The article says expanding capacity has not been approached by any government but I am not sure that's true, in Italy they are building hospital wings or re-adapting abandoned hospitals in many places. Rome has 4 planned covid hospitals as of now.
Also, the Italian government plans to hire a ton of medical and paramedical staff, money has been earmarked.
I am quite sure other governments are doing the same.
I watched an interview with one of the Italian Drs. He said they were using retired medical staff and also cancelling routine procedures which frees up staff, and they are remote training staff from other specialities.
The source for that is a random tweet that contained a lot of misinformation and false statement. No Italian friend working in the medical sector was able to confirm that it even makes any sense, and there are no official sources for that
The UK is planning to re-train other medical staff to deal with respiratory illness. I think that probably includes things like psychologists, etc. who have medical experience and can quickly be brought up to speed. Might be something like that.
> "I think that probably includes things like psychologists, etc. who have medical experience and can quickly be brought up to speed. Might be something like that.
Uh, psychologists have zero medical training or experience - maybe they could explain the patients their respiratory
failure is a symptom of insecure attachment patterns.
If you mean psychiatrists, there aren't that many of them to move the needle.
No need to be harsh. What is moving the needle is postponing elective surgery. There are a lot of anaesthetists and they are medics who can manage patients on ventilators.
And the equipment...my understanding is that ventilators are critical for those who have severe cases. Can't just magically wish for tens of thousands of ventilators....
In italy one and the only factory of ventilators which was selling worldwide 250 units per month is now producing 500-600 per month exclusively for the italian hospitals (and past orders not yet sent abroad were blocked bt the government and redirected to italian hospitals) for the next ten months.
Most hospitalised people will only need non invasive respiratory support and surveillance. I guess these cases could be handled by purposely trained health workers.
I worked for a ventilator startup for a few years, and it took us about 18 months to get our line to the point where we could make first articles built to manufacturing instead of prototype processes. These first articles then continued to develop some performance problems which needed to be rectified over the following year or so. This was starting from an empty building, which is where you'd be even if you retrofitted a ventilator factory into a car factory, because none of the tools in a car factory are precise or accurate enough to build or test a ventilator.
Yes but if you start with complete specs for a well-established production model, as well as complete specs for all the tooling and assembly machines you've got a completely different scenario. If you take experienced machinists off another line to spin it up with consulting from people who are currently building it, I would guess you could do something in six months or so. I mean, IBM built M1 Garands in WWII.
"More than 60 manufacturers have been sent a blueprint for making up to 20,000 ventilators to treat coronavirus patients, “at speed”, as Boris Johnson called on British industry to help the government prepare for a surge in cases."
I work for a very large global manufacturer w/ a presence in China, and does not produce medical equipment. My Chinese family told me (so take it w/ a grain of salt) they said 'Hey I heard your company is building ventilators to help out' and I said I don't know.
My gripe is why the other countries didn't do it too since we had more lead time. Infection rates are exponential...waiting too long to take action will cause more deaths.
A gun is very different from a medical device. The tolerances your automobile machinists are used to working at are much wider. Ventilators have to measure fractions of a cmH20 above ambient pressure, and they have to do so accurately to deliver gas, especially smaller boluses. I'm not saying it can't be done, I'm saying that training someone who is used to the tools used to building automobile engines will be practically unskilled at building ventilators, and you need to validate your people as well as your production processes, irrespective of whether you have blueprints for equipment. You have to validate everything or you will kill people with these new ventilators.
During WW2, there were not a large supply of shut down weapon factories.
Car factories, for example, could be retrofitted to fabricate ventilators. It will not be easy, it will cost money and a relatively long time, but it will probably be easier than building totally new factories, and it will be more productive than reading tweets the whole day.
From my understanding, on Italy the mortality rate of those that are hospitalized is 25%, however the mortality rate of those that are put on invasive ventilation goes over 95% (can't find the source), so for most it's basically a death sentence.
Yes, for example ~10000 people holding a degree in medicine were still awaiting to pass an abilitation exam which was removed today, allowing them to now work in the hospitals without it
A lot others already holding that certificaton were not working yet because positions in public hospitals where not accessible yet because of the turnover blocks put in place in the last decade while the government was trying to cut healthcare expenses.
there won't be any paperwork because there won't be any insurance. even your congress and senate realizes this by now. it's an unworkable proposition - you either bankrupt the 10-20% patients which require hospitalization or you bankrupt insurers. you're in for a revolution in healthcare.
Congress just had to add a ton of exemptions to a bill to guarantee paid sick leave for CORVID, making it meaningless for a vast majority of americans, because of republican pushback. Never underestimate the greed and corruption baked into the influence channels in the USA.
The problem with the House bill is that it puts employers on the hook for making the payments.
You’re just ushering small businesses faster off the cliff of insolvency if you legally require them to pay workers while they are also legally required to be shut down.
If the government is forcing a company to shut its doors, the government should be prepared to pay the employees “quarantine leave”.
The majority of patients who will require hospital care are already Medicare beneficiaries. And for many others, the insurers don't really bear any financial risk because they just process claims and pass the costs on to group buyers.
Mostly by fast tracking newly graduated, who normally have to attend a 2 to 6 year long specialty school. This would amount to around 10 000 new hires, according to the Ministry of University.
> but I am not sure that's true, in Italy they are building hospital wings or re-adapting abandoned hospitals in many places. Rome has 4 planned covid hospitals as of now.
True. But those are being done after the fact. It's too late already for Italy. By comparison, the U.S. still has time now before the curve shot straight up to the max - then no amount of measures are going to be able to keep up with the viral infection rate (and death counts)
The US, like most other countries, is only a couple of days behind Italy.
Italy had 100 total cases only ~20 days ago.
The problem with this virus is that it goes from 1 case to hell in only a couple of weeks. If you already have 100 confirmed cases, it's too late to stop what's coming.
As a follow-up to this message, we're now 9 days later and New York is overwhelmed, predicted to run out of intensive-care beds tomorrow, with other states quickly following.
Unfortunately not where it matters most, that is in Lombardia (where I live, and the hardest-hit of all regions). In fact the regional government took the matter into its own hands to attempt to convert a number of buildings in an old exposition area (not the 2015 expo area, FTR) into places to treat patients (there are still many "ifs" to see whether this will get done or not, though).
My government told us today that they have excess capacity and will not run out. They have been preparing for this crisis for “over a month now”
In fact, they are still going ahead with cutting doctors pay in the midst of it all. Maybe we deserve it for electing a nut job who only cares about budgets (Alberta)
The United States waived requirements for inspection for new hospital beds (thus allowing hospitals to increase bed count) and has ordered more ventilators and other equipment.
We know that sufficiently strong social distancing - and universal mask use - can reduce Re below 1, causing the epidemic to shrink exponentially instead of growing exponentially. Once it is small enough, good testing and contact tracing should be able to contribute a significant reduction to Re, so that you can back off on more costly measures.
As hard as it sounds for the economy to adapt to extreme social distancing for a short time and moderate for a long time, it seems like a better bet to me than trying to increase intensive care capacity - which already consumes a nontrivial fraction of gdp - by orders of magnitude and write off millions of lives.
So what are you going to do when the virus is gone in your city/state/country, isolate yourself from the rest of the world? Because the timeline/situation will be different for many other places.
Return to travel restrictions + contact tracing, and if community spread flares up again, reinstitute social distancing. Repeat until vaccine is developed.
It's also very normal for viruses to become more mild over time.
We strongly react to strong threats. It's in the viruses interest to become a weaker threat like the common cold so we tolerate it instead of actively fighting it.
They can also become much more deadly. The first pass of the 1918 pandemic was not nearly so bad as the second, which slaughtered millions of people in their 20s and 30s.
True. But I have heard that that was because, among all the soldiers in the trenches, it could be virulent and still be able to spread effectively, so it had no selection pressure to not be virulent.
Covid is a bit different, because it has a longer incubation time, but that wasn't the issue with the 1918 influenza outbreak.
That's a much rarer course and seems to be related to the conditions of WW1. Under normal circumstances, people with mild illnesses are out and about and able to spread the virus, while people with severe illnesses are confined to a bed or hospital and tend to result in an evolutionary dead end. As a result, the descendants of mild cases outcompete the descendants of severe cases, and eventually natural selection results in the dominant strains of the virus all being mild.
With the 1918 flu pandemic, mild cases of flu remained with their unit, while extremely sick cases were transported home via train for improved medical care. As a result, it was the severe cases that ended up sparking new infections, while the mild cases died out after generating herd immunity within an army company.
Most respiratory viruses follow the first scenario, although there is a caution there for people who suggest eg. transporting sick people by airliner to regions with fewer cases to make better use of available hospital capacity. Ironically asymptomatic transmission is your best friend here: if all transmission is asymptomatic, the strains that get transmitted will be the ones more likely to not cause symptoms.
I'm not sure why you're downvoted. That is exactly the right approach. Implement serious social distancing measures to reduce R0 below 1, get local outbreak under control, and then work on keeping it contained, increasing measures when necessary. Once it's more established which countries are effectively controlling the virus, travel could be more open with those countries, and more restricted with those that still have active outbreaks. (Which doesn't necessarily mean cutting off completely, but perhaps only essential travel and cargo, or unrestricted but 14 day isolation on arrival.)
Interestingly, that comment started out as +3 and is down to -2 now.
I think it may be a good harbinger of the public's willingness to endure repeated, long-term changes to their behavior. The way I see this going, we're going to get lockdowns in most countries within the next week or so. After 6 weeks or so, new cases will be negligible, and we'll declare victory and pick up our lives. The virus will silently spread from a few undetected cases during the summer, but then take off again around October, when we get a second wave. Assuming it hasn't mutated to become significantly less deadly (pretty likely - see sibling threads), that will be the real killer, because instead of starting from 1 index case in 1 city it'll be seeded from tens of thousands of sleeper cases across the globe. Public opinion won't support a second lockdown then - people will just be left to die with their families.
If you wrote the comment you can always see the score (0 now, FWIW). At least I've always been able to; hidden comment scores arrived a while after I'd already amassed a pretty high karma level.
