Dealing with Lockdown

[Xerxeskingofking]

I'd offer a much more cynical view, and unfortunately its one that is supported in political science.

In free societies, politicians are not rewarded for preparation (which goes unseen and costs money), but are rewarded for leadership in reaction (which is broadcast to constituents leading to increased popularity, cf. Trump and New York Governor Cuomo increased approval ratings.) Consequently free societies will have a tendency to systematically underinvest in preparation.

In authoritarian regimes, events such as the pandemic are oportunities for additional justification and consolidation of power. (cf. Russia, Hungary, PRC). Consequently authoritarian regimes will have a tendency to systematically underinvest in preparation too.

Of course there will be exceptions, but delivering emergency readiness is difficult engender or sustain.

More prosaically, its harder to justify a preparation cost for a undervalued or remote seeming threat, compared to some other, more pressing spending option.

"spending money on extensive viral testing apparatus is all well and good, but how does that help us fill the potholes in our roads and get the homeless off our streets?" (to name an arbitrary example)

One important thing: this is not a flu.

We have vaccines and treatment for flu, but none of those are worth a dime for SARS-COV-2. Also death rate seems to be quite higher than it appeared at the begining (Spain is having about 10% letality).

Italy has needed over 4 weeks to stabilize situation, and Spain seems to go the same way, in both cases with severe confinement of the people.

I hate to say, but US is just begining, and you'll need several weeks of severe movement restrictions to stop it, and expect your hospitals to be overcrowded in the meanwhile.

Of course, this will be not good for economy, and economical effects will also be severe...

I think the high seeming death rate is partly due to the (relative) lack of testing available, and thus the over-representation of critical and fatal cases in the confirmed cases data. Noteably, places like Germany and Iceland, which have very extensive testing regimes, seem to have a much lower death rate than Italy, spain or the UK, and this is partly due to the higher number of non critical COVID cases they have confirmed (not saying this is the only factor, but it is one of them). I know of several people who have self-isolated with suspected COVID but their isn't the testing capability to confirm if they have it or not, so their not counted by the official count.




Here in the UK, we've been in lockdown for about a week and a half. The government is giving live broadcasts every night to update us on the situation, and one thing that keeps getting mentioned is that the approximate lag between them taking action and the results of those actions being seen is about 3 weeks, so the majority of the infected persons in hospital so far are the result of infections that happened before lockdown, and they cant really be sure how effective the lockdown has been for at least anther week or two.



as for the economic costs, yhea, its gonna suck. the UK government has accounced massive mesures to try and support the economy, but it still means they are banking a immense debt that will be need to be paid off in due coruse, although goverments can hold debt of decades if they want to (the UK took nearly 100 years to pay off its ww1 debt, so something equally long term to pay off this isn't impossible.)

 

[Condottiere]

Social consensus is required to identify and deal with a perceived threat.

As regards to Germany, it may be their luck to have the right leadership in place, who has the capability to act, compared to the more chaotic political situation in Spain and Italy.

 

[whartung]

Of course, this will be not good for economy, and economical effects will also be severe...

My company is now almost entirely work from home.

We were told yesterday that they don't plan on bringing up back until June 1st, and a) that's not a hard date, and b) even if it were, they're going to bring us back gradually.

So, I'm going to be at home at least another 2 months.

The company is already closing to office building due to this. They already had mostly remote workers, now all of them are.

However, we are fortunate -- we support healthcare, so we have work and clients.

We try to go out to eat at least once a day, and I'm over tipping when we go, trying to do a fractional part.

 

[whartung]

More prosaically, its harder to justify a preparation cost for a undervalued or remote seeming threat, compared to some other, more pressing spending option.

"spending money on extensive viral testing apparatus is all well and good, but how does that help us fill the potholes in our roads and get the homeless off our streets?"

California did quite a bit of preparation several years ago, but in the interim since then the program was lost due to the budget.

 

[vegas]

An excellent example of my point.

H5N1 (bird flu) motivated the Governator Schwarzenegger to fund and build our mobile disaster hospitals. Governer Brown defunded them and shut them down.

