This is the first time that I've read about health/care workers being shunned and stigmatised, but I can see how it can happen. I can't imagine that this is a purely Japanese phenomenon, though. Anyone from anywhere outside of Japan able to point to similar media reports?
Edited to add: thanks for the posters below who pointed me at relevant articles concerning workers similarly stigmatised elsewhere. Shameful and depressing are words that spring easily to mind :-(
There are enough reports from the US about physicians and nurses getting evicted because tenants are getting concerned about coronavirus spreading in the building.
> There are enough reports from the US about physicians and nurses getting evicted because tenants are getting concerned about coronavirus spreading in the building.
To be fair this is not specific to the US e.g. in france at least one nurse was harassed into leaving (heating and hot water shut off) by their landlords, in belgium one was expelled by their co-tenants, in germany one got thrown out of a supermarket, in australia a doctor got evicted, healthcare workers got assaulted in india, …
How is that a valid concern? The only way the virus could spread would be through the building door, and maybe elevator buttons. It's a matter of cleaning those regularly and washing your hands when you get home. It's not rocket science.
It can last. It's fairly unlikely especially if people are considerate with minimum precautions.
E.g. If one sneezes uncovered into air with the right humidity, etc. it COULD survive for a while airborne. That's not to say merely by breathing a person's usual exhalations they could get it.
The virus is transmitted through droplets, or little bits of liquid, mostly through sneezing or coughing, Dr. Maria Van Kerkhove, head of WHO’s emerging diseases and zoonosis unit, told reporters during a virtual news conference on Monday. “When you do an aerosol-generating procedure like in a medical care facility, you have the possibility to what we call aerosolize these particles, which means they can stay in the air a little bit longer.”
My gf in Colombia said that healthcare workers are being told by certain groups not to go to the hospital or they will be killed. They are writing that stuff outside their doors and buildings.
What do these "groups" hope to achieve by crippling the healthcare system? Do they want to keep Coronavirus off their turf by driving healthcare workers of their turf or something else? These people are normally rational. Some piece of context is missing.
On the other hand, there are reports of Coronavirus spreading through a building through the air conditioning, and it's a fact that presymptomatic people can be infectious, consequently you really may not wish to live in the same building as an emergency physician or nurse these days. Their work still deserves recognition, but meanwhile quarantine on the hospital grounds might be a wise move.
here in medellin there are several tenants in our building (estrato 4, so not uber wealthy) begging the health care workers that do live here to temporarily live elsewhere or stop working, mostly bc there are a lot of elderly people that live here and a single unavoidable set of stairs that everyone has to use.
So people risk their lives for others ... and not get credit, but stigmatised? Glorious.
Here in germany I have not seen it, or heard of it and rather support, but my neighbours for example would be the type, to do this as well. Fear brings out ugly sides in humans.
Well, take it with a grain of salt, but there has been at least one article about a nurse in a german village, which got thrown out of a supermarket after an acquaintance told 'em that this person works in a hospital where italian COVID-19-patients are treated:
Well, it would not surprise me. I do not have any illusions about my fellow countrymen having better morals or something.
And I can understand the fear, as logically, yes, a health worker has a increased risk of infection and spreading. But it is such small minded thinking, of putting extra stress on the very people you expect to take care of you, when you finally get sick, that makes me despise those people.
So yes, everyone around a health worker need to take extra care. And if the possibility exist, for the health workers to live seperately for the crisis time, why not. If compensated adequately. But if it is not possible - and you cannot expect a mother to seperate from their family, then just make the best out of it and don't forget you are all in this together.
If the world were just, the landlady should lose the property she evicted him from. This should assuage the her fears about her tenant spreading COVID.
it's evidence that over-hyping the pandemic and stoking fears have real negative consequences. every single day there are literally thouasands of stories about how terrible and terrifying this disease is without any attempt at grounding these stories in an appropriate context (like how bad it is compared to the flu, while ignoring/defying the political connotations therein).
this isn't meant to be anti-media by any measure; but we need to hold media accountable so that it can modulate future coverage appropriately.
In the public discourse (or at least in American public discourse), any comparison between the coronavirus and the flu has come to be seen as a signal for a package of controversial ideas. The coronavirus isn't that bad, lockdowns were designed by fear-mongering globalists, etc.
The term globalist is rooted in the idea that there is a Jewish global conspiracy where they are loyal to their hereditary country of origin, not the one they are currently a citizen in. It has been used as a dog whistle for alt-right circles for quite some time and is often used as a thinly-veiled anti-semitic slur.
I don’t know you, but figured I should at least extend the curtesy of informing you of the meaning behind the words that you chose to use in-case the usage was out of error instead of deliberate.
I'm unaware of any term other than globalism for the idea that the world ought to act as a single global community rather than a bunch of nations in competition. So I'm going to have to respectfully reject attempts from alt-right circles to appropriate it for weird conspiracy theories.
in addition to what @SpicyLemonZest noted, the political left in the US (and its associated media) is pushing hard on the idea that this pandemic is the worst thing to happen in 100 years, while the political right (and its associated media) is trying to brush it off as nothing, including saying it's no worse than the flu. the obvious prize that hangs in the balance is this year's elections.
neither of those positions are reasonable, and neither will bring understanding and meaningful methods for moving forward. politics on both sides are adding so much noise that reasonable voices are getting drowned out.
this pandemic is trending toward being about 3x worse than the yearly flu. maybe it's really 5x, but it's unlikely 10x and certainly not 100x as the most panicked are fomenting over. it's also not likely less than 2x, so it's not "no worse than the flu".
that's real information that can shape our policy decisions going forward, rather than the political.
This isn't really surprising in a country where saving face, social standing and collectivism is everything. Other horrible consequences of these deeply embedded social systems are "evaporated people" [0][1] and the terrible treatment of single parents [2][3].
Do you have any insight on what differentiates Japan from other Asian countries like South Korea? Collectivism is not a unique characteristic to Japan and South Korea has arguably done a good job.
Hardest working, highly skilled and intelligent, absolutely essential to society -- we should pay doctors a wonderful premium for them sacrificing a decade of their lives to get the education that lets them confidently save lives all day long.
Most of the time when I interact with a doctor, they're just entering in information into a database.
