to sacrifice nothing and even gain, but I totally get the loss from the rest of the world.
With the death count, we will see when all cause mortality is published. If there are huge drops in heart disease and cancer deaths that would imply some things. The median age of death is over 80.
* Many of these people are not smokers themselves, they are dying from second hand smoking
* You are free to choose to smoke, but not to choose to go to a bar? It’s reasonable to forbid people to visit their grandparents but not to forbid them to smoke?
The proper comparison would be that you can choose ‘not to Covid’ as much as you can choose ‘not to lung cancer’. A nonsensical proposition.
https://www.cdc.gov/healthywater/pdf/global/programs/Globald...
I would personally characterize diarrheal diseases as a plague, but I think the broader point is fair: people have lost all perspective on how Covid compares to other causes of death around the world. How far would the tens of trillions of dollars the worlds' advanced economies have spent on Covid in 2020 have gone to eradicating childhood deaths due to dirty water?
You can't simply say "let's do both", because the fact is that we immediately found the money for one, and we haven't found it for the other despite years of effort. It speaks to our priorities.
Because it isn't a "harp". It isn't just a niggling little thing, and it isn't "dismissal" to put something into perspective.
The world's economies have thrown tens of trillions of dollars into the response to Covid (not to mention the incalculable follow-on costs in terms of mental health, missed diagnoses and the like), and nary a thought was given to what the side-effects of that response might be, or whether those resources might have been better spent elsewhere. We just did it, and it turns out that the disease will have an impact on par with something else that we spend drastically less money on in any given year.
If you literally cannot fathom why a cost/benefit calculation might be appropriate here, you have lost perspective, and the OP's point is well-taken.
Let's also remember the way the world was reshaped by 6000 deaths in new york in 2001...
Or to say it less charitably: Back at the beginning it was commonly foretold that we would do all this work to flatten the curve, and then some idiots would look at the resulting numbers and say 'See, it wasn't so bad at all!'
I thought it was around 2600 in New York (just under 3000 total).
Only if you include the verbal kind.
TBH, I don't think it matters that much. The virus is a serious situation but the stock market is acting like the worst is long over. I know the stock market is not the economy , but I think it is no longer a catastrophe but rather more like a wildfire. It could have been a far worse situation if the IFR was 2-4% as originally feared back in Feb-March. Then we would probably be seeing the S&P 500 about 50-70% lower than it is now, cuz when you got airborne cancer, that is not exactly something you can patch over by throwing stimulus money at it. Now it's more like a bad flu in terms of IFR for middle-aged people, but worse though for elderly, so I don't want to dismiss that. But it could have bene sooo much worse, and we were spared that.
clarification for the downvoters: questioning in the sense of asking a question, not engaging in anti-mask advocacy. Sorry if not being a blindly obedient serf makes me evil. Should I kill myself now and save you the trouble of forming the firing squad?
We aren't gonna get proper RCTs and hard evidence any time soon. But it's such a simple and plausible intervention, we do have good reasons to believe they help and they don't hurt anyone. It's all just so infantile
I'm totally fine with the structure of the argument with respect to mask mandates as it's typically made. Assuming no costs and at least some benefits, sure, I don't see a problem - this is within basic morality territory so far. But if the parameters are in question? My datapoint: mask mandates have effectively destroyed a familiar relationship, because it put me in the position of asking a good-faith question to a zealot. I judge the costs to me to be extremely, life-changingly high while the benefits remain uncertain.
I'm guessing you have an equally ridiculous slippery-slope follow-up as well?
Simply put, a 3 point restraint that's much easier to put on provides a decent amount of protection in the event of a crash. On the other hand, if one is engaged in motor sports, racing, etc., then the other safety measures are necessary. Just like one would use additional safety measures when working in a healthcare setting.
What's the double blinded placebo for a mask?
Assuming you could even get an ethics committee to sign of on the experiment.
I agree the data could be helpful, but I don't think that's the 'right' way to get it.
The social costs are nonzero, so I wouldn't say it's free.
Arguing that this isn’t a significant risk just begs the question: without positive data for effectiveness, nobody has any idea.
But aren’t you actually agreeing with the US federal government’s actual response? Aren’t the people saying that you should wear masks the ones going against the grain here?
Doesn’t that make _you_ the obedient surf?
S[n]ide note: I live in Australia so I have no skin in this game. Along with NZ, we’ve had very few deaths from CV19 relative to large cities in the rest of the Anglosphere, and our economies are basically open. I suppose the “police state style intervention” you speak of did reduce our short term freedom - we had 3 months of hard lockdown - but I’m writing this from our summer holiday beach AirBNB, and it sure feels like freedom to me.
Blindly obedient to who?
A mask is such a cheap and trivial precaution I don’t get the resistance. Masks are not even close to 100% effective, but the goal is to shave as many points off the viral R-factor as possible.
As for police state tactics, I don’t think they’d be considered if people were just smart and took precautions. They’re on the table because too many people insist on refusing to do simple things.
https://academic.oup.com/jpubhealth/article/42/4/717/5901977
"Deaths among adults 65 and older accounted for 80% of excess YLL in April but only 36% of excess YLL in June. Since April, working age adults 20-64 have accounted for 47% of excess YLL, and males 20 to 64 have contributed 34%."
https://healthcostinstitute.org/hcci-research/the-impact-of-...
For example, if a person dies at age 50, and life expectancy at age 50 is more 25 years, then the YLL is 25. In contrast, if a person dies at age 80 and life expectancy at 80 is 2 more years, then YLL is 2.
https://healthcostinstitute.org/hcci-research/the-impact-of-...
