Based on the localized infection cases I see across the US and have been watching as well as the characteristics of the virus (life outside host/on surfaces, in air, the degree of asymptomatic transference, etc.), it's well beyond containment IMHO.
Travel isn't going to do too much to reduce infection rates alone. We need significant cultural changes to reduce infection rates, but I don't see that happening for a variety of reasons. This country isn't about proactive action and is all about reactionary action though, so we're just waiting for that reactionary threshold. Some preventative measures have been pushed but they're no where near aggressive enough at this point.
It will be interesting how this is handled in our modern cultural, current political and work culture, etc. I suspect it's going to be fairly nasty but certainly hope not. I've been advising my parents to stock up and minimize any outside interactions for awhile.
All reductions in (non-essential) travel are good in a pandemic. That doesn't mean it's sufficient, but it's something positive.
I think we would all like to see stronger social distancing rules domestically (in the US), but here the US has a problem as it granted the President broad discretionary powers to suspend international travel but not domestic gatherings, which can't be banned via executive order and even if congress were to pass a law banning such gatherings, there would be first amendment implications as well as federalism issues.
It's not easy to pass a law giving the President this type of power and I suspect many in congress already rue passing the laws that gave the president power to suspend international travel. That's one of the prices of living in a federal government with separation of powers and a bill of rights guaranteeing right to assembly rather than in a place like China.
For example, the CDC has issued social distancing guidelines but they are only guidelines not laws: Santa Clara county has said "no thank you we'll follow our own guidelines" instead, when the CDC asked to ban meetings of more than 250 but Santa Clara banned meetings of more than 1000, and just refused to change their target to the CDC recommendation.
So the US simply lacks the tools that would allow the President to go on the air and announce "I'm declaring that the MLB season needs to be delayed and Disneyland must close." He can try to exert pressure, or rather have the CDC exert pressure, but these types of declarations are not going to happen in America.
Banning public gatherings is really something that should be done on the municipal level, maybe the state level. The federal government should not have the power to disrupt every day life from thousands of miles away.
I sympathize with this view, but it does make it harder to respond quickly with nationwide lockdowns, which is the flip side of living in such a connected world.
Long term, I think some mechanism to mandate more social isolation is going to be needed.
For example when travelling from California to Arizona, there is currently no quarantine area or checkpoint, and that's fine if you want free movement, but then it's harder to say that states should run their own pandemic policy as long as there is free movement between states.
And this is a general trade off. More interconnected world => localism is less viable as a means of countering global threats.
Practically, yes, the states these days won't do anything until the federal government tells them to. It'll work out in a nationwide lockdown, but such obedience hurt us in february when the CDC had a monopoly on test kits and nowhere near enough capacity to supply the whole country. We seem to be making all the wrong decisions in this emergency.
Those are valid points. As to the test kits, I keep hearing conflicting info -- e.g. that there was a shortage of ingredients, too much FDA red tape, etc. There will plenty of root cause analysis in the future, but I think we have to reshore critical infrastructure and there is lots of red tape to cut in both CDC and FDA.
The red tape thing is nonsense. What was lacking was/is political will. CDC/FDA/States could increase testing 100-fold overnight if they really wanted to. A decision has been made to proceed differently. Hopefully this decision is reconsidered over the next few days or things are going to get much worse. Currently, as far as I can tell, we are doing about 1000 tests a day nationwide. I can order the necessary reagents and a few water baths and a cheap microtiter plate fluorometer for overnight delivery and do a 1000 of these tests a day by hand.
I have read somewhere that CDC was trying to make a 3-in-1 test kit for SARS, MERS and this new SARS-Cov-2 virus but it was giving bad accuracy and false positives, and now they are making the one for the sars-cov-2 only.
They were making a 3 in 1 kit, but that's because the 1 was an internal control and the other 2 were two different places in the viral genome in case one mutated and became silent.
Any standard first year undergrad level biology book will describe how to run an RT-PCR test (which is what they are doing). None of the reagents and processes are difficult to make or source.
My personal theory is that someone in the executive branch wanted to secure an exclusive contract for a personal friend. Something similar happened in the first few months of the Kuwait oil fires, with certain american fire fighting firms being given exclusive contracts to fight the fires, despite lacking the technology and expertise to extinguish them.
But I'm just a cynical man. It could very well be something else and I'll be very interested to read about this emergency once it's all behind us.