Maybe we could bust this guild of ridiculous standards to maybe squeeze in a few others? I don't get why we gotta firstly work our doctors to death, and secondly ensure they are "the best." Seriously, sometimes "good enough" is just that. Just don't let junior doctors make critical decisions for people until theyve got a few years and show skill. I don't know, kinda like every other job. I'm not saying like let any schmuck do it, but any I crazy or is it not obsessive how high the barrier to entry is? That's bs purported by lobbiests and guilds of doctors trying to keep people out to keep their demand and wages high. It's the inverse of how a union (whereas this is a guild of skilled laborers not paying dues) abuse this.
It's not just about the labor, it's also about the liability and risk mitigation. Most diagnosis and treatment decisions are made by the doctor because they typically face the consequences if they are wrong.
You can blame US law for that. Why not treat them like a prosecutor once they've reached a certain expertise or status? It keeps them from any absurd liability because it's guarded by the state. I'd like to ask why doctor is going to intentionally put someones life at risk cause they're lazy? Sure you'll find some in government work, but if it's government, they'll easily have oversight.
They can also blame themselves. My partner was a healthcare worker (medical surgical) named in several lawsuits because someone on their floor fucked up and now some person is suffering. It's expensive to care for someone whose been disabled due to malpractice, so suing for even nominal damages is going to be expensive.
People make mistakes and sometimes they are deadly. This doesn't just happen to "lazy" doctors. If someone could die every time you introduced a bug, you still couldn't write bug free code.
There are services now which allow the doctor to film their interaction with a payment and then a lower paid person transcribe and do data entry. It's remarkable that we've come to that.
This is what happens when the government regulates hospitals just like they do banks. At this point they might as well single payer the whole thing. It save everybody loads of time and energy. Not to mention the abhorrently massive data entry.
From just a random source:
"The average cost of Medical Malpractice Insurance is $7,500 annually. However, there many types of doctors and countless insurance variables. Keep this in mind when searching for coverage. Surgeons pay between $30,000 and $50,000 a year."
https://howmuch.net/costs/medical-malpractice-insurance
So for most doctors its about 2% of pre-tax salary
That's not a fair point. People here talk about guilds and apprenticeships occasionally and that's what residencies are. You have a high, secure lifetime salary afterwards. It's a hard job, but it's just a career stage in an otherwise lucrative (although sometimes a difficult, stressful, and dangerous) career path.
Can you provide evidence to your claim? Not to mention that even if it were true, it would prevent or delay them from making $200k to $1m / year after residency. Hardly seems like a worthwhile trade-off.
A quick search says the average us residency salary is $61,200 as of 2019, which is above the unemployment maximum even taking into account the additional $600 a week in pandemic funding.
The pay for residents isn't bad compared to the rest of the country. But they do work crazy hours. $/hr they are making like $18/hour x 18 hours/day x 10 day rotation.
They wouldn't get a pay bump by going on UI. They would get more sleep.
In the discussion in https://news.ycombinator.com/item?id=22934704 patio11 was pilloried for claiming that, We project a true count of over 500,000 infections, including more than 5,000 severe cases, and a breakdown in provision of care (“overshoot”) in Nagoya, Osaka, and Tokyo, before the end of April.
And yet, according to medical staff, Tokyo is close to a collapse of the medical system. https://www.worldometers.info/coronavirus/country/japan/ says that there are currently over 12,000 reported cases in Japan and this doubled in the last 10 days. So it is likely to be in the 20-25k range by the end of the month. https://www.nbcnewyork.com/news/local/new-york-virus-deaths-... says that New York reported COVID-19 seems likely to underreport actual cases by a factor of 10. Which puts Japan at the 200,000-250,000. But as widespread reports say, Japan's testing has been extremely anemic. That can easily put us back in the ballpark discussed.
You know, that projection is looking reasonably close for having been made over a month ago.
The article isn’t talking about the volume of patients but the stigma on medical professionals. “Collapse” was probably a poor word choice since these days that almost exclusively means going over capacity due to a surge in Covid-19 patients.
The NY study is preliminary, not peer reviewed. The sampling strategy used over-represents people going out, and we have no information on which test was used or its accuracy.
Given antibody testing done in places like Vô, the NY results seem a bit of a stretch.
Hopefully Japan gets it together and starts testing properly, though.
The NY study does align fairly well with similar studies done in Santa Clara County and Los Angeles County in California, though. All three indicate a significantly lower IFR than previously expected.
That would only be true if their tests work well. In my experience, IgG and IgM suck big time, and I wouldn’t trust results. Would love to see one of those randomized studies with qRT-PCR tests.
The problem with RT-PCR is that it only pick up viral RNA from a currently active infection, while IgG and IgM (antibody) tests will tell you if the person tested had been infected in the past.
Also, depending on how effective the detected antibodies are in fighting off the infection, we might get insight in to how much immunity people have and how long it lasts.
You’re making a massive assumption there - that the IgG and IgM tests tell you if the person has been infected in the past. To which my experience says: no, it doesn’t. Both false positive and negative rates are very high in comparison to people previously negative / positive with RT-PCR tests.
There are major statistical problems with the Santa Clara and Los Angeles studies though. Namely selection bias, and using a test that is inaccurate enough that all reported positives are plausibly false positives.
That said, IFRs in the 1% or less range have been projected for some time, and everyone who pays attention to the numbers knows that reported dramatically understates reality (the only debate is over how much).
> All three indicate a significantly lower IFR than previously expected.
The NY study, if it holds up, suggests an IFR in the 0.8-1.0% range for NYC (depending on whether or not you include the additional excess deaths), which is in the range most experts have been assuming (0.5%-1.0% has been a common range that's been tossed around). For example, the Imperial College model used 0.9% IFR as an input. Additionally, a 10x confirmed cases to actual cases ratio is in the range most experts were assuming.
The two CA studies were outliers (and, had significant and substantive critiques), and suggested an IFR as much as 10x lower than the NY study suggests. I wouldn't call those two studies as aligning with the NY study.
Do you have any links handy discussing the issues? I have not come across anything like that in my reading and would like to read more on the critiques.
> I have been corresponding with the authors of the well-known Santa Clara County COVID-19 preprint, and I am alarmed at their sloppy behavior. The confidence interval calculation in their preprint made demonstrable math errors - 'not' just questionable methodological choices.
..
> The errors are not debatable and can be seen in these two screenshots of the supplement: 0.0034, the standard error meant to measure uncertainty about prevalence pi, is not the square root of 0.039, and the variance of a binomial estimate of proportion depends on the sample size.