I would like to think that we would keep expanding testing infrastructure during the reprieve, and so wouldn't be caught off guard. For the most part the people running large scale public health policy are smart and well informed, so this risk won't be unknown.
Or more, since this amount of people die only when sufficient care is available. If you interpret the "requires hospitalization" percentage as "will die without hospitalization" (which I'm not 100 % sure is true), as many as 15 or 20 % people can die.
15-20% don't require hospitalization. More were hospitalized to be monitored, but only about 40/705 infected from the Diamond Princess ever progressed to serious condition. And the population of cruise ships skews older.
Even if the whole world was in sync, you more or less have to hold Re below 1 forever or accept that 1-1/Re of everyone gets the virus. That's basically a tautology. But Re can be affected a lot by testing and tracing when the infected population is tiny compared to your resources, and not so much when it is huge. Re could also be affected a lot if we had a vaccine, which will probably take years in the current regulatory regime but is something that might actually benefit from disparate international approaches.
It wouldn't be crazy to ask international travelers to pay the marginal cost of extra testing and/or the negative externality of spreading the virus between worse and better controlled regions.
Don't think y our 1-1/R0 rate makes sense (I assume Re is equivalent to R0 - I'm not familiar with Re). At an R0 of 1, each person spreads to one other person. So everyone would eventually be infected, just at a linear rate. Your formula though gives 1-1/1 = 0. Similarly for an R0 less than 1 your formula goes negative.
Anyway, if R0 can be brought below 1, it wouldn't need to be indefinite. The further below 1 it is, the faster the virus will extinguish itself. This was seen in China, where they went from exponential growth to fewer new cases each day and ultimately to the situation now where most new cases are imported from other countries.
You also don't need global coordination, although it helps. Any individual country can restrict outside travel from outbreak areas, get their own R0 below 1 via social distancing to eliminate the local outbreak, and then relax social distancing locally, relying on travel restrictions and temporary quarantines of travelers from outbreak areas, plus testing and contact tracing. If cases start to flare up again, increased social distancing measures can be brought in to get them back under control.
So in theory you could do extreme distancing for a period on the order of a few months, and then normalize somewhat. It would take a global response of that sort (unlikely), a vaccine, or a change in the virus itself though to end the situation entirely.
At an R0 of 2, with no interventions, eventually half the population has had the virus and (hopefully) gained immunity. Now each person only spreads it to 1 other person, because the other person they would have infected is immune. (If R0 was 1, the epidemic would end as soon as the next person in the chain is immune.) This is where the people saying that the virus will definitely eventually infect 70% of everyone are coming from.
Re is effective spread rate, taking into account natural immunity, vaccination, contact tracing, etc. By definition, if Re>1 the epidemic is growing exponentially and if less it is shrinking.
That is exactly what is happening in Malaysia and Taiwan right now. Both countries have it under control up until a couple days ago but every other country around the world is not doing well and new outbreaks are happening (returning travelers, religious gatherings). Malaysia just announced total ban of incoming and outgoing traveling for the next 2 weeks.
Exactly. I find it strange how otherwise highly creative and open-minded people don't see this. Based on other country's experiences you could get this reasonably under control with some rather draconian measures (that might cost 1%+ of GDP to hold), but far less than total shut-down. examples:
1. Remove all testing bottlenecks.
2. Mandate face mask usage in all public settings.
3. Maintain massive queryable databases of cell phone location data for everyone. Goal is to easily find all potentially infected people if you identify a new case.
4. Keep mass gatherings (sports, conferences) closed due to difficulty contact tracing. (until number is really down)
Note that because so many countries screwed up already, a short term lockdown is necessary. But the above is how you handle life after
I don't think people are rejecting those ideas so much as ignoring them for the moment. It's too late for planning, we need a solution now, and mass para-quarantine is really the only tool that can be deployed.
By all means let's investigate other options once the first wave is under control. But right now the first wave is growing out of control in basically every western democracy.
#StayHome now, then work on a better plan. Make it work first before you make it work fast, basically.
Of those, only the third is likely. There is some hope still that the transmission rate will drop over the summer. But realistically, the post-quarantine phase will be defined by careful monitoring, a bunch of still-extant rules, and the occasional surprise outbreak. And this will go on until either we all get it or until we all get a vaccine.
I think the focus is the same. Flattening the curve effectively means reducing the R0, and the steps being taken now could theoretically get it below 1.
Sounds like we will need the suggestion in this article just to ramp up mask production. And the willingness to make mask wearing mandatory by law. There are too many idiots out there who will not do it otherwise.
It's really unfortunate that the general population of the US has zero cultural familiarity with using masks to prevent the spread of disease. This really seems like the time to do everything possible in that regard, but we don't have the supplies.
In normal times, surgical masks are cheap. If we had the supply, we should be handing them out by the dozen to households in infected areas, at airports, etc.
This touches on another hobby horse of mine. Our society, both legally and as a matter of cultural habit, tends to prefer inaction to imperfect action. The fallacy, a sort of dual to the better known "We must do something, this is something, therefore we must do this", seems to be
1. Perfection is better than imperfection
2. All our options are imperfect
3. Therefore, we will do nothing
I am almost sure that our society, even without prior preparation, could physically produce huge numbers of "more effective than nothing" masks (especially for protecting others from the wearer, which is easier) very quickly at, say, 10x the cost (because you are recruiting less than ideal resources, like factory lines designed for other things that need extra labor) and 75% effectiveness (because you aren't applying the usual extremely strict standards that apply to NIOSH masks or whatever). Even if everyone taped a paper towel or sock over their face I bet it would reduce large droplet transmission by 50%. But we are not able to do so, because
1. These masks would cost more than masks used to cost ("price gouging!"). Imperfect.
2. They wouldn't work as perfectly as physically possible. Imperfect.
3. Some people would make money selling fake masks or whatever in the confusion. Imperfect.
4. We already made a bunch of regulations mandating perfection and no one wants to take responsibility for removing them
and maybe also
5. The people who should have stockpiled masks (edit: in the government or medical supply chain, I'm not saying individuals should have thought of this!) would have to admit their mistakes
So, "we" lie to people that masks are useless (charitably, so doctors can have more; uncharitably, because 5) and do nothing.
From where I'm sitting, it feels just as plausible that it had mostly hit far larger saturation than people realize. Such that, even if this works, it should have been done literally months ago.
My perspective is someone in Seattle that almost certainly had this a month ago
I'm hesitant to put this out there but selfish game theory would be to go out and get it now, before all ICU beds are filled so that if you need a bed you can still get one...
I suppose it might be possible to get 'ahead of the curve' by having a confirmed infected person sneeze directly in your face, but yeah, it would royally suck to end up needing an ICU in a week or two from now. Doesn't seem worth the risk.
> As hard as it sounds for the economy to adapt to extreme social distancing for a short time and moderate for a long time, it seems like a better bet to me than trying to increase intensive care capacity
The article is saying do both which makes sense. In the case of CV19, we don't need to build new state-of-the-art ICUs. We only need to prepare a temporary overflow capacity that can handle a relatively brief surge of a very particular (and largely similar) kind of patient which is a still-challenging but much more tractable problem.
Space - Large circus tent-like temporary buildings used for conventions can be erected in hospital parking lots in a day.
Beds - While $5,000 robo-beds are wonderful, CV19 patients needing hospitalization have pneumonia symptoms and need to be at a constant ~30% incline - so La-Z-Boy lounge chairs are actually a decent option.
Mechanical Ventilators - The U.S. has about 160,000 ventilators. The key here is to get them where they need to be when they are needed. The chances that CV19 surges will happen everywhere at once in an area as large as CONUS are essentially zero. In Italy, while Lombardy in the North was running out of ventilators, there were hospitals in the south with unused devices. 98k of our national 160k vents are mothballed older versions in storage. Preparing some portion of these for rapid deployment, such as positioning them in FedEx / UPS overnight hubs in the central U.S. can have them ready to be wherever a surge begins to build in less than 18 hours.
Ventilator Operators - Becoming certified to operate a ventilator usually requires six months and the next gap will be having enough qualified operators where and when they're needed. An experiment was already conducted where various medically-trained, but not vent-trained, people from RNs to pediatricians to veterinarians were run through 2 days of intensive vent training and tested for apprentice-level proficiency. The winners were the veterinarians, outperforming the other specialties in performance (go figure). The resulting model showed one certified vent op can supervise six apprentice-level ops who each handle X beds (I forget the exact numbers). But you get the idea and fortunately, we have a lot of vets in the U.S.
We still have some low-digit number of weeks before likely patient surges start cropping up in different areas. Neither spread-reduction nor surge capacity increases will work perfectly, but by pragmatically working both issues together it's likely we can avert many preventable deaths.
> The winners were the veterinarians, outperforming the other specialties in performance (go figure).
1) Veterinarians deal with animals, which aren't as domesticated, civilized, intellectual, ... in some sense. So as opposed to humans they will not understand the reason why they are undergoing treatment, nor have blind faith in this human they don't know. So when an animal experiences higher or lower levels of comfort it will be more "honest" in it's body language in response to the way it is handled, or what it is feeling physically during treatment. Also the veterinarian doesn't need to model abstract conscious thought of the subject, while with humans this is inevitable and can be distracting. Could this explain the higher performance of veterinarians? After treating cows, horses, dogs, cats, ... they view the human in a way as just another animal, and pay more attention to the intuitive body language than to abstract social cues?
>CV19 patients needing hospitalization have pneumonia symptoms and need to be at a constant ~30% incline
this is with heads up, or feet up?
I read a (news, not journal) article with pictures of the Italian patients on their belly, because it allows the mucous to flow from the finely branched areas to flow into the more accessible pathways, so the mucous would collect there where it was easier to remove.
2) IF hospitals get overrun locally, and people are left to their own devices, would it be possible to disinfect a plastic tube, attach a digital endoscopic camera, disinfect both, and introduce it oneself to suck out any accumulating puddles? what would be the maximum tolerable cross section to get it to the point of collecting the mucous?
