Corona Game: A simulation of how Covid-19 spreads
koronahra.cz
koronahra.cz
First, this URL https://covidgame.info/ loads the game in English by default. There was a plan to popularize the game outside of Czechia but, frankly, we missed the window when major news outlets were interested.
To address few points mentioned in the comments: the game was tuned to the specific situation in Czech Republic around end of 2020 / beginning 2021. The goal was to build basic quantitative intuition about the behavior of the epidemiological model (SEIR model) that the general public and decision makers were lacking. The game doesn't allow for zero covid strategy - because that was never realistically considered. Likewise, we after some considerations, we didn't include cheap interventions like extensive testing, contact tracing and better government communication. This doesn't mean that we didn't support such interventions. However, Czech government proved unwilling or incapable to implement such measures and in the short/medium term broad restrictions were the only "levers" the decision makers could pull.
There is an interview for a major Czech Internet server about some aspects of the game development: https://translate.google.com/translate?sl=cs&tl=en&u=https:/...
We were working together with some real experts in Covid modelling and the model was in my opinion quantitatively sound (though, as we repeatedly said, the model was not optimized for scientific accuracy). At the end the was played by some members of the parliament, party experts and even ministers. We know that the game helped to facilitate consensus between the government and opposition in a very fragile political situation. I believe that, at the end, the game saved hundreds or thousands lives by helping to implement some necessary restrictions sooner than they'd be implemented otherwise.
The beauty of the concept is its simplicity, as well. It's a bit like an IFR training panel, or early text-based video games. You can't see where the plane is or where it's going, you only see the instrument readouts after you adjust something. Since we have all been flying blind, this is a great experience to put in front of people, simply of what it's like to adjust and wait.
Five stars, sending it to all the devs I know, also as a way to make a very engaging sim on a complex topic for people with no prior art =D
I think for decarbonization, you wouldn’t need to take as drastic of steps is taken for Covid. But if your policies are unpopular, it will be a lot easier to lose political power as the timeline is ten times as long. It only takes slightly unpopular policies to be kicked out of power. So I think that aspect would help people who think we can do extreme measures for climate change (ie abandon most of the suburbs in a decade for denser urban cores more easily served by public transit) kind of temper their views a bit and think of more politically viable methods of fighting climate change (electric cars, etc). Of course it be nice to be able to modify the game to explain other arguments, like effects that redistribution might have making those changes more politically viable. But of course like most kinds of social science Model, it’s really more of an explanation/exposition than a prediction
The game should model this because it is the only strategy that has been shown to be actually effective, and might make people realise how badly governments handled this.
Not at all. A zero-covid strategy doesn't mean “Covid doesn't happen, nothing to do here”. It means locking down entire cities as soon as a few case of unknown origin are diagnosed, and doing so every time the situation occurs: it's not a one time medicine, you must be ready to to enact local lockdowns many times.
Australia, Vietnam, China, South Korea, etc. saved hundred thousands of lives by taking extreme measures super early on. Locking down 7 million people when 9 cases have been found is an extremely tough political decision to make, but it has been immensely successful (both from the health and economy point of view). The western world has been completely oblivious to this strategy since the beginning of the pandemic, and not allowing this kind of strategy in a game is just going to reinforce this idea that there is no alternative to the deadly “flatten the curve” strategy.
I was an advocate for full lockdown in the US two weeks before the government even acknowledged the problem. I was already in quarantine a week before they did, and we isolated on a farm for a year until we got both shots. But the reality is we're in a country where we can't even convince people to get the vaccine now, much less skip spring break.
I don't think it's sending a message that total lockdown isn't an option. In fact, it's an option in the game. Lockdown in EU countries was much more severe than it was in the US. And Czechia is a landlocked nation at the heart of Europe, so closing borders is a wild and drastic thing in that context... much more so than in NZ, for example, which has rightly been called the "bolt-hole of billionaires" for the apocalypse.
I agree that we could have stopped this in its tracks if we had locked down Seattle and New York completely at the end of 2/2020. But I suspect it would have ended up in rural Missouri eventually anyway. And once it's endemic and the only option is to flatten the curve, there's no point in a simulation of a scenario that had no basis in reality, and there's still a lot of value in teaching people what flattening the curve means: preemptively locking down and closing before things get astronomically out of hand.
Not American so I can't judge about there, but in Europe, most countries closed restaurants and theaters for almost 6 months, schools for more than 3 months, people where submitted to curfews and harsh circulation restrictions (cannot go farther than 10km from your house without a justification and papers to prove so − in France for almost 4 month in total). and borders where closed for months (my brother in the UK couldn't practically come to France fro the 5 first months of this year). And people where sent to jail for not respecting those restrictions. It's not like the western world acted like “freedom-loving countries”, overall there were much more, and much longer freedom limitations in France, Italy and other European countries than there were in China.
The island vs continental countries is also a fallacy, there's been as many death in Cyprus and Malta (1.5M inhabitant together) than in NZ, Singapore, Vietnam and Taiwan grouped (more than 130M people living there). What's their excuse?
