The Dutch government isn't in denial though. Cafes, restaurants, schools universities and day cares are closed. Large gatherings are forbidden and people are encouraged to work from home and be sensible about having contact with other people.
According to the PM, the chosen strategy should prevent both a super high hospitalization rate and a lengthy lock-down of the entire country.
Hospitalisation rate (and in particular admission to ICU) + mortality rate are strongly dependendent on age and health - no children have yet died of Coronavirus. The Italians have one of the most elderly populations in the world; in the UK all of the deaths have involved people who are elderly and / or infirm.
You seem to think the simple answer is blanket lockdown + quarantine. This can only delay (not stop) infection. And how long do you think your lockdown is sustainable when millions of people are going to be thrown out of work / unable to pay their bills and entire economies go into meltdown? Two months? Three at the most? What happens after that?
> Netherlands has all the policies in place to flatten the curve. Work from home, schools closed, no big events. etc.
This is not nearly enough, unfortunately; we know this because other countries tried it initially and failed to keep the outbreak contained. You should stay at home as much as possible, and minimize your interactions with others if you must go out for whatever reason. Also, you should definitely be wearing protective equipment when outside the home. If only to protect others who might be vulnerable.
> Also, you should definitely be wearing protective equipment when outside the home.
Here in Austria, you can't even get masks or single-use hand gloves anymore. And I hear the same is happening in Germany. Moreover, we are advised _not_ to buy protective gear for individual use because that is needed for workers with much exposition to other people (like cashiers in supermarkets, helpers and medial staff). We have a lockdown, so everyone should stay at home and only go outside if necessary.
> Moreover, we are advised _not_ to buy protective gear for individual use because that is needed for workers with much exposition to other people
There's no real reason for this - not for low-grade ("surgical" or even "dust-proof") masks at least, and these are most critical in order to protect others in case you're sick and asymptomatic. Chinese suppliers are shipping those out as fast as they can make them, and many factories that normally make e.g. textiles and the like could retool and start making them if it came to that.
The other choice is to implement strict social distancing for a few months, close the border and then require a 14 day isolation for international arrivals until a vaccine is available. This is what China is doing and it's working. This isn't an illness you can "let" people have because of the effect on hospitals.
Suppose you could implement 100% lockdown of a country (which is impossible). Yes you would contain the disease, but you would only delay an outbreak. Therefore flattening the curve enough so the health-care system can help the ill is the beat strategy.
The question is: is the curve going to be flattened enough, or do we need more extreme measures like china.
In countries where the health care system is poor extreme measures are indeed needed because they really need to flatten the curve a lot.
This is not a quality of healthcare issue. The interventions are relatively straightforward: oxygen, possibly antibiotics for secondary infection, and for a small percentage of patients, ventilation.
This is a quantity of healthcare issue. China was probably the best placed of any country in terms of its ability to ramp up production of hospitals and all the necessary equipment.
Some patients will get very sick with sepsis and then it becomes a quality of care issue but that's the minority.
My concern is how long we’ll have to work to flatten the curve (i.e. how many illnesses are there per month if we get it as flat as we hope). As someone else said, another Great Depression will also bring death. Crappy options :(
This was the UK government position till a few days ago. Then they ran the numbers again and changed their mind, because even with all mitigation measures in place they estimated around 250k deaths with this approach.
The UK is now heading towards a more comprehensive shutdown and I suspect will resemble France and Spain soon - the method referred to in this paper as suppression.
This will be really damaging to the economy though and probably lead to a global depression if it is done everywhere. I'm honestly not sure which is worse, because a global depression will lead to a lot of deaths as well.
Imagine if china had gone for the herd immunity strategy instead. With a population of 1.4billion and letting everyone get infected you are
looking at 42 million deaths.
If draconian measures is what it takes, that is what the world should do.
China had no choice left because they suppressed and censored the epidemy. But after that strong measures were necessary. Other countries could have opted for the Korean or Taiwanese strategy: test early, often and broadly + quarantine suspected cases.
But it's too late for that in most countries now. Confinement it is!
It's kind of racist to describe the chinese response as suppressing and censoring and then for others its, "well woops, we were a little slow on response".