Stipulation: if the baseline life-length is 80 years and a ninety year old dies, then the YLL is 0 and not -10.
No, of course it isn't.
A 90-year old isn't expected to instantly die. They have some remaining live expectancy, maybe two or three years, even if they have passed median live expectancy.
I distrust magic, and I dislike the cognitive dissonance that comes with trying to do as I'm told while being denied basic information about the value of that behavior.
I have read the article. It's mostly a comparison between medical and non-medical cloth masks, in addition to reviewing basic properties and measures of effectiveness for masks in-general.
Until a cloth mask design is proven to be equally effective as a medical or N95 mask, wearing cloth masks should not be mandated for healthcare workers. In community settings, however, cloth masks may be used to prevent community spread of infections by sick or asymptomatically infected persons, and the public should be educated about their correct use.
This may well be true. The basis for such a distinction would be a deep point and counter-intuitive. I'm not sure it's present here, though. There is very little on the absolute benefits or effectiveness of non-medical masks. Here's what I could find:
Participants made masks from different materials, and all masks tested showed some ability to block the microbial aerosol challenges although less than that of medical masks (11). Another study found that homemade cloth masks may also reduce aerosol exposure although less so than medical masks and respirators (12).
and
Cloth masks can be made in large quantities in a short time. They can be reused after being decontaminated by various techniques, ideally washing in hot water with soap. Other methods or products include using bleach, isopropyl alcohol, or hydrogen peroxide; autoclaving or microwaving; and application of ultraviolet radiation or dry heat (16).
Also from this article, which are relevant to claims that mask-mandates have zero cost:
The general public should be educated about mask use because cloth masks may give users a false sense of protection because of their limited protection against acquiring infection (16). Correctly putting on and taking off cloth masks improves protection (Table). Taking a mask off is a high-risk process (34) because pathogens may be present on the outer surface of the mask and may result in self-contamination during removal (31).
As for general questioning, yes in the abstract everything should be questioned. But when most of the people raising questions seem to be acting in bad faith, then eventually the questions they're asking are going to be reflexively rejected. That creates an irrational blind spot for sure, but that's still a smaller rationality disruption than letting the bad faith questioners continue to destroy the discourse. Given the way herds work, I definitely agree that there could be something wrong with the specifics of the mask consensus. But my general prioritization heuristic asks why that would be someone's focus when there are significantly more pressing issues. And so any argument has a very high bar to clear, probably to the level of conclusive studies showing mask wearing is actively harmful, and not just simple conjecture on the mechanics from first principles.
> As for police state tactics, I don’t think they’d be considered if people were just smart and took precautions. They’re on the table because too many people insist on refusing to do simple things.
This is the real pisser. Being a libertarian myself, it galls me how much damage has been done to freedom, supposedly in the name of freedom. Allowing a pandemic to spread unchecked, meaning I need to treat everyone I come into contact with as potentially infected (including wearing a mask in my own house as I've got healthcare visiting), has been a grave damage to my freedom. I can only conclude the covidiots see "freedom" as the ability to behave like spoiled children, rather than the opportunity to make responsible choices.
Public figureheads preaching harmful nonsense that leads herds of people to harming themselves and their communities is about as far from the enlightened-individual libertarian ideal as possible.
What an absurdly twisted bit of authoritarian reasoning. The very point of a free society is that you should be able to refuse certain things without being forced into them for the act of refusing.
Isn't that always the case though, particularly with politics and operating systems?
It's probably wrong in a number of ways, though. The new variant overtaking the UK may cause 10 times as many deaths in the first months if it's really 50 % more infectious (the magic of compound interest).
Are people going to adequately react to such a change in risk? I have my doubts. This isn't even meant as a cynical indictment of humanity: I myself currently behave more less exactly as I did during the summer, even though local infection rates have changed by two orders of magnitude in the meantime.
I do think it would be harder, though, and it would likely involve less literally pro-plague attitudes
Reactions track with the perception of danger, not risk. We would all behave differently if the danger was a flesh-eating hemorrhagic zombie virus, rather than moderate-to-severe flu symptoms, even if the risk was unchanged.
Paul was hesitant. Like most public-health practitioners, he held that travel bans often have unintended consequences. They stigmatize countries contending with contagion. Doctors and medical equipment must be able to move around. And, by the time restrictions are put in place, the disease has usually infiltrated the border anyway, making the whole exercise pointless"
Except Australia and New Zealand have shown that is not really true. If you shut the border early enough and police it well enough, you can suppress the virus.
The idea that doctors can't travel doesn't have to be true. Put them in hotel quarantine for 14 days on arrival and then get them to work. 14 days on the way back too. All too often I hear problems(excuses truly) as to why something can't be done. But with additional planning and willpower (and not just rolling over) it can be.
Island and smaller nations have some capabilities as far as population movement controls that the big ones don't have or can't sustain for as long. Eventually COVID will come for all, suppression strategies only allow a nation to adjust the timeline.
This study shows an unexpected very early circulation of SARS-CoV-2 among asymptomatic individuals in Italy several months before the first patient was identified, and clarifies the onset and spread of the coronavirus disease 2019 (COVID-19) pandemic. Finding SARS-CoV-2 antibodies in asymptomatic people before the COVID-19 outbreak in Italy may reshape the history of pandemic.
Essentially all countries that have kept COVID in check have similar testing and quarantine policies. This is a reasonable alternative to closing the border entirely, but it was never taken up by the U.S.
It feels like those in the US are unwilling to make hard changes for the common good, be self critical and admit failure.