Could be, think of Homeland Security and those new(er) airport scanners. Mike Chertoff, formerly Secretary of Homeland Security, was instrumental in making them happen. He also happened to own a huge stake in the company that made them, since acquired by BAE Systems (who later made him a Chairman).
Even with an exclusive contract, a nation such as the US should be able to quickly ramp production of all the test kits, masks, latex gloves, respirators, oxygen concentrators, antibiotics and other pharmaceuticals that we need.
The who is pretty much everyone in government, egged on by the business community with the tacit approval or at least disinterest of the public. The when is constant over the past half century. The how is outsourcing much of our productive capability around the globe. The why is the race to the bottom for the cheapest production cost.
I don't think so. This is not a case like where we need a bunch of steal but the steel mills are closed so we have to buy the Chinese steel so (as any good business-folks will do) they raise prices 8-fold (see Oakland Bay Bridge Fiasco). The reagents for these tests are all made in america, or would take a few days to ramp up. I once made enough Taq polymerase in 12 hours to supply a lab for 12 years doing 200 PCRs a day. A single person can make gram quantities of the required oligos (enough for 100,000 PCR reactions) in any one of 500 labs in the Bay area alone in 12 hours. RT takes an hour. Amplification takes 4 hours. The readout for a sample can be done 1500 at a time in one second. There are no excuses.
Similarly in Puerto Rico after Hurricane Maria, a politically connected one-man "energy company" called Whitefish, with no experience or skills, emerged out of nowhere and was given the contracts to rebuild the entire Puerto Rican grid.
Months later nothing had happened other than he hired a few people as unskilled as himself who were just dorking around down there, while people died.
So they fired that guy and hired another company called Cobra, with the same terrible terms, and the same ineffective response. Eventually it was found out that Cobra people had paid massive bribes to officials to ensure the deal.
Whitefish was getting stuff done. It was more than one man. It had the needed skill, which was subcontracting. Whitefish got numerous teams operational in Puerto Rico before being yanked off the job by politics.
The whole story of Whitefish being unqualified is just corrupt politics. Subcontracting is a legitimate way to get the work done.
Exactly. And blanket policies are almost always terrible. Local communities have different constraints and different environments. There's no reason to believe that Fargo, North Dakota should have to respond to this in the same way that New York City does.
Singapore and Taiwan are basically cities, very dense. China is a Communist country with all kinds of totalitarian policies. South Korean cases are still climbing at more than 100 a day. You can't tell precisely what the growth curve has been because there's going to be a higher bias when they ramp up testing in many countries.
At any rate, no, a town that has 50 people per square mile should not be forced to respond in the same way as some city with 50,000 people per square mile. In the meantime, the people of Fargo have all the relevant information and their local officials can make calls as needed to suit their demands.
The rule "no gatherings over 250 people" isn't a blanket rule. It will impact cities more than rural places. The flexibility is already built into the schema.
During the Blackhawks game, the announces claim that the official NHL stance is unclear and they will be making an announcement tomorrow. They had 21k in attendance at the game tonight.
>All reductions in (non-essential) travel are good in a pandemic.
All travel is essential to somebody. All restrictions on movement also have a cost, and any analysis that only looks at the benefits of something without looking at the costs cannot hope to be correct.
I'm curious to the downvoters, do you generally believe it's a good idea to make public policy decisions without considering the downsides? It's like people who want to ban encryption because it could marginally increase the number of terrorists caught.
Of course we should consider the downsides when we make public policy decisions. In fact, if we weren't, we wouldn't be making decisions at all but merely reacting.
But we can consider the downsides and decide that we want to restrict travel.
I don't actually need to go visit my rellies. I want to, but I don't have to. On the other hand, if I go on a voluntary trip, I probably have to return home because I can't really afford a hotel indefinitely into the future.
So it's obvious to me that there is some distinction between necessary and nice to have.
I genuinely have been underwhelmed by the reaction to this disease through much of the world. It is necessary in a constitutional democracy to react sometimes to maintain the trust of the voters - or they might say "A democracy is fine when things are going well, but when the chips are down we need a strong leader who can make the decisions we need". Saying "those entertainment business can't open during this outbreak", "keep your tables at least a metre apart" and "don't travel" are reasonable reactions in this circumstance. And we need democratic leaders so that they can know when it's gone on for too long and they have to accept we can't stop it - something a "strong leader" can't tell.
What about to your job, if you don't have a job that you can do remotely? Employers generally don't like paying people who can't make it in to work, and it's hard to pay for food without money.
Aye, just got back from walking there. Pretty essential to doing IT for several hours, though, IMO.
