I will counter: How can you not feel bit of panic when you see coronavirus cases being reported daily from all parts of the World where travel is common or where there is large population?
Then you have excellent leadership in Iran which knowingly hides their coronavirus situation and thus have exported the virus to poor and incapable places like Afghanistan, Pakistan, Iraq?
Heck, compared to Iran, even Pakistan is being much more stringent and transparent.
The outbreak in China is indeed somewhat (maybe even largely) under control. But if you look at the trend in cases outside China, the growth is still clearly exponential [0].
Newly Infected vs. Newly Recovered is the one you want.
Ps. I'm using the same site, you should check how much influence Iran has in your quick-check. Also South Korea and I wouldn't be suprised with North-Korea to popup either.
It seems to be that the WHO had the correct actions for pandemics ( I was positively suprised when looking at the actual numbers). The cases in Europe are staying pretty low.
The "Newly Infected vs. Newly Recovered" chart on the site I linked above includes cases in China. The virus does in fact look to be somewhat under control in China, but not elsewhere.
X years old and not aware of statistical probability?
Mutation can happen if there are many generations in between. My option could have 1-3 generations in between which is far more realistic in a "controlled environment" than in a uncontrolled one.
It can destroy your airway and it may even lie dormant in your brain and come back when you get another flu. Surprise! Now you're dealing with a fever and pneumonia in your 30s.
Look at the global spread map. 92,303 infected vs 48,190 recovered (and these numbers are probably WAY underreported). There are 40k people still in recovery? How many more is that going to add to the death toll? The death rate is 3.3% very much not like the flu.
And if you go get sick and need medical treatment, guess what? Hospitals are going to be backed up.
It's just an incredibly irresponsible response. But be my guest and start licking some doorknobs. I'll be quarantining myself.
They are most likely not reinfections. You can still have the virus reproducing in your body, yet have recovered and are no longer spreading it. If you’re in this post-infection period, you’ll still intermittently test positive (especially when your stool is sampled). This is similar to EBV or HIV.
These tests (RT-PCR) also aren’t sensitive enough to test whether the virus is alive or dead, they test for the presence of genetic material.
From where are you drawing that rate? I was speaking of Dr. Li Wenliang, aged 33, who was one of the initial 8 doctors to raise the alarm and try to stop this epidemic in Wuhan months ago.
From everything I've read, both in Chinese and English, considerably more than 1% of the medical personnel at the front lines have perished.
I have read that the amount of exposure can be quantified, and it is possible to have a heavy dose of the virus -- which makes no sense to me -- and that healthcare workers are likely to receive these heavy doses due to frequent exposure.
I always thought that once a virus was present in your system, it was there, like a boolean, not like a degree of infection. But apparently that is not true.
That idea is not true and in fact is extremely dangerous thinking. One example is HIV. It isn't a matter of having it or not having it, the viral load makes a big difference as to what symptoms someone may exhibit as well as how likely they are to infect someone else. If your viral load is low enough then the chances of infecting other people can get low enough to be considered non-existant. On the other hand if you expose yourself to more sources of HIV, it could increase your viral load and increase symptoms and complications associated with the virus.
From what I can tell, this is largely because the testing is not in place in most parts of the world where this virus is likely spreading. Also, we largely do not have the capacity to test people, even if we had the infrastructure in place, because most people do not present with severe symptoms.
In the US, it is increasingly obvious that there are more cases than are being tested/reported. More and more healthcare professionals are reporting individuals with severe flu symptoms either not being tested for anything, or testing negative for Influenza. Proper quarantine is not being implemented to or from the US, so the subset of people who are infected but not confirmed can still travel and spread this disease.
One step further: hospitals are not prepared - at all - for this. Healthcare workers have been exposed within the last week at Harborview in Seattle, with a patient who later tested positive. Within the last week. This has been the global healthcare story for 2 months now, and major trauma centres are not treating all incoming respiratory patients as presumptive COVID-19.
Because generally, if a disease spreads rapidly it means that the fatality rate is low. Because if it wasn't, the disease wouldn't spread rapidly. I don't think there's anything to do about it. Sooner or later the virus will spread and infect all parts of the world just like the flu.
True, but the general reaction was severe. Large events were cancelled and people quarantined.
To be honest, I am due for a skying trip in three weeks and the most fear I have is that they just shut down the location and don't let me in (bad) or don't let me out again (not that bad).
I do not think I have ever witnessed a reaction so extreme to a disease that is comparably mild (I understand that the elderly and immunocompromised are at higher risk, I am referring to young, able-bodied people). This applies to Germany as well as the US. I notice the effect it has on co-workers who tend to follow social media and are constantly panicking. Constantly discussing rumours from Twitter and even staying home because they are too afraid to leave the house. The unchecked spreading of news definitely seems to have an impact on the population's behaviour and I find it somewhat concerning to observe how easy it is to push people into a frenzy.
Maybe the perspective is also a bit skewed because people that post online often tend towards the paranoid and fearful type (somewhat of a conjecture), so there might be a self-perpetuating bias. Users that are not concerned do not bother to post so everyone just reads panicky posts.
I would consider mass hysteria to be people duct taping their windows, standing in long lines outside of stores to try to get masks / hand sanitizer each morning, most people wearing masks all the time. I barely see 1 or 2 people with masks on on the subway every morning. I agree we are not at the point of "mass hysteria" right now.
I think there a a number of cases where cities and individuals are acting irrationally.
The city of Monetary, CA, is refusing to disembark a cruise ship from San Francisco, CA, which boarded less than a day before 100 miles away. San Francisco has not had any cases of the virus and the ship screened passengers for fever.
There is also a lot of phobia and persecution of Asian Americans, despite the fact that most US cases are not Asian.
lets see major virus that affects the load of relying upon hospital services infrastructure..seems that coronavirus concerns are justified not overblown
The author is not an epidemiologist, and does not appear to have any other relevant expertise to assess the situation. The people who do have that expertise consistently say that it is very serious.
Cases have declined in China only because of the extreme measures they undertook to stop it. (In other words, "hysteria.")
There is a difference between an epidemiologist doing their job and the media over-hyping the situation to deal with a slow news week.
The medical community should absolutely be in high gear right now. That doesn't mean the rest of us need to act like its an end of the world situation.
The medical community is asking us to prepare. You should be changing your behavior to reduce contact with other people, learning the necessary sanitation techniques, and preparing to be self sufficient in your home for a few weeks.