Hermetically closing borders would be very hard for Czech Republic (with strong economic and personal ties to the neighboring countries). There was political will to go for zero covid strategy anyways.
If I was allowed to go for some dream solution it would be coordinated strategy on EU (or Schengen) level.
Astral Codex Ten (the reincarnated Slate Star Codex) has an informative article on the effectiveness of lockdowns that references and employs this simulation:
https://astralcodexten.substack.com/p/lockdown-effectiveness...
ETA: The post contains a graph of the frontier of pareto-efficient outcomes against which you might want to measure yourself when playing.
See also this blogpost by one of the epidemiologists working on the game: https://translate.google.com/translate?sl=auto&tl=en&u=https...
Disclaimer: This is an unpolished toy project. It was built in a weekend by simple dude who likes to code but has no idea about virology and epidemiology.
I am guessing that the renewed interest in our game is coming from the recent post at Astral Codex Ten: https://astralcodexten.substack.com/p/lockdown-effectiveness... It is well worth reading that post.
Let me also link a post from one of our collaborators explaining how, for most countries, the dichotomy between saving lives and economy was somewhat false and relative to the real outcomes it was possible to improve both: https://translate.google.com/translate?sl=auto&tl=en&u=https...
A lot of the discussion on this forum center around the question what was the optimal policy and how well the game simulated that policy. In particular, there is a lot of discussion around the two "extreme" approaches: "zero covid" and "no interventions". That is fine, we had these discussions many times and we can explain how these approaches are represented in the game (in my opinion, not too unrealistically) but, at the same time, it somewhat misses the point. The game was about building intuition about simple epidemiological SEIR model close to the regime where the real country was operating - and for political reasons it was very unlikely that the country will radically change the course.
Lot of the game design decisions were some compromise between different goals of the game. Let me give an example: the team of authors of the game strongly believes that expanding contract tracing would a good thing. We were considering adding it to the game. However, what would be a point of adding that option to the game? It would further clutter UI (we had mobile users on mind). It would not add anything to the game because the decision to expand tracing would have no significant downside. And last it would hardly add anything to the public debate, it would just communicate that the authors of the game like contact tracing. There were already zillion of well argued opinion pieces on the topic. In fact, failures of contact tracing were more about failures of the specific agency than any conscious decision on the decision maker side. In short, tacking this issue in the game would quickly move from mathematical modeling into much more murky waters of public service efficiency.
You should also keep in mind that the game was just a small piece in a bigger mosaic of truly incredible efforts of many other volunteers. E.g. "Interdisplinary group for epidemic situations" https://www.meses.cz/. The game was never intended to provide comprehensive picture or recommendations.
Note on the "social stability score": the game population is by design very "permissive" people will generally not revolt even if you implement very harsh lockdowns of if many people die. This is because we primarily wanted to allow the player to explore the epidemiological model even for fairly extreme strategies (and public opinion is hard to model anyways). In addition, we expect that most player will play the game only once and we didn't want to frustrate too many new players by "game over" screens.
For context: here is how I see what was happening in Czechia. The spring 2020 was handled well and country avoided any significant surge in Covid cases. During summer 2020, people get used to the pandemic. New view got a significant traction: Covid is not that serious and the best course was to let it sweep through the population and gain natural herd immunity.
Since then, there was a constant tug of war between side wishing to relax the rules and the side wishing for stricter rules. Every time the disease started to decline, the "relax rules" side gained more traction and every time the hospitals were close to the capacity (or arguably above the capacity), the government implemented fairly strict measures (there was a strong consensus that everybody must be able to get healthcare).
This explains why the popular "zero covid" and "no intervention" strategies were never attempted. It is hard to tell how well our model works for these strategies. My guess is "not too poorly" but the we have much better confidence in the model in the regime much closer to real world behavior of the country.
What is this supposed to be teaching exactly?
If the model is correct then I think a lot of people would say we should have just let the disease burn out and deal with the deaths. I'm not sure that's what the designers intended.
But do you want the other [than pandemic ending] consequences? Like in your game-based example, 10% of the population dead?
To truly burn it out in real world conditions you’d need to actively infect people.
No country is a closed system. We see now that a previous immune response is better than nothing against the Delta variant. I'm wondering what will happen to the island nations that kept the virus at bay while not having a high vaccination rate, won't they have many more deaths now with the more infectious and more deadly version that other countries that "let it rip" like Sweden have at least partial widespread immunity to?
(Also, what the sibling wrote)
Because the virus wouldn't be spreading beyond the host that got it, the risk of mutation would be small.
(IMHO, we should've just massively accelerated vaccine development... even just a couple months would've saved lots of lives. If you're willing to try the strategy in my post, then accelerating vaccine approval would probably be no worse morally and probably a lot better.)
I waited a little by accident and then went full lockdown and got a total of 130k deaths
I had a doctor outright scold me for wearing a mask to the hospital here (checkup for crohns disease which I take immunosupressants for) and didnt see a single other mask in the hospital until December 2020. o.O.