But OPs point stands -- unless you're working from home and never going out to eat / get groceries / not go crazy from cabin fever you have to travel somewhere
I haven't tasted coffee in a decade, and I'm doing just finezzzzzzzz....~
Restricting routine trips to just home-to-work, work-to-home, and large-scale resupply missions is still acceptable at the moment. Make use of your local grocery's picker service with delivery to the parking lot, if you can.
Consider switching your dining-out trips to ordering via phone, fax, or electronic ordering system, and doing drive-through, carry-out, or parking-lot pickup. Pay electronically, in advance, instead of handling cash at the point-of-sale terminal. If you get cabin fever, and need to socialize, do it through screens.
It is essential for Starbucks to serve customers in order for them to stay in business. You don't have to stop going. But you can put in your order via website or app; walk into the retail location only when it's ready; pick it up without speaking to, breathing on, or touching anyone; and then leave immediately. It is possible to minimize the duration and intensity of contact, without eliminating it entirely.
It is better to be in contact with your regular friends, acquaintances, and business associates--that are all the same people every day--than to have a lot of transient contacts with complete strangers. It is slower to traverse a social network one connection at a time than to hit a lot of random, unconnected people all at once with a brodcast.
The hurdle would then be that it’s the feds’ responsibility to prove that this is the smallest infringement that would accomplish the government’s intention.
Strict scrutiny requires not only a compelling state interest but that the restriction be narrowly tailored and the least restrictive means that satisfies the purpose. See: https://en.m.wikipedia.org/wiki/Strict_scrutiny .
> ... the US has a problem as it granted the President broad discretionary powers to suspend international travel but not domestic gatherings, which can't be banned via executive order and even if congress were to pass a law banning such gatherings, there would be first amendment implications as well as federalism issues.
I don't know how strong that actually is. Over the past few years, we've seen some Trump work the courts pretty consistently. Even if his administration is doing something explicitly unconstitutional, running something all the way to the Supreme Court can take 6 to 18 months, during which time the unconstitutional order would stand (if not stayed early on).
OP's point wasn't "this is only going to have very limited effect", to which your reply "better than nothing" would be appropriate.
Their point is that there's absolutely no effect of banning travel between two areas with similar prevalence, based on rather simple logic.
Take two bags with mostly white and a similar number of red balls in them. Then, twenty times, grab one hand from each bag and empty it in the other. What's the expected change in number of red balls?
First infections are not uniformly distributed. Second, by the nature of travel people get into close contact with more and more importantly different people than usual. 200 people sitting in an aircraft for 2 hours is inherently more risky than 200 people sitting in a theater for 2 hours as aircraft mix people from wider geographic areas. So, regardless of infection rates, this is beneficial for both Europe and the US at the same time.
Multiple cities with hundreds of thousands of people in both the US and Europe are infection free right now. Extending that for even a few weeks is very useful.
This is false. Any reduction in travel is going to have a positive effect. The best situation is for people to reduce their exposure to other people and to stay at home. If they do need to be exposed to others, the best is for them to be exposed to the same set of people all the time, and not to different sets of people.
This seems not fully worked out. Assuming total travel is constrained, selectively limiting travel to particular areas concentrates travel in the remaining areas, which increases the average number of contacts between travelers, which violates your “reducing exposure to other people is best” rule of thumb.
By your model, some reductions in travel ought to have a negative effect. Is that a fair corollary?
There’s no such thing as a fixed amount of travel, and constraining it on one way concentrates it in another. That makes no sense. Constraining travel will reduce travel, which will reduce interactions between people, which will reduce the spread of the virus. We know this empirically from previous outbreaks and countermeasures.
The pressure / desire to travel is also dropping sharply, though.
Limiting all Schengen traffic is an extreme example, but it's not obvious that some level of restriction would necessarily produce a significant bottleneck effect (given that citizens are exempt).
Why would you assume total travel is constrained? Restricting travel from Europe to US will just eliminate that portion of travel, not concentrate it in the US.
There is an effect, because traveling itself creates chances for exposure. Anyone traveling on an airplane or train in close quarters, or passing through an airport or transit facility, can pick up or pass on an infection.
By your last analogy, the red balls would have paint rubbed off them in the exchanges.
Yes, but then we should be canceling all flights in the US (we should be). Only canceling flights to Europe is a tiny fraction of what's actually necessary here.
It’s a matter of timing. Europe has higher concentrations of the virus than the US. The chances that a plane from Europe contains an infected individual are getting quite high.