And who are you to say if the media are "over-hyping" the situation?
The medical community can call for calm if they think that's important, but from where I sit, isolating cases is paramount to stop the spread and getting a population ready for local quarantine situations seems fairly important too. You don't get there by sticking your head in the sand.
It's not nice to hear, but perhaps we do have to hear it.
>Cases have declined in China only because of the extreme measures they undertook to stop it.
I mean, you can't really say the author can't assess the situation because of a lack of expertise, and then immediately assess the situation with a lack of expertise.
I'm assuming that the quarantine helped, but also it might not have helped. That might have just been the natural progression of this disease. We don't know, and you can't claim that as a statement of fact.
> I mean, you can't really say the author can't assess the situation because of a lack of expertise, and then immediately assess the situation with a lack of expertise.
"China’s bold approach to contain the rapid spread of this new respiratory pathogen has changed the course of a rapidly escalating and deadly epidemic."
"China’s uncompromising and rigorous use of non-pharmaceutical measures to contain transmission of the COVID-19 virus in multiple settings provides vital lessons for the global response."
I don't think they could say it much more clearly.
> The cordon sanitaire around Wuhan and neighboring municipalities imposed since 23 January 2020 has effectively prevented further exportation of infected individuals to the rest of the country.
This makes multiple observations to that end. What you consider "extreme" is a matter of how much you want to troll the topic.
Considering China has had only ~80k cases, and Wuhan alone has 11M people, it is fair to assume that the disease certainly did not run its natural course.
I flagged this article and I think others should too. Here's why: We don't HAVE enough data points yet. Can't trust anything coming out of China and the incubation time is a couple weeks. If you look to Iran -- it's a mess. Downplaying this entire thing is the reason why we've seen this virus pop up all over the US. No one is taking quarantining seriously.
I think this shows how much people trust their government and system overall, and how much they just consume junk media like twitter, FB etc. of these days.
Here in Switzerland, I see practically no change apart from few people on streets wearing masks (by few I mean like 2 today, for the first time since months). No panic shopping, our company is not going crazy just doing what seems adequate (extra hand disinfection available, there was a question of checking if remote works OK if needed). Shops have +-same amount of people, nobody binge shopping, all is available (apart from useless face masks in pharmacies, of course). Bear in mind that in my town we have at least 5 cases, could be more (not following this closely, what would be the point apart from getting into negative mental spiral).
Same look in France just across the border - big shopping centres seems exactly same as before. Went last weekend to Grenoble and ended up shopping at Carrefour there - again, business as usual. Nobody checking anything at EU borders, in nor out.
Back home in Eastern europe, some folks are going a bit mental and things for sure look a bit differently there.
I don't know - a 15% mortality rate for 80+ year olds is pretty bad. Or do their lives not count? Or are we not responsible for trying to slow the spread?
and it's up to around ~6% - 10.5% risk for those with a precondition. If this estimate[0] turns out to be correct, everyone will either have been directly affected by loss of somebody, know somebody who lost someone, or are dead themselves.
Diabetes produces high blood sugar that damages the walls of the arteries and veins
A combination of damaged lungs (less oxygen intake than normal) and troubles moving the scarce oxygen around the body trough a partially blocked circulatory system is not good news for the patient and can increase the risk of a heart failure and dead. If the lungs fail, the heart will fail next.
> Now the Democrats are politicizing the coronavirus. You know that, right? Coronavirus. They’re politicizing it. We did one of the great jobs. You say, ‘How’s President Trump doing?’ They go, ‘Oh, not good, not good.’ They have no clue. They don’t have any clue. They can’t even count their votes in Iowa, they can’t even count. No they can’t. They can’t count their votes.
> One of my people came up to me and said, ‘Mr. President, they tried to beat you on Russia, Russia, Russia. That didn’t work out too well. They couldn’t do it. They tried the impeachment hoax. That was on a perfect conversation. They tried anything, they tried it over and over, they’ve been doing it since you got in. It’s all turning, they lost, it’s all turning. Think of it. Think of it. And this is their new hoax. But you know, we did something that’s been pretty amazing. We’re 15 people [cases of coronavirus infection] in this massive country. And because of the fact that we went early, we went early, we could have had a lot more than that.
There is a dilemma. Nobody knows beforehand how bad things are going to get. Perhaps this is just a cold, perhaps an aggressive virus that can kill a lot of people.
For public institutions responsible for health, you would never say that things aren't that bad. There is nothing to gain here. If it isn't too bad, you would have been too careful, no big deal. If you are downplaying the issue, you can get in a lot of trouble because you are suddenly responsible for every single person who died from this if the outbreak is worse than previously assumed.
Of course there are some other options like hiding the outbreak completely. Those fail as the information cannot be contained anymore.
Anyone who doesn’t think this has the potential to be a big deal and worth worrying about doesn’t understand numbers. Couching this in some facts about the seasonal flu is all you need to reveal those that are ignorant. I’m not even going explain why. The comparisons to the flu have been eviscerated so many times in the month or more.
On the contrary: his points were exactly correct. We're dealing with extremely biased estimators due to the cost and supply chain for the Covid virus test which is basically only given to very sick people, radically biasing the estimator high. At the very least, the estimator is extremely uncertain, and anyone who works with numbers should be acutely aware of this.
We're also dealing with people who completely forgot how hysterical people were over the swine flu, SARS, MERS and so on, which ultimately turned out to be nothingburgers. And a completely broken mass media system where pretty much all sources of news are about as reliable as the National Enquirer, and significantly more politically biased.
Flagging this was foolish and a further contribution to the mass hysteria.
> SARS, MERS and so on, which ultimately turned out to be nothingburgers
As a reminder, SARS and MERS were contained thanks to massive international effort to identify the spreaders, quarantines (including whole hospitals), and restrictions on air travel.
There's no question that quarantines prevent the spread of disease: there is plenty of question as to whether the disease justifies it; including in the cases of SARS and MERS.
For example: most new flus come out of China due to their agricultural practices; building a wall around China until they change the practices and isolating people in the rest of the world population who get it would actually remove the flu from the human experience. I believe flu killed 60,000 people in America last year. Are we ready to do that? Should only take a couple of years!
If given the choice between modern disease control and a wall I would choose modern disease control.
Your example of the flu is interesting. If humanity had modern resources to fight the ur-flu would it be worth the effort? How many lives would be saved over the generations if the flu hadn't become a common threat?