The Chinese government silenced the doctor first raising the issue and blocked him from communicating about the disease. If other countries do that, then they will also be suppressing and censoring. Have other countries done that?
Well, by definition there's only one doctor in the world that first raised the issue. Other countries have done similar things.
Ex. USA
- silenced one of the NIH's director of infectious disease only allowing him to say what the government wanted
- released propaganda and misinformation from the highest levels downplaying the severity
- prohibited doctors from testing people to keep the confirmed numbers low
idk, i'm sure you could find more. I'd describe the US' response more critically than the chinese. The US already knew how bad it was, and the poor behavior was from the top of government, not just some local body.
Stop throwing accusations like that and devoid the word of its meaning. It's really tasteless.
Many governments messed up. They didn't have the logistics ready for broad testing and failed to act. Now they have to resort to strong actions too. It's factual.
It's kind of appalling to put more than a million muslims into forced labor and "re-education" too.
I think it's worth remembering this in every mention of the "effectiveness" of the Chinese response. They act quickly and decisively because they have absolute power concentrated in a corrupt and authoritarian government. We can't trust anything they report because their press isn't free. In the west, the media isn't automatically right, but we can criticize and demand better standards. Likewise with the actions of our leaders.
It's also worth remembering that the Chinese had every opportunity to make sure this did not happen again after SARS. And their censorship of the discovery of the disease and the subsequent propaganda blaming the US for the disease is nothing short of disgusting.
It seems a lot of the media is focused on the fact that people are being exposed to the virus. However, the Dutch are adopting a controlled way of doing this while protecting those at risk. All measures to limit contact are in place, in a big departure from what others who claim "herd immunity" are doing.
Any comparison to the (previously?) British approach where in the weekend even concerts weren't cancelled and people are still being forced to go to the office by their employers doesn't quite hit the mark.
This is going to be one of the costliest panics in history.
A 1000 person test case was ran in isolation and they found this disease to not be very deathly, and this population was skewed toward the elderly.
Half the world’s population lives in a 2 hour flight away from Wuhan, and even without testing, there have been no random spikes in deaths especially considering most of that world is significantly poorer and without proper healthcare infrastructure.
The tragedy here isn’t about the immediate health impacts, of which are low, but of the second and third order effects to society and the world.
That office cleaning night crew ain’t getting paid. New tax revenues to fund potential research at universities isn’t raised. Those with still less fashionable diseases, will have even less money for their cause.
Where’s many places ? Let me guess you’ll say Italy and err Iran?
You know there’s like 200 other countries. Furthermore, there are 2 billion+ people living an hour or two away from China. Why aren’t they saying it’s end of days.
Please don’t just respond with a “simple they aren’t testing”.
You don’t need a test for a massive spike in deaths.
The specific question I asked was about the test case you mentioned since I couldn't find it with a quick search.
Also, I haven't really seen anyone saying it's the end of days, but more to use the US as an example, we're trying to reduce the likely death toll of millions (330M). It's heartening that it looks there's evidence that's some natural maximum coming out of China, but some US hospitals are already close to their capacity so we're trying to avoid a medical system breakdown here.
From another comment, you said why "aren’t all dead" in existing regions, when literally no one has ever said they'd all die. The most pessimistic studies I see are like, 50% of population gets it and ~5% die after the hospitals run out of capacity (and another 10% have a really, really scary few weeks), so 2.5% of the population
The Diamond Princess cruise. They were a major cluster, and coincidentally got forced quarantined and turns out to be a natural test case.
Notice how we only focus on the bank run on US hospitals. Are hospitals in poorer countries immune to these type of sudden rushes? Why aren’t we seeing millions of people in neighboring countries to China clogging up hospitals?
Is it slightly possible this is just a tad over done? What would you say are the chances of that?
People are slowly noticing the use of the WHO CFR as an actual FR is science fiction[1] at least. Well, they're not really noticing that, especially here on HN, because people are statistical imbeciles, but at least they're noticing that the denominator in the FR is a lot larger than they previously thought. That was abundantly obvious at the beginning; if you aren't widely administering a costly and rare test[2], you're enormously left censored in your estimator. You're also radically screwing up your R0 estimate.