Smaller countries with limited access to the wider discussions in English can turn very weird.
> Sweden had something like 80% support to only have event limits at 500 and no other restrictions
But even now Sweden has 0.15% of the population killed by covid-19, that is like 100 times smaller than the 10% that the GP got in the simulation.
This game perpetuates the gigantic fallacy that government intervention is the biggest factor determining spread and outcome, when in reality it's geography, structural differences, and enormous amounts of luck.
You can find counter-examples like that for more or less any posited influential factor on COVID outcomes, except for obesity. Government interventions in particular don't correlate well with anything. The models are all built on the assumptions that they should have a huge impact, but real data tells us differently - the assumptions the models are built on are unsound.
IMHO it's really a pity the game authors used this to influence the Czech parliament. These models were never validated against reality before being thrown at policymakers, instead the (sad to call them this) "scientists" simply assumed that because the underlying theories are simple they must therefore also be correct. I've had actual scientists tell me "of course lockdown works, it's basic germ theory" which demonstrates a pretty chaotic confusion between theory and reality, but that sort of attitude can be found everywhere in the academic modelling world.
Remember that politicians are in the tradeoff and bullshit business. They assume every they are told is bullshit, they repackage it and than sell it to us. My guess is if they don't like what the scientist and economist say, they just get another group they like more. It's probably a mix of the advice they get, with the tradeoff they want to make.
> "of course lockdown works"
Of course they work! The question is how much it affect the transmission ratio and the economic cost, and if people will follow the restrictions.
I like that this was call the "Corona Game" and not the "Corona Simulator". Some people noticed that in this game "doing nothing" does not drop the popularity to 0, and I think that it's very unrealistic. Other people noticed that closing the schools has a big effect in the game, but the different parts of the government here in Argentina disagree https://news.ycombinator.com/item?id=27783454
Why do you say this when there are many analyses saying they don't have any impact. At any rate that doesn't really need studies, because places that either didn't lock down, or did and then entirely removed restrictions (like Florida, Texas), did not see any large clearly artificial jump in case numbers. And yet suppressing such spikes was the sole justification for lockdowns.
That's why, when investigated, all claims I've seen that lockdowns work are either mis-analysis of the data (Flaxman et al and friends), or, justified on theoretical grounds like "of course they work, theory says they work".
It also depend on other factors. I guess most people in Florida and Texas move in their own car. Here in Argentina most people use public transport.
For example in normal times I have once a week to commute from one building of the university to another building that is like 7 miles away. I can take a bus, the trip is 90 minutes, and at rush hours it has like 100-150 persons.
I can also make the middle part of the trip using the underground/metro, so I pass under the mess of transit in downtown and the trip is only 45 minutes long. Now I have like 150+150+150=450 new friends to share the air. (And the underground/metro cars are bigger and more crowed, so perhaps it reach 200 and the total is 500.)
Many persons here in normal times must do similar or longer trips everyday, twice per day at rush hour. (Perhaps bus+train+bus, or bus+train+undergroung and the can't skip the train because they live too far away.)
(And the same morons that open in summer the window because the air conditioner is not cold enough, will close the window in winter because the wind is too cold.)
So in different places, a lockdown may have very different effects.
I believe the fact that this invalidates what was seen as robust theory is one reason (but not the biggest reason) why people are resistant to that conclusion. Yet, that is what the data demands of us.
In reality there are lots of ways to patch up germ theory to handle the ineffectiveness of lockdowns. For instance, contact tracing studies claim that almost all infections are spread in homes, care homes and hospitals, i.e. places where sick people have to be. That makes logical sense: you would expect viruses to spread in places where sick people are, and you would expect sick people to be in a bed somewhere because they feel sick. The idea that lockdowns work is strongly predicated on the belief that asymptomatic or pre-symptomatic people are highly infectious. However there's actually very little evidence of this, and quite a lot of evidence that they're not.
Lockdowns simply don't work, because a functioning society where people don't starve to death requires massive amounts of "essential" workers who have to be exempt from the lockdown rules. But a lot of people seem to think Uber Eats is run by an army of small elves or something...
> when in reality it's geography, structural differences,
Why did you cherry pick Czechia when you have neighbouring countries which are much more comparable in term of climate, culture, geography, density, &c.
Finland: 176 deaths per 1m hab
Norway: 146 deaths per 1m hab
Sweden: 1437 deaths per 1m hab
I would be very surprised if anyone actually argued that.
This is HIGHLY irregular. Right before the 2020 summer all Swedish hospitals started with corona security measures: you could not enter the hospital before talking to someone (in full protective gear) and at the very least having your temperature measured. If you were allowed inside and masks were available you would be required to wear one.
Source: visited hospitals and care centres multiple times with sick family members.