This is a claim from the submitted article with no evidence:
> In all likelihood, however, given the one-off infections that are being detected in disparate locations, thousands if not millions have already had mild or asymptomatic SARS-CoV2.
> Bruce Aylward: ... More of a surprise, and this is something we still don’t understand, is how little virus there was in the much broader community. Everywhere we went, we tried to find and understand how many tests had been done, how many people were tested, and who were they.
> In Guangdong province, for example, there were 320,000 tests done in people coming to fever clinics, outpatient clinics. And at the peak of the outbreak, 0.47 percent of those tests were positive. People keep saying [the cases are the] tip of the iceberg. But we couldn’t find that. We found there’s a lot of people who are cases, a lot of close contacts — but not a lot of asymptomatic circulation of this virus in the bigger population. And that’s different from flu. In flu, you’ll find this virus right through the child population, right through blood samples of 20 to 40 percent of the population.
> Julia Belluz: If you didn’t find the “iceberg” of mild cases in China, what does it say about how deadly the virus is — the case fatality rate?
> Bruce Aylward: It says you’re probably not way off. The average case fatality rate is 3.8 percent in China, but a lot of that is driven by the early epidemic in Wuhan where numbers were higher. ... This suggests the Chinese are really good at keeping people alive with this disease, and just because it’s 1 percent in the general population outside of Wuhan doesn’t mean it [will be the same in other countries].
I find Aylward's arguments cogent and backed with evidence from the ground. I also don't see "mass hysteria." The evidence points to COVID-19 being more severe than the seasonal flu, we have an opportunity to contain it, and we're trying to do so. Canceling large events and unnecessary travel seems reasonable.
That is a different situation, as there is not mass testing in Washington State. There was/is in China. The point of this line of argument is to get an idea if the fatality rate really is 2-3%. When we thought there might be a lot of undiagnosed cases in China, we had reason to suspect the fatality rate is lower than that. But when we systematically tried to find such cases and diagnose them, we could not discover them. That supports the conclusion that the fatality rate really is 2-3%. That people are being infected in Washington, and we don't know how, does not counter what we think is the fatality rate.
I'd disagree. My impression is that the authorities in Seattle, in order to minimize short-term disruption, are choosing to increase the potential difficulty on long timescales.
To paraphrase: "We don't want to take aggressive action until we're certain that it is actually bad.".
In many situations, that is a fine approach, but when the adversary scales exponentially, it is a dangerous road to travel.
I think there’s a difference between government emergency policy being being sluggish vs. individual response being panicked and hysterical. The latter leads to hoarding and all kinds of avoidable premature issues.
Like the Y2K bug, focusing a large amount of society's resources on the problem is the only think that may prevent it from becoming catastrophic.
I also don't see much hysteria - some real concern, starting to slowly take action, a long-overdue stock market correction that's already moderating, but not hysteria.
Moreover, this author seems to have little knowledge of the dynamics of exponential growth. They also miss the fact that the USA has essentially zero testing capability, restrict the tests to absurdly tight criteria (returned from a known hotspot, or contact w/+tested person), so new cases are now popping up across the nation.
Mostly there is completely insufficient data, especially in the USA, where the administration has gutted the science-based agencies including the CDC, is trying to protect the stock market for it's re-election before protecting the people, and so is basically flying the in the fog saying "it's fine, we don't see any mountains".
Sitting the the same dataless fog and saying "it's fine we don't see any mountains either" is not helpful.
consider that the preliminary WHO incident report regarding the chinese response to the outbreak in wuhan essentially said that the radical and severe measures taken by the chinese government were the only thing which allowed for some semblance of control over the course of weeks. if we assume that the chinese are not fabricating their numbers, it's not much of a relief for us because they still had thousands of deaths despite their colossal efforts. if we assume that the chinese have been faking their numbers, the picture is much more grim.
a lot of the hysteria in the US is stemming from the fact that the CDC is asleep at the wheel as a result of political pressure or potentially severe incompetence. after seeing how seriously the chinese took the outbreak and how badly iran is getting hit by it right now, it is extremely disconcerting to see our own government doing absolutely nothing as cases continue to mount.
we're barely even testing people. daily life is continuing as normal when perhaps it shouldn't be.
i know that this isn't the end of the world, but i'm starting to expect that this epidemic might make life a bit less comfortable for a while.
if the US gets hit very hard and some of the preventable/fixable weaknesses in american society end up being exposed and exacerbated by the epidemic, i think we'll be in a severe crisis.
You also have to consider that population density in China is dramatically higher than in most of the US. For this virus in particular, that makes a big difference.
This might be a case of excessively binary thinking? Stocking up on things you normally use is not panic buying, it's a sensible no-regrets precaution. But it tends to get called "hoarding" anyway.
Buying stuff you don't normally use can also be sensible. Consider putting together an earthquake kit in California. Unfortunately, having a pandemic kit ready isn't something most people do, but maybe it should be?
There probably are some kinds of preparation that are sensible and others that aren't, and we should try to figure out the difference.
I'm also wondering if there might be an untapped market to help people be prepared without keeping a lot of inventory themselves? Usually there is advance notice for a pandemic so you just want some assurance that someone can ship you something when it's time. This would avoid shortages by making it profitable to keep inventory.
The issue with 'prepping' as a lifestyle, the lifestyle you are wanting to sell with this idea, is that it's about prepping for the unknown. You're preparing for the worst disaster before it happens.
In that case, the idea of course is that regular routes to receive goods, like shipping, are off-line.
> I'm also wondering if there might be an untapped market to help people be prepared without keeping a lot of inventory themselves? Usually there is advance notice for a pandemic so you just want some assurance that someone can ship you something when it's time. This would avoid shortages by making it profitable to keep inventory.
This is an interesting idea, but you'd need to be really careful to avoid price-gouging laws (e.g. not accept any customers after the potential disaster begins). Even then the govt might still come after you if those products you keep for people cost significantly more then the local price.
Well, the idea would be that the option corresponds to a kit that's actually in stock somewhere, and you need to buy the option well in advance. The option would be to purchase the kit at regular price. If you don't need it, you could transfer the option to a charity.
Maybe a medical distributor would be in the best position to do this; they could regularly replace and sell this extra inventory to keep it from getting too old.
