only 44 states are shown (if I counted correctly) and GA is missing which opened the earliest. anyone know why some states, especially GA, were omitted?
EDIT: i must have missed it, from a comment below, "It says 'Among the 40 states that have consistently provided data'"
It says "Among the 40 states that have consistently provided data" (and, indeed, I count 40, not 44; missing are Alabama, Florida, Georgia, Hawaii, Idaho, Kansas, Nebraska, Nevada, South Carolina, and Tennessee).
Florida and Georgia seem really important since they opened up far enough back that we should be able to get a sense of how their shutdowns impacted infection rates.
Considering I live in Georgia -- yeah, I agree with you. There is tremendous social pressure here to just 'get things back to normal' without any sense that anybody is taking the virus seriously (or is capable of understanding its effects in the state). Our testing rate is at 3% of the population. That's within a statistical margin of error. Suggesting that it's 'safe to reopen the state' without having any evidence to back it up is irresponsible in my book.
"A number of friends and visitors to the site have noticed a discrepancy in how we count “new” cases and how the state of Georgia is counting new cases.
For example, on April 21st, Covid Mapping Project reports 934 “new” cases. Covid Tracking, a companion site run by a team from The Atlantic, doesn’t report differentials but they do report a day by day tracking of cases. On April 20, they report Georgia had 18,947 positive cases and on April 21st they reported 19,881 cases. A differential of 934. Same as us.
However, if you got the GA DPH website (where most of us source our data), you’ll see 10 “new” cases. That was later revised to 84. And then 138. It's a moving number that will likely change every day for at least a week. Quite different than the 934 we’re reporting."
I'm wondering how good fo a marker this is. We've already had people with significant heart attack symptoms refuse to go to the hospital, so is a similar trend happening here with COVID?
just to further complicate things and show how stats are all over the place, the Texas Tribune has hospitalizations flat (even slightly decreasing on average) since about May 1
Hospitalizations are a lagging indicator. The incubation period is 2 weeks, people grow sick enough to be hospitalized in week 3, and death occurs in week 4 or 5. That said, excess deaths are a reliable number, you can't fudge deaths.
I know someone who was recently hospitalized(Texas, US) but was not counted as a coronavirus patient because the test were negative(they didn’t test for anti bodies). The illness resembles almost everything I have read about people with complications from the virus. Doctors & nurses when asked, they all say that for the anti bodies test, the patient would have to go some place else.
At the bottom it has hospital resource usage. It also includes what the resource usage of hospitals was, but it lags about a week behind the current date. That type of data is harder to get.
With the many covid websites out there its surprisingly difficult to find the information you want. https://www.syracuse.com/coronavirus-ny/ is quite good in that it shows the total number of people in hostpital over time, and change in intubations. NY State only.
"No more than 25% of hospital beds in any state are occupied by coronavirus patients."
There seem to be two camps on this topic. One says that this is great, and we should continue every effort possible to stop the spread, presumably for an unlimited number of months or even years. That means staying locked down with minimal economic activity and somehow dealing with the consequences as they come. This is the "wait for the vaccine" camp, which I find hard to join because even if a safe vaccine can be created, it could be a year or two before it is sufficiently tested and deployed. California seems to be leading this camp in the US.
The second camp says that excess healthcare capacity means we should begin reopening the economy until capacity becomes strained. This is the "let the virus spread" camp, and implicit in the argument is that we should allow more people to die from the virus. This camp is winning. Most states and Western nations have started to ease restrictions knowing full well that it means the virus will spread. The hope is that less stringent restrictions can still allow the rate of transmission to be controlled enough to avoid catastrophe.
(There is also a third, fringe camp in the US of right-wingers, and while it is easy to dismiss them, they are actually winning in states like Georgia and Texas)
My understanding at the start of lockdowns was that these were intended to "bend the curve" so we could get control of the situation and then allow the virus to spread at a rate that would not overwhelm healthcare capacity. But more and more people I know seem to be in the "wait for a vaccine" camp. Personally, my imagination struggles to comprehend what another 12+ months of lockdowns would mean for civilization. The loss of life from disease, though obviously abhorrent, is actually a concept my brain can manage (which is not to imply it has more merit, just an honest observation).
I don’t think this framing is correct. No one wants things to be shut down until we have a vaccine, they want it to be shut down until we have a test and trace infrastructure in place. California’s reopen plan is gated by test and trace. It’s What every other developed country in the world is doing to allow them to reopen. We see this framed by right wingers as “stay closed” vs “open up” because they understand that this administration isn’t capable of launching an effective spread prevention program and are now solely focusing on shifting the blame.
I can’t even imagine the levels of civil disobedience in America if a track and trace program is mandated. WA state, left leaning, already proposed track and trace to go to restaurants and already walked it back after pressure. People are starting to run out of money and food and they will turn to violence. We need to follow the same light social distancing approach as Sweden and Florida imo.
Almost all US states have now eased restrictions and with barely a test and trace program among them (maybe some programs in the Northeast, but where else?).
And if California is truly waiting for testing capacity, they may be waiting a long time because their rate of testing is extremely low compared to places that have opened up. New York has twice the per capita testing as CA and they have already began opening up parts of the state (despite being hit many times harder by the virus). Even NYC is about to hit the criteria for some reopening. Meanwhile, LA announced they would continue their lockdown until August. That sure sounds like they are on a "wait for a vaccine" plan.
The European nations that have eased restrictions have higher per capita testing than most US states. But they do not all have robust test and trace programs. Denmark opened up weeks ago, including many schools, but only last week announced a test and trace program.
a) You give the contact tracing system a complete and accurate history of your contacts.
b) You actually self-isolate when told you've had contact with an infectious person.
The civil liberties crowd will fight tooth and nail against a such that it is not possible to compel b. In the absence of enforcement, the conspiracy theorists will ignore it and the merely lazy will cheat.
Not even a competent attempt at contact tracing is going to work on the American people.
Im curious how effective do you think a test and trace program is likely to be? It seems like the kind of thing that works in isolated cases where things aren't yet widespread. Has it worked anywhere "at scale" ? And then even if it is implemented super well and everyone lets apple and google track them on their phones and stuff, how effective can it possibly be if symptom-free people can transmit it for weeks? One person who commutes on the subway in new york must come within 6' of hundreds maybe thousands of people every day. How can this possibly work? (Honestly asking)
South Korea and a number of other countries have had real world success with it, and have been able to open up fairly safely.
Of course, they had politicians who reacted quickly, firmly, universally, and most importantly early. In the USA, Corona was allowed to grow much much more and far fewer resources were brought to bear in an effective way against it. So its going to be much more difficult to get back under control, but not impossible, if we can turn it around.
Whats really happening besides that though is that the world is watching the self proclaimed world leader be the least competent and most impotent in their response, and throw its hands up and give up on good strategies like contact tracing. Its embarrasing.
This seems to be something Americans are scared of more than something that actually happens. Which ought to make sense; the average Californian's commentary on New York or Italy isn't "heh, sucks to suck".
Test and Trace was never going to work in the way we think. The US is too dispersed, too large, and too opposed to government restrictions/intervention. If we had actually listened to GWB about pandemics when he was in office, and set up realistic T&T mechanisms, we might have had a chance in early January. But it quickly became apparent that we were not going to be able to contain SARS-CoV-2, and would have to try to mitigate it.