> Ok, so what's wrong with the confidence intervals in this preprint? Well they publish a confidence interval on the specificity of the test that runs between 98.3% and 99.9%, but only 1.5% of all the tests came back positive!
> That means that if the true specificity of the test lies somewhere close to 98.3%, nearly all of the positive results can be explained away as false positives (and we know next to nothing about the true prevalence of COVID-19 in Santa Clara County)
> They report a 95% confidence interval for the prevalence of COVID-19 in Santa Clara County that runs from 2.01% to 3.49% though! That seems oddly narrow, given that they have already shown that it is within the realm of possibility that the data collected are all false positives!
The most interesting thing (to me) about the Gelman page is that by the PPPS, he's hedging all of his most significant criticisms:
"The data as reported are also consistent with infection rates of 2% or 4%. Indeed, as I wrote above, 3% seems like a plausible number. As I wrote above, “I’m not saying that the claims in the above-linked paper are wrong,” and I’m certainly not saying we should take our skepticism in their specific claims and use that as evidence in favor of a null hypothesis. I think we just need to accept some uncertainty here. The Bendavid et al. study is problematic if it is taken as strong evidence for those particular estimates, but it’s valuable if it’s considered as one piece of information that’s part of a big picture that remains uncertain. When I wrote that the authors of the article owe us all an apology, I didn’t mean they owed us an apology for doing the study, I meant they owed us an apology for avoidable errors in the statistical analysis that led to overconfident claims. But, again, let’s not make the opposite mistake of using uncertainty as a way to affirm a null hypothesis."
The twitterthink reaction to this study has been vicious, mostly based on amateur re-hashes of the Gelman critique, which even Gelman himself doesn't really believe.
The study pre-print is published and some of the numbers are publicly available, we don't need to play a game of revelations here between one person and another, or incorporate Twitter users into the mix. (I didn't even realize this was being criticized over Twitter, as I don't really use the service.) Gelman's critique is quite substantive, and commenters on Gelman's post have created Bayesian analyses which incorporate the uncertainty from test sensitivity and specificity.
When I made one in PyMC3 (which lined up with a commenter's approach with PyStan), the 97% CI for the prevalence based on the non-poststratified data I got had the prevalence between (-0.3%, 1.7%). What does that mean? The test just isn't certain enough to allow us to make any conclusions, not that the null hypothesis is correct or that we can reject the null hypothesis.
There's nothing wrong with performing the study. Indeed, the publishing of the study allows us to have these vigorous debates about methods and informs future trials from being more exact and not suffering from the same problems as previous studies. But trying to extrapolate a conclusion for something as important as COVID based on studies with extremely high uncertainty is highly irresponsible. Sometimes we have to accept that coming up with statistically significant conclusions is difficult.
"When I made one in PyMC3 (which lined up with a commenter's approach with PyStan), the 97% CI for the prevalence based on the non-poststratified data I got had the prevalence between (-0.3%, 1.7%). What does that mean? The test just isn't certain enough to allow us to make any conclusions, not that the null hypothesis is correct or that we can reject the null hypothesis."
Yeah, that doesn't sound substantially different than Gelman's frequentist intuition in the blog post. I'm not sure the more complex methods are adding much here, except that you can now examine the posterior, and see what portion of the density lies below zero (i.e. probably not much of it).
IMO the "CI includes zero" was weak when Gelman advanced it, because even though it's possible, it was clear from the assay error rates that the outcome was on the tails of the distribution; even if 95% of repeated samples may include zero, very few of them actually would. So at the end of the day, as you have demonstrated, you get a non-post-stratified posterior that encompasses the point estimate they gave (1.5%), but your confidence interval is different, and perhaps the mean is lower.
Now you're just left with debating the validity of the bias adjustments they made.
That said, it's wrong to frame this in terms of a "rejecting the null hypothesis". There's no hypothesis in an observational study like this.
> So at the end of the day, as you have demonstrated, you get a non-post-stratified posterior that encompasses the point estimate they gave (1.5%), but your confidence interval is different, and perhaps the mean is lower.
You cannot use confidence intervals to argue the validity of a point estimate inside of the CI. When using frequentist methods, we usually have some sort of control group where we can use a paired test to compare sample means in order to reject a hypothesis.
I wanted to use Bayesian methods not because they were more complex, but because I felt that when a control group is not available, a Bayesian analysis would be a lot more obvious about surfacing uncertainty. Bayesian methods also allow us to actually simulate P(prevalence | data). And no, just because 1.5% is in the 95th percentile of the posterior prevalence, does not mean you can say that 1.5% is a valid estimate. What the CI shows is that, with 97% confidence, the prevalence is somewhere between -0.3% and 1.7%. Additionally, the mean of this posterior came out to 0.8% prevalence, which to me is good as, to me, saying it's inconclusive. In fact, if we use the median of P(prevalence | data), then we get very close to 0.8%, so this test is basically showing that the prevalence in this population is negligible.
"You cannot use confidence intervals to argue the validity of a point estimate inside of the CI."
You're using a Bayesian method, so you have a posterior distribution. You can sample from it.
"And no, just because 1.5% is in the 95th percentile of the posterior prevalence, does not mean you can say that 1.5% is a valid estimate."
You told me that was the confidence interval on the parameter. The confidence interval contains the point estimate for the original study. It's as valid as any other point within the confidence interval. As you say: "you cannot use confidence intervals to argue the validity of a point estimate inside the CI".
"What the CI shows is that, with 97% confidence, the prevalence is somewhere between -0.3% and 1.7%."
> You told me that was the confidence interval on the parameter. The confidence interval contains the point estimate for the original study. It's as valid as any other point within the confidence interval. As you say: "you cannot use confidence intervals to argue the validity of a point estimate inside the CI".
> Which includes 1.5%.
And everything else in the CI. If we're treating this like a CI, then it's like saying a dice will land on 1, just because it's equally likely to land on 6.
The actual P(1.5% | prevalence) is quite low at 3%.
"And everything else in the CI. If we're treating this like a CI, then it's like saying a dice will land on 1, just because it's equally likely to land on 6. The actual P(1.5% | prevalence) is quite low at 3%."
You just said that you can't use a CI to estimate the likelihood of any point within the CI (you actually can, for well-behaved problems, but I digress) when I commented that 0% isn't a likely outcome within the interval.
