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The hard part of the economics of Covid-19
- Mathnerd314 7y agoTl:dr also take over the economy and conscript people to make hospital beds
- riffraff 7y agoThe article says expanding capacity has not been approached by any government but I am not sure that's true, in Italy they are building hospital wings or re-adapting abandoned hospitals in many places. Rome has 4 planned covid hospitals as of now. Also, the Italian government plans to hire a ton of medical and paramedical staff, money has been earmarked. I am quite sure other governments are doing the same.
- dhosek 7y agoI know one national government which has delegated all the work to the regional governments.
- seemslegit 7y ago> Also, the Italian government plans to hire a ton of medical and paramedical staff, money has been earmarked. Where will this staff be coming from ? Are there medical professionals currently unemployed in Italy or working in other jobs ?
- merpnderp 7y agoLikely retirees and early graduation from students.
- dboreham 7y agoI watched an interview with one of the Italian Drs. He said they were using retired medical staff and also cancelling routine procedures which frees up staff, and they are remote training staff from other specialities.
- eecc 7y agoThey’re also handing out IKEA leaflets to orthopedists about how ICU and ventilators work; and sending them to production. It’s insane. It’s trench warfare
- Recursing 7y agoThe source for that is a random tweet that contained a lot of misinformation and false statement. No Italian friend working in the medical sector was able to confirm that it even makes any sense, and there are no official sources for that
- mgreenleaf 7y agoThe UK is planning to re-train other medical staff to deal with respiratory illness. I think that probably includes things like psychologists, etc. who have medical experience and can quickly be brought up to speed. Might be something like that.
- seemslegit 7y ago> "I think that probably includes things like psychologists, etc. who have medical experience and can quickly be brought up to speed. Might be something like that. Uh, psychologists have zero medical training or experience - maybe they could explain the patients their respiratory failure is a symptom of insecure attachment patterns. If you mean psychiatrists, there aren't that many of them to move the needle.
- harvey9 7y agoNo need to be harsh. What is moving the needle is postponing elective surgery. There are a lot of anaesthetists and they are medics who can manage patients on ventilators.
- fma 7y agoAnd the equipment...my understanding is that ventilators are critical for those who have severe cases. Can't just magically wish for tens of thousands of ventilators....
- yulaow 7y agoIn italy one and the only factory of ventilators which was selling worldwide 250 units per month is now producing 500-600 per month exclusively for the italian hospitals (and past orders not yet sent abroad were blocked bt the government and redirected to italian hospitals) for the next ten months. https://youtu.be/7Iz5tWb9f8A https://youtu.be/7Iz5tWb9f8A [hoping the english subtitles work]
- maxerickson 7y agoThe translated subtitles seem reasonable. I had to go in and switch it to translating to English.
- raphaelj 7y agoMost hospitalised people will only need non invasive respiratory support and surveillance. I guess these cases could be handled by purposely trained health workers.
- gpm 7y agoBut we can just build them. At least we could if we weren't instead shutting down our economies. Look at the manufacturing ramp up that occurred during WWII for example.
- yulaow 7y agoYes, for example ~10000 people holding a degree in medicine were still awaiting to pass an abilitation exam which was removed today, allowing them to now work in the hospitals without it [ https://www.corriere.it/scuola/universita/20_marzo_13/coronavirus-proposta-medici-abilitati-senza-esame-9c0e87fa-654f-11ea-86da-7c7313c791fe.shtml https://www.corriere.it/scuola/universita/20_marzo_13/corona... ] A lot others already holding that certificaton were not working yet because positions in public hospitals where not accessible yet because of the turnover blocks put in place in the last decade while the government was trying to cut healthcare expenses.
- DoofusOfDeath 7y agoAFAIK, physicians in the U.S. are vexed by how many hours per day they spend dealing with insurers rather than patients. I wonder how many clinic-hours we could add to our capacity by some kind of moratorium on that level of paperwork.
- baq 7y agothere won't be any paperwork because there won't be any insurance. even your congress and senate realizes this by now. it's an unworkable proposition - you either bankrupt the 10-20% patients which require hospitalization or you bankrupt insurers. you're in for a revolution in healthcare.
- kazagistar 7y agoCongress just had to add a ton of exemptions to a bill to guarantee paid sick leave for CORVID, making it meaningless for a vast majority of americans, because of republican pushback. Never underestimate the greed and corruption baked into the influence channels in the USA.