I suppose there are arguments to be made that more hot and humid climates prevent the spread of respiratory viruses in general, which is why you don't see problems in the more humid and hot regions of China and Vietnam.[3] The real question is why some countries look like Germany, and some look like Italy. The paranoid answer is Germany will soon look like Italy (and this might be true), except the claimed origin of the disease is .... Germany[4].
If it does turn out to be overblown in some sense, it's probably a valuable exercise in autarky.
Also 2% of 2 billion is 40 million dead. We are 3 months+ since this outbreak started. Everyone keeps talking about how exponentials are hard to grasp, but whats harder to grasp is:
fear + exponentials + too_many_unknowns == impossible to plot
A feature that everyone talks about is how startups grow exponentially, fine, i get it, but most end up failing and going to zero. What if this was such a case? We ascribe to it an exponential growth path and yet it fails to take off for many reasons like perhaps a dog walking service or WeWork isn't the cat's pajamas?
A 1000 person test case was ran in isolation and they found this disease to not be very deathly, and this population was skewed toward the elderly.
The mortality seems to be caused primarily by healthcare overload so far. In about 10 % cases the disease requires hospital care, if that’s available, things are mostly fine, if not, people die. How does an isolated test case model that?
Can you explain why the other 2 billion living in the region, people mostly living in terrible conditions with very little healthcare as it compares to say Italy, aren’t all dead ? Why arent they having massive spikes in deaths? Even if they can’t be tested, why aren’t we seeing it?
>A 1000 person test case was ran in isolation and they found this disease to not be very deathly, and this population was skewed toward the elderly.
Is healthy or dead the only 2 options? I think people with high fever won't be able to work and provide you with services , people that need to stay in hospitals are also a important number that you need to provide, also how many would die if there are not enough hospital bed with equipment and medicine?
Each week we see some new drug that is tested , maybe a vaccine is to be created soon so if possible delay getting people infected especially if the cost is less sport events or similar.
No, but cancel all big events especially international ones.
Still I read about antivirals that are in tests that are already approved for other illnesses so delay as much as possible by canceling entertainment crap.
This is a health issue not because of the disease being too deadly but by being a perfect combination of not being deadly enough and requiring intensive and long care for those affected by a severe case. This is not about you dying of COVID-19, it's about you dying because you got into an accident and didn't have enough ICU beds available to treat an injury you shouldn't die from. It's about avoiding crumbling to the pressure of the healthcare system which would trigger even bigger panics, even more social unrest and so on.
Don't spread misinformation or opinions as a fact, you don't know what this is gonna be, I don't know and no expert knows, this is unprecedented territory in contemporary society. You are not better than a corpus of experts all around the world that are trying to contain the side and after-effects of it, the economy taking a huge hit and its ripples flowing through the fabric of our society is part of this crisis and would be of any major outbreak.
Then there’s the fact that everyone replying to me are wielding the unknown as truths and pointing at China and Italy while at the same time disregarding literally the other 2 billion people in the area who haven’t had any of the average-to-worst case scenarios depicted by people like yourself.
I’d love to see what the infrastructure looks like in Vietnam, Indonesia, Thailand and the like and why haven’t we seen the large scale run on hospitals like everyone’s talking about.
> This is a health issue not because of the disease being too deadly but by being a perfect combination of not being deadly enough and requiring intensive and long care for those affected by a severe case.
Yes and so that's why the Dutch and others are suggesting that it would be best not to take draconian measures trying to fight infection in those who can easily survive it and use resources to protect those who can't.
It's not yet clear to me if there's a difference between what Rutte proposed and the 'flatten the curve' strategy. Isn't it the same thing by a different name?
If that's the case then they're aiming for something better controlled than in the UK, where they seem to still be in denial.
Every country, every world leader, is faced with agonizing decisions. All are shades of right/wrong. All are simply trying to do the best job they can.
46 comments
[ 2.4 ms ] story [ 86.3 ms ] threadIt doesn't take into account the high hospitalisation rate and the fact that mortality is a function of hospital stress.
According to the PM, the chosen strategy should prevent both a super high hospitalization rate and a lengthy lock-down of the entire country.
Hospitalisation rate (and in particular admission to ICU) + mortality rate are strongly dependendent on age and health - no children have yet died of Coronavirus. The Italians have one of the most elderly populations in the world; in the UK all of the deaths have involved people who are elderly and / or infirm.