Literally the same argument. If you want to argue that 1.5% is unlikely, then you have to accept that 0% is unlikely for the same reasons.
They estimate ~27k infections on April 17th, for comparison right now for that canton the authorities declare 213 deaths (likely undercounted afaik those are only deaths at hospital) and 4726 confirmed cases.
So a lower bound of 0.7% for IFR seems reasonable (and in line with other studies)
There are two NYC studies with likely over-sampling phenomena:
- the NYC antibody study one you mention, done at shopping centers, indeed likely over-represents people going out. 20%-21% of that population has antibodies.
- the SARS-CoV-2 testing study with pregnant women [1], tested just before delivery. Among those, 13% tested positive. It is reasonable to expect that this study over-represents subjects that barely go out: pregnant women to go out as little as possible to protect themselves and their future baby.
Because the sampling over-representation is opposite in the two studies, the truth is likely in between. in terms of antibodies, it is likely that the pregnant women that tested positive weeks ago have now developed antibodies or will do so in the next 1-2 weeks. Among pregnant women, the 13% also ignores women that had already developed antibodies before delivery; another phenomenon that may push the truth above 13%.
I'm not sure how Vietnam ended up on your list but I'm pretty sure they have been testing pretty extensively, and more importantly, much earlier than most other countries.
Japan's low per-capita tests could be justified by saying they don't have many per-capita cases, but their test-to-positive ratio is similar to places which have been hit hard like Italy and Portugal. It should be easier for them to have a higher ratio given that they have so few cases compared to Italy
Have you read that blog post? He published a hash as a point of reference (which is a great thing in itself, because "nobody could see it coming" bullshit comments are plenty), but on top of that, he started and led a working group and spoke out behind the scenes to relevant parties, in order to save lives.
You'd have him die on his sword and achieve nothing just for the sake of appearances.
Public sentiment alone isn't sufficient to push a country into closing down. The work done by Patrick may or may not have contributed to the authorities deciding to go ahead with the lockdown.
Exactly what kind of clout do you think he has? What kind of audience? He's a local celeb here on HN, and more broadly a somewhat prominent figure in tech circles, but he's not Bill Gates. Certainly he isn't the kind of guy to get a slot on CNN and further, if he did, he wouldn't be taken seriously.
While I get your point (why hide a prediction that could have saved lives?), I think you're overly idealistic about what impact this same prediction would have had if released publicly at the time.
As someone who works in policy, his response was about as good as I could hope for from someone not involved in policy normally. Talking privately to credible people, working with experts, and getting the message to media channels, are all what you're supposed to do. Him shouting on Twitter wouldn't have accomplished anything.
(I'm still a bit mystified by the purpose of the whole hash dropping thing. I don't really know what it achieves, aside from the potential to say "I knew it!" at some point in the future.)
considering how late they're to the game, how massive and dense Tokyo metro is, even 200,000 looks like charitable estimate to me. Tokyo metro has 38 million people.
I can't tell if you're playing troll chess or this is all just garden variety flamebait, but either way it's not what HN is for and enough is enough. I've banned this account.
FWIW I wasn't implying anything about who "rules the world" like this person said. I was legitimately curious if they knew they were using a far-right trope or if they were just repeating a bunch of stuff they've heard somewhere.
Although that can be true, rarely from what I've seen or read, I don't think it's fair to say anyone who uses the word "globalist" is an anti-semite. I happen to know Jewish people who use the term, so clearly it is not exclusively an anti-semitic doc-whistle.
I think many people use it to mean "the various ideologies supportive of globalization", or "the view that globalization is a good thing".
Some people also use this term as a synonym for "transnationalism" or "internationalism".
"Globalism" is also sometimes a shorthand for "international capitalism", which while it could sound sinister and maybe some people do mean some racist thing by it, most people just mean "corporations that span many nations".
Wikipedia also contains many definitions of "globalism" that are not anti-semitic.
"""
Manfred Steger distinguishes between different globalisms such as justice globalism, jihad globalism, and market globalism.[3] Market globalism includes the ideology of neoliberalism."""
"""
Proponents of globalism believe in global citizenship; that is, the problems of humanity can be resolved with democratic globalism. Democratic globalism is the idea that all people matter, no matter where they live, and that universal freedom and human rights can be fostered for all mankind.[5] World citizens believe in civic globalism[6] and that by thinking globally and acting locally they can effect positive change across all barriers.
"""
"""
Arguments against globalism are similar to those moved against globalisation, among which loss of cultural identity, deletion of community history, conflict of civilization, loss of political representation and collapse of the democratic process in favour of a globally managed open society.
"""
There's a reference to Donald Trump's use of the word in Wikipedia. But clearly even if one believes his use of the word is a racist dog-whistle, it doesn't follow that that is true for anyone's use of the word.
"At the hospital, about 10 nurses and other staffers have left since the first COVID-19 case was found on the medical staff. The list included clerical workers."
I fear this is going to be an increasing problem if we continue to rely on the belief that medical personnel can be abused indefinitely.
That's actually the nicer side of the problem. Given current conditions pretty much everywhere, doctors and nurses that don't run away end up overworked to the point of exhaustion. Some of them die, rest are left with PTSD. Healthcare systems worldwide are bleeding medical staff, and unfortunately, training a new medical professional takes many years (more than a decade if you want them to be any good).
If we're hemorrhaging healthcare workers, it is because we're not giving them enough support.
We're spending $2+T on keeping everyone afloat in the US. We can spend a lot of that money encouraging everyone to pitch in to fight Covid.
We need ~hundreds of thousands of contact-tracers. If that were our only need, we could offer $1,000,000 to everyone who works as a contact tracer and have money left over.
I'm already volunteering ~70% of my time on FindTheMasks.com. I can only imagine how much more work could be done if unemployed people were given the opportunity to work on fixing the root cause of unemployment!
I'm not sure what contact-tracers do (seriously, I don't know, and I'd love a description of what this job entails), but I assume they'd need PPE and tests, both of which are generally unavailable due to insufficient manufacturing capability, supply chain issues and bureaucratic blunders.
> We're spending $2+T on keeping everyone afloat in the US.
I think it's best to consider this as less "money to help fight the pandemic", and more as "money to save everyone from starvation", or alternatively "money to have a country to save from the pandemic".
> I'm already volunteering ~70% of my time on FindTheMasks.com.