When the concentrations in the US get higher it will start to make sense to constrain travel more over there. Right now the chances a domestic flight contains an infected individual is quite low, but that won’t always be the case.
Bear in mind the virus cannot be stopped, or contained at this point. All we can do is slow it down while also limiting the harm our countermeasures cause.
It’s only a matter of time before it starts over there again, even if through back-propagation from other countries. Everyone’s talking as though China solved the problem. Incredible.
They don't need to solve the problem, just keep the infection rate slow enough to be controlled medically. And then keep everything locked down enough until we can get a vaccine produced. Admittedly, a gargantuan task, and I don't think it's going to happen anywhere else.
They don't need to do that either, they could just let more people die.
That's what you're proposing, if you don't realize it. If you get the growth rate below 1, you can wipe out the disease, instead of merely delaying it.
Apart from the other two replies, the corollary of your point is that travel from a lower incidence area to a higher incidence area actually reduces the risk in the latter.
But this is clearly false because population density is another important factor for contact between people.
It's not just about containment, which signs point to being past us. If we slow the infection and spread it out over time, we do a couple things. Slowing it gives us time to develop tests and treatment and processes and systems to deal with it. Spreading it out over time means that at any given moment fewer people need medical care. Like, if everyone needs care tomorrow, obviously the system can't handle it, but if a few people need it tomorrow, and a few the day after and so on, spreading it out over time, the system can handle a few at a time.
Travel bans alone will not flatten out peak infections that are going to overload our existing healthcare infrastructure that already run at near maximum capacity during regular, non-epidemic periods.
There is a lot more leadership across government (federal, state, local), private industry, and independent individuals could be doing to proactively reduce transference and even stomp out significant portions of infection is followed through. My point is that our cultural trends surrounding all of these (governments, work, personal action) are almost all running counter to what we need to be doing.
We need strong government leadership at all levels pushing support out where possible, be it resources, accurate non-politically influenced/dictated information, etc. Businesses can be more proactively supporting work from home more where feasible, extend sick leave or create sick leave options to reduce pressures to work, provide some security/continued employment for those who need it (especially demographics at high risk). People can avoid attending work when sick, reduce/limit public exposure (be it out shopping, attending an event, etc.), practice frequent hand washing, limit exposing themselves to at risk populations, etc.
Economically it's a disaster (as the markets are also anticipating) but it's going to be one way or another. It seems to me that you're better off to take a well calculated hit that can bounce back to a healthy workforce that doesn't strain existing healthcare infrastructure than trying to pretend nothing is going on, minimal fallout will occur, and play-it-by ear.
Well calculated hit in an economic sense. As a side effect I suppose you could argue that some economic losses can lead to deaths... but that's certainly not the goal.
IMO the only reason we aren't reporting large numbers of new cases is because of the lack of widespread testing currently being done compared to other countries at this moment (other countries are performing magnitudes higher tests a day).
Even if you think you have it, there's still not enough test kits available yet - even if you're swabbed it can be days for a result(Saying this from west michigan).
And because people with mild symptoms aren't likely going to the doctor. They can't afford to take off work and go, and if it's simply mild right now, why risk their livelihood? I kinda hope this whole thing is a wake-up call for why our system is so unsustainable.
People on reddit (take that as you will) have been reporting that even if the symptoms are significant and match the profile, tests aren't being run if no travel has taken place recently. These people get turned away.
COVID-19 doesn't mean there aren't regular flu / colds going around, too.
Long distance travel and exposure to those who have been (e.g. hugging your wife got off a plane from Spain 2 days ago) is still a top predictor for exposure.
> COVID-19 doesn't mean there aren't regular flu / colds going around, too.
Which is exactly why everyone with those symptoms needs to be tested. One of the most important things we need to do right now is detect the people who got the virus through community transmission.
> Long distance travel and exposure to those who have been (e.g. hugging your wife got off a plane from Spain 2 days ago) is still a top predictor for exposure.
I'd say that testing those people should be lower priority, since an assumption they're infected is more likely to be accurate, so they can take preventative measures without needing a test.
> Which is exactly why everyone with those symptoms needs to be tested.
This. I'm in my twenties so it's very possible for me to get COVID and only experience cold like symptoms (or less!). I'm sorry to everyone, but I won't self-quarantine myself for 14 days just because I have a stuffy nose (it's likely a cold right?). I'm fortunate enough to have the ability to take time off/work remote - but what if it's a cold this week and COVID in two weeks? I can't take a month off.