Now we wish we had them, but paying for preparation turns out to be too hard to sustain/too easy to cut.

EDIT: (wrote the wrong flu strain the first time)

 

[Timerover51]

There are also life expectancies on some of the equipment. We have been talking to our daughter about that. You can only stockpile things so long before you have to replace them.

 

[flykiller]

10 million new unemployed just these first two weeks. "flattening the curve" is gonna flatten a whole lotta other things.

Very true. Unfortunately, very necessary.

heh. we have to destroy the nation to save it.

there's a time to back burn, but this just ain't it.

 

[Grav_Moped]

heh. we have to destroy the nation to save it.

there's a time to back burn, but this just ain't it.

Patients getting hospitalized right now were infected two weeks ago, and were spreading it in the meantime.

By the time you see an outbreak, it's already too late.

We missed our chance at containment.

 

[Fovean]

It is true that there are a few variants of COVID-19. They are functionally identical, though, and will almost certainly each will be vulnerable to the same vaccine once it is found. None of the variants show the genetic hallmarks of having been engineered.

Emphasis mine. This is a very interesting comment, can you elaborate on what those markers are and which viruses we know to be engineered?

cheers

 

[Grav_Moped]

Emphasis mine. This is a very interesting comment, can you elaborate on what those markers are and which viruses we know to be engineered?

cheers

The proximal origin of SARS-CoV-2 (Nature.com)

It is improbable that SARS-CoV-2 emerged through laboratory manipulation of a related SARS-CoV-like coronavirus. As noted above, the RBD of SARS-CoV-2 is optimized for binding to human ACE2 with an efficient solution different from those previously predicted. Furthermore, if genetic manipulation had been performed, one of the several reverse-genetic systems available for betacoronaviruses would probably have been used. However, the genetic data irrefutably show that SARS-CoV-2 is not derived from any previously used virus backbone.

RBD: Receptor Binding Domain

 

[BRJN]

Testing for infection (in the US anyway) is skewed heavily towards patients who come to the hospital for treatment. We have anecdotes and self-volunteered information for people who caught Coronavirus but never stayed in a hospital. We have almost no idea about people who got "a nasty flu bug" and recovered but never considered that their illness might have been Coronavirus.

Besides the day-to-day treating the sick, we need a major effort to manufacture enough test kits to get _everybody_ tested, to learn the true scope and scale of the problem. Then we can take informed action accordingly.

 

[vegas]

Well, yes and no.

Yes, the original sin of the US public health response to Covid-19 (if we set aside lack of preparation) is our lack of testing at scale. It meant that we have had no effective response to the contagion other than physcial distancing of asymptomatics and isolating the sick. If we had fast, effective testing earlier, we could have tried to contain SARS-2 virus (e.g. done aggressive contact tracing and testing) but it really seems too late for that now as too many people in too many places are carriers and we still don't have adequate testing. (100K tests per day isn't very good for a nation of 330M).

But there is an important "no" part too. We do have reasonable estimates about how pervasive the disease is because we have very good (though not perfect) estimates of who has died from Covid-19. We can relying on data from nations that have had better testing regimes (eg. South Korea and Germany) to estimate the fatality rate of the disease. Back calculating our infection rate from the known fatalities and fatality rates isn't that hard. It won't be perfect, but it gives you a good idea of the infection rate.

So I pay attention to the San Francisco area (because it's where I'm from) and New York City (because it's the epicenter of the US outbreak.) It's not hard too see from fatalities that the SF area has an infection rate around 0.4%. That is almost an order of magnitude higher than the confirmed cases (0.05% of the local population) because our testing is so limited and so slow, but the body count tells an undeniable story of the prevalence of the disease here. Similarly, New York City has an infection rate of around 7% of the population based on the fatality experience, regardless of their confirmed cases of 0.75% of the population. (It is no surprise that the NY Times is reporting that 1 in 6 NYPD are out sick or quarantined when you realize that 1 in 14 New Yorkers are infected in the first place.)

 

[Condottiere]

Bill Gates has been publicly warning the electorate, and privately the administration(s), for years, about the dangers of a pandemic.