My strong and sincere thanks for the hard work you do!
Contact tracing is about asking the patient where they have been in the last few weeks, identifying (tracing) every person they've been in contact with during that time, finding out where and how they caught the virus (ie the specific person they caught it from), and also finding and immediately quarantining everyone the patient has had contact with. It's not a process that necessarily needs PPE, more the ability to go through someone's Google Location History data and make lots of phone calls to people.
Australia is even introducing an open source app next week (like Singapore has) to automatically collect Bluetooth IDs of nearby devices as a person walks outdoors, so people can be more easily traced & notified / quarantined if they've been in contact with someone who has been infected.
Here's one of our Australian state government's explanation of contact tracing, in this case for Tuberculosis:
>> We need ~hundreds of thousands of contact-tracers. If that were our only need, we could offer $1,000,000 to everyone who works as a contact tracer and have money left over.
But it isn't. $350 billion in PPP funds ran out in 10 days and only covered maybe 5-7% of businesses. $500 billion was just authorized by Congress and will run out in the same amount of time and maybe cover 10% of businesses.
Not even 20% of SMBs who need money due to the economic shutdown have received it - and this money only carries them across the finish line in a few months.
We're talking about double digit trillions of dollars to float the economy into Q3, much less the healthcare system. This is either impractical (my opinion) or we lack the political will to do it, but in either case, it is super unlikely to happen.
Burakumin: "They were originally members of outcast communities in the Japanese feudal era, composed of those with occupations considered impure or tainted by death (such as executioners, undertakers, workers in slaughterhouses, butchers, or tanners), which have severe social stigmas of kegare (穢れ or "defilement") attached to them."
In Argentina nurses and health care personnel have been abused by their neighbors. In one case, a nurse was harassed and threatened until she was forced to leave the apartment she was renting (yes, she filed a complaint with the law).
Unfortunately fear drives some people to get very nasty, even against people who could save them. Or maybe they always were nasty.
This specific issue is hardly limited to japan. You can sadly find this sort of cases in the US, in India, in Germany, in France, in Belgium, Australia, …
From cars getting degraded to harassment to eviction to assault and battery.
It certainly didn't call them villages. Rather preferred "plantation", "ghetto", "reservation", "inner city", "hazardous housing inventory".
It also has a history of owning them as furniture, of killing them in many manners, of breaking treaties with them, of hanging them as town event, of not treating them, of banning them from states, cities, neighborhoods, of excluding them from society, public places, social benefits, … and I'm sure I'm forgetting a bunch.
Are we still talking about doctors and medical staff here? Sounds like you just want to drag a whole host of other issues into this conversation, but I urge you to try and stay focused on the discussion we're having, and not the one you seem to want to have...
> Are we still talking about doctors and medical staff here?
I assumed not since Japan does not have “a history of confining [doctors and medical staff] to villages” So your comment could only apply to the treatment of burakumin.
> Sounds like you just want to drag a whole host of other issues into this conversation
You’re the one who made mistreatment of minorities the issue, it’s not really my problem if it also makes you uncomfortable.
This is described as "stigma", but it looks like people making reasonable decisions trying to avoid getting sick. The child of someone who works in a hospital really does bring higher than normal risk to their daycare.
People with medical jobs not being able to get childcare is a serious problem, but we need dedicated separate childcare if we're going to keep the spread down.
For a disease as transmissible as Ebola or the flu that might be true, but for a brand new highly transmissible disease like COVID-19 with limited testing supply, it might be safer to live near someone who might actually have access to regular testing. Do the people stigmatizing healthcare workers have the data to back up your theory?
Trying to explain away prejudice with science requires actual science.
I know in some places the hospital workers are given decent hotel accommodations, that seems to be a pretty reasonable compromise for medical workers in dense living situations, in some places that would require building some additional places or taking possession of some, but given the amount of slack resources right now that also seems reasonable
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[ 5.9 ms ] story [ 198 ms ] threadEdited to add: thanks for the posters below who pointed me at relevant articles concerning workers similarly stigmatised elsewhere. Shameful and depressing are words that spring easily to mind :-(
Daily Beast isn't a real newspaper of record, but I've seen similar articles in reputable papers: https://www.thedailybeast.com/coronavirus-nurses-face-evicti...
The Doctor Came to Save Lives. The Co-op Board Told Him to Get Lost.
To be fair this is not specific to the US e.g. in france at least one nurse was harassed into leaving (heating and hot water shut off) by their landlords, in belgium one was expelled by their co-tenants, in germany one got thrown out of a supermarket, in australia a doctor got evicted, healthcare workers got assaulted in india, …
Not sure what a solution might be.
https://www.cnbc.com/2020/03/18/coronavirus-lives-for-hours-...
E.g. If one sneezes uncovered into air with the right humidity, etc. it COULD survive for a while airborne. That's not to say merely by breathing a person's usual exhalations they could get it.
The virus is transmitted through droplets, or little bits of liquid, mostly through sneezing or coughing, Dr. Maria Van Kerkhove, head of WHO’s emerging diseases and zoonosis unit, told reporters during a virtual news conference on Monday. “When you do an aerosol-generating procedure like in a medical care facility, you have the possibility to what we call aerosolize these particles, which means they can stay in the air a little bit longer.”
https://www.cnbc.com/2020/03/18/coronavirus-lives-for-hours-...
You are aware that the virus spreads primarily through air?
Those medical workers have as much right to their place of shelter as anyone else.
This is a despicable form of NIMBYism. The people complaining expect medical professionals to save them, but don't want to treat them as equals.
I was going to mention something about housing co-op politics, but it seems that NYC co-ops are a unique beast: https://www.investopedia.com/articles/personal-finance/09011...
Either way, NYC style or regular co-ops, the politics can get pretty nasty so I'm not surprised at all...
I doubt that. Crises surface suppressed flaws (and strengths), not usually create new ones.
People who would threaten anyone with "you will be killed" for anything, got there before the crisis.
here in medellin there are several tenants in our building (estrato 4, so not uber wealthy) begging the health care workers that do live here to temporarily live elsewhere or stop working, mostly bc there are a lot of elderly people that live here and a single unavoidable set of stairs that everyone has to use.
Here in germany I have not seen it, or heard of it and rather support, but my neighbours for example would be the type, to do this as well. Fear brings out ugly sides in humans.
https://www.merkur.de/leben/karriere/angst-coronavirus-krank...