For me, the critical pieces of info everyone should consider are these:
1) Washing hands often, significantly reduces chances of getting infected (because virus has a fat membrane that breaks when in contact with soap)
2) If you are under 60 yrs old, covid-19 infection becoming fatal is extremely low, which in turn means, keep older population away from anyone carrying this virus, hence self-quarantine around elders is extremely important.
3) Wear mask only if infected.
4) The virus doesn't last long on dry surfaces, hot weather (bumped up the heat in house by a few degrees, yet comfortable enough).
5) I try to eat cooked foods (no salads, no cold foods). This should further reduce the chances of getting infected
6) Follow less frequent yet more reliable sources of news (this is the hardest to achieve for most people).
(correct me if I'm wrong, or add more to it if needed)
Although a single sneeze releases up to 40,000 droplets,[96] most of these droplets are quite large and will quickly settle out of the air.[94] How long influenza survives in airborne droplets seems to be influenced by the levels of humidity and UV radiation, with low humidity and a lack of sunlight in winter aiding its survival;[94] ideal conditions can allow it to live for an hour in the atmosphere.[97]
Virus can penetrate through eyes, nose and mouse; but not skin. Adding that bit of a detail is important. "Oh I didn't touch my face, but I licked my fingers".
Does this contradict 4) above? I don't have the expertise to judge, but the plain sense of the words suggests it does.
Persistence of coronavirus on inanimate surfaces [0]
Most data were described with the endemic human coronavirus strain (HCoV-) 229E. On different types of materials it can remain infectious for from 2 hours up to 9 days.
Your #3 is not borne out by evidence or studies. Respirators, surgical masks, and pediatric masks have all modeled and/or shown to provide a significant degree of protection.
A related questions to ask oneself:
- who most needs to be healthy, you or medical providers?
- assuming we agree medical providers are in greater need of remaining healthy, does buying a mask from Ace Hardware or Home Depot take it out of the hands of a medical provider?
- will masks being out of stock at Ace Hardware affect a supply chain decision that would have otherwise gone to the hospital? if so, who is doing that wrong and why not intervene there?
- what about the principle where airlines tell you to put on your oxygen mask before your child's, and the notion that some % of Americans will find themselves as medical care providers to a household?
Having enough masks for the second scenario is relevant if you have 'at risk' household members.
On #4, some research suggests 9 days at comfortable room temperatures, 30C for instance.
2) needs a very key caveat. When you have access to medical care and are under 60 years old, mortality is very low. Even if you're old, access to medical care lowers mortality to less than the oft quoted 2% rate.
The issue is that mortality climbs rapidly for all age buckets if you don't have access to medical care. If and when the medical system buckles under load, things get dark very fast.
I live 1 mile from Evergreen Hospital and 3 miles from the Life Care facility, and I'm immunocompromised. Most of my B lymphocytes and a bunch of my T helper cells are gone. In the past couple of days 7 immunocompromised people within walking distance of me were killed by this thing. I don't think I'm in hysteria, but I sure as hell am not leaving my house until I can be convinced that it's under control in my area.
So far it would seem that when COVID-19 finds its way into a care facility for the sick and/or elderly, it incubates for a few days and then starts killing people left and right. And some of the best hospitals in America (e.g., Evergreen and Harborview) can't save them.
We've seen what does and doesn't work in places like Japan, Korea, and Italy. Meanwhile most of the schools around here are still open and the workers transferring suspected COVID-19 patients to ambulances are using only loose-fitting face masks as PPE.
I feel like we're collectively failing an open-book test right now.
You’re one of the few folks on HN talking about this who actually has something to worry about...but ironically, you’re not spreading misinformation or panic, like so many other people. I hope this doesn’t end up being as bad for sick people as it seems it might.
That said, I think your comment about “failing an open-book test” is a bit unfair. Yes, the governmental response around the world has been bungled, and no, it isn’t good. But it’s also pretty much true that there was never going to be a chance to contain this virus, outside of isolating it to Wuhan in November (i.e. before anyone knew about it). And a bad flu will rip through vulnerable populations as well...it’s why we beg and plead for people to get the flu shot every year (even though they never do...)
There is simply no way to contain a respiratory virus that has spread to tens of thousands of people. At that point, you need to plan for isolation and care for the vulnerable, and stop flailing around with travel bans (which don’t work) and quarantines and whatnot. It’s insane to me, for example, that Seattle public health officials are operating as if this virus isn’t already endemic. They have good evidence that it is!
The biggest test we’re failing right now is controlling panic and allocating resources intelligently.
First, the kids are fine. This virus doesn’t really seem to affect children.
Second, “worrying” accomplishes nothing. Wash your hands; avoid people when you’re sick. Avoid sick people. Have a couple weeks of groceries on hand if you think quarantine is likely. These are things you should be doing every year during flu season.
But I can’t stress this enough: there’s nothing we can be doing, rationally, where we can shave off a bit of economic growth in exchange for less virus. At this point, the virus is endemic. Quarantines make panicky people feel good, but don’t actually help. Isolation of Wuhan was a good thing to try, but it failed.
It’s time for the next step: acknowledgement that the virus is everywhere, and directly protecting vulnerable populations. This is going to happen sooner or later.
You could immediately fund the CDC to "absurd" levels, such as by giving them say, 100 billion dollars. I think that would be far more effective than rate cuts which are likely far more "expensive" but won't actually help.
Though, I want to see the current CDC leadership out. They should not have silently removed their total tests done. The world needs to see their current incompetence as a lesson.
There are obvious ways you can exchange economic growth for lower mortality. See: China. Within a month, it will have fewer active cases and daily new cases than the United States.
I suspect it will end up endemic, but the rate at which it infects everybody matters, a lot. That rate of new infection changes the load profile for the medical system, and it's when the system is overloaded that mortality skyrockets. Halving the infection rate could cut mortality by 90%.
And that's to say nothing of other advantages of kicking the can down the road, like higher temperatures decreasing transmission, doctors developing improved treatment protocols, and even a vaccine.
Slowing down the virus is fine. There is no effective way to do that by hobbling economic growth.
We don’t need quarantines and travel bans and trip cancellations and business shutdowns to slow the virus. These have always been scientifically dubious overreactions. Investing in hospital capacity and contact tracing, on the other hand, makes a lot of sense.
The drastic, economically expensive steps China took didn’t stop the virus from spreading out of (or within) China. Quarantines haven’t been effective anywhere else. There are things we can do to slow the virus, but few of them require massive economic impact.
