Coronavirus

[Liberty]

There were a bunch of articles about Taiwan how well they managed.  And they didnt have shutdown.

 

What did they do? Please describe it to us. I don't think you understand what measures were deployed there to get good results.

[arcube]

1) There was no exponential growth in India before shutdown. Hardly 1-2 deaths a day till March 22nd.

    In fact on March 21st its ZERO deaths.

 

  The exponential growth came after shutdown - I didn't know that is the purpose of shutdown.

 

So you're saying that the shutdown caused exponential growth of deaths?  Like, your expectation would be if you isolate people into groups of 4 and never let them have any sort of contact with any other group, your death rate from COVID-19 would be higher than allowing everyone to intermix to their heart's content?

 

Huh. That's kind of a strange theory, but OK. 

 

"When you put in the lockdown, it seems like it's about 2 weeks until cases fall"

      -2.5 weeks later zero deaths on March 21st came to about 24 deaths on April 07th

 

3, 4, 5 are irrelavant to India as the absolute cases are small for a country of billion+ people.

 

Yeah, I included those in there because I thought you wanted an explanation of when deaths should be decreasing, not to discredit your "quarantining causes order-of-magnitude spikes in COVID-19 deaths" theory. My mistake.

 

I dont have any theory.  I dont think there is enough information to make a theoretical model.

 

Empirically the theory YOU proposed doesnt match the data at hand.  In India the exponential growth started after lockdown. Thats not a theory.  Thats data.

 

Also, the deaths all of South East Asia are low where there were no lockdowns till now.  Thats not a theory.. Not a model.  Thats data.

 

That sure sounds like a logical cry you are making - Yes that is DATA. In itself it is useless, and has to be interpreted in some manner within a context. 

 

You keep talking about South East Asia - What countries are you counting in those?

 

Eventhough not separate country, Hongkong, and then Taiwan, Japan, Malaysia, Singapore.

 

There were a bunch of articles about Taiwan how well they managed.  And they didnt have shutdown.

 

Ok let's assume they have managed it, tell us please how they managed it and at what stage. And let's say that we were too late to manage it the way they managed, what were the options left for us?

[cubsfan]

Just an honest question on how much trust you can put into a model where the underlying data is unknown.

 

I know it might humble some people. At least it should.

 

Does it look like we were headed to 500,000 deaths in the USA?

 

Seems like we will save thousands of lives as well by the severe reduction in driving that is happening.

Should we just stay on lockdown?

 

Be nice to understand the real tradeoffs taking place by our esteemed scientific community.

 

1) You're not doing what you're saying your doing. You're not some epistemology geek trying to refine our thinking. You're just trying to score points with a few questions that don't really add any insight to the discussion, because we're clearly already aware of what you're saying here and then some. Meanwhile, you ignore all the other points that have been made to you and have no response for them and haven't updated your thinking on anything even when people point out the obvious flaws in what you say, so this isn't good faith discussion, just BS trolling on your part.

 

Deaths from driving don't compound daily for weeks and weeks and risk destroying the healthcare sector of multiple countries by overwhelming it with patients while shutting down international travel and supply chains, btw.

 

2) The US definitely was on track for something in the magnitude of 500k deaths or more a few weeks ago when those numbers were floated, but changes in policy have changed the trajectory (mostly thanks to governors and mayors deciding to shut down in the face of a vacuum of leadership at the federal level, but many states were still much slower than they should've been if there had been leadership at the top, and they'll have bigger outbreaks than they otherwise would've -- was it the governor of Georgia who recently said he didn't know symptomatic people could transmit it and then shut down because of it?). There's reflexivity here, as high predictions lead to bigger actions which lead to fewer deaths (and then to dumbass saying "well, we did it for nothing, see how it wasn't as bad as initially predicted?"). It's Y2K all over again. If we do it right, the early predictions don't come to pass, but it doesn't mean that we should've done nothing. The variables are linked, not independent.

 

Definitely one of your best answers Liberty. And yes, you made me see the light on the comparison to auto deaths - perfect - not exponential.