I'm from West Michigan - ATM there's very little testing available, and I'd only be tested if I had recently traveled. But we're past the point where recently traveling is such a big indicator - we're seeing plenty of community transmission for me to believe it's very likely everywhere already, and any lack of cases is because of a lack of testing.
This is a twice-in-a-century event. (Consider AIDS the other pandemic.) Our system should not be built for outlier events. Instead, we should make exceptions for those outlier events. (For example, we could have salary supports for those in quarantine and unable to work remotely equal to their average reported income over the last 12 weeks || a minimum wage and support for landlords or mortgages until the pandemic ends.)
Overpay for an extreme case rather than adapt your system around it.
Now, I have other complaints about our system and how it is unsustainable, but this is a poor argument as to why.
yes, the case count is about to sky rocket because wide spread testing is coming online but hopefully the fatality count doesn't. I think the authorities need to do a better job communicating that a steep rise in cases detected doesn't mean a steep rise in severe or lethal cases.
I think a steep rise in infection counts due to increased testing/detection would be a great thing. More data is always better in these situations and more confirmed infections with confirmed recoveries would probably ease everyone's minds a bit more.
To be clear I'm not saying more infections are a good thing, simply that if there are a lot more cases that already exist, knowing they exist and having more accurate data that shows us COVID19 is less harmful than currently perceived/projected would be good for everyone.
The president didn't say that the virus is a partisan hoax. His actions clearly indicate he doesn't believe it is a hoax.
The president did claim that some criticisms about his handling of the situation were a "new hoax" in the same way he has labeled previous unfounded criticism and accusations as hoaxes.
"His actions clearly indicate he doesn't believe it is a hoax."
Huh?
He called Fox News and said on air ""So if, you know, we have thousands or hundreds of thousands of people [with COVID-19] that get better, just by, you know, sitting around and even going to work, some of them go to work, but they get better,""
His whole schtick until just about a few hours ago was that the risks were all hugely overblown.
I am also curious to know exactly which "previous unfounded criticisms" you are referring to.
I don't know if I'd call that blatantly partisan. Stupid, perhaps, or a hamfisted attempt to prevent panics and economic crashes, but it's not especially political.
Yes. Yes it is. How many times has Trump tweeted about the stock market and how it proves he is a great president? Hundreds. Literally. His NEA chair has explicitly stated "I have long believed that stock markets are the best barometer of the health, wealth and security of a nation. And today's stock market message is an unmistakable vote of confidence for the president." His entire political argument for reelection is premised on his "business acumen." His down playing of coronavirus (to what end? why?) was a blatantly partisan attempt to gamble that this whole thing would blow over rather than risk spooking the markets.
Given the impacts that the stock market crash and his handling of the virus crisis are likely to have on the election, it is definitely a political matter. Realistically any time a president comments on anything it is a political matter.
so? That is not the same thing as saying it is a hoax. Plenty of reasonable criticisms to make but that doesn’t mean the President thinks the virus itself is a hoax. I am arguing for clear communication and facts and people are basically saying screw that let’s just spread rumors because, reasons. How is that helpful?
> Even if you think you have it, there's still not enough test kits available yet
The messaging on this has been pathetic. The other day UW in Seattle announced they had a capacity to test 1,000/day. Not adequate for the nation, but for the PNW, sure.
I'm in Seattle. While there may be official "kits" for this, the protocol can be run in any competent lab set up for this type of assay. DNA primers specific for covid-19 would need to be ordered, but this is routine.
ETA: I'm having trouble locating positive control template sequences.
I am happy for S. Korea running 100,000+ tests, and embarrassed that the US has maybe run 1000s at this point. I also think that the virus is widely dispersed in the US and the best we can hope for is to keep the case load at a level manageable by our health care system. I'm pretty worried about that though.
I'm betting we've been seeded since even before Wuhan's quarantine started. My folks and I all got pretty thoroughly sick during a cruise in early January, and they're becoming increasingly convinced it was COVID (especially since my stepmom tested negative for any sort of flu, and this was well before there were reports of COVID outside of China so of course the doctors wouldn't think to test for it even if they happened to have a test kit); it's increasingly difficult for me to be skeptical of that conclusion.
Thankfully all of us seemed to get over it without much complication, and it doesn't seem like very many of the people we've since interacted with have come down with it. We might very well have just been lucky, though.
