It will be interesting to see how elastic the supply of healthcare services is in the US versus the social systems if a pandemic does break out. History has shown that when mobilized for a common cause, the US is a force even when compared to socialist and authoritarian states. Thunder God Mountain may not have been possible in the US, but in the worst case scenario, it will interesting to see what is possible in the US.
> Thunder God Mountain may not have been possible in the US
What would you say would be the biggest impediment here? I would think actually that just government regulation in and of itself would prevent any private company from achieving this feat. And even Federal and State governments are similarly encumbered by regulation.
It seems like the US government isn't structured to deploy such resources so quickly (e.g., FEMA's responses to Katrina, Sandy, etc.) and regulation would seem to kill private efforts. Maybe a state or local government could pull it off with accommodation from federal regulators.
In the US, private industry is broadly empowered to say "No" or "I'll see you in court" to government demands, to a larger degree than many other countries.
The side effect of empowering private industry is that organizations like FEMA and the CDC can't force much, and typically advise or request.
Which doesn't get things done nearly as efficiently when it's a situation where proposed actions are detrimental to one corporation, even if good for the nation.
I sent this email to my team last night. Feel free to steal it for your own workplaces.
We should consider working from home.
You may all have seen the news by now. A patient was just diagnosed with COVID-19 at UC Davis after having no known contact with anyone travelling. Importantly, they were diagnosed after being intubated already for 7 days. It is suspected that this is the first known case of public transmission of the virus in the US. From what we know about the incubation times and progression of the illness, that means they contracted it sometime between 14-21 days ago. This is the letter UC Davis sent to their staff.
If the virus has already been in the wild in California for 3 weeks, it seems likely to me that it has or will reach the bay area, and given the limited testing capability that has been reported, we may not know until the first cases end up in the ICU, weeks after exposure.
The death rate for young healthy people is relatively low, around 0.2%. It is much higher for older people, who it kills in double digit percentages. Still, 20% of the people it infects need intensive hospital care. Many epidemiologists now suspect that it is likely to become endemic, and that 40-70% of the world's population will contract it. https://www.theatlantic.com/health/archive/2020/02/covid-vac...
So what can we do?
The most important thing to keep the death rate low is to reduce the burden on the hospital system so that they don't end up with more cases needing critical care than they can handle. And the most important thing for reducing the burden on hospitals is to slow the spread of the virus, so that even if it ends up infecting all of us, it doesn't infect all of us at once.
We're fortunate enough that aside from impromptu collaboration and whiteboarding, all of our concrete tasks can be done at home. Most workers will not be in this situation, and will have to come to work to keep the economy running. For those of you familiar with random graph theory, the average number of edges in a graph has an exponential effect on its diameter, and so the best thing we can do is to avoid as much contact as we can. https://www.ndsu.edu/pubweb/~novozhil/Teaching/767%20Data/ch...
I'm already conveniently WFH with a cold, which I hope is just a cold, but I think we should consider making this the norm, at least until we have more clarity on what the situation is.
I wonder why people/news seem so obsessed about the death rate itself, while ignoring the incidence of permanent organ tissue damage caused in survivors, as some papers already indicate. I'm assuming this has to be studied further.
As far as I’ve seen, the only papers have been on permanent organ damage in SARS and MERS. I don’t know how there would be a paper out on COVID19 given that it’s barely been a month since it started infecting a large number of patients.
I would keep your expectations low. I’m in NYC working at a public tech company that is explicitly making a big push to become more distributed and remote-friendly and there’s been not a whisper about people switching to work from home. Everyone seems desperate to totally ignore this crisis until it’s on their doorstep. Which will probably be in the next few weeks when we actually start testing and cases explode.
Horrible thought - given the nature of this disease (kills aged 50+, very infectious) and the demographic of US leadership on all sides... what impact might this have on the dynamics of US politics?
It kills about 2% of those infected, and about 30% of the population are over 50 so it might kill very roughly 6% of those over 50. Most of those will be the quite elderly and infirm though, most people active in their 50s and 60s should be ok although of course lightning can strike where it will. I'm in the UK but the demographics are pretty similar.
I'm not too worried for myself in my mid 50s, but have real concerns for my wife's parents and my mother.
Who is this person? As far as I can tell it’s just some random person speculating. Is there a reason we should be taking them seriously? Because a lot of this seems like fear mongering.