3) instead of ventilation which is very hard to DIY because of volutrauma and barotrauma, could circulating air work? I envision a double tube brought deep into the common pathway (without obstructing passage of air for breathing, or alternatively a third tube to atmosphere), and simply introducing the same volume as air as being removed by the other tube, so a significant fraction of air will directly exit again through the second tube, but some of the air will mix with the local ambient air in the lungs before exiting through the second tube. i.e. the setup does not replace nor displace breathing, but simply circulates air. This might inadvertently cool the lungs, so there should be proper temperature control on the high flow rate air.
The viral growth is not the only exponential thing here, the costs of bringing down R0 are also highly non-linear, and it works both for and against us.
Against: it is going to be much more expensive to get R0 from 1.5 to 1 than from 4 to 3.5. A plausible assumption may be that a constant percentage reduction carries a fixed cost. Also: the more infected you have the more expensive it becomes.
For: As you said, once it's brought under control, cheaper measures that don't work at scale can be be used it to keep it from flaring up again [1]. That's what China is trying to do and so far it seems to work well. The whole herd immunity insanity seems to be predicated on the idea that social distancing does not work and the second wave will kill you later. But evidence so far suggests the opposite, although this may change.
In terms of war-style production: It seems criminally stupid that so far no Western country has embraced readily available trivial and ridiculously low cost means to significantly reduce spread. Like getting everyone to wear face masks, all the time. There seems to be excellent evidence it is very effective for bringing R0 down massively, both from academic studies on influenza[2] and SARS and also from circumstantial evidence like just comparing case growth between face mask using countries and non-using countries for the current outbreak[3]. Of course that requires actually producing a lot of face masks – but how hard can that be? As far as I am aware the current state is that even terrible face masks would help massively with preventing carriers from infecting others.
The cost per live is somewhere on the humanitarian end of the spectrum, but I think this argument is worth engaging with. If there is any realistic chance of eradicating covid-19 rather than just mitigating it, clearly is is what we must do and will pay enormous dividends even in the fairly short term.
Getting Re below 1 seems like the right approach, but I really hope that we can do this through extensive testing and travel restrictions. This way anyone who gets any illness and can be tested immediately, tell their friends to get tested, and isolate themselves. Meanwhile the rest of society can function more or less normally, even if they have to watch sports on TV instead of live, and after a sick individuals recover they can be retested and rejoin society again. This seems so much better to me having everyone spend 18 months in moderate isolation until a vaccine is approved.
At least summer is coming and it's substantially safer to be with people outside.
I am not sure I agree with the thrust of this article. The gist seems to be: if we do a sufficiently good job with containment measures (e.g. social distancing), we might succeed in limiting short-term infections, but we will have to remain in this mode for years (with ruinous effects on the economy). The offered alternative is to acknowledge that a significant fraction of the population will be infected eventually, and so we should scale up hospital capacity to accommodate that.
This doesn't seem like a very good alternative. Even with adequate hospital care, the true fatality rate seems to be in the neighborhood of 0.5% to 1%, which would be quite harsh if allowed to spread throughout the population.
I am hoping that improvements in treatment can make the difference. A vaccine may not be available for quite some time, but drugs that reduce the fatality rate might be ready sooner.
Of course the actual course of action must include some mix of all-of-the-above: containment, new hospitals, new treatments.
EDIT: as voidmain notes, we might also hope to quickly reduce the number of infections to the point where we can contain them with testing and contact tracing, rather than blanket shutdowns.
Drugs (a few of them are in Phase III and trials are already ongoing, with some results expected next month) will likely help first. If you can treat the severely sick patients, and even just cut one week out of the 3-4 they need to spend in the hospital, it would be a huge success. In fact I'd argue that most of the problems we are facing are because there is no appropriate treatment.
Vaccines will likely take more time, due to long-term effects that need to be investigated (as many mentioned in some other HN story today).
I've upvoted because the article encourages proactive thinking so that we don't just sit in our homes congratulating ourselves how well we socially distanced from each other. What is sadly missing is some back-of-the-napkin math estimating the required capacity increase. Like, is it closer to x2 or x100? is it feasible at all? What is the damage to economy from doing this compared to lock-down for N months?
I believe that nobody really expects to meet the gap between actual capacity and "required" capacity, i.e. that it can't and won't get met - nonetheless, raising the capacity to save lives will save more lives; even if it's not sufficient.
It's worth noting that every early "flatten the curve" illustration example that I saw had the lower curve still above the capacity, just not nearly as much, however by the time it reached mass media, it had somehow morphed to the lower curve at or below capacity... probably because they thought it sells the idea better? but at the cost of misleading the public about what's feasible.
> I believe that nobody really expects to meet the gap between actual capacity and "required" capacity
Well, that's exactly my problem - I don't really know what kind of gap to expect. It is all very qualitative at this point but scenarios (and thus the best course of action) are wildly different depending on how exactly do the relevant quantities compare to each other. Of course "we don't know yet" is a perfectly valid answer but then it must be clearly stated in the article that this is just a speculation describing a plausible scenario.
I read some articles that did the math on that, but I can't easily find them now. IIRC it was an order of magnitude difference - i.e. flattening the curve enough to meet capacity would require to stretch it out to something 10 years (certainly an unreasonable goal), so flattening it out over a single year would be something like 10 times over the current capacity. It's hard to estimate how much reasonable actions can increase capacity - 20%? 50%? 100%? But nowhere close to 10x increase.
Again, irrelevant. Capacity increase is lives saved. Flattening the curve is a multiplier on that, and is thus also lives saved. "Enough" doesn't matter as much as the fact that "more" scales linearly. Every bed of capacity you add is at least one life saved, even if you never get close to enough.
One variable that is still not known and would make a huge difference is how many people are asymptomatic and with that catch this and have no symptoms. That effects infection rates and also getting a better grasp upon how many recovered as well as infected.
Not just a case of testing those for infection, that cat left the bag in every country on that end. Need to also test for those who are now immune without being aware.
Otherwise may well see spreads more than expected due to these people spreading the virus when they have no symptoms and also prevent paralysation of those who are immune, isolating when they don't even know they had it already.
So knowing that variable will become key in tackling this and currently we have no idea upon that.
There have been a couple of population studies to try to measure asymptomatic infections. It appears that about 50%+ of people are symptomatic, so unfortunately significant percentages of people are going to need hospitalization.
That article was heavily flagged because it has a bad title and a pessimistic message, but it was the first article that I saw with an approximate calculation of the size of the problem.
Thanks. Although the author is not an expert and he kind of lost me when he used normal distribution to model the curve, it still looks like the right ballpark. That's a lot.
He could have replaced the normal distribution by any other roundly curve and the result doesn't change too much. For example with the SRI model you don't get a Gaussian https://simple.wikipedia.org/wiki/SIR_model , but the graphic is close enough. It's less peaky than the Gaussian so it should make things easier, but the reduction probably will be a small factor, something between 1 and 2.
"Second, flattening the curve assumes that you actually don’t go too far and that much of the population actually becomes infected and then immune. Immunity from Covid-19 is still an open scientific question but, let’s assume that is more likely to be true than not. If you reduce the infection rate too far, then most of the population does not become infected and that means that once you stop policies such as social distancing the virus can emerge once more and we all have to do this again."
So timing of such measures important and too early can be more damaging than too late, overall.
Guess more eye's will be upon the UK now after reading this.
And the NL. Seems that Rutte (NL prime minister) is betting the farm on herd immunization and minimizing economic disruption while letting the virus spread “under control”.
If it sounds a lot like the Chernobyl script it’s because it is.
They are going for managed infection of those who need medical intervention with the majority not needing such intervention.
Ergo, managing capacity in a way that is mindful that winter 20/21 will come around faster than we realise. After all the West has just entered spring, so 6 months from now we are in Autumn and the seasonal impacts like normal flu etc start to traction up again.
May well be a case sadly to say that every extra death now, will mean two or more less deaths in the comming winter. Sadly it may well get right down to that uncomfortable truth. Hard to say and honestly, not sure how anybody could articulate that without upsetting anybody in some way, shape or form. But that does seem to be the jist of it.
The logic of the UK position is well articulated in this very HN-friendly article by a UK epidemiologist unaffiliated with the govt scientific advice team [complete with graphs, the Python code of his illustratory models and an appropriate caveat about the magnitude of the uncertainties of the assumptions the scientific advisory team's models will have made]
> The reason that this happens is that social distancing measures do not lead to herd immunity, so once they are lifted the epidemic starts again. In the absence of a vaccine, it is therefore meaningless to speak about whether a policy 'aims' to get herd immunity or not, since every country in the world will reach herd immunity unless it is able to implement social distancing for an indefinite period of time.
i predict this is exactly what will happen: indefinite social distancing. impact may be reduced with fast tests and large scale testing so isolation and contact quarantining is immediate.
It's plausible that COVID-19 will lead to behavioural change around hygiene and remote work, greater travel restrictions and possibly even a degree of acceptance of periodic lockdowns, but the idea humanity as a whole is going to permanently shift towards social distancing after millennia of doing the opposite stretches credulity. At risk groups moving towards social distancing, maybe [for some old people that won't even be much of a change], but that's where the theoretical possibility of herd immunity of the general population not in permanent isolation comes into play.
indefinite does not mean infinite. effectively until a vaccine is deployed globally or global herd immunity is achieved after ten years of pandemic or however long it takes.
One of the few things epidemiologists can be certain of in their assumptions is that our economy and society won't sustain indefinite lockdowns. Extended localised lockdowns, until R0 drops below 1, yes. Repeated localized lockdowns, maybe but decreasingly so. Let's wait until we have a vaccine or something, no.
I agree completely, that’s what I had in mind, but wasn’t really precise enough - basically whatever’s South Korea doing right now. Access to testing, test all suspected cases, quarantine and isolate, and the economy can sort of be back to pre-pandemic order of magnitude.
I really don't like the cavalier attitude with which this author treats the open question of Coronavirus immunity. "Let's assume it's more likely than not going to generate immunity" (paraphrased) seems unfair, and that a fair treatment would simply consider both alternatives.
Do you have links to solid evidence? I saw an article from an expert (I'm blanking on the specific article right now) that other "cov" viruses are known to have a limited immunity that lasts for possibly several weeks or so.