And I can understand the fear, as logically, yes, a health worker has a increased risk of infection and spreading. But it is such small minded thinking, of putting extra stress on the very people you expect to take care of you, when you finally get sick, that makes me despise those people.
So yes, everyone around a health worker need to take extra care. And if the possibility exist, for the health workers to live seperately for the crisis time, why not. If compensated adequately. But if it is not possible - and you cannot expect a mother to seperate from their family, then just make the best out of it and don't forget you are all in this together.
https://www.theguardian.com/world/2020/mar/22/nhs-paramedic-...
The same also happened to a doctor in the UK:
https://news.sky.com/story/coronavirus-nhs-doctor-evicted-fr...
And with some "journalists" relying on twitter to write their articles, it gets harder to distinct hearsay from real news.
In Montpellier, owners shutting down hot water and heating to force a nurse to move out:
https://www.la-croix.com/Sciences-et-ethique/Sante/Coronavir...
In Marseille, neighbors left an anonymous note asking to 2 sisters working as nurse and firefighter to leave the residence:
https://www.ouest-france.fr/sante/virus/coronavirus/coronavi...
https://www.cnn.com/2020/04/13/us/custody-coronavirus-er-doc...
this isn't meant to be anti-media by any measure; but we need to hold media accountable so that it can modulate future coverage appropriately.
What political connotations?
I don’t know you, but figured I should at least extend the curtesy of informing you of the meaning behind the words that you chose to use in-case the usage was out of error instead of deliberate.
neither of those positions are reasonable, and neither will bring understanding and meaningful methods for moving forward. politics on both sides are adding so much noise that reasonable voices are getting drowned out.
this pandemic is trending toward being about 3x worse than the yearly flu. maybe it's really 5x, but it's unlikely 10x and certainly not 100x as the most panicked are fomenting over. it's also not likely less than 2x, so it's not "no worse than the flu".
that's real information that can shape our policy decisions going forward, rather than the political.
[1] https://www.zeit.de/arbeit/2020-04/intensivpflege-coronaviru...
[0] https://www.pri.org/stories/2017-04-25/japans-evaporated-peo...
[1] https://www.businessinsider.com/evaporated-people-disappeari...
[2] https://www.theatlantic.com/business/archive/2017/09/japan-i...
[3] https://www.youtube.com/watch?v=PYmivmkZvIg
Doctors are the highest paid job in every state: https://www.businessinsider.com/highest-paying-job-in-every-...
Doctors earn a median salary of 313k (its around 100k for software engineers): https://www.medscape.com/viewarticle/911668
Our doctors earn about 3x as much as other first world countries.
Maybe we could bust this guild of ridiculous standards to maybe squeeze in a few others? I don't get why we gotta firstly work our doctors to death, and secondly ensure they are "the best." Seriously, sometimes "good enough" is just that. Just don't let junior doctors make critical decisions for people until theyve got a few years and show skill. I don't know, kinda like every other job. I'm not saying like let any schmuck do it, but any I crazy or is it not obsessive how high the barrier to entry is? That's bs purported by lobbiests and guilds of doctors trying to keep people out to keep their demand and wages high. It's the inverse of how a union (whereas this is a guild of skilled laborers not paying dues) abuse this.
People make mistakes and sometimes they are deadly. This doesn't just happen to "lazy" doctors. If someone could die every time you introduced a bug, you still couldn't write bug free code.
There are services now which allow the doctor to film their interaction with a payment and then a lower paid person transcribe and do data entry. It's remarkable that we've come to that.
On the other side, PAs and NPs are taking on an ever increasing amount of healthcare responsibilities and are rapidly growing professions that barely existed a few years ago. (https://www.aanp.org/news-feed/nurse-practitioner-role-conti...)
So for most doctors its about 2% of pre-tax salary
They wouldn't get a pay bump by going on UI. They would get more sleep.
And yet, according to medical staff, Tokyo is close to a collapse of the medical system. https://www.worldometers.info/coronavirus/country/japan/ says that there are currently over 12,000 reported cases in Japan and this doubled in the last 10 days. So it is likely to be in the 20-25k range by the end of the month. https://www.nbcnewyork.com/news/local/new-york-virus-deaths-... says that New York reported COVID-19 seems likely to underreport actual cases by a factor of 10. Which puts Japan at the 200,000-250,000. But as widespread reports say, Japan's testing has been extremely anemic. That can easily put us back in the ballpark discussed.
You know, that projection is looking reasonably close for having been made over a month ago.
It is about the stigma causing the medical professionals to quit, which will lead to lower, and hence exceeded, capacity. It helps when you read it.
Given antibody testing done in places like Vô, the NY results seem a bit of a stretch.
Hopefully Japan gets it together and starts testing properly, though.
Also, depending on how effective the detected antibodies are in fighting off the infection, we might get insight in to how much immunity people have and how long it lasts.
RT-PCR will not tell you any of that.
That said, IFRs in the 1% or less range have been projected for some time, and everyone who pays attention to the numbers knows that reported dramatically understates reality (the only debate is over how much).
The NY study, if it holds up, suggests an IFR in the 0.8-1.0% range for NYC (depending on whether or not you include the additional excess deaths), which is in the range most experts have been assuming (0.5%-1.0% has been a common range that's been tossed around). For example, the Imperial College model used 0.9% IFR as an input. Additionally, a 10x confirmed cases to actual cases ratio is in the range most experts were assuming.
The two CA studies were outliers (and, had significant and substantive critiques), and suggested an IFR as much as 10x lower than the NY study suggests. I wouldn't call those two studies as aligning with the NY study.
https://twitter.com/wfithian/status/1252692357788479488
> I have been corresponding with the authors of the well-known Santa Clara County COVID-19 preprint, and I am alarmed at their sloppy behavior. The confidence interval calculation in their preprint made demonstrable math errors - 'not' just questionable methodological choices.
..
> The errors are not debatable and can be seen in these two screenshots of the supplement: 0.0034, the standard error meant to measure uncertainty about prevalence pi, is not the square root of 0.039, and the variance of a binomial estimate of proportion depends on the sample size.
Another critique:
https://twitter.com/jjcherian/status/1251272333177880576
> Ok, so what's wrong with the confidence intervals in this preprint? Well they publish a confidence interval on the specificity of the test that runs between 98.3% and 99.9%, but only 1.5% of all the tests came back positive!