- zaroth 7y agoThe problem with the House bill is that it puts employers on the hook for making the payments. You’re just ushering small businesses faster off the cliff of insolvency if you legally require them to pay workers while they are also legally required to be shut down. If the government is forcing a company to shut its doors, the government should be prepared to pay the employees “quarantine leave”.
- nradov 7y agoThe majority of patients who will require hospital care are already Medicare beneficiaries. And for many others, the insurers don't really bear any financial risk because they just process claims and pass the costs on to group buyers.
- giovan-ni 7y agoMostly by fast tracking newly graduated, who normally have to attend a 2 to 6 year long specialty school. This would amount to around 10 000 new hires, according to the Ministry of University.
- seemslegit 7y agoThis makes sense. I guess I expected it to have already happened, probably should tap into senior-year med and nursing students as well.
- devy 7y ago> but I am not sure that's true, in Italy they are building hospital wings or re-adapting abandoned hospitals in many places. Rome has 4 planned covid hospitals as of now. True. But those are being done after the fact. It's too late already for Italy. By comparison, the U.S. still has time now before the curve shot straight up to the max - then no amount of measures are going to be able to keep up with the viral infection rate (and death counts)
- lawn 7y ago> By comparison, the U.S. still has time now before the curve shot straight up to the max How much time do you think there is? Until recently there have been very little testing, so we don't even know where the US is on the curve. Even if we assume it's early, that's still just a couple of weeks if time.
- bad_user 7y agoThe US, like most other countries, is only a couple of days behind Italy. Italy had 100 total cases only ~20 days ago. The problem with this virus is that it goes from 1 case to hell in only a couple of weeks. If you already have 100 confirmed cases, it's too late to stop what's coming.
- aksss 7y agoSo conversely if US hasn’t gone to hell in a couple weeks, it indicates we’ve been doing something right?
- bad_user 7y agoSadly that's not a possibility. According to mathematical models the capacity of your hospitals will be exceeded by more than 30 times. Give it another week or two. https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf https://www.imperial.ac.uk/media/imperial-college/medicine/s...
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- lbeltrame 7y ago> Rome has 4 planned covid hospitals as of now. Unfortunately not where it matters most, that is in Lombardia (where I live, and the hardest-hit of all regions). In fact the regional government took the matter into its own hands to attempt to convert a number of buildings in an old exposition area (not the 2015 expo area, FTR) into places to treat patients (there are still many "ifs" to see whether this will get done or not, though).
- gentleman11 7y agoMy government told us today that they have excess capacity and will not run out. They have been preparing for this crisis for “over a month now” In fact, they are still going ahead with cutting doctors pay in the midst of it all. Maybe we deserve it for electing a nut job who only cares about budgets (Alberta)
- rwmurrayVT 7y agoWhen I was in Edmonton and Calgary it always seemed like Alberta was hellbent on moving the exact opposite direction of the other provinces.
- tathougies 7y agoThe United States waived requirements for inspection for new hospital beds (thus allowing hospitals to increase bed count) and has ordered more ventilators and other equipment.
- voidmain 7y agoWe know that sufficiently strong social distancing - and universal mask use - can reduce Re below 1, causing the epidemic to shrink exponentially instead of growing exponentially. Once it is small enough, good testing and contact tracing should be able to contribute a significant reduction to Re, so that you can back off on more costly measures. As hard as it sounds for the economy to adapt to extreme social distancing for a short time and moderate for a long time, it seems like a better bet to me than trying to increase intensive care capacity - which already consumes a nontrivial fraction of gdp - by orders of magnitude and write off millions of lives.
- zambal 7y agoSo what are you going to do when the virus is gone in your city/state/country, isolate yourself from the rest of the world? Because the timeline/situation will be different for many other places.
- deleted 7y ago[deleted]
- nostrademons 7y agoReturn to travel restrictions + contact tracing, and if community spread flares up again, reinstitute social distancing. Repeat until vaccine is developed.
- the-pigeon 7y agoIt's also very normal for viruses to become more mild over time. We strongly react to strong threats. It's in the viruses interest to become a weaker threat like the common cold so we tolerate it instead of actively fighting it.
- jeremyjh 7y agoThey can also become much more deadly. The first pass of the 1918 pandemic was not nearly so bad as the second, which slaughtered millions of people in their 20s and 30s.