I wouldn't bet on "solid" evidence for a while. Hang around the /r/covid19 subreddit for the latest data. There have been very few reported cases of someone getting it again and of those a lot of evidence points to relapse rather than reinfection.
Given the large # of cases and their high concentrations in specific places, it seems likely that we would see many cases of reinfection if previous patients weren't immune.
I've been wondering about the military being asked to take over in the US for a while. We don't seem to have our Churchill to replace the dollar store Chamberlain.
1. In a world where both major parties come together to immediately make him President, I imagine he would be willing to resign his Senate seat.
2. Do you have a citation on Senators being unable to serve as Speaker of the House? It certainly makes sense, and I've seen references about senators not holding roles in other branches concurrently (e.g. executive or judicial), but nothing definitive on senators holding house officer roles.
It's conceivable (not likely or easy) that the Senate could under some circumstances vote to remove Pence and Trump, but it is absolutely not conceivable that they would do both so close together that whichever they did second would be unable to appoint a new VP before being removed. It's also not conceivable that the democrat majority House would ever appoint Romney as speaker.
What I am still trying to understand is if we get variations of the flu virus every year so dramatic that sometimes they guess on the vaccine completely wrong (like this year) then why aren't we going to have a Covid-19 variant this winter that everyone can catch again?
Apparently 30% of cases of the common cold are cause by coronavirus. And the worrying thing is that the immunity we acquire for those is only temporary.
At this point, I think it's just appropriate to say "we don't know yet". This is a new virus, and not much is known about it yet.
And that is why drug development needs to go parallel with a vaccine. If a vaccine fails, we can fall back to drugs to prevent people from going into ICUs (hopefully).
Also... I hesitate to say this because it smells of ad hominem, but in this view the enormous cost of extreme shutdowns is mostly the cost of a mulligan for poor decision making and actions early in the crisis. This may make this view less popular with the various organizations that made those mistakes.
This isn't a mulligan, that's the trouble. Previous contact tracing efforts had the advantage that we knew where the initial cases were coming from - China, primarily Wuhan - and could use that as a starting point. Those failed in most countries. After shrinking the epidemic down, the initial cases are basically just random people who have what looks like a cold. It'd be like searching for a few needles in a massive haystack.
South Korea did just fine, they managed to prevent the exponential curve so far. In the USA, the government just fucked up and did nothing, even actively engaged in disinformation.
I think that approach is exactly why contact tracing didn't work. A virus that spreads as contagiously and stealthily as this one means that contract tracing alone is not able to achieve Re<1. Eventually (in the case of Washington state, apparently with the first known case?) someone escapes your net and then exponential growth does its magic, because you aren't decreasing Re for anyone not already in your contact graph. (CDC refused to test anyone without a clearly documented link to Wuhan)
A working version of this that actually affects the asymptotics rather than just buying you a few weeks at best has to be able to identify new case clusters while they are small, and then find and isolate a significant fraction of the cases (working backward as well as forward). Table stakes for this is the ability to test everyone with flulike symptoms who tests negative for flu (and flu tests have horrible sensitivity, so that is a lot of people). As I see it from my comfortable armchair, CDC should have made sure long before the epidemic that the RT-PCR capacity to do that existed (doing other work at private and public labs) and could be recruited and online to do this within a few days of the virus being sequenced. You also would need everyone to at least moderately change their behavior because I don't think this would be enough by itself. Simple things like not going to work sick or tolerating co-workers or employees who do seem like feasible changes with both cultural and legal levers to pull that could be very low cost and contribute significantly to Re reduction.
More speculatively, you might be able to do even better using pooled PCR tests to look for RNA in large groups, giving you a chance to spot even asymptomatic cases. Is there viral rna in sewer water or garbage? PCR amplifies exponentially, it should be able to cope with a fair amount of dilution.
It's not as easy as adding more beds. Each ICU unit has to have specific amount of staff around it, resource, which cannot be easily increased by planned economy.
There are workarounds and corners to cut, like making last year students into doctors without exams, moving doctors from other specialities to intensive care. But it's not exactly the same.
Its not as good as a doctors or even an RN degree, but I wonder could a crash course for health care workers tailored specifically to the symptoms of this disease be sufficient to fill that gap?
>There are nuances when it comes to ICUs and ventilators, etc. But the bottom line is: Even in optimistic flattening the curve scenarios, the curve cannot flatten enough.
This always felt intuitively true given exponential growth - realistically flatten the curve was more platitude than practical, an desperate appeal by media in democratic countries to position a "civilized" solution in order to avoid mass panic and draconian measures. Now they're elevating Korea as the exemplar response model when the country is practically an island like Taiwan, Singapore, Hong Kong. It's simply not applicable to geographic realities of most countries where borders can't be simply shut and where a lack of infrastructure investment make the kind of techno-authoritarian solutions that made agile responses in those countries possible. Canada doesn't even have an official Corona dashboard, instead news media as to collate information from an updated table using data from archive.org, people paying in cash, nothing is getting wiped down, minimal mask use etc. If anything, countries without Asian Tiger advantages need to crack down harsher to make up for these deficiencies. No one is going to build enough triage hospitals and medical material to outpace any variant of this curve. No developed country is civilized enough to sacrifice this much for the greater good. This is a stick, not carrot and certainly not rhetoric situation. If Corona is as bad as the numbers project, flatten the curve is going to kill a lot of people in retrospect because politicians can't stomach "lock it down".
Incrementally flattening the curve does save incrementally many lives. It’s taken hold over “lock it down” because it rings better and is factual. You can accomplish something individually by staying inside instead of being fatalistic because nobody else will do it, and it isn’t just a platitude .
Incremental is not a proportional response to exponential. Compared to a lock down, you're not saving incrementally more lives but allowing for exponentially more death. The only rationale for it is to slowly acclimatize the population to embrace more drastic action, i.e. panic management. Even stringent, well organized quarantines in Chinese provinces with less infection is running 6+ weeks with full compliance. Partial compliance means those who adhere will be stuck inside for a long time, it's not tenable even assuming the curve can be flattened in a sensible time frame in first place, which I don't believe it is. Basically we're dragging past the point where shutdown is a viable option with half measures, which will only leave to excess fatalities. Obviously I'm not an expert and hope I'm wrong.
If the system is out of ventilators and you keep from infecting a person who’d need a ventilator, that’s one death prevented. If everybody is going to catch it, you want to maximize ventilator-hours, i.e. delay as much as possible or flatten the curve. This makes it beneficial conduct to avoid social contact whether other people are doing it or not.
These approval processes are there for a reason though. If you are going to inject some pathogen to millions of people, you better be sure that it has no strong, even long term, undesirable effect.
It's not so much the injections, but just allowing the development of alternative processes that may scale much faster than the 70 year old egg-based process.
When we look back in retrospective, the CDC and FDA will be under scrutiny to take more preventative measures.
It'll be interesting to see how Italy (lockdown) compares with the UK (just let it infect everyone) compares with South Korea (extensive testing & contact tracing, plus social distancing) in a couple months.
My sense is that the UK will probably fold and institute a lockdown once their ICU capacity gets overwhelmed and healthy young people start dying in the streets. Either that or they'll face a revolution and then have a lot more problems. Of course, by the time it gets to either of those points it'll be too late to effectively change course.
But it's interesting to see at least one country take the position that "Hey, we're going to let this run its course, take our lumps now, and try to get back to business as usual ASAP." I could be wrong, and maybe this is a genius application of heartless logic. Time will tell.
>My sense is that the UK will probably fold and institute a lockdown once their ICU capacity gets overwhelmed and healthy young people start dying in the streets. Either that or they'll face a revolution and then have a lot more problems. Of course, by the time it gets to either of those points it'll be too late to effectively change course.
>My sense is that the UK will probably fold and institute a lockdown once their ICU capacity gets overwhelmed and healthy young people start dying in the streets. Either that or they'll face a revolution and then have a lot more problems. Of course, by the time it gets to either of those points it'll be too late to effectively change course.
> Looks like that's already happening
Is UK ICU capacity overwhelmed and are young people dying in the streets?
that article is pure gold, if it was the onion i wouldn't be able to tell.
> "We were expecting herd immunity to build. We now realise it’s not possible to cope with that," professor Azra Ghani, chair of infectious diseases epidemiology at Imperial, told journalists at a briefing on Monday night.
i can multiply numbers fifteen times in a row and come to that conclusion. alternatively, i can watch italian tv. did these people never looked up from their models to confront them with actual reality?
How long did it take them to no longer expect herd immunity to build? 12 hours? That must be one of the most ridiculous acts of about-face in public policy in this generation.
That's not even close to true, schools, restaurants, pubs and sporting establishments are shut down. Events with 100 or more people attending are not allowed and the government is actively working to help companies deal with less productivity due to people working from home or in staggered shifts. They also recommend social distancing. This is not "Hey, we're going to let this run its course, take our lumps now, and try to get back to business as usual ASAP." as the grandparent mentioned.
>"Hey, we're going to let this run its course, take our lumps now, and try to get back to business as usual ASAP." I could be wrong, and maybe this is a genius application of heartless logic
Related, if we take the numbers out of China at face value: A tiny tiny fraction of the population has been infected (acquired immunity). So what now? Lock everything down until a vaccine is discovered?
Basically, masks in public, no-contact thermometers everywhere, and QR codes that you scan to enter a subway or a building. There's more, but that's the core.
There, they determine if you've been infected. If you have been, they send you to a group isolation ward, where you spend a few weeks chilling out and doing group dance exercises. If can't stand up and dance, you get treatment.
It's clearly a society at war, and I'm sure some ugly details are hidden. But it looks better than hiding indoors while our medical system burns and our elderly relatives die (and at least some of us younger folk wind up with scarred lungs).
AFAIK the UK line has consistently been "we'll do it, but not yet, because we can only do it for a limited time and so far the numbers don't warrant it". That's not a U-turn, that's doing pretty much what you said you were going to do.
The always said they thought the peak was 10-14 weeks away and that the UK was about 4 weeks behind Italy. They now say that the UK is about 3 weeks behind italy and we are at the beginning of the dramatic up-swing so, time to apply the brakes.