 

I have NO idea if this one size fits all approach is the correct approach. I seriously mean that - it's humbling trying to figure it out.

I do expect the deaths and costs to the country for an extended lockdown will be immense. That is pretty obvious.

The sooner people get back to work the better.  I read the Hammer and Dance a few times last month. I get it.

It's highly contagious, and it's lethal depending on age/condition.  I'm still not sure of the true cost to society.

And if there are workarounds for areas of the country that do not look like NYC - they should be explored.

Masks, hygiene, social distancing, isolating the vulnerable, etc - all seem to play reduce the problem.

 

Either way - there are lots of lives at stake.

 

I still think it pays to be humble given the unknowns.

 

[Liberty]

Definitely one of your best answers Liberty. And yes, you made me see the light on the comparison to auto deaths - perfect - not exponential.

 

I have NO idea if this one size fits all approach is the correct approach. I seriously mean that - it's humbling trying to figure it out.

I do expect the deaths and costs to the country for an extended lockdown will be immense. That is pretty obvious.

The sooner people get back to work the better.  I read the Hammer and Dance a few times last month. I get it.

It's highly contagious, and it's lethal depending on age/condition.  I'm still not sure of the true cost to society.

And if there are workarounds for areas of the country that do not look like NYC - they should be explored.

Masks, hygiene, social distancing, isolating the vulnerable, etc - all seem to play reduce the problem.

 

Either way - there are lots of lives at stake.

 

I still think it pays to be humble given the unknowns.

 

Agreed. It pays to be very humble.

 

But being humble mostly should mean being very prepared ahead of time (it's not about predicting rain, but about building arks), studying the issue deeply and trying to understand it as well as we can and learning best practices from others that did good jobs in the past, because we're fallible and should put all chances on our side when the sh*t hits the fan, recruiting the very best people and getting them to work together on the problem, over-reacting early rather than under-reacting so that we have a 10000x bigger problem later that costs way more than any early over-reaction, getting started as fast as possible on any measures like defense production act because we can't be sure how bad it'll get and how long it'll take to get going rather than dither for weeks, etc. All of that is being humble, IMO. Being arrogant is thinking you don't have to prepare, you'll just whing it when the time comes, that you can BS your way through it, you don't have to listen to epidemiologists and virologists and hospital heads but rather get advice from TV personalities and your son-in-law, that you have a "gut feeling" it'll go away on its own, that it's all others fault, muddying the messaging to the population because we like the attention and airtime and the sound of our own voice rather than let the people who know what they're talking about have the mic, etc.

 

So yes, humility very much so, and arrogance is what got us here.

[RichardGibbons]

The big change in my mental model over the last few days is that the numbers in the USA might not be as accurate as I thought. I was assuming that because USA has a decent healthcare system, it would also have decent data.

 

But, while I thought USA would have more deaths (per capita) than comparable countries with socialized medicine because of people being reluctant to seek medical help, I foolishly didn't clue into the fact that this discrepancy would cause almost all the numbers to be low compared to countries with socialized medicine.  (Kind of like China--if we lock someone in their house, they die, and we don't test the body, it doesn't count in the COVID-19 stats!)

 

That New York "at home" deaths comparison is quite eye-opening. It would be useful to get year over year deaths numbers for a variety of countries to get a rough idea of how many COVID-19 deaths are missed in different places.

[Hoodlum]

Canadian Prime Minister mentioned today that it would be months before they consider relaxing protective measures.

 

https://www.theglobeandmail.com/politics/article-return-to-work-will-be-graduated-and-likely-months-off-trudeau-says/

 

He cautioned that it would be a “few months, probably” before Canada is in a position to consider relaxing protective measures in place that have most Canadians staying at home and many businesses shuttered or working at partial capacity.

[cwericb]

I have a problem with the statistics that are presented to us on a daily basic.

 

“There were 500 new cases of Covid-19 confirmed today today.”

 

Well obviously that number is out of the total number tested.