By their own admission, they fail to quantify their findings. So, my issue is that they’re sound bites that a lot of people were predisposed to agree with (eg “American healthcare is bad and expensive”) and therefore unlikely to evaluate critically.
People have also argued the opposite: the US is special because we have large natural borders (mostly). Or maybe the US is special because the US has a large Chinese-American population, many of whom travel regularly.
Epidemiology is a science. Why listen to Twitter randos when you have specialists?
(Counterpoint: HN has a huge selection bias for educated, technical types and a higher overall pool of talent. Doesn't mean disinformation campaigns and marketing won't work on this crowd, though)
Public Health is an actual line of business based on science.
Access to health care is a factor in that unhealthy populations are more at risk of complications. The thing that makes covid scary is how it spreads, and the focus of the health authorities is intervening to slow that down.
I am not an expert in the field, but I consulted for a few of them in the past. Ignore twitter bullshit with political overtones and seek out what is being said by CDC, state health departments and related researchers.
Well just about none of them are substantiated with any data. You can say things like “people in the US will avoid going to the hospital because of the bill” and it sounds right because of our perception of the US health system, but is it really? Do we have actual numbers showing this is actually the case, and if so, how extensive it will be? And do we have reason to believe those numbers will hold in this exceptional circumstance? Yes, when people believe they might have the flu, they could potentially try and wait out going to the doctor. But do we believe that in an environment where we have people so acutely aware of the coronavirus outbreak that they are buying out supplies of masks, posting long twitter screeds on potential doomsday scenarios, and side-eyeing every Asian-American with a cough, that when they start to show symptoms they still are going to get hung up on the cost of a clinic visit?
The same goes for many of the other assertions, such as parents forcing their children to go school sick. Or the extremely thin premise of elderly people dying because of a huge number of parents sticking them with their sick children while they work. In fact, what data we do have seems to suggest that children barely get sick from this thing at all, or their sickness is so mild it doesn’t get diagnosed. A recent paper in JAMA found that of the first 44,672 cases confirmed in China, only 416 were in children younger than 10. In fact, only 10% were in people younger than 30.[0] It seems ridiculous to entertain scenarios where elderly people all die off because overworked parents foist their parental duties onto them.
It’s also worth stating that a lot of these concerns are not unique to the US. Many of them also apply to other countries like China and Japan, which are already in the midst of their outbreak. Yes, author is only comparing the US and Europe, but that seems like a useless comparison given that the number of infections in both regions is so small and contained right now.
And finally, the author fails to account for reasons why the US might be better off than Europe. As is often pointed out on this site, usually in a negative context, the US is far less dense than Europe. Fewer people are living in tightly packed urban communities, and more live in suburban and rural areas. Far fewer rely on public transportation. That means far fewer opportunities to come across someone contagious. And the US has some measure of protection in its borders. Except for Canada and Mexico, we can only be accessed via plane or boat. Most of the EU has open borders, meaning that it will only be that much more difficult to coordinate quarantines and control measures.
> Well just about none of them are substantiated with any data. You can say things like “people in the US will avoid going to the hospital because of the bill” and it sounds right because of our perception of the US health system, but is it really? Do we have actual numbers showing this is actually the case, and if so, how extensive it will be? And do we have reason to believe those numbers will hold in this exceptional circumstance? Yes, when people believe they might have the flu, they could potentially try and wait out going to the doctor. But do we believe that in an environment where we have people so acutely aware of the coronavirus outbreak that they are buying out supplies of masks, posting long twitter screeds on potential doomsday scenarios, and side-eyeing every Asian-American with a cough, that when they start to show symptoms they still are going to get hung up on the cost of a clinic visit?
How dense do you have to be to assume that the default answer to pretty much all these questions is "no" or [citation needed]?
It's like asking for data to prove the world is round. Sure, in isolation that's a fair enough question, but practically speaking it's idiotic.
Lots of people over here would not go to a doctor when they have flu symptoms, even if it's free to do so because we're not retarded, collectively. But if it can cost money it's obvious we'd be even less likely to do so, society and 'Asians' and spread of corona-virus be damned.
The common reaction to something uncommon is, well, common. I'd say it's upon the 'commoners' to provide data that this thing that experts say is worrisome is, in fact, not.