While it's easy to take political sides with this, that's in the past. We could have had better CDC leadership than Redfield. We could have had better leadership on the NSC than we had after the advisory committee was disbanded. We could have had better presidential leadership. We could have used testing kits from Germany until US kits were effective.
There's a lot of shoulda/coulda/woulda. But here we are.
None of this stuff is in the past. It could be anywhere from 12 months to forever until we have a vaccine. We might have missed the boat on our first wave (in frankly, the most unforgivable way possible), but we still have lots of time to improve in case we get further waves. And we damned well better assume those are coming.
> We might have missed the boat on our first wave (in frankly, the most unforgivable way possible), but we still have lots of time to improve in case we get further waves.
In much of the country that isn't NYC, including many of the places aggressively reopening, the first wave hasn't even peaked yet, so it's not so much that we missed the boat on the first wave and are now into preparing for potential later waves, we’re still actively screwing up the first wave.
Hopefully we'll have better plans in place, and leaders willing to act on them for COVID-20. My point about T&T was that it doesn't work when you have 1M infections. It's ideal when an epidemic/pandemic first starts to show up. But for now, it's useless health theater.
yes, I don't understand it, but there seems to be a large group who want the lockdowns to remain no matter what. A commenter in a thread last week even went so far as to say the lockdowns were, overall, good for society. I have no explanation except maybe the national election. I hope that's not it because the wholesale destruction of livelihoods just to stick it to the other side is a very depressing thought.
-- Many of those making these comments are probably WFH with some level of normalcy so they don't really see how and why a lot of people are anxious to open things back up.
-- In the same general vein, they see a push to reopen as part of an agenda that puts "the economy" over people for the benefit of Big Business/The Rich.
-- They think there must be a near-term technological/policy fix if only the bad politicians would stop messing things up.
> California’s reopen plan is gated by test and trace
California’s plan has multidimensional standards, it's not accurate to say it's “gated by test and trace”. But yes, the ability to effective monitor leading indicators of caseload and isolated the infected and exposed is fairly significant, and test is key to both and the trace part of test and trace an important factor in the second.
And what's going to happen when there is a vaccine and it's only 50% effective or whatever it's likely to be? Will they move the goalposts again? The economic toll of these lockdowns is going to have real effects on economic well-being (and health outcomes!) worldwide. I'll bet the cost just in human life will end up being greater from the lockdowns than from the virus.
You only need a certain level of vaccine effectiveness in order to reach herd immunity and reduce the spread of the virus. Even a 50% effective vaccine might also reduce the overall danger of the coronavirus if you do end up catching it as well.
Frankly speaking, the idea that opening up will somehow fix everything isn't true. People are still going to be afraid to go to public places, and we have multiple examples of cities or areas that decided to open up too early getting slammed by a second wave of infections (See: Hokkaido, Texas).
So yes, in this case it's a 'moving goalposts' situation because our knowledge and way of dealing with the coronavirus evolves over time. That's the entire point of slowly opening up with a viable test infrastructure. If you don't adjust as the situation evolves, then you get hit with a second wave making the lockdown pointless and prolonging the economic effects. Especially if people start suing local businesses when they get sick for not following the guidelines.
I get your point, but to me hospital underutilization implies that whatever restrictions there are, they can be eased more. Ease the lockdown restrictions in a reasonable way and watch for runaway growth in cases.
> and we have multiple examples of cities or areas that decided to open up too early getting slammed by a second wave of infections (See: Hokkaido, Texas)
Where are you seeing that Texas is getting "slammed by a second wave"? I'm looking at Worldometers, and their daily new cases looks relatively flat. Apparently there was a big jump yesterday, but the state is claiming that correlates with a much higher rate of testing. (This is part of why we should look at the 7 day average, not just the day by day numbers.)
If their rate does happen to be increasing, what makes that a second wave, vs them just not hitting the peak of their first wave yet?
The state has been lying and politicizing the coronavirus problem since the beginning and in general they've been inflating the # of tests done in order to justify reopening the state. A great example of this politicking is that they've been fighting tooth and nail to prevent cities and counties from implementing their own coronavirus measures.
As for the second wave, the fact that we've hit a large jump in cases is specifically what I'm talking about. It does not bode well for the next few weeks, especially because there has been little to no effort from the state to actually implement measures to ensure that we keep the curve flat. Local health officials have also been raising the alarm on both our lack of testing infrastructure and the idea that a second wave is already occurring.
Yeah, I've seen so many "in two more weeks things are going to be much worse" predictions that haven't come true in the past 6 weeks or so that I've mostly started ignoring them (unless they're backed by some level of evidence).
Deaths from COVID-19 can take weeks from the initial infection. I'm not disputing or supporting anything else in this thread, but "there aren't a lot of extra deaths" doesn't really offer much data either way. Maybe in a few weeks.
Texas has only been re-opened for a couple of weeks, so I don't know what you're talking about. If you're talking about the epidemic more generally: the virus has killed nearly 90,000 Americans in less than eight weeks, so it's not like it's let anyone down in the 'killing loads of people in a short period of time' department.
> we have multiple examples of cities or areas that decided to open up too early getting slammed by a second wave of infections (See: Hokkaido, Texas).
I haven’t seen any evidence showing Texas getting slammed by a second wave. All data sources I have seen, including the linked article, show a stable rate or relatively small uptick.
I tend to stay out of these discussions but there has been a huge shifting of the goalposts.
>My understanding at the start of lockdowns was that these were intended to "bend the curve" so we could get control of the situation and then allow the virus to spread at a rate that would not overwhelm healthcare capacity.
Yes. The standard argument went along the lines of we have to limit movement and interactions for a while so that we can "flatten the curve" and not overwhelm the hospital system. Now that that has happened in most cases, though, the goalpost has moved towards the availability of a hopefully effective vaccine in the next year or two [ADDED: and/or maybe effective testing/tracing whose effectiveness in general is TBD]. Which, even if we assume some behaviors change, doesn't seem like a practical long-term strategy.
Bingo. It seemed like most people were on board with the idea of flattening the curve because it was a compromise: don't overwhelm the healthcare system, but continue life as much as possible. No unnecessary extra deaths, but no unnecessary shutdowns. Now we seem to have thrown that message out the window completely and it feels super deceptive.
But those countries don't actually believe contact tracing is effective. When China sees a cluster of cases, they don't say "it's cool because contact tracing will protect us", they lock down the city until the cluster goes away.
You are lumping in a lot of quite diverse places. China and South Korea took quite different approaches. China's is, as you state, very blunt. South Korea has used contact tracing to good effect.
My comment wasn't "all countries in Asia", it was about countries in Asia using contact tracing well.
I think flattening the curve was always more generally about creating a time delay so that progress could be made on multiple fronts.
It was about health care capacity. It was also about testing capacity. It was also about producing/procuring PPE and logistical planning for all the things to come. It was also to learn more about this thing, since there are so many unknowns.
This is a tragic US centric point of view. From an international point of view there are 2 camps: aggressive and complacent. Aggressive means contact tracing every single case. This is only possible with using all the gold standard tools to reduce virus spread: massive testing, travel restrictions, universal masking, and sanitizing. South Korea has demonstrated that this works fairly well even in a democracy even with few social distancing policies. They only recently closed bars.