You seem to think the simple answer is blanket lockdown + quarantine. This can only delay (not stop) infection. And how long do you think your lockdown is sustainable when millions of people are going to be thrown out of work / unable to pay their bills and entire economies go into meltdown? Two months? Three at the most? What happens after that?
Yes most people will get the virus anyway, anywhere. All measures are there to "flatten the curve". https://www.npr.org/sections/health-shots/2020/03/13/8155022...
Netherlands has all the policies in place to flatten the curve. Work from home, schools closed, no big events. etc.
Its only fair that the prime minister says: everybody will get it. heck 50% to 75% of the cases are asymptomatic.
This is not nearly enough, unfortunately; we know this because other countries tried it initially and failed to keep the outbreak contained. You should stay at home as much as possible, and minimize your interactions with others if you must go out for whatever reason. Also, you should definitely be wearing protective equipment when outside the home. If only to protect others who might be vulnerable.
Here in Austria, you can't even get masks or single-use hand gloves anymore. And I hear the same is happening in Germany. Moreover, we are advised _not_ to buy protective gear for individual use because that is needed for workers with much exposition to other people (like cashiers in supermarkets, helpers and medial staff). We have a lockdown, so everyone should stay at home and only go outside if necessary.
There's no real reason for this - not for low-grade ("surgical" or even "dust-proof") masks at least, and these are most critical in order to protect others in case you're sick and asymptomatic. Chinese suppliers are shipping those out as fast as they can make them, and many factories that normally make e.g. textiles and the like could retool and start making them if it came to that.
The question is: is the curve going to be flattened enough, or do we need more extreme measures like china.
In countries where the health care system is poor extreme measures are indeed needed because they really need to flatten the curve a lot.
This is a quantity of healthcare issue. China was probably the best placed of any country in terms of its ability to ramp up production of hospitals and all the necessary equipment.
Some patients will get very sick with sepsis and then it becomes a quality of care issue but that's the minority.
https://www.imperial.ac.uk/media/imperial-college/medicine/s...
The UK is now heading towards a more comprehensive shutdown and I suspect will resemble France and Spain soon - the method referred to in this paper as suppression.
This will be really damaging to the economy though and probably lead to a global depression if it is done everywhere. I'm honestly not sure which is worse, because a global depression will lead to a lot of deaths as well.
They've capped out at under 100k cases (at least for the first wave) with 3k deaths: https://en.wikipedia.org/wiki/File:2020_coronavirus_patients...
Imagine if china had gone for the herd immunity strategy instead. With a population of 1.4billion and letting everyone get infected you are looking at 42 million deaths.
If draconian measures is what it takes, that is what the world should do.
But it's too late for that in most countries now. Confinement it is!
Ex. USA
- silenced one of the NIH's director of infectious disease only allowing him to say what the government wanted
- released propaganda and misinformation from the highest levels downplaying the severity
- prohibited doctors from testing people to keep the confirmed numbers low
idk, i'm sure you could find more. I'd describe the US' response more critically than the chinese. The US already knew how bad it was, and the poor behavior was from the top of government, not just some local body.
Many governments messed up. They didn't have the logistics ready for broad testing and failed to act. Now they have to resort to strong actions too. It's factual.
I think it's worth remembering this in every mention of the "effectiveness" of the Chinese response. They act quickly and decisively because they have absolute power concentrated in a corrupt and authoritarian government. We can't trust anything they report because their press isn't free. In the west, the media isn't automatically right, but we can criticize and demand better standards. Likewise with the actions of our leaders.
It's also worth remembering that the Chinese had every opportunity to make sure this did not happen again after SARS. And their censorship of the discovery of the disease and the subsequent propaganda blaming the US for the disease is nothing short of disgusting.
Any comparison to the (previously?) British approach where in the weekend even concerts weren't cancelled and people are still being forced to go to the office by their employers doesn't quite hit the mark.
A 1000 person test case was ran in isolation and they found this disease to not be very deathly, and this population was skewed toward the elderly.
Half the world’s population lives in a 2 hour flight away from Wuhan, and even without testing, there have been no random spikes in deaths especially considering most of that world is significantly poorer and without proper healthcare infrastructure.