Yeah, but she does have operations research experience with the air force and campaign analysis experience with the navy, and she's not making any biology claims that aren't reasonably supported by the literature, she's drawing conclusions about secondary effects which seems more in her wheel house.
Also, she has a BS in computer science, which often seems to qualify anybody in the HN comment sections to be an authority on anything.</sarcasm>
I’m apparently not saying she’s not entitled to have an opinion and voice it. However, whether she should be taken seriously is a different matter. I certainly don’t take most HN comments on health (or anything) seriously.
It sounds more like someone took the typical America sucks topics from a weeks worth of front page submissions from Reddit. Complete with a jab at the current administration.
They could’ve added some stats at the end to convince people to go to the doc but instead it just ends.
Literally no part seems like fear mongering. It even goes out of its way to say this is a risk assessment and the author is not asserting these things _will_ happen.
Seems like perfectly fair lay person analysis to me. It would be somewhat of an argument from authority fallacy to dismiss based only on no health background.
“I’m not saying this will happen but it could” is a pretty standard fear-mongering hedge.
(I don’t want to call what they’re doing fear mongering either because that suggests bad intent. I don’t think their intentions are bad. I just think we’re paying a lot of attention to a Twitter thread because it’s on top of Hacker News, not because of its own merits as a well-reasoned argument.)
Twitter is basically like a digital swewer outlet right into your computer and phone, getting that raw digital sewage from the source. Brilliant invention.
Maybe it is fear mongering, but the points raised are valid issues mainly caused by the American health care system. In Japan where I live, drugs that Americans are used to getting over the counter like Tylenol are prescription and no one thinks twice about going to the doctor for the most minor ailment. Obviously the US is the complete opposite of this. The American health care system does have systemic issues that MAY make the coronovirus worse there. I don't think the author is doing anyone a disservice by pointing that out.
Feigl-Ding has been fearmongering since the virus hit the mainstream, including tweeting out non peer reviewed preprinted papers claiming the R0 of the disease was far higher than it is, with commentary that was sensational (“HOLY MOTHER OF GOD”) and simply wrong (claiming the R0 was 8x higher than SARS, when current estimates are that it’s similar). He’s had to walk back lots of claims and has been so irresponsible that he has been called out by fellow epidemiologists and has had an entire article written about him as an example of how misinformation spreads[0]. Take anything coming from his mouth with a huge grain of salt, even with the “Harvard” label trailing his name.
ok, but considering how many fewer people take public transportation in the US, and on average how less dense living conditions are it may be that the risks balance out.
Edit: I will also say that health care in the US is excellent for many people. I know it is an unpopular opinion but all I can say that most people I know (myself included) have access to excellent health care, included with the employer-sponsored plan, with all costs covered (I pay directly into a tax-free health saving plan and use that, for the first $5K costs, after which additional costs are covered).
I did not know about the screening for coronavirus being ineffective. A 35 y/o guy at work died from the flu a little over a week ago (Denver). If it was coronavirus, they'd know, wouldn't they?
It’s not that screening is ineffective, it’s that the initial kits sent out by the CDC were defective. That isn’t true everywhere (places where patients have been evacuated to have testing capabilities, like California, Chicago, and Omaha), and samples can still be tested at the CDC, it just leads to a delay. It’s not ideal but it isn’t like testing simply isn’t working.
As for the man in Denver, it would be very unlikely to be COVID. There is some evidence starting to emerge currently of transmission now occurring in the US, but it’s still very early and concentrated to where you might expect. It takes a while for coronavirus to kill (about 7-14 days after symptoms appear), and so if this dude was sick with it, he would almost certainly have to have had either traveled out of the country (to China), or been close with someone who had. That is something any competent medical staff will ask, and if it were the case, they could send samples to be tested to the CDC.
It may be possible moving forward that if community transmission starts spreading here in the US, things could start slipping through the cracks, but at this point it’s highly unlikely that anyone in Colorado who died a week ago was sick with COVID
This seems like it's missing the forrest for the trees. COVID19 is a strain of flu and like all flus, it affects the respiratory system. For this reason, COVID19's mortality rate is 2.8% among men in China, compared to 1.9% among women, which can at least partially be attributed to men smoking at a rate of >50% whereas women smoke at a rate of 2% in China. [1] I think that the thread's focus on the interplay between the healthcare system and the spread of COVID19, which imho is going to be lessened because of fears of the virus making people more likely to go to the hospital. On the other hand, The US overall has fewer smokers[2], which makes the effects of COVID19 less likely to be severe on those who do get it. Most cases are mild[3], so its more important to see where the severe cases will be, rather than cases overall
Considering most of this is common knowledge and was largely discussed elsewhere recently, it’s still shocking to see how normalized is USA’s dystopian existence. It’s like COVID19 is the least of their problems considering what‘s considered “normal”.