It's categorically false that it didn't stop the virus from spreading within China. Those measures shifted an exponential growth curve to a sublinear one.
Did I panic? I don’t know. I began to prepare in early February for the possibility of draconian cordon sanitaire, widespread panic, and the consequent interruption in supply after learning that in Wuhan initial warnings had been suppressed, and mass gatherings permitted during a time the virus was in the population. Because of that head start, and the dramatic R_0 of this bug, I sensed this was no ordinary outbreak.
I resumed my efforts in mid February after learning that the CDC had rejected WHO test kits, then had produced defective test kits, which, coupled with unreasonably strict test criteria, caused virtually no surveillance in the US to be done. It did not inspire confidence that mass gatherings continued to be held, and were even encouraged (e.g., San Francisco's Mayor's issuance of a statement encouraging RSA conference attendance, or the recent Bernie Sanders rally in San Jose).
Note that the failure of the US to adequately surveil, moreover its failure to respond quickly to that failure, mirrors what transpired in Wuhan. In the case of Wuhan, the national state only became aware of the problem when the local medical system was overwhelmed, and the epidemic had gone, ahem, viral.
Given the similarity between the surveillance gap in China and the US, and the failure to respond to that gap in the US, I thought prudent to continue to prepare.
I might, though, have a different perspective due to the fact that my father was head of serology and virology labs with reporting, diagnostic, and research responsibilities for animal diseases for a US state. Or, maybe a little knowledge is a dangerous thing, I don’t know. But I can, thus, recommend journalistic potboilers such as “Rats, Lice, and Men” and “Plagues and Peoples”. More seriously, David Quammen, given the background he gained in evolutionary biology from writing “Song of the Dodo”, in “Spillover” gives what’s probably the best elucidation of zoonotic pathogens.
Previous zoonotic pathogenic outbreaks have killed more than probably all wars combined. Disruption of habitat by human colonization and climate change have intersected with mass jet travel to increase the likelihood that pathogens will make it from animal reservoirs to our species.
Panic gets a bad rap. It is much better to panic early, when you have the leisure to plan ahead with abundant resources. Panic becomes bad late in the game when resources are constrained and there is not time to implement or optimize a plan. In short: The time to panic is now.
“Mass hysteria” sounds extreme and seems to exaggerate our joint response to date.
What I’ve observed from friends and news out of Seattle is general caution and a measured public response, which if successful can dramatically slow the rate of transmission.
This was originally going to be a reply to Fruffy's comment.
I don't see mass hysteria, but I do see growing concern.
The last several decades of child-rearing in the US have been marked by an increased focus upon stress rduction, conflict mitigation, and obstacle-clearing for the purposes of opening up a larger swath of opportunities for our children in their futures.
Especially among the upper and middle-classes, I believe that this has resulted in a larger portion of the population lacking the fundamental coping mechanisms to respond rationally and proportionally to perceived threats.
Combined with a lack of actual experience dealing with pandemics in our cultural memory, lower social capital in our immediate communities preventing stronger bonds of mutual reassurance/support, and our ability to communicate our concerns with a broad likeminded audience over the internet, and I don't wonder that an unreasonably high number of young individuals panicking over the COVID outbreak.
I don't know that this is the case in Europe, as it is outside my direct experience. But Europeans seem to have a greater sense of institutional trust than we do here stateside.
We seem to be in a constant state of cultural hyperventilation right now. Of all the wolves we've worried about wandering the earth, COVID's the one that's actually coming for us, irrespective of ethnicity, gender, or creed, and it's also the one we lack the tools to effectively combat at scale.
Even though the article raises a number of reasons why the outbreak may not be as bad as we fear, if someone's truly concerned that they're in danger of passing from it, reach out to them and ask how you can help.
Especially among the lower-classes, self-quarantine isn't a realistic option, and constructing a network of mutual support for the event that it does become as bad as our most panicked commentators say it might be is a good way to keep everyone's emotional and physical struggles down while we weather the storm, if and when it comes.
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[ 9.0 ms ] story [ 197 ms ] threadTweets of mass-disruption have done more than any WMD.
Then you have excellent leadership in Iran which knowingly hides their coronavirus situation and thus have exported the virus to poor and incapable places like Afghanistan, Pakistan, Iraq?
Heck, compared to Iran, even Pakistan is being much more stringent and transparent.
The amount of casualties seem to be in control.
Okay, Iran is acting stupid. But we don't even do business with them. Tourism is minimal.
Hell, I'd even prefer to get it, so I'm over it ( 32 years old)
[0]: https://www.worldometers.info/coronavirus/coronavirus-cases/...
Newly Infected vs. Newly Recovered is the one you want.
Ps. I'm using the same site, you should check how much influence Iran has in your quick-check. Also South Korea and I wouldn't be suprised with North-Korea to popup either.
It seems to be that the WHO had the correct actions for pandemics ( I was positively suprised when looking at the actual numbers). The cases in Europe are staying pretty low.
32 years on Earth and you're unfamiliar with mutation?
Mutation can happen if there are many generations in between. My option could have 1-3 generations in between which is far more realistic in a "controlled environment" than in a uncontrolled one.
Would you have done the same with SARS? Because it's similar to that disease (from what we know: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1287568/).
It can destroy your airway and it may even lie dormant in your brain and come back when you get another flu. Surprise! Now you're dealing with a fever and pneumonia in your 30s.
https://www.businessinsider.com/coronavirus-in-charts-covid-...
Look at the global spread map. 92,303 infected vs 48,190 recovered (and these numbers are probably WAY underreported). There are 40k people still in recovery? How many more is that going to add to the death toll? The death rate is 3.3% very much not like the flu.
And if you go get sick and need medical treatment, guess what? Hospitals are going to be backed up.
It's just an incredibly irresponsible response. But be my guest and start licking some doorknobs. I'll be quarantining myself.
These tests (RT-PCR) also aren’t sensitive enough to test whether the virus is alive or dead, they test for the presence of genetic material.
From everything I've read, both in Chinese and English, considerably more than 1% of the medical personnel at the front lines have perished.
I always thought that once a virus was present in your system, it was there, like a boolean, not like a degree of infection. But apparently that is not true.
In the US, it is increasingly obvious that there are more cases than are being tested/reported. More and more healthcare professionals are reporting individuals with severe flu symptoms either not being tested for anything, or testing negative for Influenza. Proper quarantine is not being implemented to or from the US, so the subset of people who are infected but not confirmed can still travel and spread this disease.