This was not just some New Age hippy prophesying in the desert.

History demonstrated that it was inevitable, the question was probability, which was affected by human behaviour.

I believe almost all pandemics originate in China, and usually due to the close interaction between animals and humans in unsanitary settings.

 

[McPerth]

I believe almost all pandemics originate in China, and usually due to the close interaction between animals and humans in unsanitary settings.

Well, H1N1 2009 flu pandemic originated in California or Mexico, and the origin of the 1918 one (also H1N1 flu) is not clear...

 

[Straybow]

But there is an important "no" part too. We do have reasonable estimates about how pervasive the disease is because we have very good (though not perfect) estimates of who has died from Covid-19. We can relying on data from nations that have had better testing regimes (eg. South Korea and Germany) to estimate the fatality rate of the disease. Back calculating our infection rate from the known fatalities and fatality rates isn't that hard. It won't be perfect, but it gives you a good idea of the infection rate.

So I pay attention to the San Francisco area (because it's where I'm from) and New York City (because it's the epicenter of the US outbreak.) It's not hard too see from fatalities that the SF area has an infection rate around 0.4%. That is almost an order of magnitude higher than the confirmed cases (0.05% of the local population) because our testing is so limited and so slow, but the body count tells an undeniable story of the prevalence of the disease here. Similarly, New York City has an infection rate of around 7% of the population based on the fatality experience, regardless of their confirmed cases of 0.75% of the population. (It is no surprise that the NY Times is reporting that 1 in 6 NYPD are out sick or quarantined when you realize that 1 in 14 New Yorkers are infected in the first place.)

I don't think anybody has accurate infection scope data. Infection and mortality rate "estimates" are a guess on top of extrapolations. It would help to put things in a wider perspective. Even the common cold has ~5% fatality for age 80+, which is the category of a large percentage of CV deaths. Based on that, CV is only 3 times as bad as common cold.

The Bay area has a normal death rate of 129/day. With 100 deaths as of April 6, a 34 day period from the first California death, that's 3/day. The slope of the curve at present is about 8.5/day. During flu season the Bay area has about 6/day as a ratio of the state population (can't find county breakdown on that, or peak rate). Both figures share common data that could be double-counted, statistically speaking, because pneumonia mortality is most often counted for whatever disease initially presented in the case. Many pneumonia deaths aren't tested for flu and an autopsy isn't called for. CDC simply counts them as one category.

If people tracked and watched daily data on any communicable disease they'd get paranoid. We really don't need to test everyone.

South Korea didn't do any of this. They isolated positive test patients, and the most vulnerable elderly and their caretakers self-quarantined. Everyone else went about their business as normal (of course, masks are a bit more normal there than here). They knocked it down from 800-ish cases per day to less than 100 cases/day in three weeks. Their fatality rate is listed as 0.9% of positive cases.

 

[Timerover51]

Well, H1N1 2009 flu pandemic originated in California or Mexico, and the origin of the 1918 one (also H1N1 flu) is not clear...

There is a book on Project Gutenberg written by a physician regarding the 1918 flu pandemic. http://www.gutenberg.org/files/61607/61607-h/61607-h.htm

Regarding the 1918 pandemic, he twice places the initial appearance in Spain once in Southwestern Spain, and once in Southeastern Spain, Barcelona to be specific. However, he notes the appearance of the flu in Hawaii in June of 1918, prior to the appearances in Spain. This may indicate an Asian source for it. He also comments on the successful use of Quinine in treating the flu. This is interesting as to the use of Chloroquine in current treatment.

Note: This book has been downloaded quite a lot in the last 30 days.

 

[vegas]

You are thinking about this correctly, Stray, but some of your data you are assuming isn't right.

It certainly is true that everything about the covid-19 pandemic is an estimate at this point. If past epidemics are any indication, it will take years to figure out a "true" rates of infection with SARS-2 or the covid-19 fatality rate. But that reality doesn't mean we are completely in the dark. Public health professionals are used to dealing with high degrees of uncertainty.

It would help to put things in a wider perspective. Even the common cold has ~5% fatality for age 80+, which is the category of a large percentage of CV deaths. Based on that, CV is only 3 times as bad as common cold.