It might already be too late for UK. Italy missed the mark by a week and it's a disaster in parts of the country. I'm from Slovenia and we implemented a total shutdown of public life. Now we are now waiting to see if it'll work. We went from 1 confirmed case to a shutdown in 10 days. And it's far from guaranteed that shutdown will work as it might be a few days too late.
Uk tactic looks very sensible to me. They will institute a lockdown long before that. But they recognize a lockdown for a prolonged time is very challenging in itself and there aren't many good reasons to be doing it too early.
You can't really do that. If you think of this in terms of the control over the virus being a Proportion-Integral-Derivative type system, then given how long it takes to gather more information about the current infection level in the populace you're either going to overshoot after the corner(too little pressure applied) or undershoot(too much pressure applied) after the corner. You can't apply perfect control to this kind of system such that the corner is perfectly square.
Especially where our knowledge is imperfect and subject to a lot of latency, we have to accept that we have very little actual control over how quickly the curve speeds or slows. Thus the bell-shaped curves.
That's... completely insane. There "aren't many reasons to be doing it too early"? Stopping, or at least slowing the spread of a worldwide pandemic isn't a good reason? Preventing 3% of your population from dying over the next year isn't a good reason?
Waiting until the problem obviously seems like a real problem is exactly what crushed cultures under epidemics in the past.
The UK strategy is based on the idea that the pandemic cannot be stopped, but can be slowed down and directed away from the most vulnerable. So there are certain assumptions there that people can agree or disagree with. But its not 'completely insane'.
And yes South Korea and China seem to have stopped the pandemic in their countries, and have done an impressive job at it, but its early days and not at all clear how sustainable their approach is, or whether that approach would work everywhere.
It is too late for stopping it and you can barely delay it either.
You delay a few days or maybe 1-2 weeks if stringent but it won't be as effective when you desperately need it to be. Likely more will die if you start too early.
Yeah, the pragmatic mindset might as well calculate the savings on pensions from deceased elderly. I personally find this unacceptable. More should have been done earlier and it didn’t happen. We’ll see how this affects the next elections though..
Was out tonight going to supermarket, the social distancing isn't enforced. I still saw half full pubs. Bare in mind it's Monday, if nothing changes expect full pubs and business as usual coma Friday. Nothing has changed.
So far number of cases has been multiplying by 10 every ~16 days. Incubation period is 4-14 days. I.e. when you institute quarantine, cases will still multiply like crazy for another 4-14 days. In other words, you have to do it "too early". If you do it when you're nearing ICU capacity, you are waaaay too late.
25 to 35% growth rates seem like the norm withiut (or nearly withiut) any restrictions and nearly no public awareness. That a full lockdown quickly stops the spread is obvious, but it will be interesting to see how well the UK/Swedish model works with. strict social distancing but without lickdowns or even shutdowns of e.g restaurants.
Our math might need some correction. The statistics I was citing is daily contamination rate of 15-25%, and multiplication by 10 every 16 days (which comes out to a daily contamination rate of 15%). A daily rate of 25% gives you multiplication by 10 every 10.5 days.
> My sense is that the UK will probably fold and institute a lockdown
They (we) have already shifted towards a lockdown (voluntary for now, but people have been told to avoid office, pubs and travelling[0]) due to the model used being updated with the data from Italy.
A couple of teleconferences with Italian doctors was what spooked Norwegian authorities to institute wartime measures while we still had only 200 confirmed cases. Glad the rest of the world seems to follow.
I'm pretty confused by the European government's responses. While the UK is the most brazen, all others are essentially also saying that there's no other way other than letting a non-negligible percentage of the population die, and that the best they can do is try to ensure that everyone who needs an ICU gets one. And all the while incurring a massive economic cost. Italy, France, Switzerland and Austria have effectively halted most of the economic activity, initially for 2 weeks to a month, but it's likely that it's either going to be longer, or that they'll have to repeat the process. That's 100s of billions of dollars gone just there, not counting for the long-term impact and all the social problems that'll follow. I'm puzzled that the idle workforce and the lost money isn't diverted to urgent and massive scaling of testing and protection equipment.
Of course, all it takes is a UK to screw everyone over by not playing along and providing a population pool for the virus to mutate. And then a ton of poor countries who probably can't do anything even if they wanted, where it's just starting.
Add Norway and Denmark to the list of countries that have halted large part of their economic activity.
Honestly, I think the UK, Sweden et al. will be "voted out" here. Commerce can't continue between countries that follow the China/South Korea model of keeping R0 < 1, because frequent large outbreaks are bound to follow. Britain can't economically dominate its neighbors like that today. Sweden, forget about it.
This is a spectacular high-stakes experiment. But if Boris Johnson isn't persuaded by public opinion and a high death toll, his trading partners will.
Both approaches put strong selection pressure on the virus to mutate to a milder form, so even in the absence of a vaccine, we'll win in the long term.
> there's no other way other than letting a non-negligible percentage of the population die.
That's not what is being said. What is being said is that specifically to avoid people dying, you need to stop ICUs being overwhelmed, but that in their judgement and modelling an immediate hard clamp down is not the best way.
If U.K. goes it alone they will be out of sync with the rest of the world in terms of travel restrictions. No one will be going in or out of U.K. until everywhere else has caught up to their herd immunity or we have a vaccine. Not sure how this lack of travel affects their economy.
is completely false. It was hyped by some out of context quotes by some media outlets and spread like a literal virus and people didn't bother to find out the reality, and so we see the same mis information being shared here.
We need to flatten the curve of these misinformation viruses
It's sort of weird to hear everyone talking about how social distancing is now the norm, when in the last few days up through today, there have been viral videos of massive crowds at airports, bars, and beaches. The governor of West Virginia just held a press conference encouraging people to go out to eat at restaurants. Several states are supposed to have democratic primary elections tomorrow. I didn't watch the debates, but apparently candidates were encouraging their supporters to go out and vote.
Telling the population to do social distancing and hoping they actually follow through is a fool's game. Several states have realized this and started taking measures into their own hands. This includes closing all resturaunts, schools and movie theaters. What they should do next is give the police P95 masks and disposable gloves and train them to use them. This would allow them to have the police drive around and distribute food to families that need it so they don't have to go to the store. They should also heavily incentivize all businesses to give their employees time paid off right now, or allow their employees to work from home.
It's up to the states to either postpone the elections or ramp up infrastructure to ensure they can be done safely (more polling places for no long lines, multi day elections to reduce the rush, lots of cleainging supplies with cleaning between votes, etc). But saying people shouldn't vote at all is antidemocratic. Why not shut down the national election as well and just give it to (candidate you dont like)?
I'm curious what happened / is happening in Japan.
Here in Tokyo it looks almost like business as usual. Some companies are letting people stay at home but most are not. While cities in the USA are banning gatherings of 100 or more, here in Tokyo every train ever 3 minutes during rush hour has 8 to 16 cars stuffed with 100+ people per car.
I have no idea what the actual infection rate here is or the ICU usage rate. 2 weeks ago Japan was considered the place to avoid. Now it's the USA and Europe. Japan hasn't seemed to have taken any drastic measures so far or maybe I'm just not paying attention.
what you're saying is extremely surprising. I'd love to have more infos on the situation in japan. Last time i read something about it, it seemed the japanese gvt wasn't very open on what they were doing.
AFAIK they are doing very little testing in Japan, so there is no problem that can be reported, the USA and UK as far as we can tell were copying that until the UK got called out on it after that PM press conference and the states got testing approved independently of the CDC test.
https://www.upi.com/Top_News/World-News/2020/03/10/Japanese-...
Not testing would still mean there should be an issue with lots of people dying from respiratory failure. If their infection rate is high even without testing I'd expect that issue to end up in the news.
Japan has strange numbers. The infection grows steadily at a rate of 10% per day, compared to 20% in most other countries. It doesn’t seem to slow down however.
Indeed, given what I remember of Tokyo's morning peak hour density in subway cars it would have gone ballistic or will yet. Although they do use routinely use masks even in normal times.
The cynical take is that aging demographic is one of the biggest problems facing Japan today and this is a way to deal with it.
Maybe it's the masks. Not by avoiding people catching it, but by reducing the spread to others. How tragically ironic it would be if the West has derided the most effective measure.
> The cynical take is that aging demographic is one of the biggest problems facing Japan today and this is a way to deal with it
The problem is aging population are people who 40 or 50 now, not people who are 70 and 80. The latter may die because of cv, but the problem of aging population goes nowhere because people in 40 or 50 will get older eventually.
The current 65+ bracket is already pretty heavy - heavier than Italy, the 40-50 bracket at the top of the inverted pyramid and will become a big problem couple of decades from now.
It threw me at first, but I think it is supposed to make this point: Although this kind of forced economic shift would feel very new for most of us, humans have managed it before. Specifically, and most recently, in WW2.
Singapore and HK are cities, really, and the Singapore approach, aggressive contact tracing with mandatory stay at home orders, doesn't scale.
Taiwan and Japan are outliers so far, and they are monocultures, with famous compliance rates.
Korea is somewhat similar to Japan, but took a hit early, and has managed to beat it back.
China appears to have peaked, but did this with massive application of governmental policies which would never fly in the West.
Flatten the curve doesn't change that a large number of people are going to get this disease. The best news is danger increases with age, unlike the Spanish Flu. Africa is very young (media age), the US and China are roughly the same, while the EU in general is older (Italy and Germany especially). What matters is not hospital beds per capita, but ICU beds per capita. The US does much better by that measure. You don't need an ICU bed to give oxygen, which is what most serious clinical cases require. MIT Sloan gave a prize last year for a less expensive, simpler ventilator designed for most cases in countries with limited resources. We have options that aren't explored yet.
I don't see why contact tracing doesn't scale. The only thing preventing Google and Apple from producing a contact history for everyone is privacy laws and people without phones.
Given that so many people are now staying home, working from home etc, I can't see how we can't slow the virus. Right now, I assume the people coming forward are those that have been possibly exposed a week ago before all the lock downs. I have hopes that this thing is thwarted quick, when the President (with info from the CDC) said this could last into July, I genuinely became worried about the state of the world after this. The state of the economy, I can't even say I'd have a job if it lasted that long.