 

If there were 1,000,000 tested, it wouldn’t be that big a deal. If there 5,000, 1,000 or 500 in total tested, that is a different matter.

[RichardGibbons]

I dont have any theory.  I dont think there is enough information to make a theoretical model.

 

Empirically the theory YOU proposed doesnt match the data at hand.  In India the exponential growth started after lockdown. Thats not a theory.  Thats data.

 

Ok, why don't you walk me through where my proposed theory doesn't match the data (note: I'm assuming your numbers are accurate--I've spent no time looking at India.)

 

My theory is that lockdowns make no measurable difference to diagnosed cases for a minimum of two weeks, and no measurable difference to deaths for at least four weeks, and more realistically five weeks.

 

Why does your "we had exponential growth in deaths for 2.5 weeks after the lockdown" data contract my theory?  2.5 weeks is much less than five weeks, so what am I misunderstanding?

 

Thanks!

[RichardGibbons]

Canadian Prime Minister mentioned today that it would be months before they consider relaxing protective measures.

 

https://www.theglobeandmail.com/politics/article-return-to-work-will-be-graduated-and-likely-months-off-trudeau-says/

 

He cautioned that it would be a “few months, probably” before Canada is in a position to consider relaxing protective measures in place that have most Canadians staying at home and many businesses shuttered or working at partial capacity.

 

Hard to know what to read into that article, since Trudeau's hedging all over the place (fair enough--I would be too).

 

IMO, two weeks after each province is passed its peak, he should allow any business with fewer than 200 people in a room to open up, provided that all that businesses' employees and customers are willing to wear a mask for all interactions (except restaurants).

 

(Two weeks is a relatively short time past the peak, but, just as the delay between infection and symptoms is bad on the upswing, the delay is actually good on the downswing since it effectively means four weeks between the peak and when a large number of new cases might come into the hospital as a result of any decrease in social distancing.)

[Spekulatius]

It is interesting to see how different some countries are doing they seem comparable. For example, Portugal was long considered a backwater relative to Spain and they have a similar mediterran culture, but Portugal has competently handled this crisis (early lockdowns which citizens actually followed )while Spain did not.

 

This article in German  but with some Google translation you can figure out what’s written there:

https://www.spiegel.de/politik/ausland/corona-krise-wie-portugal-es-schafft-vom-virus-nicht-dahingerafft-zu-werden-a-41a9c2a2-ef73-4ee7-8c44-5b3cfa1fbc4e

 

On the other hand France looks pretty bad and it looks like they have dropped the ball on testing too. A lot of lessons  will be learned on this hopefully.

[Guest cherzeca]

 

"Black Mirror update: Outside the NY metro area, hospitals are empty."

 

can confirm this is true in Jax

[SHDL]

I posted this link previously but the “BCG helps” theory does a curiously good job fitting several cross country/region differences in how things are going:

 

https://www.jsatonotes.com/2020/03/if-i-were-north-americaneuropeanaustral.html

 

Could be just a coincidence but interesting nonetheless. A controlled experiment is underway in Australia and we should know the results in a few months.

[Jurgis]

After the high risk group have been identified, please also add a bailout package for them until vaccine has been found. Easy peasy, recession solved.

 

No, I'd say just kill them all. They gonna die anyway.

 

A lot of problems solved.

 

The risk group is probably 1/3 of the population depending on how it is defined.

 

Maybe we should exclude guests at Mar-a-Lago then.  ::)

[cubsfan]

https://www.dailywire.com/news/tests-might-explain-lower-virus-numbers-in-ca-hit-earlier-than-suspected

 

Researchers are testing a theory that the coronavirus COVID-19 may have arrived in California much earlier than suspected,

and thus the state’s lower number of cases compared to elsewhere in the nation may be due to a kind of herd community.

 

 

Hard to explain the difference between NY and CA - California has 2X the population of NY,  yet NY has 13X the deaths from COVID-19.

California was supposed to be an epicenter given the largest population of Chinese in America - and the most Asian travelers from China.