> That means that if the true specificity of the test lies somewhere close to 98.3%, nearly all of the positive results can be explained away as false positives (and we know next to nothing about the true prevalence of COVID-19 in Santa Clara County)
> They report a 95% confidence interval for the prevalence of COVID-19 in Santa Clara County that runs from 2.01% to 3.49% though! That seems oddly narrow, given that they have already shown that it is within the realm of possibility that the data collected are all false positives!
Andrew Gelman (Stats at Columbia) had a commonly shared piece: https://statmodeling.stat.columbia.edu/2020/04/19/fatal-flaw...
Also a good dive into the issues: https://medium.com/@balajis/peer-review-of-covid-19-antibody...
Mercury News also had a good article covering a lot of this: https://www.mercurynews.com/2020/04/20/feud-over-stanford-co...
And yes, lots of twitter discussions from folks in the field, e.g. Natalie Dean of University of Florida https://twitter.com/nataliexdean/status/1251309217215942656 and Trevor Bedford (Fred Hutchinson) https://twitter.com/trvrb/status/1251332447691628545 and others.
"The data as reported are also consistent with infection rates of 2% or 4%. Indeed, as I wrote above, 3% seems like a plausible number. As I wrote above, “I’m not saying that the claims in the above-linked paper are wrong,” and I’m certainly not saying we should take our skepticism in their specific claims and use that as evidence in favor of a null hypothesis. I think we just need to accept some uncertainty here. The Bendavid et al. study is problematic if it is taken as strong evidence for those particular estimates, but it’s valuable if it’s considered as one piece of information that’s part of a big picture that remains uncertain. When I wrote that the authors of the article owe us all an apology, I didn’t mean they owed us an apology for doing the study, I meant they owed us an apology for avoidable errors in the statistical analysis that led to overconfident claims. But, again, let’s not make the opposite mistake of using uncertainty as a way to affirm a null hypothesis."
The twitterthink reaction to this study has been vicious, mostly based on amateur re-hashes of the Gelman critique, which even Gelman himself doesn't really believe.
When I made one in PyMC3 (which lined up with a commenter's approach with PyStan), the 97% CI for the prevalence based on the non-poststratified data I got had the prevalence between (-0.3%, 1.7%). What does that mean? The test just isn't certain enough to allow us to make any conclusions, not that the null hypothesis is correct or that we can reject the null hypothesis.
There's nothing wrong with performing the study. Indeed, the publishing of the study allows us to have these vigorous debates about methods and informs future trials from being more exact and not suffering from the same problems as previous studies. But trying to extrapolate a conclusion for something as important as COVID based on studies with extremely high uncertainty is highly irresponsible. Sometimes we have to accept that coming up with statistically significant conclusions is difficult.
Yeah, that doesn't sound substantially different than Gelman's frequentist intuition in the blog post. I'm not sure the more complex methods are adding much here, except that you can now examine the posterior, and see what portion of the density lies below zero (i.e. probably not much of it).
IMO the "CI includes zero" was weak when Gelman advanced it, because even though it's possible, it was clear from the assay error rates that the outcome was on the tails of the distribution; even if 95% of repeated samples may include zero, very few of them actually would. So at the end of the day, as you have demonstrated, you get a non-post-stratified posterior that encompasses the point estimate they gave (1.5%), but your confidence interval is different, and perhaps the mean is lower.
Now you're just left with debating the validity of the bias adjustments they made.
That said, it's wrong to frame this in terms of a "rejecting the null hypothesis". There's no hypothesis in an observational study like this.
You cannot use confidence intervals to argue the validity of a point estimate inside of the CI. When using frequentist methods, we usually have some sort of control group where we can use a paired test to compare sample means in order to reject a hypothesis.
I wanted to use Bayesian methods not because they were more complex, but because I felt that when a control group is not available, a Bayesian analysis would be a lot more obvious about surfacing uncertainty. Bayesian methods also allow us to actually simulate P(prevalence | data). And no, just because 1.5% is in the 95th percentile of the posterior prevalence, does not mean you can say that 1.5% is a valid estimate. What the CI shows is that, with 97% confidence, the prevalence is somewhere between -0.3% and 1.7%. Additionally, the mean of this posterior came out to 0.8% prevalence, which to me is good as, to me, saying it's inconclusive. In fact, if we use the median of P(prevalence | data), then we get very close to 0.8%, so this test is basically showing that the prevalence in this population is negligible.
You're using a Bayesian method, so you have a posterior distribution. You can sample from it.
"And no, just because 1.5% is in the 95th percentile of the posterior prevalence, does not mean you can say that 1.5% is a valid estimate."
You told me that was the confidence interval on the parameter. The confidence interval contains the point estimate for the original study. It's as valid as any other point within the confidence interval. As you say: "you cannot use confidence intervals to argue the validity of a point estimate inside the CI".
"What the CI shows is that, with 97% confidence, the prevalence is somewhere between -0.3% and 1.7%."
Which includes 1.5%.
> Which includes 1.5%.
And everything else in the CI. If we're treating this like a CI, then it's like saying a dice will land on 1, just because it's equally likely to land on 6.
The actual P(1.5% | prevalence) is quite low at 3%.
You just said that you can't use a CI to estimate the likelihood of any point within the CI (you actually can, for well-behaved problems, but I digress) when I commented that 0% isn't a likely outcome within the interval.
Literally the same argument. If you want to argue that 1.5% is unlikely, then you have to accept that 0% is unlikely for the same reasons.
They estimate ~27k infections on April 17th, for comparison right now for that canton the authorities declare 213 deaths (likely undercounted afaik those are only deaths at hospital) and 4726 confirmed cases.
So a lower bound of 0.7% for IFR seems reasonable (and in line with other studies)
Nitpick: it's Vò https://it.wikipedia.org/wiki/Vo%27
I used to ride my bike through there on many a Sunday when I lived in Padova.
- the NYC antibody study one you mention, done at shopping centers, indeed likely over-represents people going out. 20%-21% of that population has antibodies.
- the SARS-CoV-2 testing study with pregnant women [1], tested just before delivery. Among those, 13% tested positive. It is reasonable to expect that this study over-represents subjects that barely go out: pregnant women to go out as little as possible to protect themselves and their future baby.