Just insane.
That's the global numbers, which are still dominated by China. In China there may have been a real slowdown thanks to draconian measures.
But have a look at the WHO numbers excluding China. It's definitely still exponential. The doubling time has even been shrinking. My plot:
https://docs.google.com/spreadsheets/d/e/2PACX-1vQTpoR9gmgei...
Source of the numbers: https://www.who.int/emergencies/diseases/novel-coronavirus-2...
(I still haven't decided if this point is true or not)
( Belgium)
To be honest, I am due for a skying trip in three weeks and the most fear I have is that they just shut down the location and don't let me in (bad) or don't let me out again (not that bad).
Seems to me that's a good thing, that is stopping the spread / not allowing it to go out of control.
Maybe the perspective is also a bit skewed because people that post online often tend towards the paranoid and fearful type (somewhat of a conjecture), so there might be a self-perpetuating bias. Users that are not concerned do not bother to post so everyone just reads panicky posts.
There is also a lot of phobia and persecution of Asian Americans, despite the fact that most US cases are not Asian.
Cases have declined in China only because of the extreme measures they undertook to stop it. (In other words, "hysteria.")
The medical community should absolutely be in high gear right now. That doesn't mean the rest of us need to act like its an end of the world situation.
The medical community can call for calm if they think that's important, but from where I sit, isolating cases is paramount to stop the spread and getting a population ready for local quarantine situations seems fairly important too. You don't get there by sticking your head in the sand.
It's not nice to hear, but perhaps we do have to hear it.
I mean, you can't really say the author can't assess the situation because of a lack of expertise, and then immediately assess the situation with a lack of expertise.
I'm assuming that the quarantine helped, but also it might not have helped. That might have just been the natural progression of this disease. We don't know, and you can't claim that as a statement of fact.
This is the assessment of the WHO, not mine. https://www.who.int/docs/default-source/coronaviruse/who-chi...
"China’s uncompromising and rigorous use of non-pharmaceutical measures to contain transmission of the COVID-19 virus in multiple settings provides vital lessons for the global response."
I don't think they could say it much more clearly.
This makes multiple observations to that end. What you consider "extreme" is a matter of how much you want to troll the topic.
Here in Switzerland, I see practically no change apart from few people on streets wearing masks (by few I mean like 2 today, for the first time since months). No panic shopping, our company is not going crazy just doing what seems adequate (extra hand disinfection available, there was a question of checking if remote works OK if needed). Shops have +-same amount of people, nobody binge shopping, all is available (apart from useless face masks in pharmacies, of course). Bear in mind that in my town we have at least 5 cases, could be more (not following this closely, what would be the point apart from getting into negative mental spiral).
Same look in France just across the border - big shopping centres seems exactly same as before. Went last weekend to Grenoble and ended up shopping at Carrefour there - again, business as usual. Nobody checking anything at EU borders, in nor out.
Back home in Eastern europe, some folks are going a bit mental and things for sure look a bit differently there.
[0] https://www.worldometers.info/coronavirus/coronavirus-age-se...
Get real.
A combination of damaged lungs (less oxygen intake than normal) and troubles moving the scarce oxygen around the body trough a partially blocked circulatory system is not good news for the patient and can increase the risk of a heart failure and dead. If the lungs fail, the heart will fail next.
https://www.cnbc.com/2020/02/28/trump-says-the-coronavirus-i...
Straight from the horses mouth. But I'm sure he was misquoted and taken out of context...
https://www.snopes.com/fact-check/trump-coronavirus-rally-re...
His exact words:
> Now the Democrats are politicizing the coronavirus. You know that, right? Coronavirus. They’re politicizing it. We did one of the great jobs. You say, ‘How’s President Trump doing?’ They go, ‘Oh, not good, not good.’ They have no clue. They don’t have any clue. They can’t even count their votes in Iowa, they can’t even count. No they can’t. They can’t count their votes.
> One of my people came up to me and said, ‘Mr. President, they tried to beat you on Russia, Russia, Russia. That didn’t work out too well. They couldn’t do it. They tried the impeachment hoax. That was on a perfect conversation. They tried anything, they tried it over and over, they’ve been doing it since you got in. It’s all turning, they lost, it’s all turning. Think of it. Think of it. And this is their new hoax. But you know, we did something that’s been pretty amazing. We’re 15 people [cases of coronavirus infection] in this massive country. And because of the fact that we went early, we went early, we could have had a lot more than that.
For public institutions responsible for health, you would never say that things aren't that bad. There is nothing to gain here. If it isn't too bad, you would have been too careful, no big deal. If you are downplaying the issue, you can get in a lot of trouble because you are suddenly responsible for every single person who died from this if the outbreak is worse than previously assumed.
Of course there are some other options like hiding the outbreak completely. Those fail as the information cannot be contained anymore.
We're also dealing with people who completely forgot how hysterical people were over the swine flu, SARS, MERS and so on, which ultimately turned out to be nothingburgers. And a completely broken mass media system where pretty much all sources of news are about as reliable as the National Enquirer, and significantly more politically biased.
Flagging this was foolish and a further contribution to the mass hysteria.
As a reminder, SARS and MERS were contained thanks to massive international effort to identify the spreaders, quarantines (including whole hospitals), and restrictions on air travel.
For example: most new flus come out of China due to their agricultural practices; building a wall around China until they change the practices and isolating people in the rest of the world population who get it would actually remove the flu from the human experience. I believe flu killed 60,000 people in America last year. Are we ready to do that? Should only take a couple of years!
Your example of the flu is interesting. If humanity had modern resources to fight the ur-flu would it be worth the effort? How many lives would be saved over the generations if the flu hadn't become a common threat?
If a contagious disease with a 34% mortality rate don't justify containment. What does?
> In all likelihood, however, given the one-off infections that are being detected in disparate locations, thousands if not millions have already had mild or asymptomatic SARS-CoV2.
An assistance director general and epidemiologist for the WHO, Bruce Aylward, makes the opposite argument in a recent Vox interview (https://www.vox.com/2020/3/2/21161067/coronavirus-covid19-ch...):
> Bruce Aylward: ... More of a surprise, and this is something we still don’t understand, is how little virus there was in the much broader community. Everywhere we went, we tried to find and understand how many tests had been done, how many people were tested, and who were they.