In Australia, it appears some early models predicted between 50k to 150k lives lost assuming no response. A statistical life is valued at over $4m, meaning a cost of $200bn to $600bn. Also, with 60% of the population infected, that would mean over 12 million people infected - we still don't have a good idea what the long-term issues will be - but one study in Australia found ~5% of people experiencing "long covid" symptoms, which would mean at least 600,000 people with long-term complications - which in our hypothetical Harkonnen society we'd likely just shove them into a hole somewhere and forget about them, otherwise we'd have to deal with their social welfare (yuck!) and strain on the health system.
No doubt the cost, responses, short and long term impacts, etc, will be something economists and sociologists will debate for decades to come.
https://www.smh.com.au/politics/federal/thousands-of-predict...
https://en.wikipedia.org/wiki/Value_of_life#Australia
https://www.abc.net.au/news/2021-06-24/long-covid-nsw-resear...
Edit: On thinking about it, I think the value of life is based on insurance / compensation purposes, perhaps the value of a life in terms of total GDP contribution would be different? Anyway, a subject more for the actuaries and economists I think. Interesting to consider nonetheless, which I think may be the overall point of this game.
That is the value of an "average" life. But the average age of death from covid is over 75, so the actual economic cost would be much less (which is accounted for when using https://en.wikipedia.org/wiki/Quality-adjusted_life_year, the standard way of measuring these things).
https://astralcodexten.substack.com/p/lockdown-effectiveness...
I take issue with this.
The average age in the UK of death was 83 I think, compared to an average life expectancy of 82. Most had more than one comorbidity. Do we really expected these people to live until 90?
In addition to this a lot of the early deaths were in care homes were the residents aren't expected to live 8 years (less than 3 years from a very quick search). That would mean that non care home residents would need to average an ever higher amount of life for that to be true.
Sorry, that seems kind of ridiculous.
Throw in the youngers and it is clear enough the math should work out fine.
The expected life expectancy you give isn't for people with an average of two comorbidities.
And it’s not just COVID… if the hospitals are overrun many other things will have much higher mortality, like trauma cases.
https://www.thelancet.com/journals/lanpub/article/PIIS2468-2...
Anyway, the effect of failing to "fallten the curve" in Lombardy are well documented. And this happened in December 2019 before we had a global pandemic.
https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/burd...
Even if we go with your numbers, we get an average of 4-5% and since we know there was a huge spike in the middle of the outbreak it is not unrealistic to assume they were above 10% at some point.
This happened for a short time in tiny part of Italy and the death rate skyrocketed.
Note that only 1/4 of the infections get detected in the game the game so the ratio deaths/detected infections will be 4% (the deaths/actual infections is 1%) - likely too optimistic in the scenario of overwhelmed testing capacity.
If you do nothing in the game, you kill 1% of the population during the first wave and you kill another ~0.5% in winter after the natural immunity of some people expires. Again, the real country was simply not willing to go that far.
A funny fellow with a knack for understanding society at large.
Why is there no option to have Contact Tracing & QR Codes? Even initially in the pandemic that's how Taiwan got on top of it. Why can't we do mass testing & localised lockdowns?
I know it's a game, but I feel like the USA/Europe don't even really consider the measures in place that have had the most impact on curbing the spread in places that went for elimination.
For one thing, it is a small and remote island.
For another thing, it supplies most of the world's sterile bovine serums because the country has never had a case of mad cow disease. Laugh all you want, but that's a lucrative market and they are very good at border controls.
But yes, being remote, and being islands surrounded by lots of ocean definitely helps.
Also, both of our largest islands are far larger than Czechia. The South Island/Te Waipounamu is over twice the size of Czechia.
Unless you're suggesting the US station ten million soldiers on the border and shoot anyone who tries to enter (hint: this is not politically feasible) closing the US is hopeless.
...so how much Covid was brought to Czechia by illegal entry?
in response to what you are saying, we can't exclude the Commonwealth from "the West", but maybe it's about time to make a term that does essentially do that. The complement to the union in graph theory. The West except the Commonwealth.
Well, we haven't eradicated it have we. Keeps popping up.
We'll only know if the lockdowns are worthwhile after few years of accounting.
The game could have multiple levels of 'border closure'; Australia has relaxed border restrictions over the course of the pandemic.
That's not to say the same equation holds true from here on in. Constant revaluation is required.
We need to rapidly expand vaccination instead along with increasing equity with regards to other countries, especially poorer ones.
Improved contact tracing and testing is something we and the experts we worked with strongly supported. And we did consider adding them to the game. At the end, these features ended on the "cutting floor". We felt these features would a) be complicating the game too much b) they would lead to an optimal strategy too far away from what the the real country was doing. Unfortunately, real Czechia didn't use summer and fall 2020 to implement these "smart measures". In winter 2020/2021 only crude restrictive measures were available to manage the incoming virus surge.
I think you’re right that the ability to pull off zero (as opposed to 10-20/day) rests squarely on the availability of extremely competent and fast testing and tracing. It’s either that or unacceptably draconian measures. Scaling up contact tracing capability To that level in Victoria took months because it’s really hard, so if you don’t see the slow movement on that front, it’s easy to see zero cases as a political impossibility. Maybe that’s what’s going on in NSW right now, alongside people getting used to the strictness necessary to make it work.