 

If California were it's own country - it would rank much lower than Germany, which is a supposed success story.

California is 1/2 the death rate of Germany.

 

So what explains the difference NY and CA?

 

Certainly, not density - as San Franscio, Santa Clara and LA are jam packed with people?

In Fresno county with 1.2M people, there is only 1 death.

 

This article suggests perhaps herd immunity.

 

There is a lot we still don't understand.

 

 

[Spekulatius]

I posted this link previously but the “BCG helps” theory does a curiously good job fitting several cross country/region differences in how things are going:

 

https://www.jsatonotes.com/2020/03/if-i-were-north-americaneuropeanaustral.html

 

Could be just a coincidence but interesting nonetheless. A controlled experiment is underway in Australia and we should know the results in a few months.

 

Some conflicting data - France and Spain are not doing well. Spain is actually worse than Italy right now. Spain and

France both habe BCG vaccination.Also, Portugal, which has no BCG vaccination and is poorer does much better than Spain, it’s direct and richer neighbor which does have BCG vaccination. So quite a few countries run counter this trend eventhough they are otherwise comparable.

[Liberty]

 

Estimates from the IHME #COVID19 model that projects the scope and length of the epidemic (and is closely watched by White House) show an improving outlook with far fewer deaths. The exception is Lousiana. Still grim statistics and a lot of death and disease, but outlook better.

 

While Lousiana shows worsening epidemic overall, they too show reduction in estimated deaths. This overall higher preservation of life, and better estimated case fatality rates than many other countries, reflects in part extraordinary capacity and effectiveness of U.S. healthcare

 

[Liberty]

 

"Black Mirror update: Outside the NY metro area, hospitals are empty."

 

can confirm this is true in Jax

 

Considering they cancelled all elective procedures and appointments (or doing them by phone or video) and everything else, and people are probably doing EVERYTHING humanly possible to avoid going to the hospital right now, that makes sense.

[Cigarbutt]

https://www.dailywire.com/news/tests-might-explain-lower-virus-numbers-in-ca-hit-earlier-than-suspected

Researchers are testing a theory that the coronavirus COVID-19 may have arrived in California much earlier than suspected,

and thus the state’s lower number of cases compared to elsewhere in the nation may be due to a kind of herd community.

Hard to explain the difference between NY and CA - California has 2X the population of NY,  yet NY has 13X the deaths from COVID-19.

California was supposed to be an epicenter given the largest population of Chinese in America - and the most Asian travelers from China.

If California were it's own country - it would rank much lower than Germany, which is a supposed success story.

California is 1/2 the death rate of Germany.

So what explains the difference NY and CA?

Certainly, not density - as San Franscio, Santa Clara and LA are jam packed with people?

In Fresno county with 1.2M people, there is only 1 death.

This article suggests perhaps herd immunity.

There is a lot we still don't understand.

There is indeed and this is a multi-variable equation. It could obviously be related to policy etc..

I've been wondering about this too from a Canadian perspective. The two western most provinces (British Columbia and Alberta) have lower cases versus central and more eastern provinces (Ontario and Quebec). The extent of testing is different to some degree but, from a micro and macro point of view, policies and socio-economic variables are quite comparable across the board. For those who want to elaborate on stupid politics, stupid individuals etc, go ahead...    A possible contributing factor is genetic. First, on the host side: I guess it's possible that regional genetic differences may explain a relatively weak or strong resistance to the virus. This also may apply on the virus side as genomic sequencing is starting to show that the virus mutates in a certain direction, creating different branches (with potentially different virulence, not proven yet). The virus sort of acquires a domestic passport based on its origin. Some work is starting to give credence to this hypothesis. More to follow i guess.

https://www.bnnbloomberg.ca/most-nyc-covid-19-cases-came-from-europe-genome-researchers-say-1.1419250

[Liberty]

A lot of places in California were early with social distancing and shutdowns. A lot of techies over there saw this coming early (and I remember some derisive articles about it at the time, about the paranoid VCs having "no handshake" policies and taking their kids out of school)... I think this helps explains why California has done better. Any action done very early in a daily exponential process will have HUGE consequences weeks down the line. I doubt we're anywhere near high enough to have herd immunity yet, as early serum tests I've seen are still low single digits and we'd need much higher numbers to get there.