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60 comments
[ 2.8 ms ] story [ 108 ms ] threadtrue...and then you get the $752,245.88 bill total from 36 different doctors and hospitals for a 7 day hospital stay.
What would you say would be the biggest impediment here? I would think actually that just government regulation in and of itself would prevent any private company from achieving this feat. And even Federal and State governments are similarly encumbered by regulation.
The side effect of empowering private industry is that organizations like FEMA and the CDC can't force much, and typically advise or request.
Which doesn't get things done nearly as efficiently when it's a situation where proposed actions are detrimental to one corporation, even if good for the nation.
We should consider working from home.
You may all have seen the news by now. A patient was just diagnosed with COVID-19 at UC Davis after having no known contact with anyone travelling. Importantly, they were diagnosed after being intubated already for 7 days. It is suspected that this is the first known case of public transmission of the virus in the US. From what we know about the incubation times and progression of the illness, that means they contracted it sometime between 14-21 days ago. This is the letter UC Davis sent to their staff.
If the virus has already been in the wild in California for 3 weeks, it seems likely to me that it has or will reach the bay area, and given the limited testing capability that has been reported, we may not know until the first cases end up in the ICU, weeks after exposure.
The death rate for young healthy people is relatively low, around 0.2%. It is much higher for older people, who it kills in double digit percentages. Still, 20% of the people it infects need intensive hospital care. Many epidemiologists now suspect that it is likely to become endemic, and that 40-70% of the world's population will contract it. https://www.theatlantic.com/health/archive/2020/02/covid-vac...
So what can we do?
The most important thing to keep the death rate low is to reduce the burden on the hospital system so that they don't end up with more cases needing critical care than they can handle. And the most important thing for reducing the burden on hospitals is to slow the spread of the virus, so that even if it ends up infecting all of us, it doesn't infect all of us at once.
We're fortunate enough that aside from impromptu collaboration and whiteboarding, all of our concrete tasks can be done at home. Most workers will not be in this situation, and will have to come to work to keep the economy running. For those of you familiar with random graph theory, the average number of edges in a graph has an exponential effect on its diameter, and so the best thing we can do is to avoid as much contact as we can. https://www.ndsu.edu/pubweb/~novozhil/Teaching/767%20Data/ch...
For people coming to the office, the WHO has a document on getting your workplace ready for COVID-19 that I'd encourage you to read and internalize. https://www.who.int/docs/default-source/coronaviruse/getting...
I'm already conveniently WFH with a cold, which I hope is just a cold, but I think we should consider making this the norm, at least until we have more clarity on what the situation is.
(edited to clarify)
I'm not too worried for myself in my mid 50s, but have real concerns for my wife's parents and my mother.
One cannot be pro-vaccination and anti-public-healthcare, for example, for reasons extremely analogous to the argument made in the twitter thread.
People have also argued the opposite: the US is special because we have large natural borders (mostly). Or maybe the US is special because the US has a large Chinese-American population, many of whom travel regularly.
Epidemiology is a science. Why listen to Twitter randos when you have specialists?
(Counterpoint: HN has a huge selection bias for educated, technical types and a higher overall pool of talent. Doesn't mean disinformation campaigns and marketing won't work on this crowd, though)
Access to health care is a factor in that unhealthy populations are more at risk of complications. The thing that makes covid scary is how it spreads, and the focus of the health authorities is intervening to slow that down.
I am not an expert in the field, but I consulted for a few of them in the past. Ignore twitter bullshit with political overtones and seek out what is being said by CDC, state health departments and related researchers.
The same goes for many of the other assertions, such as parents forcing their children to go school sick. Or the extremely thin premise of elderly people dying because of a huge number of parents sticking them with their sick children while they work. In fact, what data we do have seems to suggest that children barely get sick from this thing at all, or their sickness is so mild it doesn’t get diagnosed. A recent paper in JAMA found that of the first 44,672 cases confirmed in China, only 416 were in children younger than 10. In fact, only 10% were in people younger than 30.[0] It seems ridiculous to entertain scenarios where elderly people all die off because overworked parents foist their parental duties onto them.