Because the sampling over-representation is opposite in the two studies, the truth is likely in between. in terms of antibodies, it is likely that the pregnant women that tested positive weeks ago have now developed antibodies or will do so in the next 1-2 weeks. Among pregnant women, the 13% also ignores women that had already developed antibodies before delivery; another phenomenon that may push the truth above 13%.
[1]: https://www.nejm.org/doi/full/10.1056/NEJMc2009316
The samples were done at grocery stores. Non-essential businesses are closed in New York. Most people here still have to go out to get groceries.
There is no evidence that this has led to an oversample; these are hypotheses advanced by people on reddit and HN.
Anemic is definitely a nice way to put it.
Japan is testing at a per capita rate below that of Iraq, Ukraine, Vietnam, Mongolia, Moldova and South Africa.
Their testing rate is so extraordinarily low, the US is testing more people per day than Japan has tested in total across the past four months.
https://www.worldometers.info/coronavirus/
Japan's low per-capita tests could be justified by saying they don't have many per-capita cases, but their test-to-positive ratio is similar to places which have been hit hard like Italy and Portugal. It should be easier for them to have a higher ratio given that they have so few cases compared to Italy
You'd have him die on his sword and achieve nothing just for the sake of appearances.
While I get your point (why hide a prediction that could have saved lives?), I think you're overly idealistic about what impact this same prediction would have had if released publicly at the time.
(I'm still a bit mystified by the purpose of the whole hash dropping thing. I don't really know what it achieves, aside from the potential to say "I knew it!" at some point in the future.)
We do control the weather, but no cabal can control a cranky NYC co-op board (Not even Bill Gates and the UN)
Apologies if I sent this a bit offtopic, dang.
I think many people use it to mean "the various ideologies supportive of globalization", or "the view that globalization is a good thing".
Some people also use this term as a synonym for "transnationalism" or "internationalism".
"Globalism" is also sometimes a shorthand for "international capitalism", which while it could sound sinister and maybe some people do mean some racist thing by it, most people just mean "corporations that span many nations".
Wikipedia also contains many definitions of "globalism" that are not anti-semitic.
https://en.wikipedia.org/wiki/Globalism
""" Manfred Steger distinguishes between different globalisms such as justice globalism, jihad globalism, and market globalism.[3] Market globalism includes the ideology of neoliberalism."""
""" Proponents of globalism believe in global citizenship; that is, the problems of humanity can be resolved with democratic globalism. Democratic globalism is the idea that all people matter, no matter where they live, and that universal freedom and human rights can be fostered for all mankind.[5] World citizens believe in civic globalism[6] and that by thinking globally and acting locally they can effect positive change across all barriers. """
""" Arguments against globalism are similar to those moved against globalisation, among which loss of cultural identity, deletion of community history, conflict of civilization, loss of political representation and collapse of the democratic process in favour of a globally managed open society. """
There's a reference to Donald Trump's use of the word in Wikipedia. But clearly even if one believes his use of the word is a racist dog-whistle, it doesn't follow that that is true for anyone's use of the word.
I fear this is going to be an increasing problem if we continue to rely on the belief that medical personnel can be abused indefinitely.
We're spending $2+T on keeping everyone afloat in the US. We can spend a lot of that money encouraging everyone to pitch in to fight Covid.
We need ~hundreds of thousands of contact-tracers. If that were our only need, we could offer $1,000,000 to everyone who works as a contact tracer and have money left over.
I'm already volunteering ~70% of my time on FindTheMasks.com. I can only imagine how much more work could be done if unemployed people were given the opportunity to work on fixing the root cause of unemployment!
> We're spending $2+T on keeping everyone afloat in the US.
I think it's best to consider this as less "money to help fight the pandemic", and more as "money to save everyone from starvation", or alternatively "money to have a country to save from the pandemic".
> I'm already volunteering ~70% of my time on FindTheMasks.com.
My strong and sincere thanks for the hard work you do!
Australia is even introducing an open source app next week (like Singapore has) to automatically collect Bluetooth IDs of nearby devices as a person walks outdoors, so people can be more easily traced & notified / quarantined if they've been in contact with someone who has been infected.
Here's one of our Australian state government's explanation of contact tracing, in this case for Tuberculosis:
https://www.healthywa.wa.gov.au/Articles/A_E/Contact-tracing...
(Edit: and here's some info about the Australian and Singaporean contact tracing apps, if you haven't heard of them before)
https://www.theguardian.com/world/2020/apr/17/australias-cor...
But it isn't. $350 billion in PPP funds ran out in 10 days and only covered maybe 5-7% of businesses. $500 billion was just authorized by Congress and will run out in the same amount of time and maybe cover 10% of businesses.
Not even 20% of SMBs who need money due to the economic shutdown have received it - and this money only carries them across the finish line in a few months.
We're talking about double digit trillions of dollars to float the economy into Q3, much less the healthcare system. This is either impractical (my opinion) or we lack the political will to do it, but in either case, it is super unlikely to happen.
Burakumin: "They were originally members of outcast communities in the Japanese feudal era, composed of those with occupations considered impure or tainted by death (such as executioners, undertakers, workers in slaughterhouses, butchers, or tanners), which have severe social stigmas of kegare (穢れ or "defilement") attached to them."
Add to this now "medical professionals".
In Argentina nurses and health care personnel have been abused by their neighbors. In one case, a nurse was harassed and threatened until she was forced to leave the apartment she was renting (yes, she filed a complaint with the law).
Unfortunately fear drives some people to get very nasty, even against people who could save them. Or maybe they always were nasty.
From cars getting degraded to harassment to eviction to assault and battery.
It also has a history of owning them as furniture, of killing them in many manners, of breaking treaties with them, of hanging them as town event, of not treating them, of banning them from states, cities, neighborhoods, of excluding them from society, public places, social benefits, … and I'm sure I'm forgetting a bunch.
I assumed not since Japan does not have “a history of confining [doctors and medical staff] to villages” So your comment could only apply to the treatment of burakumin.
> Sounds like you just want to drag a whole host of other issues into this conversation
You’re the one who made mistreatment of minorities the issue, it’s not really my problem if it also makes you uncomfortable.
People with medical jobs not being able to get childcare is a serious problem, but we need dedicated separate childcare if we're going to keep the spread down.
Trying to explain away prejudice with science requires actual science.
Only institutions (involving decision making by multiple humans) can help in these circumstances, because we need each other.