The biggest dividing line here seems to be masks. Countries whose leaders initially told them not to wear masks are struggling to achieve universal masking compliance. Most seem to have given up on being aggressive and are now having these debates of complacency.
What's the evidence again that universal masking compliance works and is necessary? It seems that some jurisdictions like California (or, hell, Wyoming, way lower than any country in Asia) have had very low transmission rates without it.
Nope, also outdoor. If you're queuing up for e.g. shopping, you must distance and wear a mask.
From the first article I linked: "Are you leaving the house? Facial coverings are required to be worn by anyone older than 12 while waiting in line or inside any essential business, using public transit, riding in a taxi/Lyft/Uber or seeking healthcare, as well as anytime you come within 6 feet of someone from outside your household."
California also has a large proportion of East Asians, where mask-wearing is common, especially when you might have a cold, so that you don't spread it to the next person. Epidemiology is culture-bound. By now everyone knows that the incubation period for coronaplague is long and that pre-symptomatic people are a significant source of spread. It's not a long leap for an East Asian person to think that they might carry the disease without knowing and want to minimize spreading it.
This kind of speculation is cryptically racist. My observations are anecdotal, but walking around in public areas such as parks where mask wearing is asked for I see east Asians ignoring the requests as much as non east Asians (I'm of east asian extraction myself)
This is still a very us centric view. California isn't low compared to Asian countries. But all California shows is that you can achieve low transmission rates with lockdowns done early enough. But of course lockdowns are not sustainable. It's really odd to bring up Wyoming. Any rural area can potentially avoid outbreaks. South Dakota has outbreaks now though.
I remember when the first "we suggest wearing a mask" came out. It was followed with a worry about masks becoming a bigger deal than they should. I remember hearing over and over during the same meeting that masks were not a replacement for keeping a 6' distance between people. Now it seems the whole country is Mask vs No-Mask when the actual experts suggest it's the 6' distance that really counts. Masks were just as an additional precaution and not meant to be front and center.
Meanwhile, in other countries where they actually want to get their economies going, people simply wear masks, because they're an added layer of protection, cheap, easy, and current evidence is that they do help contain the spread of the disease.
Sure, the US isn't as advanced or well-run as... the Czech republic, but we should at least try and aim for what those kinds of countries can accomplish.
yes they do help some but they're not the end all be all of protection which was my point. Wearing a mask or not wearing a mask has become a much bigger deal than it should be. People are protesting over a mask and people are social shaming over a mask, it's not that important. Maintaining distance and washing your hands is much much more important than a mask.
Unless you believe we should wait for a vaccine, we don't need "the end all be all of protection", we only need adequate protocols to stop the spread of the virus from overwhelming healthcare systems. If we can find low impact ways (washing hands, wearing masks) that are effective enough to allow us to curtail physical distancing, that is hugely advantageous.
Given the terrible situation in Brazil (and Mexico), is it not possible that the whole of the Americas could be cordoned off, while Europe and East Asia continue with efforts to suppress the virus?
Testing and tracing has already been tried and shown to be more or less impossible in dense cities with no immunity. It’s not for lack of trying that many cities failed to contain the outbreak in February. Granted, it’s a lot simpler when people are aware, but it’s still likely that cities will fail again as soon as people move about normally.
I suspect a reasonable middle ground strategy is to aim for just some immunity (say 15% or 25%) while not overwhelming healthcare, after which tracing and isolation has a chance of working while also allowing a somewhat functioning society (Note: I mean for dense cities. This could still mean 5% in a country, as in Spain for example).
The hard part is ensuring that as few as possible of those that are infected are in risk groups. This is something that proved difficult in many places.
There is a set of restrictions that allows the aggressive testing/tracing/isolation work for a naive population, and a different set of restrictions that is sufficient for to contain the spread in a population with 20% immunity. My feeling is that the former set of restrictions isn’t viable in democratic countries, or sustainable for the time we are talking about (1-2 years) without leading to something that costs more than is won.
I think random comparisons are pretty much completely lacking in information. Fewer died in country X than country Y doesn't mean policy is better. Nor does "they have fewer cases", or "they have fewer deaths". A tiny outbreak will yield few dead regardless of policy. Not all small outbreaks necessarily become large outbreaks, despite poor policy (why, we don't know yet). What would impress me is a region that with sustainable and accepted policies contain an outbreak in a population with very low immunity. Or a region that can reach a high level of immunity without the disease reaching vulnerable groups.
The "gold standard" idea is not what is actually happening. Look at the various European countries that have opened up. There are as many different sets of protocols as there are nations, and only a few might qualify as the gold standard. So there is at least a third camp between "aggressive and complacent", and that is where the vast majority of nations and US states currently fall.
It’s staggering to me how much people in the US have an normalized this level of death and injury, driven by a failed state response, when counter examples like South Korea and Taiwan exist.
The U.S. has 86,541 coronavirus deaths. South Korea has 260. Even if we adjust for population, we expect the US to have 1700, were we following South Korea’s example.
How is it that people have just swung fully into embracing our having 50 times as many deaths as we could have prevented? How is it that people believe the rush to “reopen,” without implementing measures at the level of countries like South Korea and Taiwan, won’t result in an even worse outcome?
I think it is because even with the current measures, we still have the 86,000 deaths. And at this point, people think the South Korea style measures won't work (too high of a case load, the cat is already out of the bag), and people are getting lock down fatigue.
So one way of looking at it -- no matter what we do, some large percentage (say 70%) of the population will get infected, and a percentage of them will die. By continuing the lock downs, those infections get pushed down the road a bit but they won't be prevented. The only thing that lock downs are good for is to keep the health system from being overwhelmed (where a larger percentage of those infected will die due to lack of resources).
Now my question, is the above a reasonable set of assumptions? I don't see it spelled out like that anywhere, but reading between the lines that seems like what the pro reopening people are saying.
Now, what I'd personally like to see, is instead of a full re-opening, is an order that says any job that can be done remotely, the employer must allow the employees to do remote. Because there are a number of cases I've seen reported here where people were forced into the office just because management wanted to see butts in seats.
We know lockdowns help keep the growth rate manageable. What we don't know is what will happen to the economy once the lockdowns fade.
My gut is that short of more direct Federal aid to individuals (in the form of checks), we'll see people forced back to work as businesses re-open. Consumer spending will still be shit, since no one but fools will be going to football games, theaters, anywhere with crowds. And people will be clinging to their money. So the velocity of money will dwindle.
And unless the government indemnifies businesses against lawsuits arising from COVID infections, businesses will be slow to re-open as well. Wrongful death lawsuits for failing to provide a safe work environment will be very popular.
> Now my question, is the above a reasonable set of assumptions? I don't see it spelled out like that anywhere, but reading between the lines that seems like what the pro reopening people are saying.
Yes, except it's only part of the argument. The other big one is, the economic shutdown is doing significant harm itself: not just lack of funds for rent/mortgage, but also food shortages, delayed surgeries, and so on.
The argument is that the economic shutdown combined with the virus deaths only being delayed and not stopped is going to cause significantly more harm than just stopping the lockdown.
I think some of deniers are the same people that take as a matter of faith that governments policies and actions are always bad. Which is why they believe lockdowns aren't working.