You obviously get how these things interact since you built the game mechanics simulating public trust in government in response to measures. It’s no different from the rest of them, it just only works at the small end of the log scale. And to get to the small end and make zero cases an option you have to play the rest of the game like a champ.
Endgame for Victoria is that our leader, who according to large swathes of Australian media is basically a dictator, is probably getting re-elected by a significant margin. There should be a button for answering 90 minutes of press questions live on TV every day for 4 months straight.
I'd vote for Dan if I could.
This seems like an obvious expedient during a pandemic? I guess, if you can set up facilities (crucially staffing) to allow repatriation with full quarantining that may be preferable.
How would you rather they behaved? Allowing non-essential international travel is idiotic in such circumstances.
Edit: It would be interesting that the site remember all the previous tries. I finally was able to avoid saturating the hospitals, but I don't remember how the other metrics compare with my previous tries.
Edit: Removed the link to the "version in English" because my link does not change the language.
It's surprising accurate with its headlines — and was quite unnerving to live it irl.
And it's educational in the sense that the player must get just the right balance of transmission and symptoms before mutating ever-increasing lethality before becoming detected to 'win' the game (ie kill all humans).
Now I have no remorse on playing on easy mode :)
I tried to do nothing and refuse all vaccinations etc... But it only killed 1/10 of the population. At least with Plague I could aim for total annihilation :)
In the beginning everyone was searching for information, reading articles, and sharing experiences and listening to stories. It was the main topic of conversation for months. In places where the first wave hit hard, personal experiences were a much more credible source of information, and motivator of behaviour, than random edicts from officials.
And the reason "hard" government policies are so problematic is that they shift responsibility for both actions and consequences from individuals to some faceless authority. What does a restaurant owner think after six months of lost livelihood, when they finally catch it and it feels like a cold? That's more responsibility than any random government official can bear, and why voluntary measures first is so important.
A real government has waaay more ways to fight the pandemic. For example tracing of cases can be done, if there are few enough cases. Strict controls on quaranteen for returners from other countries.
However, the game sends the message: "Could you have done better?" Perhaps not too wrong.
EDIT: Just tried the game: The more you do to help people, and the more lives you save, the angrier they get. The people are the happiest if you let 10% of them die. It doesn't make any sense, but then again, the last 18 months have not made a lot of sense either.
To some degree killing 10% is the optimal strategy but only for emotionless androids.
Are people getting unhappy because their relatives died though?
Reading the discussions on various Czech news sites, it actually makes perfect sense: "we have to learn to live with it", "only the weak will not survive", "let's ditch the face masks already!", "just look at Sweden" and more. People hate the restrictions way more than they hate the virus. People want things to be like before and if they aren't, they're angry at the most visible threat to their wellbeing.
https://i.imgur.com/AAj8Hm6.png
I then ran a case with no restrictions or spending, got 140k deaths and very high approval (80ish?). Implemented only masks and border closures got a very similar result, about 140k deaths but much lower approval (around 45).
Next time, I did nothing. Didn't invest in any vaccination campaigns or anything. Over 145k dead (yay, Army called in to dig mass graves!) And still 439B in debt.
https://koronahra.cz/results/60e67dfdfecc84001a33a410
Government survived in both cases (it's fair to point out that a sufficiently violent overthrowing of the government will end up killing people, so you should avoid it). So the first situation seemed like a better option. Each Czech life saved cost $440k (US). Worth every penny.
The mink are the only ones we _know_ transmitted it. But I don't think we've looked much.
Dogs, for one, do _not_ do social distancing.
Plus, since we learned it aerosolizes more than was initially thought, the animal that walked through your airspace 15 minutes before can share lungspace with you. They don't have to get that close to you, especially at night when the windspeed is low.
such an infection would require the virus to hit a number of very low probability events in a row, like simply surviving outside the body for 15 minutes and a coordinated beelining of millions of particles into your lungs rather than dispersing out to the many orders of magnitude of space everywhere else around it. needless to say, it's quite unlikely, like less than lightning strike unlikely. as a society, we badly need to improve our ability to comparatively assess (and respond to) risk.
Approx 1% deaths. Which I think is acceptable, to allow 99% of the population to be able to return to a normal life so quickly.
However, I'm not sure I understand the impact of the hospitals being over capacity? Does the model factor in extra deaths of people who can't get treated for non-Covid problems?
That's 100 million people dead, globally? And higher than UK deaths during WW2?
https://topforeignstocks.com/2016/04/19/chart-world-war-ii-c...
Or is "population" a proxy for "me"?
So from that I can extrapolate that people want a 'return to a normal life quickly', as opposed to living with Covid over an extended time period.
> Or is "population" à proxy for "me"?