It’s also worth stating that a lot of these concerns are not unique to the US. Many of them also apply to other countries like China and Japan, which are already in the midst of their outbreak. Yes, author is only comparing the US and Europe, but that seems like a useless comparison given that the number of infections in both regions is so small and contained right now.
And finally, the author fails to account for reasons why the US might be better off than Europe. As is often pointed out on this site, usually in a negative context, the US is far less dense than Europe. Fewer people are living in tightly packed urban communities, and more live in suburban and rural areas. Far fewer rely on public transportation. That means far fewer opportunities to come across someone contagious. And the US has some measure of protection in its borders. Except for Canada and Mexico, we can only be accessed via plane or boat. Most of the EU has open borders, meaning that it will only be that much more difficult to coordinate quarantines and control measures.
[0] https://jamanetwork.com/journals/jama/fullarticle/2762130?gu...
How dense do you have to be to assume that the default answer to pretty much all these questions is "no" or [citation needed]?
It's like asking for data to prove the world is round. Sure, in isolation that's a fair enough question, but practically speaking it's idiotic.
Lots of people over here would not go to a doctor when they have flu symptoms, even if it's free to do so because we're not retarded, collectively. But if it can cost money it's obvious we'd be even less likely to do so, society and 'Asians' and spread of corona-virus be damned.
The common reaction to something uncommon is, well, common. I'd say it's upon the 'commoners' to provide data that this thing that experts say is worrisome is, in fact, not.
I fail to see any health background.
Also, she has a BS in computer science, which often seems to qualify anybody in the HN comment sections to be an authority on anything.</sarcasm>
They could’ve added some stats at the end to convince people to go to the doc but instead it just ends.
Seems like perfectly fair lay person analysis to me. It would be somewhat of an argument from authority fallacy to dismiss based only on no health background.
(I don’t want to call what they’re doing fear mongering either because that suggests bad intent. I don’t think their intentions are bad. I just think we’re paying a lot of attention to a Twitter thread because it’s on top of Hacker News, not because of its own merits as a well-reasoned argument.)
The flu infects 50 million people in the US every year and kills 0.1% of them.
COVID-19 appears to have higher mortality by at least 20x.
It also appears to be more contagious.
But if it can't be contained before a vaccine is ready, and assuming it only infects the same number of people as the flu, a million could die.
Eric Feigl-Ding, Epidemiologist at Harvard pointed out:
- US has no free testing or treatment for population.
- US government does not cover any preventive measures for healthcare workers like China does.
[0] https://www.theatlantic.com/technology/archive/2020/01/china...
Edit: I will also say that health care in the US is excellent for many people. I know it is an unpopular opinion but all I can say that most people I know (myself included) have access to excellent health care, included with the employer-sponsored plan, with all costs covered (I pay directly into a tax-free health saving plan and use that, for the first $5K costs, after which additional costs are covered).
https://en.wikipedia.org/wiki/List_of_OECD_countries_by_hosp...
Here are the full stats:
https://stats.oecd.org/index.aspx?queryid=30183
But also, #beds per capita isn't the same as spare capacity.
USA: 2.9
Italy: 3.18
China: 4.36
Hong Kong: 5.4
South Korea: 12.27
Japan: 13.05
Source: https://en.wikipedia.org/wiki/List_of_OECD_countries_by_hosp...
As for the man in Denver, it would be very unlikely to be COVID. There is some evidence starting to emerge currently of transmission now occurring in the US, but it’s still very early and concentrated to where you might expect. It takes a while for coronavirus to kill (about 7-14 days after symptoms appear), and so if this dude was sick with it, he would almost certainly have to have had either traveled out of the country (to China), or been close with someone who had. That is something any competent medical staff will ask, and if it were the case, they could send samples to be tested to the CDC.
It may be possible moving forward that if community transmission starts spreading here in the US, things could start slipping through the cracks, but at this point it’s highly unlikely that anyone in Colorado who died a week ago was sick with COVID
[1]https://www.nytimes.com/2020/02/20/health/coronavirus-men-wo...
[2]http://worldpopulationreview.com/countries/smoking-rates-by-...
[3]https://www.nytimes.com/2020/02/27/world/asia/coronavirus-tr...
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