I'll point out at the current rate of infection in California it would take over 100 years to get to herd immunity levels. We will have a vaccine next summer. And before that we will have enough contact tracing an surveillance in place. As well an a vast scale the public for the most part is now aware of the dangers and cautious.
Many parts of the world used lockdowns to get cases under control, and plan to use test-trace-isolate (and hopefully any better treatments that are discovered) to manage the epidemic. The claim that "all those infections [and presumably deaths] can't be prevented" seems to be at very best unjustified, at worst -- demonstrably untrue.
To all indications, South Korea responded competently and aggressively, and they have roughly five deaths per million. But Japan half-assed their response, and they have six.
People are blaming/crediting governments with total control of the outcome, when it's far more likely that yet-unknown environmental, genetic, etc. factors explain much of the variation between countries. That doesn't mean we should excuse government incompetence, but we shouldn't assume the same measures in a different country would have yielded the same death rate.
ETA: If you think something is wrong here, please comment in addition to downvoting. Do you think Japan's response was actually better than Italy's, or Spain's, or any of the countries with much tighter restrictions and many more deaths? If so, why (beyond the circular argument that they have fewer deaths)?
The only reason I agree with you is because you said "the same death rate". If we change it to "a reduced death rate" that's absolutely what we should be assuming. South Korea's measures were born of SARS - we will probably have the same measures ready after this coronavirus. Why not use the lessons learned in South Korea rather than the same ones learned in our own countries?
I said explicitly that I didn't intend my comment as a defense of incompetent government responses, so I'm not sure why anyone would take it that way? It's certainly true that e.g. the USA would have fewer deaths if our response hadn't been so late and chaotic; but that doesn't mean the same measures that brought South Korea to five deaths per million would have brought the USA anywhere near that.
Yes I agree. I understand the point you are making and I don't think what we have contradicted each other. I accept South Korea's measures won't get most Western countries near their death rate. However I felt the need to add that the methods are based on past experience and just because they won't have the same power they will still be extremely effective in combating the virus.
Certainly fair, though I'd probably replace "extremely effective" with "our best ideas to solve a very serious problem, and therefore worth trying".
For example, is Reff < 1 in Korea only because of contact tracing? They're doing a commendable job with that, and it's certainly helping, but by how much? Is their voluntary physical distancing actually responsible for most of their success? Or some yet-unknown factor?
I'm not sure how anyone could answer that now with confidence. That uncertainty shouldn't stop us from implementing the best ideas we have, but I believe it should be acknowledged.
Singapore's measures were born of SARS too, and it didn't save them. We should definitely try and learn from other countries, but it doesn't make sense to simply assume that a photocopy of their strategy would have worked as well elsewhere.
I agree. I'm not very aware of Singapore's specific case - however I believe they are having a lot of issues because of overcrowding of migrant workers.
As far as I see it this is exactly this threads OPs point. i.e The same measures won't reduce the death rate to the same amount.
But this does not mean they have not reduced the death rate and aren't good advice everywhere.
"Singapore's measures were born of SARS too, and it didn't save them."
Singapore has 21 deaths as of May 14. Adjusting this number to the US population gives 1,117 deaths. The US has 89,908 deaths and rising. I would gladly trade with Singapore.
What makes you think we ever had the option to? Singapore's response was certainly better than the USA's, and the American equivalent of that would near-certainly have resulted in fewer deaths; but why do you think that explains most of the difference between the two countries' death rates?
In particular, how do you explain Japan? They barely locked down, and they're missing most of their cases so the contact tracing is at best reducing Reff by ~20% (per below). I personally suspect that Japan has benefited from some combination of masks, a culture of hygiene and distance, and the weather; but I'm far from confident, and disappointed to see others behaving with such apparent confidence in the face of all we don't know.
I don't know what makes this virus spread or not spread. All I know is that as long as another Wuhan/Lombardy/NYC is still possible, we should be doing every damned thing we can do to control this epidemic as though it's deadly everywhere.
Hopefully scientists will figure out that chrysanthemum pollen or TB vaccinations reduce the severity, and then we can deploy that tool here. Until that happens: we have to act like this disease is going to explode. That isn't confidence, it's just common sense.
That doesn't seem like a useful attitude to me. Even if we neglect the economy except to the extent it keeps sick people alive, the USA spends about 20% of GDP on health care, and considers treatments cost-effective around $100k/QALY (quality-adjusted life year). Assuming that percentage stays constant, a 10% drop in GDP is about $2T, of which about $400B would have gone to health care. That's 4M QALY, or the equivalent of 300k dead 75-year-olds (assuming perfect quality, using SSI tables for life expectancy, male and female average). So if whatever you do causes a 10% drop in GDP and saves fewer QALY than that, then in a meaningful statistical sense, you've killed people.
The cost of the coronavirus in mortality is massive, but the cost of the reaction is too, even just in lives as above. Some measures seem clearly cost-effective to me (masks, not standing too close, keeping kids in stable groups, etc.), but others (closing schools completely) do not. It's not hard for me at all to imagine a response that causes more societal harm than the virus itself.
You're assuming that you can let the virus burn out of control without it having any negative effects on the economy. I'm going to be polite, so I'll just say that assumption is unrealistic.
Imagine that the virus did what it did in NYC or Lombardy, but did it in every city in the US. Given our understanding of the virus, this is very possible. Now forget the statistics: just think viscerally about what that would mean for schools, office jobs, retail businesses, hospitals. You'd get all those deaths plus the economic damage of a lockdown. This isn't an either/or.
Basically: if we're not going to control this thoughtfully, we'd better pray that some as-yet-unknown effect stops the spread most places, or that people naturally socially-distance enough to stop it. I hope one of those happens, maybe it will happen, but I have zero reason to believe it will right now.
I'm not sure what makes you think I'm advocating "letting the virus burn out of control"? I specifically listed control measures that I advocated (masks, distance), and those alone seem to be mostly working for Japan without further restrictions--though I fully agree yet-unknown factors may mean those alone won't work in some other places.
And I certainly agree the virus alone has economic impact, even if the government (recklessly) took no steps to control it. So do the math with the incremental cost in GDP for whatever intervention you favor, but remember that every extra percent of lost GDP is ~30k dead 75-year-olds in lost health care spending under the model above, even before considering any other economic impact. There is no safe path here, just different and uncertain tradeoffs.
Japan didn’t “half-ass” their response, they just took a different approach from South Korea (attacking clusters), rooted in their experience with combatting TB.
In addition, they have a highly pro-social society that took it upon itself to do things like engage in universal mask wearing and social distancing measures.
That being said, we’re still very early in the course of this disease, so it’s hard to know how the responses will measure up in terms of durability. Since many epidemiologists are predicting a dark course this coming winter, I suppose we will see, but my bet would be on South Korea, given that their response is more firmly rooted in their experience with SARS.
The US has neither the aggressive government response, cluster-based methods of Japan, nor an especially pro-social society. You can’t really compare “half-hearted” measures across countries absent this context, but if even if you wanted to, it’s quite clear that our “half-heartedness” is far more deadly.
What specific measures do you think Japan took that were effective here? They've been able to do more contact tracing from clusters than the USA; but is that because they're better at contact tracing, or because the outbreak naturally grew slower there, and they had an easier task?