- snewman 7y agoI am not sure I agree with the thrust of this article. The gist seems to be: if we do a sufficiently good job with containment measures (e.g. social distancing), we might succeed in limiting short-term infections, but we will have to remain in this mode for years (with ruinous effects on the economy). The offered alternative is to acknowledge that a significant fraction of the population will be infected eventually, and so we should scale up hospital capacity to accommodate that. This doesn't seem like a very good alternative. Even with adequate hospital care, the true fatality rate seems to be in the neighborhood of 0.5% to 1%, which would be quite harsh if allowed to spread throughout the population. I am hoping that improvements in treatment can make the difference. A vaccine may not be available for quite some time, but drugs that reduce the fatality rate might be ready sooner. Of course the actual course of action must include some mix of all-of-the-above: containment, new hospitals, new treatments. EDIT: as voidmain notes, we might also hope to quickly reduce the number of infections to the point where we can contain them with testing and contact tracing, rather than blanket shutdowns.
- Diederich 7y ago> remain in this mode for years What's your basis for that? It seems like a vaccine will be available well before years have gone by.
- lbeltrame 7y agoDrugs (a few of them are in Phase III and trials are already ongoing, with some results expected next month) will likely help first. If you can treat the severely sick patients, and even just cut one week out of the 3-4 they need to spend in the hospital, it would be a huge success. In fact I'd argue that most of the problems we are facing are because there is no appropriate treatment. Vaccines will likely take more time, due to long-term effects that need to be investigated (as many mentioned in some other HN story today).
- dunkelheit 7y agoI've upvoted because the article encourages proactive thinking so that we don't just sit in our homes congratulating ourselves how well we socially distanced from each other. What is sadly missing is some back-of-the-napkin math estimating the required capacity increase. Like, is it closer to x2 or x100? is it feasible at all? What is the damage to economy from doing this compared to lock-down for N months?
- PeterisP 7y agoI believe that nobody really expects to meet the gap between actual capacity and "required" capacity, i.e. that it can't and won't get met - nonetheless, raising the capacity to save lives will save more lives; even if it's not sufficient. It's worth noting that every early "flatten the curve" illustration example that I saw had the lower curve still above the capacity, just not nearly as much, however by the time it reached mass media, it had somehow morphed to the lower curve at or below capacity... probably because they thought it sells the idea better? but at the cost of misleading the public about what's feasible.
- dunkelheit 7y ago> I believe that nobody really expects to meet the gap between actual capacity and "required" capacity Well, that's exactly my problem - I don't really know what kind of gap to expect. It is all very qualitative at this point but scenarios (and thus the best course of action) are wildly different depending on how exactly do the relevant quantities compare to each other. Of course "we don't know yet" is a perfectly valid answer but then it must be clearly stated in the article that this is just a speculation describing a plausible scenario.
- PeterisP 7y agoI read some articles that did the math on that, but I can't easily find them now. IIRC it was an order of magnitude difference - i.e. flattening the curve enough to meet capacity would require to stretch it out to something 10 years (certainly an unreasonable goal), so flattening it out over a single year would be something like 10 times over the current capacity. It's hard to estimate how much reasonable actions can increase capacity - 20%? 50%? 100%? But nowhere close to 10x increase.
- Zenst 7y ago"Second, flattening the curve assumes that you actually don’t go too far and that much of the population actually becomes infected and then immune. Immunity from Covid-19 is still an open scientific question but, let’s assume that is more likely to be true than not. If you reduce the infection rate too far, then most of the population does not become infected and that means that once you stop policies such as social distancing the virus can emerge once more and we all have to do this again." So timing of such measures important and too early can be more damaging than too late, overall. Guess more eye's will be upon the UK now after reading this.
- eecc 7y agoAnd the NL. Seems that Rutte (NL prime minister) is betting the farm on herd immunization and minimizing economic disruption while letting the virus spread “under control”. If it sounds a lot like the Chernobyl script it’s because it is.
- Zenst 7y agoThey are going for managed infection of those who need medical intervention with the majority not needing such intervention. Ergo, managing capacity in a way that is mindful that winter 20/21 will come around faster than we realise. After all the West has just entered spring, so 6 months from now we are in Autumn and the seasonal impacts like normal flu etc start to traction up again. May well be a case sadly to say that every extra death now, will mean two or more less deaths in the comming winter. Sadly it may well get right down to that uncomfortable truth. Hard to say and honestly, not sure how anybody could articulate that without upsetting anybody in some way, shape or form. But that does seem to be the jist of it.