This same argument process--that to "flatten the curve" in the way all the cutesy diagrams show isn't going to be sufficient to avoid chaos unless we maintain social distancing for years, and that we are deluding everyone into thinking this is "the solution" and that life is somehow going to go back to normal in a couple months (which is where most of the people I know--normal people, not all of my super paranoid friends ;P--are with their mental timelines) to the point where we are not concentrating any effort on anything else (to the point where believing "flattening the curve" is some panacea is maybe even a "dangerous delusion"), including capacity expansion and explicit tracing--was made by someone in an article on medium a few days ago. The prior article had the same little modified graphs showing the true problem, but had actual math to back up their back of the envelope calculations for why it will take years. FWIW, that article was shat on... hard... by people here on Hacker News, and was even flagged, because people even here are apparently so bought into the narrative that they take arguments that it isn't sufficient as somehow "so don't do it: social distancing is bad" (which is bullshit, and not what either of these arguments were/are saying). It is absolutely frustrating how much of an uphill battle it is to even get people to analyze this stuff quickly: we keep having to wait until things get notably worse and then we are willing to look at something only slightly more drastic. I have had friends making this same argument for like a month now and everyone just treats them as if they were literally insane or something :(.
I think you're conflating what the general public believes with what those in control believe.
It is in the public's best interest for the general public to only worry about what is within their control (so as to avoid panic). Therefore, the general public is being led to believe that all is going to be OK after a couple months of social distancing.
I guarantee you behind the scenes, those in control are scrambling to take immediate and drastic action to ramp up our medical treatment capacity.
...but I am an elected government official (for a hyper local government, though in a good position where I get to peak behind the curtain of the regional government above me) and the vast majority of my friends work in government; and when I present the argument about capacity expansion moving the line on that cute graph upward as a critical thing we should be doing in addition to moving the peak down and to the right using capacity expansion, the reaction was literally "huh, I hadn't thought about it that way before" :(.
This is something that I've been afraid of for a while. I know a few nurses that work in some of the most best staffed, well funded Magnet hospitals and they say they run at 90% capacity on the best of days.
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[ 4.2 ms ] story [ 327 ms ] threadAlso, the Italian government plans to hire a ton of medical and paramedical staff, money has been earmarked.
I am quite sure other governments are doing the same.
Where will this staff be coming from ? Are there medical professionals currently unemployed in Italy or working in other jobs ?
It’s insane. It’s trench warfare
Uh, psychologists have zero medical training or experience - maybe they could explain the patients their respiratory failure is a symptom of insecure attachment patterns.
If you mean psychiatrists, there aren't that many of them to move the needle.
https://youtu.be/7Iz5tWb9f8A [hoping the english subtitles work]
Look at the manufacturing ramp up that occurred during WWII for example.
"More than 60 manufacturers have been sent a blueprint for making up to 20,000 ventilators to treat coronavirus patients, “at speed”, as Boris Johnson called on British industry to help the government prepare for a surge in cases."
https://www.theguardian.com/business/2020/mar/16/vauxhall-ow...
I work for a very large global manufacturer w/ a presence in China, and does not produce medical equipment. My Chinese family told me (so take it w/ a grain of salt) they said 'Hey I heard your company is building ventilators to help out' and I said I don't know.
My gripe is why the other countries didn't do it too since we had more lead time. Infection rates are exponential...waiting too long to take action will cause more deaths.
Car factories, for example, could be retrofitted to fabricate ventilators. It will not be easy, it will cost money and a relatively long time, but it will probably be easier than building totally new factories, and it will be more productive than reading tweets the whole day.
https://www.reuters.com/article/us-health-coronavirus-draege...
If your country doesn't have a local manufacturer for these things, it seems you are kinda out of luck.
[ https://www.corriere.it/scuola/universita/20_marzo_13/corona... ]
A lot others already holding that certificaton were not working yet because positions in public hospitals where not accessible yet because of the turnover blocks put in place in the last decade while the government was trying to cut healthcare expenses.
I wonder how many clinic-hours we could add to our capacity by some kind of moratorium on that level of paperwork.
You’re just ushering small businesses faster off the cliff of insolvency if you legally require them to pay workers while they are also legally required to be shut down.
If the government is forcing a company to shut its doors, the government should be prepared to pay the employees “quarantine leave”.
True. But those are being done after the fact. It's too late already for Italy. By comparison, the U.S. still has time now before the curve shot straight up to the max - then no amount of measures are going to be able to keep up with the viral infection rate (and death counts)
How much time do you think there is? Until recently there have been very little testing, so we don't even know where the US is on the curve.
Even if we assume it's early, that's still just a couple of weeks if time.
Italy had 100 total cases only ~20 days ago.
The problem with this virus is that it goes from 1 case to hell in only a couple of weeks. If you already have 100 confirmed cases, it's too late to stop what's coming.
According to mathematical models the capacity of your hospitals will be exceeded by more than 30 times.
Give it another week or two.
https://www.imperial.ac.uk/media/imperial-college/medicine/s...
https://ourworldindata.org/coronavirus#trajectories-since-th...
Unfortunately not where it matters most, that is in Lombardia (where I live, and the hardest-hit of all regions). In fact the regional government took the matter into its own hands to attempt to convert a number of buildings in an old exposition area (not the 2015 expo area, FTR) into places to treat patients (there are still many "ifs" to see whether this will get done or not, though).
In fact, they are still going ahead with cutting doctors pay in the midst of it all. Maybe we deserve it for electing a nut job who only cares about budgets (Alberta)
As hard as it sounds for the economy to adapt to extreme social distancing for a short time and moderate for a long time, it seems like a better bet to me than trying to increase intensive care capacity - which already consumes a nontrivial fraction of gdp - by orders of magnitude and write off millions of lives.
We strongly react to strong threats. It's in the viruses interest to become a weaker threat like the common cold so we tolerate it instead of actively fighting it.
Covid is a bit different, because it has a longer incubation time, but that wasn't the issue with the 1918 influenza outbreak.
(Note well: I am not an epidemiologist.)
With the 1918 flu pandemic, mild cases of flu remained with their unit, while extremely sick cases were transported home via train for improved medical care. As a result, it was the severe cases that ended up sparking new infections, while the mild cases died out after generating herd immunity within an army company.
Most respiratory viruses follow the first scenario, although there is a caution there for people who suggest eg. transporting sick people by airliner to regions with fewer cases to make better use of available hospital capacity. Ironically asymptomatic transmission is your best friend here: if all transmission is asymptomatic, the strains that get transmitted will be the ones more likely to not cause symptoms.
I think it may be a good harbinger of the public's willingness to endure repeated, long-term changes to their behavior. The way I see this going, we're going to get lockdowns in most countries within the next week or so. After 6 weeks or so, new cases will be negligible, and we'll declare victory and pick up our lives. The virus will silently spread from a few undetected cases during the summer, but then take off again around October, when we get a second wave. Assuming it hasn't mutated to become significantly less deadly (pretty likely - see sibling threads), that will be the real killer, because instead of starting from 1 index case in 1 city it'll be seeded from tens of thousands of sleeper cases across the globe. Public opinion won't support a second lockdown then - people will just be left to die with their families.
Is there somewhere to check that score, or is it a higher karma feature?
Yes, that or have 2-4% of the infected population die...
It wouldn't be crazy to ask international travelers to pay the marginal cost of extra testing and/or the negative externality of spreading the virus between worse and better controlled regions.
Anyway, if R0 can be brought below 1, it wouldn't need to be indefinite. The further below 1 it is, the faster the virus will extinguish itself. This was seen in China, where they went from exponential growth to fewer new cases each day and ultimately to the situation now where most new cases are imported from other countries.
You also don't need global coordination, although it helps. Any individual country can restrict outside travel from outbreak areas, get their own R0 below 1 via social distancing to eliminate the local outbreak, and then relax social distancing locally, relying on travel restrictions and temporary quarantines of travelers from outbreak areas, plus testing and contact tracing. If cases start to flare up again, increased social distancing measures can be brought in to get them back under control.
So in theory you could do extreme distancing for a period on the order of a few months, and then normalize somewhat. It would take a global response of that sort (unlikely), a vaccine, or a change in the virus itself though to end the situation entirely.
Re is effective spread rate, taking into account natural immunity, vaccination, contact tracing, etc. By definition, if Re>1 the epidemic is growing exponentially and if less it is shrinking.
2) invest into medical research
3) hope you can manufacture something effective by the time the next wave hits
1. Remove all testing bottlenecks.
2. Mandate face mask usage in all public settings.
3. Maintain massive queryable databases of cell phone location data for everyone. Goal is to easily find all potentially infected people if you identify a new case.
4. Keep mass gatherings (sports, conferences) closed due to difficulty contact tracing. (until number is really down)
Note that because so many countries screwed up already, a short term lockdown is necessary. But the above is how you handle life after
By all means let's investigate other options once the first wave is under control. But right now the first wave is growing out of control in basically every western democracy.
#StayHome now, then work on a better plan. Make it work first before you make it work fast, basically.
After that, the virus may go away on its own, or it might mutate into a weaker form. Or we might have treatments on the way.
Masks production can be increased. But you need hundreds of millions a day of production and won't get there in a short period of time.
(I've been trying to simulate this, but ended up battling matplotlib unsuccessfully to create a graph.)
It's really unfortunate that the general population of the US has zero cultural familiarity with using masks to prevent the spread of disease. This really seems like the time to do everything possible in that regard, but we don't have the supplies.
In normal times, surgical masks are cheap. If we had the supply, we should be handing them out by the dozen to households in infected areas, at airports, etc.