I certainly agree that stuff like Japan's existing mask culture (and general culture of hygiene/distance) is helping, and that those can and should be emulated. That's a separate question from their current government response, though.
And I worry about winter too. Everything about seasonality is speculative now (and it's shocking how little we know about why a cold and flu season exists), but I can't help suspect that many countries that think they've eliminated the coronavirus have an unpleasant wave ahead.
And thanks for the reasonable counterpoint--whoever downvoted you should explain themselves too.
They’re better at contact tracing and cluster-squashing because they have a large, long-standing network of public health centers with the express goal of combatting infectious disease outbreaks:
> In 1935, with funding from the Rockefeller Foundation, Japan opened its first public health centre (PHC) in Tokyo. The country then put in place a programme that led to the building of another 187 nationwide. They survived the war and the occupation. But the thing of note is that before and after the war, their priority, says Taniguchi, was always to “stay watchful all the time” for the emergence of TB cases. If one was found, they were tasked with rushing to the patient's residence, checking for clusters and sterilising the house
Seventy-five years on, 469 PHCs are in operation across the country, with each manned, on average, by 64 medical professionals, including one to two licensed doctors. They still locate clusters, track links and conduct tests. It is this “accumulated wealth of expertise, rarely found elsewhere” that has made the difference. Japan has not had to rely on mass testing strategies because it’s health care history had already left a cluster-crushing strategy embedded in its system
But Japan's 729 coronavirus deaths imply something around 72,900 infections assuming 1% IFR. They actually report 16k. How could the contact tracing be what's keeping their Reff < 1, if they're missing ~80% of the cases?
Because Japan’s approach to testing, focusing on clusters, results in an undercounting of total cases in favor of the most dangerous set of cases. Cluster-squashing is about identifying and grounding to a halt circumstances where things can grow out of control quickly. They devote most of their resources to this and don’t have mass, on-demand testing like Korea. This results in their undercounting cases (arguably less serious cases, but again we’ll have to see the comparative efficacy long-term between the two countries).
So you're arguing that even though Japan's contact tracing is missing ~80% of the cases, it's still catching the ~20% that would have spread the disease disproportionately? What's the difference between the high-spreading groups that they catch and the low-spreading they don't need to? Is this a characteristic of the patient's biology, behavior, environment, something else?
Maybe you're saying that R < 1 almost everywhere in Japan, and they're disproportionately identifying the few places where it's > 1 ("circumstances where things can grow out of control") and intervening? I could believe that; but that still fails to explain why R > 1 there only in a few hotspots, while NYC ended up with ~20% infected even after lockdowns.
> Maybe you're saying that R < 1 almost everywhere in Japan, and they're disproportionately identifying the few places where it's > 1 ("circumstances where things can grow out of control") and intervening
From what I understand, this is the thinking guiding the Japanese government’s response and their zoned lockdowns. Whether or not this is true, or will continue to be true, is unclear, but as you’ve pointed out, they’re roughly on track with South Korea thus far.
To your second point: no one really knows. Looking at the example of other countries, universal, correct use of masks does seem to be an important mitigating factor. This was not practiced in NYC until well into the outbreak and social distancing measures were slow to be adopted as well (either by people taking it upon themselves or by government decree).
I agree fully with your comment above. I'm glad I live in a region with a mask order, though compliance among non-Asians here is hit or miss. That kind of difference (which I guess isn't quite environmental; in an earlier comment I'd included "pre-existing behavioral", which I should have here) has made life easier for the Japanese government and harder for the American one--again, not to excuse the late and confused mask messaging from the USA, just to say that even with early and clear messaging the USA would probably still have had lower and less competent mask use than Japan.
I certainly don't mean to suggest we shouldn't be trying our best ideas to control the virus, even if we're not sure whether they'll work or why. I just don't like the idea of low death counts as conclusive evidence that whatever a government is doing is good, especially to the extent it lets authoritarians that have seen low death counts (for reasons related or unrelated to their response) like China promote their models to the rest of the world.
I'm not sure what you mean by "normalized" or "embracing" here. A few obnoxious people do admittedly go around saying we've done a great job, but most Americans agree it's very sad.
Unfortunately, we can't bring 80k down to 1700 by just saying the number ought to be lower or being really sad about it. If there's some way to immediately stop coronavirus deaths, we don't know what it is and we don't reasonably expect to find it soon.
I think it's fine to point out that we can't bring people back to life, but I think it's a little too much to say "gosh, this is too hard and we don't know how to manage this epidemic." A number of other countries have (and are having) success by moving to test-trace-isolate and using short, evidence-driven lockdowns to control severe outbreaks. The US, at least many jurisdictions, are not. We aren't even using our Federal government's full powers to ramp up testing capacity.
And a number of other countries are not having success as well. The current state of the world isn't very compatible with a story where simply enacting the right policies brings a large outbreak under control. (After all, even long evidence-driven lockdowns aren't driving transmission in the US anywhere close to 0.)
The fact that some countries are using test-and-trace effectively doesn't seem to be refuted by the fact that other countries are doing poorly. Are those countries also following South Korea's model? Do they have the medical and biotech resources of S. Korea and the US?
There are enough degrees of freedom to define South Korea's model such that only successful countries are following it. The fact that every single Western European country is sitting together at the top of the per-capita charts makes it hard to believe that it's just a matter of picking the right policies and executing them.
In every region of the world, countries with lots of medical and biotech resources are generally doing worse. Korea, China, and Japan are all doing worse than Thailand and Vietnam, Eastern Europe is doing better than Western Europe, and Canada and the US are the worst hit countries in the Americas. The list of countries which have seemingly controlled the coronavirus despite being unable to control tuberculosis and malaria is very long.
The degree of the epidemic in a given country during March-April seems to reflect at least three factors: (1) luck (e.g., did you get early spread like Lombardy), (2) public health policy, and (3) resource limitations that were unavoidable given the short warning period.
South Korea was well prepared by SARS, and did extremely well on (2)+(3). Other Western nations had good policy responses, but didn't have the resources in place by February/March.
However, many countries that were unprepared have since made significant efforts to increase resources and deploy successful policy. A look at the epidemic curves in May shows that results are diverging even between Western countries that had similar initial growth. Some, despite starting with a similar initial case spread, are seeing significantly greater declines than others. Some are deploying testing resources at a higher rate.
Ignoring current performance and lumping all Western nations together completely ignores all of this and makes it seem like humans are helpless to control epidemics, which is an absurd claim.
Looking at current epidemic curves reinforces my belief that humans are helpless to control epidemics. Epidemic curves of individual American states shows the same thing [1]; some states have seen a speedy decline, and some are kinda stuck, with no correlation to any policy decision I'm aware of.
For example,there are doubtless exacerbating factors in the case of NYC (density, transit, lots of travelers). However, whatever you may like or not like about the specific policy responses at all levels of government with respect to NYC, I think it's hard to make the case that it was a uniquely bad response compared to not only everywhere else in the US but everywhere else in the world.
Isn’t “percentage of occupied beds w/ covid” a terrible metric? As states open up and elective surgeries, car accidents etc increase the denominator will inevitably increase and this will appear to go down regardless of any positive change. What is wrong with the much simpler metric of “number of beds used by covid patients”?
It seems like what you want is the percentage of hospital beds dedicated to covid patients, or perhaps the percentage of beds unoccupied, since the purpose of the curve flattening effort is to keep the health care system from collapsing.