> In Guangdong province, for example, there were 320,000 tests done in people coming to fever clinics, outpatient clinics. And at the peak of the outbreak, 0.47 percent of those tests were positive. People keep saying [the cases are the] tip of the iceberg. But we couldn’t find that. We found there’s a lot of people who are cases, a lot of close contacts — but not a lot of asymptomatic circulation of this virus in the bigger population. And that’s different from flu. In flu, you’ll find this virus right through the child population, right through blood samples of 20 to 40 percent of the population.
> Julia Belluz: If you didn’t find the “iceberg” of mild cases in China, what does it say about how deadly the virus is — the case fatality rate?
> Bruce Aylward: It says you’re probably not way off. The average case fatality rate is 3.8 percent in China, but a lot of that is driven by the early epidemic in Wuhan where numbers were higher. ... This suggests the Chinese are really good at keeping people alive with this disease, and just because it’s 1 percent in the general population outside of Wuhan doesn’t mean it [will be the same in other countries].
I find Aylward's arguments cogent and backed with evidence from the ground. I also don't see "mass hysteria." The evidence points to COVID-19 being more severe than the seasonal flu, we have an opportunity to contain it, and we're trying to do so. Canceling large events and unnecessary travel seems reasonable.
To paraphrase: "We don't want to take aggressive action until we're certain that it is actually bad.".
In many situations, that is a fine approach, but when the adversary scales exponentially, it is a dangerous road to travel.
Like the Y2K bug, focusing a large amount of society's resources on the problem is the only think that may prevent it from becoming catastrophic.
I also don't see much hysteria - some real concern, starting to slowly take action, a long-overdue stock market correction that's already moderating, but not hysteria.
Moreover, this author seems to have little knowledge of the dynamics of exponential growth. They also miss the fact that the USA has essentially zero testing capability, restrict the tests to absurdly tight criteria (returned from a known hotspot, or contact w/+tested person), so new cases are now popping up across the nation.
Mostly there is completely insufficient data, especially in the USA, where the administration has gutted the science-based agencies including the CDC, is trying to protect the stock market for it's re-election before protecting the people, and so is basically flying the in the fog saying "it's fine, we don't see any mountains".
Sitting the the same dataless fog and saying "it's fine we don't see any mountains either" is not helpful.
consider that the preliminary WHO incident report regarding the chinese response to the outbreak in wuhan essentially said that the radical and severe measures taken by the chinese government were the only thing which allowed for some semblance of control over the course of weeks. if we assume that the chinese are not fabricating their numbers, it's not much of a relief for us because they still had thousands of deaths despite their colossal efforts. if we assume that the chinese have been faking their numbers, the picture is much more grim.
a lot of the hysteria in the US is stemming from the fact that the CDC is asleep at the wheel as a result of political pressure or potentially severe incompetence. after seeing how seriously the chinese took the outbreak and how badly iran is getting hit by it right now, it is extremely disconcerting to see our own government doing absolutely nothing as cases continue to mount.
we're barely even testing people. daily life is continuing as normal when perhaps it shouldn't be.
i know that this isn't the end of the world, but i'm starting to expect that this epidemic might make life a bit less comfortable for a while.
if the US gets hit very hard and some of the preventable/fixable weaknesses in american society end up being exposed and exacerbated by the epidemic, i think we'll be in a severe crisis.
Trump fired the entire pandemic response team.
https://www.snopes.com/fact-check/trump-fire-pandemic-team/
Buying stuff you don't normally use can also be sensible. Consider putting together an earthquake kit in California. Unfortunately, having a pandemic kit ready isn't something most people do, but maybe it should be?
There probably are some kinds of preparation that are sensible and others that aren't, and we should try to figure out the difference.
I'm also wondering if there might be an untapped market to help people be prepared without keeping a lot of inventory themselves? Usually there is advance notice for a pandemic so you just want some assurance that someone can ship you something when it's time. This would avoid shortages by making it profitable to keep inventory.
The issue with 'prepping' as a lifestyle, the lifestyle you are wanting to sell with this idea, is that it's about prepping for the unknown. You're preparing for the worst disaster before it happens.
In that case, the idea of course is that regular routes to receive goods, like shipping, are off-line.
>Usually there is advance notice for a pandemic
Where'd you come up with that?
This is an interesting idea, but you'd need to be really careful to avoid price-gouging laws (e.g. not accept any customers after the potential disaster begins). Even then the govt might still come after you if those products you keep for people cost significantly more then the local price.
Maybe a medical distributor would be in the best position to do this; they could regularly replace and sell this extra inventory to keep it from getting too old.
1) Washing hands often, significantly reduces chances of getting infected (because virus has a fat membrane that breaks when in contact with soap)
2) If you are under 60 yrs old, covid-19 infection becoming fatal is extremely low, which in turn means, keep older population away from anyone carrying this virus, hence self-quarantine around elders is extremely important.
3) Wear mask only if infected.
4) The virus doesn't last long on dry surfaces, hot weather (bumped up the heat in house by a few degrees, yet comfortable enough).
5) I try to eat cooked foods (no salads, no cold foods). This should further reduce the chances of getting infected
6) Follow less frequent yet more reliable sources of news (this is the hardest to achieve for most people).
(correct me if I'm wrong, or add more to it if needed)
What's your source for this? What temperature is required to see this effect? How sure are you that your house is hot enough?
[0] https://www.google.com/search?q=flu+humidity
https://ccdd.hsph.harvard.edu/will-covid-19-go-away-on-its-o...
Persistence of coronavirus on inanimate surfaces [0]
Most data were described with the endemic human coronavirus strain (HCoV-) 229E. On different types of materials it can remain infectious for from 2 hours up to 9 days.
[0] https://www.sciencedirect.com/science/article/pii/S019567012...
Your #3 is not borne out by evidence or studies. Respirators, surgical masks, and pediatric masks have all modeled and/or shown to provide a significant degree of protection.
A related questions to ask oneself:
- who most needs to be healthy, you or medical providers?
- assuming we agree medical providers are in greater need of remaining healthy, does buying a mask from Ace Hardware or Home Depot take it out of the hands of a medical provider?
- will masks being out of stock at Ace Hardware affect a supply chain decision that would have otherwise gone to the hospital? if so, who is doing that wrong and why not intervene there?
- what about the principle where airlines tell you to put on your oxygen mask before your child's, and the notion that some % of Americans will find themselves as medical care providers to a household?
Having enough masks for the second scenario is relevant if you have 'at risk' household members.