Absolutely not. I am totally fine with my splendid isolation. Most of the world could burn for all I care. The human race hasn't done me much favours in my life, so why should I care about people I don't even know?
I also upvoted you, not because I like you, but because you took the time to engage in dialogue.
I've always suspected claims that overcapacity hospitals drastically increasing the mortality rate are not supported by data. Obviously if more people have covid, more people will die from covid, but normalized to the number of people that had the disease.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7685049/
There was a lot of misinformation and confusing data at the start of the pandemic regarding hospital beds. Here in the US, hospitals tend to operate near capacity as SOP - a result of for profit healthcare seeking max profitability. Most hospitals here also started reserving a percentage of their beds, both ICU and general care, for covid patients. These reserved but sometimes unoccupied beds were not factored in when local hospitals reported being at capacity - so a local radio station might say "these local hospitals are at max capacity" without reporting that they still have 5% beds free specifically for covid patients. I suspect this may have caused some deaths by people not seeking care because they thought it wasn't available when it was, however I haven't seen anything to validate that hypothesis (and I doubt there will ever be any data).
One interesting sidenote is that the military hospitals that President Trump rolled out while he was still in charge had very little effect:
https://www.npr.org/2020/05/07/851712311/u-s-field-hospitals...
Out of curiosity, which mechanism are you thinking about that would lead you to the conclusion that hospital capacity doesn't impact mortality? The story that I have heard the most is that hospitals start to turn away people if they don't have beds from them, leading to either delay in care or no care at all. Both delay or no care lead to higher mortality. I cannot really think of a story where an over-capacity hospital leads to the same or reduced mortality.
If you believe that hospital closures lead to hospital overcapacity or delays in care, you can find some literature that shows that closing hospitals leads to an increase in mortality in the community [1].
I think the emphasis on ventilators at the beginning of the pandemic likely caused an increase in mortality in hospitalized patients. At peak panic, there was a big push to create and distribute ventilators, including open source projects, big name tech billionaires dedicating resources, etc. Then we realized these were actually damaging lungs further, and nixed that treatment, switching to oxygen supplementation only.
First, it's that hospitals effect on covid mortality is lower than believed. Second, while morbid, I assume mortality risk can be assessed pretty accurately by hospital staff. If you must triage, triaging someone who has a 99% chance of dying in the hospital and a 100% chance of dying outside the hospital raises the expected deaths by 0.01. Hospitals tend to serve everyone they can (for good reason) but the value add part comes from serving people who have a high chance of dying out of the hospital AND a relatively low chance of dying in the hospital.
These could be wildly wrong assumptions.
I would think hospital closures would cause a large increase in mortality rates as you don't get to triage effectively at that point.
One of the regions got an alpha variant wave sooner and the local hospitals actually went over capacity, with triage going on. You can see it in the time-variable CFR plots.
https://www.linkedin.com/pulse/what-cfr-data-can-tell-us-pan...
Roughly it seems case fatality rate increased almost 2-fold, despite hundreds of patients being transported out of the region by ambulances.
( https://translate.google.com/translate?sl=auto&tl=en&u=https...)
In the US, there is now evidence that community spread was occuring much earlier than initially thought - we didn't know about infections because test were unavailable. Also, you will only ever learn about infections after people get tested.
Hospitalizations trail infection by 1-3 weeks, and death is 1-3 weeks after that.
The decisions you made 2 months ago show up in mortality 'now'
Add to that, the number of times where authorities went back and fixed the numbers. For a long time, there were not concrete numbers; in many cases the number of fatalities may never be known or agreed upon.
There are, however, countries that have achieved zero CoVID and then reopened and sustained zero CoVID. But this is only possible with strict border quarantine rules, extensive contact tracing and immediate mass testing whenever a new case shows up.
Is that actually true? The big success stories like Taiwan and Australia seem to keep getting imported cases and needing to lock down again.
With mask/max10/closeHR/CloseUni you can get a good enough result for the first wave until the summer holidays. Perhaps you can reopen a little more.
(Max100 also work, but the hospitals are too saturated and I get too worried.)
The problem is the second wave after the "cold weather" arrives. Be prepare to hit "full lockdown" as soon as it start increasing. Open when a little when he wave disappears, but you may need to close again.
Continue with that until the vaccines arrive. With this simple strategy I got 32.3K deaths and a cost of 441B https://koronahra.cz/results/60e63272fecc84001a33a31a (Not in my first try.)
Someone got 6.4K death and a cost of 268B, that is much better.
Someone got 2.3K death and a cost of 342B, that looks like a good tradeoff.
Someone got 40.1K death and a cost of 141B, that is very cheap if you don't care abut people.
The graph in the finish scree has the result of other players. It's interesting to see that there is a lot possible improvement. (Perhaps also luck, some events are randomized.)
I find it hard to impose a lot of restrictions when there’s basically 10 people per day infected, but suddenly it’s 500+/day.