1. Perfection is better than imperfection
2. All our options are imperfect
3. Therefore, we will do nothing
I am almost sure that our society, even without prior preparation, could physically produce huge numbers of "more effective than nothing" masks (especially for protecting others from the wearer, which is easier) very quickly at, say, 10x the cost (because you are recruiting less than ideal resources, like factory lines designed for other things that need extra labor) and 75% effectiveness (because you aren't applying the usual extremely strict standards that apply to NIOSH masks or whatever). Even if everyone taped a paper towel or sock over their face I bet it would reduce large droplet transmission by 50%. But we are not able to do so, because
1. These masks would cost more than masks used to cost ("price gouging!"). Imperfect.
2. They wouldn't work as perfectly as physically possible. Imperfect.
3. Some people would make money selling fake masks or whatever in the confusion. Imperfect.
4. We already made a bunch of regulations mandating perfection and no one wants to take responsibility for removing them
and maybe also
5. The people who should have stockpiled masks (edit: in the government or medical supply chain, I'm not saying individuals should have thought of this!) would have to admit their mistakes
So, "we" lie to people that masks are useless (charitably, so doctors can have more; uncharitably, because 5) and do nothing.
From where I'm sitting, it feels just as plausible that it had mostly hit far larger saturation than people realize. Such that, even if this works, it should have been done literally months ago.
My perspective is someone in Seattle that almost certainly had this a month ago
The article is saying do both which makes sense. In the case of CV19, we don't need to build new state-of-the-art ICUs. We only need to prepare a temporary overflow capacity that can handle a relatively brief surge of a very particular (and largely similar) kind of patient which is a still-challenging but much more tractable problem.
Space - Large circus tent-like temporary buildings used for conventions can be erected in hospital parking lots in a day.
Beds - While $5,000 robo-beds are wonderful, CV19 patients needing hospitalization have pneumonia symptoms and need to be at a constant ~30% incline - so La-Z-Boy lounge chairs are actually a decent option.
Mechanical Ventilators - The U.S. has about 160,000 ventilators. The key here is to get them where they need to be when they are needed. The chances that CV19 surges will happen everywhere at once in an area as large as CONUS are essentially zero. In Italy, while Lombardy in the North was running out of ventilators, there were hospitals in the south with unused devices. 98k of our national 160k vents are mothballed older versions in storage. Preparing some portion of these for rapid deployment, such as positioning them in FedEx / UPS overnight hubs in the central U.S. can have them ready to be wherever a surge begins to build in less than 18 hours.
Ventilator Operators - Becoming certified to operate a ventilator usually requires six months and the next gap will be having enough qualified operators where and when they're needed. An experiment was already conducted where various medically-trained, but not vent-trained, people from RNs to pediatricians to veterinarians were run through 2 days of intensive vent training and tested for apprentice-level proficiency. The winners were the veterinarians, outperforming the other specialties in performance (go figure). The resulting model showed one certified vent op can supervise six apprentice-level ops who each handle X beds (I forget the exact numbers). But you get the idea and fortunately, we have a lot of vets in the U.S.
We still have some low-digit number of weeks before likely patient surges start cropping up in different areas. Neither spread-reduction nor surge capacity increases will work perfectly, but by pragmatically working both issues together it's likely we can avert many preventable deaths.
> The winners were the veterinarians, outperforming the other specialties in performance (go figure).
1) Veterinarians deal with animals, which aren't as domesticated, civilized, intellectual, ... in some sense. So as opposed to humans they will not understand the reason why they are undergoing treatment, nor have blind faith in this human they don't know. So when an animal experiences higher or lower levels of comfort it will be more "honest" in it's body language in response to the way it is handled, or what it is feeling physically during treatment. Also the veterinarian doesn't need to model abstract conscious thought of the subject, while with humans this is inevitable and can be distracting. Could this explain the higher performance of veterinarians? After treating cows, horses, dogs, cats, ... they view the human in a way as just another animal, and pay more attention to the intuitive body language than to abstract social cues?
>CV19 patients needing hospitalization have pneumonia symptoms and need to be at a constant ~30% incline
this is with heads up, or feet up?
I read a (news, not journal) article with pictures of the Italian patients on their belly, because it allows the mucous to flow from the finely branched areas to flow into the more accessible pathways, so the mucous would collect there where it was easier to remove.
2) IF hospitals get overrun locally, and people are left to their own devices, would it be possible to disinfect a plastic tube, attach a digital endoscopic camera, disinfect both, and introduce it oneself to suck out any accumulating puddles? what would be the maximum tolerable cross section to get it to the point of collecting the mucous?
3) instead of ventilation which is very hard to DIY because of volutrauma and barotrauma, could circulating air work? I envision a double tube brought deep into the common pathway (without obstructing passage of air for breathing, or alternatively a third tube to atmosphere), and simply introducing the same volume as air as being removed by the other tube, so a significant fraction of air will directly exit again through the second tube, but some of the air will mix with the local ambient air in the lungs before exiting through the second tube. i.e. the setup does not replace nor displace breathing, but simply circulates air. This might inadvertently cool the lungs, so there should be proper temperature control on the high flow rate air.
The viral growth is not the only exponential thing here, the costs of bringing down R0 are also highly non-linear, and it works both for and against us.
Against: it is going to be much more expensive to get R0 from 1.5 to 1 than from 4 to 3.5. A plausible assumption may be that a constant percentage reduction carries a fixed cost. Also: the more infected you have the more expensive it becomes.
For: As you said, once it's brought under control, cheaper measures that don't work at scale can be be used it to keep it from flaring up again [1]. That's what China is trying to do and so far it seems to work well. The whole herd immunity insanity seems to be predicated on the idea that social distancing does not work and the second wave will kill you later. But evidence so far suggests the opposite, although this may change.
In terms of war-style production: It seems criminally stupid that so far no Western country has embraced readily available trivial and ridiculously low cost means to significantly reduce spread. Like getting everyone to wear face masks, all the time. There seems to be excellent evidence it is very effective for bringing R0 down massively, both from academic studies on influenza[2] and SARS and also from circumstantial evidence like just comparing case growth between face mask using countries and non-using countries for the current outbreak[3]. Of course that requires actually producing a lot of face masks – but how hard can that be? As far as I am aware the current state is that even terrible face masks would help massively with preventing carriers from infecting others.
[1] This argument is also made here:
https://arguablywrong.home.blog/2020/03/12/epidemiological-m...
The cost per live is somewhere on the humanitarian end of the spectrum, but I think this argument is worth engaging with. If there is any realistic chance of eradicating covid-19 rather than just mitigating it, clearly is is what we must do and will pay enormous dividends even in the fairly short term.
[2] e.g. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1539-6924....
[3] https://twitter.com/epsilon3141/status/1238838106440241152
At least summer is coming and it's substantially safer to be with people outside.
This doesn't seem like a very good alternative. Even with adequate hospital care, the true fatality rate seems to be in the neighborhood of 0.5% to 1%, which would be quite harsh if allowed to spread throughout the population.
I am hoping that improvements in treatment can make the difference. A vaccine may not be available for quite some time, but drugs that reduce the fatality rate might be ready sooner.
Of course the actual course of action must include some mix of all-of-the-above: containment, new hospitals, new treatments.
EDIT: as voidmain notes, we might also hope to quickly reduce the number of infections to the point where we can contain them with testing and contact tracing, rather than blanket shutdowns.
What's your basis for that? It seems like a vaccine will be available well before years have gone by.
Vaccines will likely take more time, due to long-term effects that need to be investigated (as many mentioned in some other HN story today).
It's worth noting that every early "flatten the curve" illustration example that I saw had the lower curve still above the capacity, just not nearly as much, however by the time it reached mass media, it had somehow morphed to the lower curve at or below capacity... probably because they thought it sells the idea better? but at the cost of misleading the public about what's feasible.
Well, that's exactly my problem - I don't really know what kind of gap to expect. It is all very qualitative at this point but scenarios (and thus the best course of action) are wildly different depending on how exactly do the relevant quantities compare to each other. Of course "we don't know yet" is a perfectly valid answer but then it must be clearly stated in the article that this is just a speculation describing a plausible scenario.
If we're talking about high casualty numbers, stretching it a year or two, while we wait for a vaccine _might_ be feasible.
Not just a case of testing those for infection, that cat left the bag in every country on that end. Need to also test for those who are now immune without being aware.
Otherwise may well see spreads more than expected due to these people spreading the virus when they have no symptoms and also prevent paralysation of those who are immune, isolating when they don't even know they had it already.
So knowing that variable will become key in tackling this and currently we have no idea upon that.
This study shows the number of symptomatic patients broken out by age group on the Diamond Princess which was a very well-studied population. https://www.medrxiv.org/content/10.1101/2020.03.04.20031104v...
That article was heavily flagged because it has a bad title and a pessimistic message, but it was the first article that I saw with an approximate calculation of the size of the problem.
So timing of such measures important and too early can be more damaging than too late, overall.
Guess more eye's will be upon the UK now after reading this.
If it sounds a lot like the Chernobyl script it’s because it is.
Ergo, managing capacity in a way that is mindful that winter 20/21 will come around faster than we realise. After all the West has just entered spring, so 6 months from now we are in Autumn and the seasonal impacts like normal flu etc start to traction up again.
May well be a case sadly to say that every extra death now, will mean two or more less deaths in the comming winter. Sadly it may well get right down to that uncomfortable truth. Hard to say and honestly, not sure how anybody could articulate that without upsetting anybody in some way, shape or form. But that does seem to be the jist of it.
https://personalpages.manchester.ac.uk/staff/thomas.house/bl...
nb the UK has since issued stronger isolation guidelines and downplayed herd immunity in the media. Longer paper about their current model https://www.imperial.ac.uk/media/imperial-college/medicine/s...
> The reason that this happens is that social distancing measures do not lead to herd immunity, so once they are lifted the epidemic starts again. In the absence of a vaccine, it is therefore meaningless to speak about whether a policy 'aims' to get herd immunity or not, since every country in the world will reach herd immunity unless it is able to implement social distancing for an indefinite period of time.
i predict this is exactly what will happen: indefinite social distancing. impact may be reduced with fast tests and large scale testing so isolation and contact quarantining is immediate.
Given the large # of cases and their high concentrations in specific places, it seems likely that we would see many cases of reinfection if previous patients weren't immune.
2. Do you have a citation on Senators being unable to serve as Speaker of the House? It certainly makes sense, and I've seen references about senators not holding roles in other branches concurrently (e.g. executive or judicial), but nothing definitive on senators holding house officer roles.