> Isn’t “percentage of occupied beds w/ covid” a terrible metric?
It's not perfect, but in terms of the readily available data, it's not terrible.
> As states open up and elective surgeries, car accidents etc increase the denominator will inevitably increase
OTOH, there's a credible argument that that is a kind of positive progress itself. And, no, it's not inevitable that the denominator will go up if COVID already has hospitals at capacity.
> What is wrong with the much simpler metric of “number of beds used by covid patients”?
That's a good measure for any state, but bad for comparing conditions among states. Share of available hospital beds occupied by COVID-19 patients might be better, but “available” is not always clear since physical capacity and staffing and other support may not yield the same maximum. Because of required staffing ratios, etc.
Notably missing is Georgia, which opened up weeks ago, and where both the new cases and deaths continued to fall. In fact GA is missing from the news in general, unlike 2 weeks ago, when everyone was predicting a massive explosion in new cases.
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[ 2.2 ms ] story [ 180 ms ] threadEDIT: i must have missed it, from a comment below, "It says 'Among the 40 states that have consistently provided data'"
If I sound nervous, it's because I am.
"A number of friends and visitors to the site have noticed a discrepancy in how we count “new” cases and how the state of Georgia is counting new cases.
For example, on April 21st, Covid Mapping Project reports 934 “new” cases. Covid Tracking, a companion site run by a team from The Atlantic, doesn’t report differentials but they do report a day by day tracking of cases. On April 20, they report Georgia had 18,947 positive cases and on April 21st they reported 19,881 cases. A differential of 934. Same as us.
However, if you got the GA DPH website (where most of us source our data), you’ll see 10 “new” cases. That was later revised to 84. And then 138. It's a moving number that will likely change every day for at least a week. Quite different than the 934 we’re reporting."
Here's the dashboard I use: https://dashboards.securedatakit.com/public/dashboard/e430d0...
One thing I find a little suspect about this article, although I do respect Axios, is that hospital usage in Texas has not peaked yet and is currently rising (https://covid19.healthdata.org/united-states-of-america/texa...).
https://apps.texastribune.org/features/2020/texas-coronaviru...
Excess deaths aren't a reliable indicator of COVID-19 impact because of post hoc ergo propter hoc problems.
Am I missing something? It doesn't look like this has any data on hospitalizations. The graphs are all based on "projected" data.
There seem to be two camps on this topic. One says that this is great, and we should continue every effort possible to stop the spread, presumably for an unlimited number of months or even years. That means staying locked down with minimal economic activity and somehow dealing with the consequences as they come. This is the "wait for the vaccine" camp, which I find hard to join because even if a safe vaccine can be created, it could be a year or two before it is sufficiently tested and deployed. California seems to be leading this camp in the US.
The second camp says that excess healthcare capacity means we should begin reopening the economy until capacity becomes strained. This is the "let the virus spread" camp, and implicit in the argument is that we should allow more people to die from the virus. This camp is winning. Most states and Western nations have started to ease restrictions knowing full well that it means the virus will spread. The hope is that less stringent restrictions can still allow the rate of transmission to be controlled enough to avoid catastrophe.
(There is also a third, fringe camp in the US of right-wingers, and while it is easy to dismiss them, they are actually winning in states like Georgia and Texas)
My understanding at the start of lockdowns was that these were intended to "bend the curve" so we could get control of the situation and then allow the virus to spread at a rate that would not overwhelm healthcare capacity. But more and more people I know seem to be in the "wait for a vaccine" camp. Personally, my imagination struggles to comprehend what another 12+ months of lockdowns would mean for civilization. The loss of life from disease, though obviously abhorrent, is actually a concept my brain can manage (which is not to imply it has more merit, just an honest observation).
And if California is truly waiting for testing capacity, they may be waiting a long time because their rate of testing is extremely low compared to places that have opened up. New York has twice the per capita testing as CA and they have already began opening up parts of the state (despite being hit many times harder by the virus). Even NYC is about to hit the criteria for some reopening. Meanwhile, LA announced they would continue their lockdown until August. That sure sounds like they are on a "wait for a vaccine" plan.
The European nations that have eased restrictions have higher per capita testing than most US states. But they do not all have robust test and trace programs. Denmark opened up weeks ago, including many schools, but only last week announced a test and trace program.
a) You give the contact tracing system a complete and accurate history of your contacts.
b) You actually self-isolate when told you've had contact with an infectious person.
The civil liberties crowd will fight tooth and nail against a such that it is not possible to compel b. In the absence of enforcement, the conspiracy theorists will ignore it and the merely lazy will cheat.
Not even a competent attempt at contact tracing is going to work on the American people.
Of course, they had politicians who reacted quickly, firmly, universally, and most importantly early. In the USA, Corona was allowed to grow much much more and far fewer resources were brought to bear in an effective way against it. So its going to be much more difficult to get back under control, but not impossible, if we can turn it around.
Whats really happening besides that though is that the world is watching the self proclaimed world leader be the least competent and most impotent in their response, and throw its hands up and give up on good strategies like contact tracing. Its embarrasing.
While it's easy to take political sides with this, that's in the past. We could have had better CDC leadership than Redfield. We could have had better leadership on the NSC than we had after the advisory committee was disbanded. We could have had better presidential leadership. We could have used testing kits from Germany until US kits were effective.
There's a lot of shoulda/coulda/woulda. But here we are.
In much of the country that isn't NYC, including many of the places aggressively reopening, the first wave hasn't even peaked yet, so it's not so much that we missed the boat on the first wave and are now into preparing for potential later waves, we’re still actively screwing up the first wave.
I wouldn't say "no one":
> Los Angeles Mayor Eric Garcetti said Wednesday that the city will "never be completely open until we have a cure,"
This is also a mentality I've seen numerous times on the web, including this site.
This is absurd, and indicates a politician pandering for the next election.
For ebola, with 25% to 90% mortality, it can be justified.
For corona, with under 0.1% mortality for working-age people, it's madness.
"The average EVD case fatality rate is around 50%. Case fatality rates have varied from 25% to 90% in past outbreaks."
https://www.afro.who.int/health-topics/ebola-virus-disease
-- Many of those making these comments are probably WFH with some level of normalcy so they don't really see how and why a lot of people are anxious to open things back up.
-- In the same general vein, they see a push to reopen as part of an agenda that puts "the economy" over people for the benefit of Big Business/The Rich.
-- They think there must be a near-term technological/policy fix if only the bad politicians would stop messing things up.
California’s plan has multidimensional standards, it's not accurate to say it's “gated by test and trace”. But yes, the ability to effective monitor leading indicators of caseload and isolated the infected and exposed is fairly significant, and test is key to both and the trace part of test and trace an important factor in the second.
Speak for yourself. The US doesn't have a vaccine, enough testing or tracing.
Wishing doesn't make it so. End the lockdown now.
Frankly speaking, the idea that opening up will somehow fix everything isn't true. People are still going to be afraid to go to public places, and we have multiple examples of cities or areas that decided to open up too early getting slammed by a second wave of infections (See: Hokkaido, Texas).