It seems very likely that many people (especially in areas with lots of travel to/from China) who had "a bad flu" followed by a chest infection in January or early February actually had COVID.
We are unlikely to ever find out, because we won't have a reason to give everyone antibody tests
Small sample size but: similar experience here (in the middle of the USA). One of my son's friend's mother was even hospitalized for "pneumonia" for a few days. This was the first time I heard of a fairly young fit person having pneumonia due to the flu.
A couple of people I know at work (in Canada) had pneumonia in December (I think). Sometimes pneumonia is pneumonia. I assume even more had it and I just don't know.
Neither of them had traveled anywhere recently.
I dunno, where was your cruise and were there lots of mainland Chinese people on it? Sadly the symptoms for CoVid-19 are pretty common across a variety of diseases, so “flu-like but not flu” doesn’t necessarily point to this. At that time during the outbreak, it seems likely you would have needed to have people from Wuhan on-board.
Los Angeles → Catalina Islands → Ensenada → Los Angeles
> and were there lots of mainland Chinese people on it?
I mean, I didn't exactly go around asking people "are you from China?", but based on the number of people who sounded like they were speaking Mandarin I'd tentatively answer "yes".
> Sadly the symptoms for CoVid-19 are pretty common across a variety of diseases, so “flu-like but not flu” doesn’t necessarily point to this.
Indeed, which is why I'm still at least somewhat skeptical. Still, it's hard to rule it out, especially given the relatively-severe symptoms (not the absolute worst I've felt, but it was pretty bad).
Lots of people live in LA who haven't been to China in decades speak Chinese as a first language. The relevant question is whether there were many people on that cruise directly visiting directly from Wuhan/Hubei. LA-catalina-ensenada-LA? Doubt it. Not exactly the type of cruise someone flies thousands of miles for.
True. Like I said, it ain't like I was going around asking people if they're from Wuhan, lol
That said, you'd be surprised what draws tourists from mainland China; Las Vegas and Reno (for example) both get plenty of Chinese tourists looking specifically to gamble, and I'd imagine the ship's onboard casino to have a similar appeal. Plus, there were plenty of other tourists from long distances, too, both from within the US (East Coast) and from Europe and Australia (from what I gathered from the people whom I did talk to). So evidently there were at least some non-Chinese tourists flying thousands of miles for it; seems reasonable that some mainland Chinese tourists might, too.
That's a really good dataset (with a really clunky visualization, but hey!)
Indeed. There are typically above 3000 deaths/week due to Pneumonia and 200/week due to influenza at this time of year. We had a smallish spike in mid-late January, where for 3 consecutive weeks, deaths were above trend at nearly 4000 & 400 per week.
If you assume a 1% mortality rate for COVID, and you assume all deaths are due to pneumonia, and you assume the entire late-January spike is due to COVID, that could be hiding 300,000-400,000 US cases. (To be clear, those are all questionable assumptions! The mortality rate could easily be either lower or higher, a meaningful fraction of deaths might not show as pneumonia or influenza, and it is normal for there to be a moderate spike above trend at some point in the flu season)
That doesn't mean that there were or weren't a few hundred thousand cases in that time -- it just means that some significant number of cases could easily hide in "routine-looking" spikes in the graph.
This does mean, though, that it is unlikely that everybody who got "the really bad flu" that's been going around this year actually had COVID -- but, especially if you live in a place with lots of people who travel to China regularly (like I do!), it isn't unreasonable to wonder if that "really bad flu followed by a lower-respiratory-tract infection that tested negative for influenza" you got in late January/early February wasn't really COVID.
(Remember, though, that while the rapid influenza test has a pretty low false-positive rate, it's got about a 50% false negative rate -- so testing negative shouldn't lead you to assume it isn't influenza)
If you are in ICU with flu symptoms, they don't just shrug when the rapid influenza test comes back negative. There are reflex tests that can be run to confirm positive or negative.
Critical cases and fatal cases are way more likely to be detected for this reason -- but during the 3 weeks I was talking about, it was believed that there was no COVID in the US, except for folks evacuated from China to quarantine sites.
During that time unexplained pneumonia leading to death -- especially in an older individual -- would likely not have been thought to be COVID, and would just have gone on the books as pneumonia.
14% of cases result in severe pneumonia. R0 is about 4. Average incubation time 6 days. Average time to death/severe illness from onset of symptoms 16 days. If your folks and you got COVID before the Wuhan quarantine you would know someone, likely several people, personally who is/are in the hospital right now with severe respiratory distress.