 

There might be more asymptomatic people than we think, but that has pros and cons, as they still can transmit to vulnerable people and are harder to spot.

[Spekulatius]

^ I would say that NYC is still different than SF or LA in that most people use public transportation in  NYC which is not to the same extend the case in SF or LA. If you ever took the subway or the LIRR (in my case) in NYC you knows how got of a transmission vector this might be. Boston also has significant public transportation for commute and is a hot spot as well. Likely other reasons like SF being really proactive (shelter in place on February 25) or perhaps the warmer weather might be factor too.

 

That’s the thing with exponential growth models , a couple of seemingly small factors can make a huge difference in the end.

[SHDL]

I posted this link previously but the “BCG helps” theory does a curiously good job fitting several cross country/region differences in how things are going:

 

https://www.jsatonotes.com/2020/03/if-i-were-north-americaneuropeanaustral.html

 

Could be just a coincidence but interesting nonetheless. A controlled experiment is underway in Australia and we should know the results in a few months.

 

Some conflicting data - France and Spain are not doing well. Spain is actually worse than Italy right now. Spain and

France both habe BCG vaccination.Also, Portugal, which has no BCG vaccination and is poorer does much better than Spain, it’s direct and richer neighbor which does have BCG vaccination. So quite a few countries run counter this trend eventhough they are otherwise comparable.

 

Reading the article it looks like Spain had it between 1965-1981 and Portugal had it between 1965-2017 — which seems consistent with the latter doing better?

[Spekulatius]

I posted this link previously but the “BCG helps” theory does a curiously good job fitting several cross country/region differences in how things are going:

 

https://www.jsatonotes.com/2020/03/if-i-were-north-americaneuropeanaustral.html

 

Could be just a coincidence but interesting nonetheless. A controlled experiment is underway in Australia and we should know the results in a few months.

 

Some conflicting data - France and Spain are not doing well. Spain is actually worse than Italy right now. Spain and

France both habe BCG vaccination.Also, Portugal, which has no BCG vaccination and is poorer does much better than Spain, it’s direct and richer neighbor which does have BCG vaccination. So quite a few countries run counter this trend eventhough they are otherwise comparable.

 

Reading the article it looks like Spain had it between 1965-1981 and Portugal had it between 1965-2017 — which seems consistent with the latter doing better?

 

True, misread it, although this means that that the difference only applies to those under 40, which don’t tend to get hit that hard. Spain is also doing worse than Italy right now. There could be a lot of factors and it’s likely more than one.

[SHDL]

I posted this link previously but the “BCG helps” theory does a curiously good job fitting several cross country/region differences in how things are going:

 

https://www.jsatonotes.com/2020/03/if-i-were-north-americaneuropeanaustral.html

 

Could be just a coincidence but interesting nonetheless. A controlled experiment is underway in Australia and we should know the results in a few months.

 

Some conflicting data - France and Spain are not doing well. Spain is actually worse than Italy right now. Spain and

France both habe BCG vaccination.Also, Portugal, which has no BCG vaccination and is poorer does much better than Spain, it’s direct and richer neighbor which does have BCG vaccination. So quite a few countries run counter this trend eventhough they are otherwise comparable.

 

Reading the article it looks like Spain had it between 1965-1981 and Portugal had it between 1965-2017 — which seems consistent with the latter doing better?

 

True, misread it, although this means that that the difference only applies to those under 40, which don’t tend to get hit that hard. Spain is also doing worse than Italy right now. There could be a lot of factors and it’s likely more than one.

 

The figure at the end of part 4) partially speaks to this. It suggests that the death rate of young people is much higher in Spain than it is in many other countries.

 

I agree there are likely a lot of other factors at play.