So yes, in this case it's a 'moving goalposts' situation because our knowledge and way of dealing with the coronavirus evolves over time. That's the entire point of slowly opening up with a viable test infrastructure. If you don't adjust as the situation evolves, then you get hit with a second wave making the lockdown pointless and prolonging the economic effects. Especially if people start suing local businesses when they get sick for not following the guidelines.
Where are you seeing that Texas is getting "slammed by a second wave"? I'm looking at Worldometers, and their daily new cases looks relatively flat. Apparently there was a big jump yesterday, but the state is claiming that correlates with a much higher rate of testing. (This is part of why we should look at the 7 day average, not just the day by day numbers.)
If their rate does happen to be increasing, what makes that a second wave, vs them just not hitting the peak of their first wave yet?
As for the second wave, the fact that we've hit a large jump in cases is specifically what I'm talking about. It does not bode well for the next few weeks, especially because there has been little to no effort from the state to actually implement measures to ensure that we keep the curve flat. Local health officials have also been raising the alarm on both our lack of testing infrastructure and the idea that a second wave is already occurring.
https://apps.texastribune.org/features/2020/texas-coronaviru...
They're not hiding bodies, so the excess fatality rate would reveal any lies they're telling.
I haven’t seen any evidence showing Texas getting slammed by a second wave. All data sources I have seen, including the linked article, show a stable rate or relatively small uptick.
>My understanding at the start of lockdowns was that these were intended to "bend the curve" so we could get control of the situation and then allow the virus to spread at a rate that would not overwhelm healthcare capacity.
Yes. The standard argument went along the lines of we have to limit movement and interactions for a while so that we can "flatten the curve" and not overwhelm the hospital system. Now that that has happened in most cases, though, the goalpost has moved towards the availability of a hopefully effective vaccine in the next year or two [ADDED: and/or maybe effective testing/tracing whose effectiveness in general is TBD]. Which, even if we assume some behaviors change, doesn't seem like a practical long-term strategy.
Only if you don't look at countries where it seems to be working pretty well, mostly in Asia.
My comment wasn't "all countries in Asia", it was about countries in Asia using contact tracing well.
It was about health care capacity. It was also about testing capacity. It was also about producing/procuring PPE and logistical planning for all the things to come. It was also to learn more about this thing, since there are so many unknowns.
The biggest dividing line here seems to be masks. Countries whose leaders initially told them not to wear masks are struggling to achieve universal masking compliance. Most seem to have given up on being aggressive and are now having these debates of complacency.
Bay area: https://www.mercurynews.com/2020/04/22/coronavirus-bay-area-...
San Diego: https://www.10news.com/news/coronavirus/what-to-know-about-t...
Los Angeles: https://losangeles.cbslocal.com/2020/05/14/coronavirus-covid...
From the first article I linked: "Are you leaving the house? Facial coverings are required to be worn by anyone older than 12 while waiting in line or inside any essential business, using public transit, riding in a taxi/Lyft/Uber or seeking healthcare, as well as anytime you come within 6 feet of someone from outside your household."
https://www.usatoday.com/story/opinion/2020/04/04/czech-gove...
Sure, the US isn't as advanced or well-run as... the Czech republic, but we should at least try and aim for what those kinds of countries can accomplish.
https://www.youtube.com/watch?v=ICc_H75R05A
https://en.wikipedia.org/wiki/Defense_in_depth_(computing)
They're a bit uncomfortable, but so are ventilators...
Given the terrible situation in Brazil (and Mexico), is it not possible that the whole of the Americas could be cordoned off, while Europe and East Asia continue with efforts to suppress the virus?
I suspect a reasonable middle ground strategy is to aim for just some immunity (say 15% or 25%) while not overwhelming healthcare, after which tracing and isolation has a chance of working while also allowing a somewhat functioning society (Note: I mean for dense cities. This could still mean 5% in a country, as in Spain for example). The hard part is ensuring that as few as possible of those that are infected are in risk groups. This is something that proved difficult in many places.
There is a set of restrictions that allows the aggressive testing/tracing/isolation work for a naive population, and a different set of restrictions that is sufficient for to contain the spread in a population with 20% immunity. My feeling is that the former set of restrictions isn’t viable in democratic countries, or sustainable for the time we are talking about (1-2 years) without leading to something that costs more than is won.
I mean, I know Iowa is a really dense place where everyone uses public transportation, but maybe they could at least make an effort...
This isn't some small, statistically insignificant difference. It's a massive difference in the number of cases and deaths.
They have 300 deaths and 10k confirmed cases, suggesting they have confirmed 10% to a third of all cases.
It’s also impressive that they managed to keep the outbreak so small without extreme mitigations like other places with similar outbreaks.
I don’t think that most western countries can emulate it though. Next time, perhaps (this is South Korea’s second SARS outbreak).
They certainly can't if they don't even... try.
The U.S. has 86,541 coronavirus deaths. South Korea has 260. Even if we adjust for population, we expect the US to have 1700, were we following South Korea’s example.
How is it that people have just swung fully into embracing our having 50 times as many deaths as we could have prevented? How is it that people believe the rush to “reopen,” without implementing measures at the level of countries like South Korea and Taiwan, won’t result in an even worse outcome?
So one way of looking at it -- no matter what we do, some large percentage (say 70%) of the population will get infected, and a percentage of them will die. By continuing the lock downs, those infections get pushed down the road a bit but they won't be prevented. The only thing that lock downs are good for is to keep the health system from being overwhelmed (where a larger percentage of those infected will die due to lack of resources).
Now my question, is the above a reasonable set of assumptions? I don't see it spelled out like that anywhere, but reading between the lines that seems like what the pro reopening people are saying.
Now, what I'd personally like to see, is instead of a full re-opening, is an order that says any job that can be done remotely, the employer must allow the employees to do remote. Because there are a number of cases I've seen reported here where people were forced into the office just because management wanted to see butts in seats.
My gut is that short of more direct Federal aid to individuals (in the form of checks), we'll see people forced back to work as businesses re-open. Consumer spending will still be shit, since no one but fools will be going to football games, theaters, anywhere with crowds. And people will be clinging to their money. So the velocity of money will dwindle.
And unless the government indemnifies businesses against lawsuits arising from COVID infections, businesses will be slow to re-open as well. Wrongful death lawsuits for failing to provide a safe work environment will be very popular.
Yes, except it's only part of the argument. The other big one is, the economic shutdown is doing significant harm itself: not just lack of funds for rent/mortgage, but also food shortages, delayed surgeries, and so on.
The argument is that the economic shutdown combined with the virus deaths only being delayed and not stopped is going to cause significantly more harm than just stopping the lockdown.
(Hour-later edit, fix the wording at the end)
I'll point out at the current rate of infection in California it would take over 100 years to get to herd immunity levels. We will have a vaccine next summer. And before that we will have enough contact tracing an surveillance in place. As well an a vast scale the public for the most part is now aware of the dangers and cautious.
People are blaming/crediting governments with total control of the outcome, when it's far more likely that yet-unknown environmental, genetic, etc. factors explain much of the variation between countries. That doesn't mean we should excuse government incompetence, but we shouldn't assume the same measures in a different country would have yielded the same death rate.
ETA: If you think something is wrong here, please comment in addition to downvoting. Do you think Japan's response was actually better than Italy's, or Spain's, or any of the countries with much tighter restrictions and many more deaths? If so, why (beyond the circular argument that they have fewer deaths)?