We're not really hearing any reports of unexplained deaths that might be covid deaths, and the US is advanced enough to not miss deaths like that, so one thing that might put an upper bound on how behind we are. Then again, there's a delay while symptoms progress.
This already happened in Seattle [1]. Undetected COVID deaths are not "unexplained" because they look like flu deaths, so they're simply catalogued as being from the flu.
"In fact, officials would later discover through testing, the virus had already contributed to the deaths of two people, and it would go on to kill 20 more in the Seattle region over the following days."
[1] https://www.nytimes.com/2020/03/10/us/coronavirus-testing-de...
It cannot be contained. That’s what the pandemic declaration means (even though the WHO should have done this weeks ago).
At this point, the only rational thing to do is to try to slow the spread. The good news is that this is a very mild virus, and the vast majority of infected people will have minor symptoms. The fatality rate in Korea is currently 0.6%, and becuase of the comprehensive nature of their testing, this should be considered the upper bound on CFR.
It cannot be contained. That’s what the pandemic declaration means
That's the exact opposite of what the WHO said when they made the pandemic declarations:
"We cannot say this loudly enough, or clearly enough, or often enough: all countries can still change the course of this pandemic," reads a statement from Tedros Adhanom Ghebreyesus, director-general of WHO.[1]
It is not the exact opposite in any way. Your quote does not support your assertion. The truth is that it cannot be contained. It can be slowed down though.
But that's not true. While lethality is estimated at tops 3.6%, the cases requiring hospitalization, including breathing apparatus, etc are quite high, and it WILL overflood the capacity of hospitals in virtually every country that didn't take really really serious precautions, of which there are only a handful.
It will be a big problem both in Europe and in the US, because they are starting to take measures only now.
The vast majority of cases are mild, like a head cold. This is a fact, and has been reported around the world.
You’re arguing about relative hospitalization rates, but that has nothing to do with the discussion here. Mild cases aren’t clogging up ICU wards at all, because they’re quite mild.
I think you mean that this should be considered the goal upper bound on CFR. It's really the lower bound on CFR if you do everything right. If you do everything wrong, like the US is heading towards, you get overloaded health systems, critical shortages, and a 12% CFR or higher.
A 12% CFR is overstating it, but also because we won't be counting the heart attacks that weren't treated, the chemo and radiation therapy that was postponed, and the other health effects.
I think the true measure will be the year over year total mortality.
If we overload our hospitals then CFR will go towards the number of cases that require hospitalization. Which is around 20%. Italy is currently far over hospital capacity and has a CFR today of 8% and rising.
Media and government keep making this claim, yet where are the recovery numbers of people? It drags on for weeks and weeks with no end in sight, correct? And current case fatality rate in Italy is 8%, was 7% this morning, was 6% yesterday - because they do not have hospital resources for the number of serious cases they have.
Serious, critical, and dead outcomes are said to be over 20% of case. This being described as "very low, a very small number" by certain people. That is not a low number at all.
South Korea has been at 0.8% the last two days, and will continue to climb as their open cases resolve one way or another. Plus, didn't they just have a spike in Seoul?
There was a spike in Seoul. Based on their reaction so far, I have a great deal of confidence in their ability to isolate it and react effectively.
Regarding the rise in CFR: it will naturally go up as cases decline, because fatalities stem from a time when the case rate was more rapidly increasing. Korea’s case rate had been declining for several days:
It IS happening in Italy, and it definitely happened in China. The difference is that Japan, South Korea and Singapore have much more powerful nationwide governments. This allowed them to put infection controls in place much earlier than we have in the USA. It remains to be seen where we top out, numbers-wise, vs. hospital capacity.
Here in Washington Governor Inslee declared a State of Emergency, which gives him the power to, among other things, mobilize the National Guard and State militias to establish field hospitals. This is essentially the same reaction China had with regard to building temporary hospitals, but at the state level instead of the federal level. We don't need federal powers, just competent state leadership.
My Bellevue daycare told me today that they probably won’t close unless a worker, kid, or family member gets the virus or...the state shuts them down. Fun times.
I’m ok with their precautions. Not only are they keeping things super clean, but they are giving my kid more hygiene education and training then I could possibly do on my own. For example, washing hands at home is a bit of a struggle because the sink is so high, it is much easier to drill in the habit at daycare, not to mention the peer pressure they apply by making a game out of it for all the kids at once. Child psychology is working for us in this case as long as it remains safe.