The tragedy here isn’t about the immediate health impacts, of which are low, but of the second and third order effects to society and the world.
That office cleaning night crew ain’t getting paid. New tax revenues to fund potential research at universities isn’t raised. Those with still less fashionable diseases, will have even less money for their cause.
You know there’s like 200 other countries. Furthermore, there are 2 billion+ people living an hour or two away from China. Why aren’t they saying it’s end of days.
Please don’t just respond with a “simple they aren’t testing”.
You don’t need a test for a massive spike in deaths.
From another comment, you said why "aren’t all dead" in existing regions, when literally no one has ever said they'd all die. The most pessimistic studies I see are like, 50% of population gets it and ~5% die after the hospitals run out of capacity (and another 10% have a really, really scary few weeks), so 2.5% of the population
Notice how we only focus on the bank run on US hospitals. Are hospitals in poorer countries immune to these type of sudden rushes? Why aren’t we seeing millions of people in neighboring countries to China clogging up hospitals?
Is it slightly possible this is just a tad over done? What would you say are the chances of that?
I suppose there are arguments to be made that more hot and humid climates prevent the spread of respiratory viruses in general, which is why you don't see problems in the more humid and hot regions of China and Vietnam.[3] The real question is why some countries look like Germany, and some look like Italy. The paranoid answer is Germany will soon look like Italy (and this might be true), except the claimed origin of the disease is .... Germany[4].
If it does turn out to be overblown in some sense, it's probably a valuable exercise in autarky.
[1] https://www.nytimes.com/2020/03/16/health/coronavirus-statis...
[2] And FWIIW none of the tests are well calibrated; in fact there are numerous tests in use with radically different biases.
[3] https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3551767
[4] https://www.reuters.com/article/us-health-coronavirus-italy-... (I mean, it seems unlikely, but it's a common assertion)
fear + exponentials + too_many_unknowns == impossible to plot
A feature that everyone talks about is how startups grow exponentially, fine, i get it, but most end up failing and going to zero. What if this was such a case? We ascribe to it an exponential growth path and yet it fails to take off for many reasons like perhaps a dog walking service or WeWork isn't the cat's pajamas?
The mortality seems to be caused primarily by healthcare overload so far. In about 10 % cases the disease requires hospital care, if that’s available, things are mostly fine, if not, people die. How does an isolated test case model that?
Is healthy or dead the only 2 options? I think people with high fever won't be able to work and provide you with services , people that need to stay in hospitals are also a important number that you need to provide, also how many would die if there are not enough hospital bed with equipment and medicine?
Each week we see some new drug that is tested , maybe a vaccine is to be created soon so if possible delay getting people infected especially if the cost is less sport events or similar.
Are you really proposing to quarantine everyone for a year?
Don't spread misinformation or opinions as a fact, you don't know what this is gonna be, I don't know and no expert knows, this is unprecedented territory in contemporary society. You are not better than a corpus of experts all around the world that are trying to contain the side and after-effects of it, the economy taking a huge hit and its ripples flowing through the fabric of our society is part of this crisis and would be of any major outbreak.
Then there’s the fact that everyone replying to me are wielding the unknown as truths and pointing at China and Italy while at the same time disregarding literally the other 2 billion people in the area who haven’t had any of the average-to-worst case scenarios depicted by people like yourself.
I’d love to see what the infrastructure looks like in Vietnam, Indonesia, Thailand and the like and why haven’t we seen the large scale run on hospitals like everyone’s talking about.
Happen to have any sources?
Also discussion on the UK government suggesting there's going to be a winter resurgence.
As of 5 feb there were supposed to have been 5000 chinese tourists trapped on bali after flights were halted.. https://www.straitstimes.com/asia/se-asia/indonesia-to-stop-...
Yes and so that's why the Dutch and others are suggesting that it would be best not to take draconian measures trying to fight infection in those who can easily survive it and use resources to protect those who can't.
If that's the case then they're aiming for something better controlled than in the UK, where they seem to still be in denial.
Every country, every world leader, is faced with agonizing decisions. All are shades of right/wrong. All are simply trying to do the best job they can.
Not an easy time for anyone.