For example, is Reff < 1 in Korea only because of contact tracing? They're doing a commendable job with that, and it's certainly helping, but by how much? Is their voluntary physical distancing actually responsible for most of their success? Or some yet-unknown factor?
I'm not sure how anyone could answer that now with confidence. That uncertainty shouldn't stop us from implementing the best ideas we have, but I believe it should be acknowledged.
As far as I see it this is exactly this threads OPs point. i.e The same measures won't reduce the death rate to the same amount.
But this does not mean they have not reduced the death rate and aren't good advice everywhere.
Singapore has 21 deaths as of May 14. Adjusting this number to the US population gives 1,117 deaths. The US has 89,908 deaths and rising. I would gladly trade with Singapore.
In particular, how do you explain Japan? They barely locked down, and they're missing most of their cases so the contact tracing is at best reducing Reff by ~20% (per below). I personally suspect that Japan has benefited from some combination of masks, a culture of hygiene and distance, and the weather; but I'm far from confident, and disappointed to see others behaving with such apparent confidence in the face of all we don't know.
Hopefully scientists will figure out that chrysanthemum pollen or TB vaccinations reduce the severity, and then we can deploy that tool here. Until that happens: we have to act like this disease is going to explode. That isn't confidence, it's just common sense.
The cost of the coronavirus in mortality is massive, but the cost of the reaction is too, even just in lives as above. Some measures seem clearly cost-effective to me (masks, not standing too close, keeping kids in stable groups, etc.), but others (closing schools completely) do not. It's not hard for me at all to imagine a response that causes more societal harm than the virus itself.
Imagine that the virus did what it did in NYC or Lombardy, but did it in every city in the US. Given our understanding of the virus, this is very possible. Now forget the statistics: just think viscerally about what that would mean for schools, office jobs, retail businesses, hospitals. You'd get all those deaths plus the economic damage of a lockdown. This isn't an either/or.
Basically: if we're not going to control this thoughtfully, we'd better pray that some as-yet-unknown effect stops the spread most places, or that people naturally socially-distance enough to stop it. I hope one of those happens, maybe it will happen, but I have zero reason to believe it will right now.
And I certainly agree the virus alone has economic impact, even if the government (recklessly) took no steps to control it. So do the math with the incremental cost in GDP for whatever intervention you favor, but remember that every extra percent of lost GDP is ~30k dead 75-year-olds in lost health care spending under the model above, even before considering any other economic impact. There is no safe path here, just different and uncertain tradeoffs.
In addition, they have a highly pro-social society that took it upon itself to do things like engage in universal mask wearing and social distancing measures.
That being said, we’re still very early in the course of this disease, so it’s hard to know how the responses will measure up in terms of durability. Since many epidemiologists are predicting a dark course this coming winter, I suppose we will see, but my bet would be on South Korea, given that their response is more firmly rooted in their experience with SARS.
The US has neither the aggressive government response, cluster-based methods of Japan, nor an especially pro-social society. You can’t really compare “half-hearted” measures across countries absent this context, but if even if you wanted to, it’s quite clear that our “half-heartedness” is far more deadly.
I certainly agree that stuff like Japan's existing mask culture (and general culture of hygiene/distance) is helping, and that those can and should be emulated. That's a separate question from their current government response, though.
And I worry about winter too. Everything about seasonality is speculative now (and it's shocking how little we know about why a cold and flu season exists), but I can't help suspect that many countries that think they've eliminated the coronavirus have an unpleasant wave ahead.
And thanks for the reasonable counterpoint--whoever downvoted you should explain themselves too.
> In 1935, with funding from the Rockefeller Foundation, Japan opened its first public health centre (PHC) in Tokyo. The country then put in place a programme that led to the building of another 187 nationwide. They survived the war and the occupation. But the thing of note is that before and after the war, their priority, says Taniguchi, was always to “stay watchful all the time” for the emergence of TB cases. If one was found, they were tasked with rushing to the patient's residence, checking for clusters and sterilising the house
Seventy-five years on, 469 PHCs are in operation across the country, with each manned, on average, by 64 medical professionals, including one to two licensed doctors. They still locate clusters, track links and conduct tests. It is this “accumulated wealth of expertise, rarely found elsewhere” that has made the difference. Japan has not had to rely on mass testing strategies because it’s health care history had already left a cluster-crushing strategy embedded in its system
https://moneyweek.com/economy/global-economy/601264/cluster-...
Maybe you're saying that R < 1 almost everywhere in Japan, and they're disproportionately identifying the few places where it's > 1 ("circumstances where things can grow out of control") and intervening? I could believe that; but that still fails to explain why R > 1 there only in a few hotspots, while NYC ended up with ~20% infected even after lockdowns.
From what I understand, this is the thinking guiding the Japanese government’s response and their zoned lockdowns. Whether or not this is true, or will continue to be true, is unclear, but as you’ve pointed out, they’re roughly on track with South Korea thus far.
To your second point: no one really knows. Looking at the example of other countries, universal, correct use of masks does seem to be an important mitigating factor. This was not practiced in NYC until well into the outbreak and social distancing measures were slow to be adopted as well (either by people taking it upon themselves or by government decree).
I certainly don't mean to suggest we shouldn't be trying our best ideas to control the virus, even if we're not sure whether they'll work or why. I just don't like the idea of low death counts as conclusive evidence that whatever a government is doing is good, especially to the extent it lets authoritarians that have seen low death counts (for reasons related or unrelated to their response) like China promote their models to the rest of the world.
Unfortunately, we can't bring 80k down to 1700 by just saying the number ought to be lower or being really sad about it. If there's some way to immediately stop coronavirus deaths, we don't know what it is and we don't reasonably expect to find it soon.
In every region of the world, countries with lots of medical and biotech resources are generally doing worse. Korea, China, and Japan are all doing worse than Thailand and Vietnam, Eastern Europe is doing better than Western Europe, and Canada and the US are the worst hit countries in the Americas. The list of countries which have seemingly controlled the coronavirus despite being unable to control tuberculosis and malaria is very long.
South Korea was well prepared by SARS, and did extremely well on (2)+(3). Other Western nations had good policy responses, but didn't have the resources in place by February/March.
However, many countries that were unprepared have since made significant efforts to increase resources and deploy successful policy. A look at the epidemic curves in May shows that results are diverging even between Western countries that had similar initial growth. Some, despite starting with a similar initial case spread, are seeing significantly greater declines than others. Some are deploying testing resources at a higher rate.
Ignoring current performance and lumping all Western nations together completely ignores all of this and makes it seem like humans are helpless to control epidemics, which is an absurd claim.
[1] https://www.endcoronavirus.org/states
It's not perfect, but in terms of the readily available data, it's not terrible.
> As states open up and elective surgeries, car accidents etc increase the denominator will inevitably increase
OTOH, there's a credible argument that that is a kind of positive progress itself. And, no, it's not inevitable that the denominator will go up if COVID already has hospitals at capacity.
> What is wrong with the much simpler metric of “number of beds used by covid patients”?
That's a good measure for any state, but bad for comparing conditions among states. Share of available hospital beds occupied by COVID-19 patients might be better, but “available” is not always clear since physical capacity and staffing and other support may not yield the same maximum. Because of required staffing ratios, etc.