Regardless of fatality rates for the age 80+ cohort (and I don't think your common cold fatality rate is correct, btw), widen the lens again and look at a few more cohorts and it is clear covid-19 is far more consequential. Boris Johnson (age 55) would not be in the ICU right now if he had a common cold. Cold and flu do not put 20% of infected working age adults (20-65) in the hospital like covid-19. Cold and flu don't kill 0.5-1% of people in their 50s. This is a far more serious disease than cold or flu for the working age set.

And while there are certainly cases of over-counting (from people who have SARS-2 infections and die, but not from covid-19) and under-counting (from people who die of covid-19 but are never identified), it is a safe bet given the limited nature of testing that under-counting fatalities dominates.

South Korea didn't do any of this. They isolated positive test patients, and the most vulnerable elderly and their caretakers self-quarantined. Everyone else went about their business as normal (of course, masks are a bit more normal there than here).

This is bit is wrong and misleading. Misleading because South Korea has options that most other countries don't. They have far greater per capita testing capacity. That makes isolation and contact tracing possible. They also have and use surveillance and tracking technology as well as public health resources that simply do not exist at the same scale in the US (for one example).

It is wrong to suggest that "everyone else went about business as usual." Schools were closed. Large gatherings banned. Teleworking encouraged. Buildings required masks and temperature checks to enter. Physical distancing may have been voluntary, but it was still highly promoted and followed. It was and is anything but "business as usual" in Korea.

They knocked it down from 800-ish cases per day to less than 100 cases/day in three weeks. Their fatality rate is listed as 0.9% of positive cases.

The first of these stats is highly misleading, and the second is wrong. Yes, the peak outbreak stabilized after about 3 weeks, but South Korea hasn't been able to relax their procedures and haven't been able to drive the pace of infection down. They are 48 days into their public health response.

Korea's fatality rate experience with covid-19 has continued to increase, and today it stands at 1.9%.

 

[McPerth]

There is a book on Project Gutenberg written by a physician regarding the 1918 flu pandemic. http://www.gutenberg.org/files/61607/61607-h/61607-h.htm

Regarding the 1918 pandemic, he twice places the initial appearance in Spain once in Southwestern Spain, and once in Southeastern Spain, Barcelona to be specific. However, he notes the appearance of the flu in Hawaii in June of 1918, prior to the appearances in Spain. This may indicate an Asian source for it. He also comments on the successful use of Quinine in treating the flu. This is interesting as to the use of Chloroquine in current treatment.

Note: This book has been downloaded quite a lot in the last 30 days.

Well, while not denying the possibility, Barcelona was not among the places I've ever read as its origin... In fact, most I've read about it talk about unkown origin, the name of Spanish Influeza given due to Spain, being not under war censorship, was the first to report it.

In any case, from this same book:

Origin in south eastern Spain, Barcelona, a seaport; April, 1918, where a German submarine is said to have carried it; originally acquired by this boat at the Baltic port or ports of Danzig or Stettin.

So, it seems it was imported to Barcelona from the Baltic, hinting it was not the origin...

In any case, after just skim reading the book, I saw some inconsistencies or wrong info, as the same fact Barcelona is in Sout east Spain (just look at a map, you'll see it's east/north east), or the fact in Spanish flu is called catarro (this Word is used for a common cold, while flu is gripe is Spanish).

I hope the rest of the book is better documented...

 

[flykiller]

Korea's fatality rate experience with covid-19 has continued to increase, and today it stands at 1.9%

that's about what the cruise ship diamond princess's rate is turning out to be, and they had no internal quarantine and an (presumably) elderly population. bad flu nothing more.

 

[Condottiere]

Taiwan, Hong Kong and South Korea had a bad experience with SARS, learnt their lessons, and took appropriate precautions to ensure they can minimize fallout when another pandemic hit them.

Singapore tends to be foresighted, the Philippines has threatened to shoot violators, while the Japanese have been strongly advised to follow guidelines; so have the North Koreans, though I suspect they probably still will get shot.

Indochina, don't know what's going on there.