I found that fully closing schools works better than closing high-risk, and you can leave business fully open for significant periods. My best is 2,582 deaths at a cost of 385B. https://koronahra.cz/results/60e6550661cdc10019e509ce
Masks and max 10 stay on the whole time. I close unis at +100 infections, close all schools at +200, close high-risk at +400, and essentials only at +800. Ease up on the restrictions when infections go down. I ignored those breakpoints and left things as open as possible during the warm weather period, since you can safely do that as long as you kept the initial outbreak under control.
Edit: 2,112 deaths at 380B, just targeting +75/+150/+300/+600: https://koronahra.cz/results/60e65b5dfecc84001a33a3a3
Edit 2: 1,691 at 405B using the 2112 strat with slight adjustments based on intuition: https://koronahra.cz/results/60e65cc061cdc10019e509e6
It's well known schools are a major contributor to spread of diseases (and I did read some papers on flu spread in schools prior to making my decision to check the verity of the common wisdom on schools being Petri dishes of disease!).
The National government and the government of the Province of Buenos Aires that control the ¿20? satellite cities [1] (with a total of x3 more population than the city) disagree, so they closed the schools.
After some time, the city closed some the classes of the oldest kids, and the province opened the classes of the smallest kids. And perhaps both made additional opening and closing, I lost track now. (If you have some spare popcorn and can read Spanish or are fine with an autotranslation, you can use Google to get more info. It's heavily politicized, so take each news source with a grain of salt.)
Anyway, ... it's not so clear how much is the spread rate in schools, and it's also not clear that they are using the correct coefficient in the model in this game. My guess is that we will need like 10-20 years to get an accurate model, and meanwhile we should try to make some educated guest.
I think the model in this game is accurate enough to decide between schools and business in real life, but it's useful to get an intuitive feeling of other stuff, like that you should not wait until the hospitals are at 100% of capacity to start a lockdown.
1) no warm weather bonus in the second year?
2) maybe it would be fun to play with a fixed budget. As things stand it’s a little hard to make the trade off between money and lives
I understand that games like this one have to be based on actually available data and models. Still, testing and efficient track & trace schemes could be (have been) a huge factor in preventing COVID-19 spread.
For example, if everyone took a rapid antigene test twice a day, we'd be able to track new infections very quickly and before those can spread any further.
If implemented properly, with such a scheme we perhaps could even do without any additional measures (other than vaccination, that is), incur merely a fraction of the current costs, and still keep the numbers of deaths and severe cases much lower than they are with the blunt instrument that is blanket lockdowns.
It's a matter of how such a scheme would be implemented. One could imagine working with incentives, for example.
Alternatively, being able to produce a valid, up-to-date test result at any time could be made mandatory. This might seem draconian but it's a lot less so than unending lockdowns and the perspective of continued social distancing.
Those procedures (tests, vaccinations) can be entirely voluntary (as they are right now).
However, then you could be facing a situation where not enough people get vaccinated or tested for curbing the spread of the virus.
Societies will have to decide if they’re fine with the consequences that entails.
Personally, I think that lockdowns and any other mandatory measures should be lifted once everyone’s vaccinated who wants to be vaccinated.
Others - and societies as a whole - might disagree, though, which from my point of view would be a major problem, especially if continued lockdowns then are still considered the only viable alternative.
Track and trace was introduced and failed in most countries.
It's true that getting tested frequently is invasive, quite literally so.
We seem to forget too easily, though, that lockdowns and the civil rights restrictions that come with them are much more invasive (albeit perhaps not that literally in most cases). Yet, we still put up with those.
> Track and trace was introduced and failed in most countries.
That's because most countries made a half-arsed attempt at best, sometimes hampered by largely imaginary privacy requirements.
The main concern with the track & trace apps available in the EU, for example, was to supposedly comply with GDPR and local privacy laws, rather than protecting people from contracting and spreading a disease.
This is why these apps were expressly designed to only store data in a decentralised fashion, which effectively kept local health authorities from using that data to do their job.
The funny thing is: In terms of GDPR, there of course is nothing that keeps you from storing such data on a server (much less so even, if you're a government agency) as long as you have the user's consent and explicitly state how that data will be used.
Cornell University used on-campus labs to PCR test students up to 3 times per week, and that level of surveillance testing mostly kept things under control. There's a talk on YouTube explaining how they used models to choose the necessary frequency of surveillance testing within subgroups [0]. I thought it was an encouraging example of models and data driving policy to actually solve the problem at hand. So yes, there's evidence that surveillance testing works, and it doesn't even need to be as frequent as 2x daily. Testing is also important because we won't necessarily always get a working vaccine as quickly as we did this time.
There was some country in Eastern Europe that mailed everyone a test right? I remember reading that it didn’t end up reducing cases, so maybe that soured people on the idea.
One decent strat to explore was just turning on extra comp and nothing else. Social stability tended to stay at the max. 141k people died. Knowing how strong this is, you can just buy your way out of almost any upset with other choices for a relatively marginal increase in costs.
A couple things I didn't understand:
* My immune numbers started to go down at some point. Why?