On #4, some research suggests 9 days at comfortable room temperatures, 30C for instance.
The issue is that mortality climbs rapidly for all age buckets if you don't have access to medical care. If and when the medical system buckles under load, things get dark very fast.
All my points assume access to decent health/medical services
So far it would seem that when COVID-19 finds its way into a care facility for the sick and/or elderly, it incubates for a few days and then starts killing people left and right. And some of the best hospitals in America (e.g., Evergreen and Harborview) can't save them.
We've seen what does and doesn't work in places like Japan, Korea, and Italy. Meanwhile most of the schools around here are still open and the workers transferring suspected COVID-19 patients to ambulances are using only loose-fitting face masks as PPE.
I feel like we're collectively failing an open-book test right now.
That said, I think your comment about “failing an open-book test” is a bit unfair. Yes, the governmental response around the world has been bungled, and no, it isn’t good. But it’s also pretty much true that there was never going to be a chance to contain this virus, outside of isolating it to Wuhan in November (i.e. before anyone knew about it). And a bad flu will rip through vulnerable populations as well...it’s why we beg and plead for people to get the flu shot every year (even though they never do...)
There is simply no way to contain a respiratory virus that has spread to tens of thousands of people. At that point, you need to plan for isolation and care for the vulnerable, and stop flailing around with travel bans (which don’t work) and quarantines and whatnot. It’s insane to me, for example, that Seattle public health officials are operating as if this virus isn’t already endemic. They have good evidence that it is!
The biggest test we’re failing right now is controlling panic and allocating resources intelligently.
I'm worries and don't think it is a problem if we would reduce the global economy fora year to get rid of it.
Or that everyone on the planet should get vaccinated and should life more aware.
Second, “worrying” accomplishes nothing. Wash your hands; avoid people when you’re sick. Avoid sick people. Have a couple weeks of groceries on hand if you think quarantine is likely. These are things you should be doing every year during flu season.
But I can’t stress this enough: there’s nothing we can be doing, rationally, where we can shave off a bit of economic growth in exchange for less virus. At this point, the virus is endemic. Quarantines make panicky people feel good, but don’t actually help. Isolation of Wuhan was a good thing to try, but it failed.
It’s time for the next step: acknowledgement that the virus is everywhere, and directly protecting vulnerable populations. This is going to happen sooner or later.
Though, I want to see the current CDC leadership out. They should not have silently removed their total tests done. The world needs to see their current incompetence as a lesson.
I suspect it will end up endemic, but the rate at which it infects everybody matters, a lot. That rate of new infection changes the load profile for the medical system, and it's when the system is overloaded that mortality skyrockets. Halving the infection rate could cut mortality by 90%.
And that's to say nothing of other advantages of kicking the can down the road, like higher temperatures decreasing transmission, doctors developing improved treatment protocols, and even a vaccine.
We don’t need quarantines and travel bans and trip cancellations and business shutdowns to slow the virus. These have always been scientifically dubious overreactions. Investing in hospital capacity and contact tracing, on the other hand, makes a lot of sense.
The drastic, economically expensive steps China took didn’t stop the virus from spreading out of (or within) China. Quarantines haven’t been effective anywhere else. There are things we can do to slow the virus, but few of them require massive economic impact.
https://www.kirklandreporter.com/news/coronavirus-death-toll...
I resumed my efforts in mid February after learning that the CDC had rejected WHO test kits, then had produced defective test kits, which, coupled with unreasonably strict test criteria, caused virtually no surveillance in the US to be done. It did not inspire confidence that mass gatherings continued to be held, and were even encouraged (e.g., San Francisco's Mayor's issuance of a statement encouraging RSA conference attendance, or the recent Bernie Sanders rally in San Jose).
Note that the failure of the US to adequately surveil, moreover its failure to respond quickly to that failure, mirrors what transpired in Wuhan. In the case of Wuhan, the national state only became aware of the problem when the local medical system was overwhelmed, and the epidemic had gone, ahem, viral.
Given the similarity between the surveillance gap in China and the US, and the failure to respond to that gap in the US, I thought prudent to continue to prepare.
I might, though, have a different perspective due to the fact that my father was head of serology and virology labs with reporting, diagnostic, and research responsibilities for animal diseases for a US state. Or, maybe a little knowledge is a dangerous thing, I don’t know. But I can, thus, recommend journalistic potboilers such as “Rats, Lice, and Men” and “Plagues and Peoples”. More seriously, David Quammen, given the background he gained in evolutionary biology from writing “Song of the Dodo”, in “Spillover” gives what’s probably the best elucidation of zoonotic pathogens.
Previous zoonotic pathogenic outbreaks have killed more than probably all wars combined. Disruption of habitat by human colonization and climate change have intersected with mass jet travel to increase the likelihood that pathogens will make it from animal reservoirs to our species.
What I’ve observed from friends and news out of Seattle is general caution and a measured public response, which if successful can dramatically slow the rate of transmission.
I don't see mass hysteria, but I do see growing concern.
The last several decades of child-rearing in the US have been marked by an increased focus upon stress rduction, conflict mitigation, and obstacle-clearing for the purposes of opening up a larger swath of opportunities for our children in their futures.
Especially among the upper and middle-classes, I believe that this has resulted in a larger portion of the population lacking the fundamental coping mechanisms to respond rationally and proportionally to perceived threats.
Combined with a lack of actual experience dealing with pandemics in our cultural memory, lower social capital in our immediate communities preventing stronger bonds of mutual reassurance/support, and our ability to communicate our concerns with a broad likeminded audience over the internet, and I don't wonder that an unreasonably high number of young individuals panicking over the COVID outbreak.
I don't know that this is the case in Europe, as it is outside my direct experience. But Europeans seem to have a greater sense of institutional trust than we do here stateside.
We seem to be in a constant state of cultural hyperventilation right now. Of all the wolves we've worried about wandering the earth, COVID's the one that's actually coming for us, irrespective of ethnicity, gender, or creed, and it's also the one we lack the tools to effectively combat at scale.
Even though the article raises a number of reasons why the outbreak may not be as bad as we fear, if someone's truly concerned that they're in danger of passing from it, reach out to them and ask how you can help.
Especially among the lower-classes, self-quarantine isn't a realistic option, and constructing a network of mutual support for the event that it does become as bad as our most panicked commentators say it might be is a good way to keep everyone's emotional and physical struggles down while we weather the storm, if and when it comes.