Not saying that's likely but technically there is nothing lawful stopping them.
https://www.telegraph.co.uk/books/what-to-read/churchills-un...
And that is why drug development needs to go parallel with a vaccine. If a vaccine fails, we can fall back to drugs to prevent people from going into ICUs (hopefully).
Besides, partial resistance is a thing. When our immune system has seen some other similar virus, we get a much less severe version of the disease.
0: https://www.washingtonpost.com/local/trafficandcommuting/tra...
A working version of this that actually affects the asymptotics rather than just buying you a few weeks at best has to be able to identify new case clusters while they are small, and then find and isolate a significant fraction of the cases (working backward as well as forward). Table stakes for this is the ability to test everyone with flulike symptoms who tests negative for flu (and flu tests have horrible sensitivity, so that is a lot of people). As I see it from my comfortable armchair, CDC should have made sure long before the epidemic that the RT-PCR capacity to do that existed (doing other work at private and public labs) and could be recruited and online to do this within a few days of the virus being sequenced. You also would need everyone to at least moderately change their behavior because I don't think this would be enough by itself. Simple things like not going to work sick or tolerating co-workers or employees who do seem like feasible changes with both cultural and legal levers to pull that could be very low cost and contribute significantly to Re reduction.
More speculatively, you might be able to do even better using pooled PCR tests to look for RNA in large groups, giving you a chance to spot even asymptomatic cases. Is there viral rna in sewer water or garbage? PCR amplifies exponentially, it should be able to cope with a fair amount of dilution.
There are workarounds and corners to cut, like making last year students into doctors without exams, moving doctors from other specialities to intensive care. But it's not exactly the same.
This always felt intuitively true given exponential growth - realistically flatten the curve was more platitude than practical, an desperate appeal by media in democratic countries to position a "civilized" solution in order to avoid mass panic and draconian measures. Now they're elevating Korea as the exemplar response model when the country is practically an island like Taiwan, Singapore, Hong Kong. It's simply not applicable to geographic realities of most countries where borders can't be simply shut and where a lack of infrastructure investment make the kind of techno-authoritarian solutions that made agile responses in those countries possible. Canada doesn't even have an official Corona dashboard, instead news media as to collate information from an updated table using data from archive.org, people paying in cash, nothing is getting wiped down, minimal mask use etc. If anything, countries without Asian Tiger advantages need to crack down harsher to make up for these deficiencies. No one is going to build enough triage hospitals and medical material to outpace any variant of this curve. No developed country is civilized enough to sacrifice this much for the greater good. This is a stick, not carrot and certainly not rhetoric situation. If Corona is as bad as the numbers project, flatten the curve is going to kill a lot of people in retrospect because politicians can't stomach "lock it down".
And then get old people to stay at home, perhaps with a family member or carer to assist them.
Go fuck yourself your authoritarian asshole. You'll shoot me before you get me into the military.
Sure, that may take 9-18 months. But preventing the "second wave" is more important than reacting to it.
When we look back in retrospective, the CDC and FDA will be under scrutiny to take more preventative measures.
My sense is that the UK will probably fold and institute a lockdown once their ICU capacity gets overwhelmed and healthy young people start dying in the streets. Either that or they'll face a revolution and then have a lot more problems. Of course, by the time it gets to either of those points it'll be too late to effectively change course.
But it's interesting to see at least one country take the position that "Hey, we're going to let this run its course, take our lumps now, and try to get back to business as usual ASAP." I could be wrong, and maybe this is a genius application of heartless logic. Time will tell.
RemindMe!2months ;-)
Looks like that's already happening: https://www.buzzfeed.com/alexwickham/coronavirus-uk-strategy...
> Looks like that's already happening
Is UK ICU capacity overwhelmed and are young people dying in the streets?
No.
Don’t spread rumours in this situation.
> "We were expecting herd immunity to build. We now realise it’s not possible to cope with that," professor Azra Ghani, chair of infectious diseases epidemiology at Imperial, told journalists at a briefing on Monday night.
i can multiply numbers fifteen times in a row and come to that conclusion. alternatively, i can watch italian tv. did these people never looked up from their models to confront them with actual reality?
Related, if we take the numbers out of China at face value: A tiny tiny fraction of the population has been infected (acquired immunity). So what now? Lock everything down until a vaccine is discovered?
Basically, masks in public, no-contact thermometers everywhere, and QR codes that you scan to enter a subway or a building. There's more, but that's the core.
If you have a fever, then they send you to a specialized fever clinic: https://mobile.twitter.com/MikeIsaac/status/1238604080571772...
There, they determine if you've been infected. If you have been, they send you to a group isolation ward, where you spend a few weeks chilling out and doing group dance exercises. If can't stand up and dance, you get treatment.
It's clearly a society at war, and I'm sure some ugly details are hidden. But it looks better than hiding indoors while our medical system burns and our elderly relatives die (and at least some of us younger folk wind up with scarred lungs).
If you run their model for UK with weak mitigation, Moderate/North epidemiology, you get 390,000 total deaths.
Especially where our knowledge is imperfect and subject to a lot of latency, we have to accept that we have very little actual control over how quickly the curve speeds or slows. Thus the bell-shaped curves.
Waiting until the problem obviously seems like a real problem is exactly what crushed cultures under epidemics in the past.
And yes South Korea and China seem to have stopped the pandemic in their countries, and have done an impressive job at it, but its early days and not at all clear how sustainable their approach is, or whether that approach would work everywhere.
It is too late for stopping it and you can barely delay it either.
You delay a few days or maybe 1-2 weeks if stringent but it won't be as effective when you desperately need it to be. Likely more will die if you start too early.
Thank god.
Think about something akin to some sort of nuclear reactor with control rods up you've just started to insert.
They (we) have already shifted towards a lockdown (voluntary for now, but people have been told to avoid office, pubs and travelling[0]) due to the model used being updated with the data from Italy.
https://www.bbc.co.uk/news/uk-51917562
Of course, all it takes is a UK to screw everyone over by not playing along and providing a population pool for the virus to mutate. And then a ton of poor countries who probably can't do anything even if they wanted, where it's just starting.
Honestly, I think the UK, Sweden et al. will be "voted out" here. Commerce can't continue between countries that follow the China/South Korea model of keeping R0 < 1, because frequent large outbreaks are bound to follow. Britain can't economically dominate its neighbors like that today. Sweden, forget about it.
This is a spectacular high-stakes experiment. But if Boris Johnson isn't persuaded by public opinion and a high death toll, his trading partners will.
Both approaches put strong selection pressure on the virus to mutate to a milder form, so even in the absence of a vaccine, we'll win in the long term.
That's not what is being said. What is being said is that specifically to avoid people dying, you need to stop ICUs being overwhelmed, but that in their judgement and modelling an immediate hard clamp down is not the best way.
Trump just announced advice not to gather for 2 weeks. A 2 week restriction is a drop in the sea.
China is celebrating lifting of many restrictions. But the virus will come back in those areas and the restrictions will come back too.
is completely false. It was hyped by some out of context quotes by some media outlets and spread like a literal virus and people didn't bother to find out the reality, and so we see the same mis information being shared here.
We need to flatten the curve of these misinformation viruses
- schools/nurseries open
- theatres/bars/restaurants open
- stadiums open
- large gatherings allowed
The Mayor of London was still organising mass events a few days ago ( https://www.facebook.com/sadiqforlondon/posts/30260791107781... )
But they're crammed as usual.
And businesses can't claim insurance money if they close, as they're not required to close by law.
From https://www.bbc.co.uk/news/uk-51917562 social distancing is now in place.
The original announcements said that it would always be in place, but that they wanted to wait because it is hard for people over prolonged periods.
I think it's fair to say that advising social distancing is the norm. But actually doing it very much isn't yet.
Here in Tokyo it looks almost like business as usual. Some companies are letting people stay at home but most are not. While cities in the USA are banning gatherings of 100 or more, here in Tokyo every train ever 3 minutes during rush hour has 8 to 16 cars stuffed with 100+ people per car.
I have no idea what the actual infection rate here is or the ICU usage rate. 2 weeks ago Japan was considered the place to avoid. Now it's the USA and Europe. Japan hasn't seemed to have taken any drastic measures so far or maybe I'm just not paying attention.
This has an infographic on testing - Japan was next to last (on the chart at least) per person testing for industrialized countries as of March 4. https://www.vox.com/science-and-health/2020/3/12/21175034/co...
The cynical take is that aging demographic is one of the biggest problems facing Japan today and this is a way to deal with it.
The problem is aging population are people who 40 or 50 now, not people who are 70 and 80. The latter may die because of cv, but the problem of aging population goes nowhere because people in 40 or 50 will get older eventually.
This my cynical response to you cynical take.
This is cynical nitpicking.
So all the people who are 90+ years old?
https://time.com/5802293/coronavirus-covid19-singapore-hong-...
Taiwan can produce 10M masks per day in country of 23M
https://abcnews.go.com/Health/taiwan-sets-world-fight-corona...
Taiwan and Japan are outliers so far, and they are monocultures, with famous compliance rates.
Korea is somewhat similar to Japan, but took a hit early, and has managed to beat it back.
China appears to have peaked, but did this with massive application of governmental policies which would never fly in the West.
Flatten the curve doesn't change that a large number of people are going to get this disease. The best news is danger increases with age, unlike the Spanish Flu. Africa is very young (media age), the US and China are roughly the same, while the EU in general is older (Italy and Germany especially). What matters is not hospital beds per capita, but ICU beds per capita. The US does much better by that measure. You don't need an ICU bed to give oxygen, which is what most serious clinical cases require. MIT Sloan gave a prize last year for a less expensive, simpler ventilator designed for most cases in countries with limited resources. We have options that aren't explored yet.
At least I hope to god that’s what they’re thinking.
https://news.ycombinator.com/item?id=22575356
https://news.ycombinator.com/item?id=22581950
It is in the public's best interest for the general public to only worry about what is within their control (so as to avoid panic). Therefore, the general public is being led to believe that all is going to be OK after a couple months of social distancing.
I guarantee you behind the scenes, those in control are scrambling to take immediate and drastic action to ramp up our medical treatment capacity.