* How many people are there? The game suggests 10 million, but near the end it suggested there could have been 14 million people infected. I wonder if this game just uses an exponential model under its hood rather than something logarithmic.
* Can the vaccine pr ever work out favorably? Seems like it doesn't.
The methodology page [0] explains resistant people eventually become susceptible to infection again.
> but near the end it suggested there could have been 14 million people infected
Since the game is tracking total number of infections, rather than people infected, and since infected people can become susceptible again, that would explain the #infections > total population.
At least in the uk, there are agent-based models which have been used for policy (although it’s impossible to tell if they were effective in driving policy decisions in practice - the UK media would say no, although it’s a little bit more nuanced in reality).
I'd play it again in Tropico.
This game has an unrealistic rate of decay when measures are taken. You can take every possible action (full lockdown, throw all the money at the problem) to the max from day 1, and you'll spend the whole game at 10 new cases per day, even after the vaccine rollout. That's just not how things play out.
As for the political aspect of the question, ie.: "what options are available to us"...
I regret to be so blunt but in almost every case, when you hear people say that we can't afford eradication and that the best we can do is mitigate, that right there is what I would call serious political bullshit. It's what politicians say when they don't want to make difficult unpopular decisions. Eradication is almost always* the cheaper option.
* (exceptions may apply)
On the contrary, the game is realistic in this aspect. Czechia was basically never able to close the borders so tightly you would prevent "all imports". What "closed borders" meant in practice were tens of thousands people crossing the border every day. With prevalence in the rest of the Europe often much higher than 1 in 10k, this means you always have a stream of imports.
Note that some of the borders look like this: https://polar.cz/data/gallery/modules/polar/news/articles/vi... you have a town on both sides, and in normal times, due to Schengen, people are used to work and shop cross-border. ?In such contexts you can prevent most of cross-border travel, but not all of it.
b) getting back to zero does not mean staying at zero. China has had long stretches of time with zero reported cases of local transmission, punctuated by brief outbreaks like the current one.
That's different from people who get infected in China. There have been long stretches of time with zero local cases in China.
Just to illustrate the difference, here's a typical daily report from China's main public health authority:[1]
> BEIJING, June 28 (Xinhua) -- The Chinese mainland on Sunday reported 21 imported COVID-19 cases but no new locally transmitted cases, the National Health Commission said in its daily report on Monday.
The "imported cases" are among travelers undergoing quarantine.
There have been a few outbreaks with local transmission, but so far, all of them have been successfully contained before they spread very far. Right now, for example, there's an outbreak in a town on the border with Myanmar. The town itself has been locked down and everyone in it (270k people) has undergone PCR testing, and will be tested a second time over the coming days. So far, about two dozen infected people have been identified. However, outside of this town, there are currently zero local cases in China.
1. http://www.xinhuanet.com/english/2021-06/28/c_1310031605.htm
This would simply be impossible if there were community spread of the virus inside China. With open restaurants, theaters, etc., the virus would spread like wildfire in China's dense cities, and everyone would know about it. The strict lockdowns in early 2020 worked to bring cases very near zero, and they were followed up with mass testing campaigns (for example, nearly all 11 million residents of Wuhan were tested in June 2020) to find the last few infections.[1,2]
The common reaction among many people, to deny that China eliminated SARS-CoV-2 within its borders, simply isn't tenable.
1. "Post-lockdown SARS-CoV-2 nucleic acid screening in nearly ten million residents of Wuhan, China": https://www.nature.com/articles/s41467-020-19802-w
2. "Comprehensive large-scale nucleic acid–testing strategies support China’s sustained containment of COVID-19": https://www.nature.com/articles/s41591-021-01308-7
Did nothing. Costs within a budget. Zero days of school lost. Only 150k dead for 15M infections (~1%).
The czech republic, in general, has below average respiratory outcomes due to higher than average levels of smoking and historically high levels of air pollution under communism (they burned brown coal), as well as an older population (1% of the population experiences acute respiratory infections each year). But all of these factors are improving, with cleaner air, declining smoking rates, etc.
Read the parent of the comment you responded to.
In the first position is Peru with ~6000 death/million. After that there are a bunch of countries with ~3000 death/million including Czechia. And then the number goes down.
Czechia has ~11000000 habitants, so 150K/11M is like ~13000 death/million that is the double of the current country with more death/million and like four time bigger than the other countries.
Apart from the fact that I can't fathom how you could say that 1% of an entire country's population is "not a lot", do you have a source for how many people died as "cost of lockdowns"? I see this being regurgitated a lot but I doubt that more people died due to lockdowns/restrictions than from Covid19 itself.
Yet this doesn't apply to the unknown long-term effects of the mRNA vaccines?
I managed to keep costs somewhat low with a total of 2300 deaths.
If there is a settings panel that I'm missing, that would be great. Though I also noticed it's a lot better at lower speeds (since the actions are visible with 2 weeks delay I had it on fast-forward at first, more arcade style for a first run than weigh-and-deliberate style)