The Japanese response has actually been pretty lackluster and haphazard. I'm rather surprised rates there have not been exploding the way they did in Korea, Iran and Italy.
A colleague and myself were pondering this today. He mentioned the 'bow', and general cultural aversion to physical contact. I found that interesting and plausible to consider.
The Japanese response was not so bad when viewed in hindsight.
In comparison, Korea's response was disastrously wrong. Their "Let's test everyone" policy sent lots of people into medical limbo ("We can’t let you go because you're COVID-19 positive ... but meanwhile we have particularly nothing to do for you because you're not that ill") and got their hospitals flooded with mild cases.
Singapore did a top job containing it but it's a small country, one airport..., countries like the US or Italy on the other hand will have a different outcome.
It'd be pretty sweet if it took a pandemic for the government to solidify sick day laws.
Too bad money making is somehow above preventing others getting sick. People wouldnt show up to work if they didn't have to worry about their wages. I'm sorry but 3 sick days is garbage and requiring doctors notes is asine when your healthcare plan is shite. Not to mention wasting a day in a hospital. Companies can afford this stuff. It's not often and it's minimal to say the least. But God forbid a small business can't have someone for 80 hours a week at minimum wage!
I've seen many tech companies in the Boston area announce employees can (or must) work from home, since the governor of Massachusetts declared a state of emergency on Tuesday and encouraged such actions. All governors should do likewise.
Admittedly, the Biogen conference was... a bit of a fuck-up. But yes, all our universities are sending their kids home, white-collar workplaces are moving towards WFH policies, etc. I've been WFH since earlier this week myself, and I went shopping for food and soap with my wife Tuesday night.
I'm seeing more indications of people taking things seriously. The first cases were announced in my state (Michigan) today, and already most universities have cancelled in-person learning, various gatherings are being cancelled, etc. It sounds like my church—on the west side of the state (the two confirmed cases are on the east side)—will be altering plans, perhaps even cancelling services as early as this Sunday. The concept of "social distancing" is rapidly gaining steam.
This depends on how you're defining containment. Grounding aircraft may not decrease the current case count, you're right, but it may help not adding to it, or adding as much, or as fast. Because of this, it may still be worth doing.
The notion that we're going to abandon containment measures in favor of mitigation, which I've seen in many places (not in your comment though of course), is wrong. We're going to be doing both.
As someone posted on FB, the infection rate spikes a lot more with no measures, and flattens with more preventative measures. So while the same number of people may be infected overall, it lessens stress on the healthcare system when it is more spread out.
Which democratic(* - I was going to use Western) nations do though? Seriously the freedom enjoyed by those in these nations and the significant time any global conflict or pandemic have pretty much restricted the ability of leadership in those countries from taking action that would have any true effect short of trying to implement martial law, which in most countries would be met with protests and in some with courts being tied up.
Now I will not attempt to speak for Europe but the US government could certainly push short public advisories and messages to adults and children through broadcast TV and even get the cooperation of streaming services as well. Short thirty to ninety second spots that give helpful non panic information.
The US President is hamstrung by both political disagreement and the law. There were articles he is loathe to declare any national emergency declaration until approached by the governors of many of the states. If he did without states approaching him and asking you can damn well guarantee there were would be Democrats out there claiming he was trying to be a Dictator and comparing him to Putin. The same article concerning the declaration also reveals all the behind the scenes work going on with Congress to get funds in place before any message is put forth so that the government as a whole looks to be cooperating as well as acting appropriately.
The current administration in the US has been more proactive than any previous administration during any previous outbreak, despite the deluge of criticisms that were surprisingly absent during said previous outbreaks. The measures that have been taken thus far are more than aggressive enough, based on the information we currently have. We're just a few steps away from shutting everything down completely, which wouldn't be good for anything at this point. It doesn't get much more proactive than that.
Based on the localized infection cases I see across the US and have been watching as well as the characteristics of the virus (life outside host/on surfaces, in air, the degree of asymptomatic transference, etc.), it's well beyond containment IMHO.
Travel isn't going to do too much to reduce infection rates alone. We need significant cultural changes to reduce infection rates, but I don't see that happening for a variety of reasons. This country isn't about proactive action and is all about reactionary action though, so we're just waiting for that reactionary threshold. Some preventative measures have been pushed but they're no where near aggressive enough at this point.
It will be interesting how this is handled in our modern cultural, current political and work culture, etc. I suspect it's going to be fairly nasty but certainly hope not. I've been advising my parents to stock up and minimize any outside interactions for awhile.