[orthopa]

https://www.dailywire.com/news/tests-might-explain-lower-virus-numbers-in-ca-hit-earlier-than-suspected

 

Researchers are testing a theory that the coronavirus COVID-19 may have arrived in California much earlier than suspected,

and thus the state’s lower number of cases compared to elsewhere in the nation may be due to a kind of herd community.

 

 

Hard to explain the difference between NY and CA - California has 2X the population of NY,  yet NY has 13X the deaths from COVID-19.

California was supposed to be an epicenter given the largest population of Chinese in America - and the most Asian travelers from China.

 

If California were it's own country - it would rank much lower than Germany, which is a supposed success story.

California is 1/2 the death rate of Germany.

 

So what explains the difference NY and CA?

 

Certainly, not density - as San Franscio, Santa Clara and LA are jam packed with people?

In Fresno county with 1.2M people, there is only 1 death.

 

This article suggests perhaps herd immunity.

 

There is a lot we still don't understand.

 

There is no way this is possible. A couple people here told me so. Cant wait to see those antibody tests. Hopefully for everyone this speeds the timeline to herd immunity up.

 

Two ideas that I still cant bring together are 1. The virus is very contagious, 2. A low level of the population has been exposed.

 

Looking at normal flu year and the number of people that become infected compared to a virus like this that is "much more contagious" it doesn't make sense at first glance. I dont posit flu based on deaths but means of spread via sneezing, coughing, close contact etc.

 

 

Flu

 

Luckily we have a known benchmark, the 2018-2019 flu season with 35.5 million cases, wide spread testing and a cheap available vaccine given.

 

https://www.cdc.gov/flu/about/burden/2018-2019.html

 

160ish million flu vaccines given in 2019 (not sure of efficacy for argument sake assume 50% so you protecting 80 million people from spreading it once exposed via respitory mechanisms)

 

https://www.cdc.gov/flu/fluvaxview/coverage-1819estimates.htm

 

Flu season running from November peaking in Jan and out to March/April.

 

Partial/Inherited immunity

 

Corona

 

First cases in a country with daily flights to US in mid November, lockdown from said country 2.5 months later,  widespread lock down mid march. Point is plenty of time for unfettered spread into the country at major international airports across the entire US. 

 

No vaccine and no monitoring for months.

 

More contagious then flu, no herd immunity or individual immunity.

 

Suspected very high asymptomatic and mild symptomatic case load contributing to exponential spread while in unoticed incubation period.

 

___________________________________________________________

 

That being said we come to the conclusion that the number exposed is very low? I dont get it, and didnt get it from the beginning.

 

How do those 2 statements come together, anyone? 10% of the population definitively gets the flu with 50% of the nation vaccinated but only 1-5% has Corona now? Idk.  :o

 

 

 

 

 

[Guest Schwab711]

https://www.dailywire.com/news/tests-might-explain-lower-virus-numbers-in-ca-hit-earlier-than-suspected

 

Researchers are testing a theory that the coronavirus COVID-19 may have arrived in California much earlier than suspected,

and thus the state’s lower number of cases compared to elsewhere in the nation may be due to a kind of herd community.

 

 

Hard to explain the difference between NY and CA - California has 2X the population of NY,  yet NY has 13X the deaths from COVID-19.

California was supposed to be an epicenter given the largest population of Chinese in America - and the most Asian travelers from China.

 

If California were it's own country - it would rank much lower than Germany, which is a supposed success story.

California is 1/2 the death rate of Germany.

 

So what explains the difference NY and CA?

 

Certainly, not density - as San Franscio, Santa Clara and LA are jam packed with people?

In Fresno county with 1.2M people, there is only 1 death.

 

This article suggests perhaps herd immunity.

 

There is a lot we still don't understand.

 

Maybe early China travel restrictions vs unrestricted European travel?

 

https://www.google.com/amp/s/www.bloomberg.com/amp/news/articles/2020-04-08/most-nyc-covid-19-cases-came-from-europe-genome-researchers-say