- deleted 7y ago[deleted]
- notahacker 7y agoThe logic of the UK position is well articulated in this very HN-friendly article by a UK epidemiologist unaffiliated with the govt scientific advice team [complete with graphs, the Python code of his illustratory models and an appropriate caveat about the magnitude of the uncertainties of the assumptions the scientific advisory team's models will have made] https://personalpages.manchester.ac.uk/staff/thomas.house/blog/modelling-herd-immunity.html https://personalpages.manchester.ac.uk/staff/thomas.house/bl... nb the UK has since issued stronger isolation guidelines and downplayed herd immunity in the media. Longer paper about their current model https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf https://www.imperial.ac.uk/media/imperial-college/medicine/s...
- SomeHacker44 7y agoI really don't like the cavalier attitude with which this author treats the open question of Coronavirus immunity. "Let's assume it's more likely than not going to generate immunity" (paraphrased) seems unfair, and that a fair treatment would simply consider both alternatives.
- jsight 7y agoI don't know who you are wanting to be "fair" to here. The stronger evidence seems to be on the side immunity.
- dwaltrip 7y agoDo you have links to solid evidence? I saw an article from an expert (I'm blanking on the specific article right now) that other "cov" viruses are known to have a limited immunity that lasts for possibly several weeks or so.
- jsight 7y agoI wouldn't bet on "solid" evidence for a while. Hang around the /r/covid19 subreddit for the latest data. There have been very few reported cases of someone getting it again and of those a lot of evidence points to relapse rather than reinfection. Given the large # of cases and their high concentrations in specific places, it seems likely that we would see many cases of reinfection if previous patients weren't immune.
- dboreham 7y agoI've been wondering about the military being asked to take over in the US for a while. We don't seem to have our Churchill to replace the dollar store Chamberlain.
- Gibbon1 7y agoEasy enough solution would be for congress to appoint Mitt Romney as speaker of the house, then impeach and remove Pence and Trump.
- ISL 7y agoWhile the sentiment that you've expressed is possible, Mitt Romney cannot do it, as he is a senator.
- dtparr 7y agoActually, the Speaker of the House can be anyone the House chooses.
- sp332 7y agoRomney would not be allowed to hold both offices at once. He would have to step down as Senator to be Speaker of the House.
- dtparr 7y ago1. In a world where both major parties come together to immediately make him President, I imagine he would be willing to resign his Senate seat. 2. Do you have a citation on Senators being unable to serve as Speaker of the House? It certainly makes sense, and I've seen references about senators not holding roles in other branches concurrently (e.g. executive or judicial), but nothing definitive on senators holding house officer roles.
- sp332 7y ago
- ck2 7y agoWhat I am still trying to understand is if we get variations of the flu virus every year so dramatic that sometimes they guess on the vaccine completely wrong (like this year) then why aren't we going to have a Covid-19 variant this winter that everyone can catch again?
- floe 7y agoMy (low-information) understanding is that coronaviruses have much lower mutation rates than flu viruses!
- lbeltrame 7y agoThey have a proofreading RNA polymerase, IIRC, which means that indeed they have a lower error rate than other viruses.
- ebalit 7y agoApparently 30% of cases of the common cold are cause by coronavirus. And the worrying thing is that the immunity we acquire for those is only temporary.
- lbeltrame 7y agoAt this point, I think it's just appropriate to say "we don't know yet". This is a new virus, and not much is known about it yet. And that is why drug development needs to go parallel with a vaccine. If a vaccine fails, we can fall back to drugs to prevent people from going into ICUs (hopefully).
- RivieraKid 7y agoThis is true, the influenza virus contains 8 small strands of RNA, which means that two different influenza viruses can combine to create a novel one.
- marcosdumay 7y agoThe influenza has a completely atypical rate or mutation. For most diseases, one infection is enough to make a person resistant for life. Besides, partial resistance is a thing. When our immune system has seen some other similar virus, we get a much less severe version of the disease.
- voidmain 7y agoAlso... I hesitate to say this because it smells of ad hominem, but in this view the enormous cost of extreme shutdowns is mostly the cost of a mulligan for poor decision making and actions early in the crisis. This may make this view less popular with the various organizations that made those mistakes.
- makomk 7y agoThis isn't a mulligan, that's the trouble. Previous contact tracing efforts had the advantage that we knew where the initial cases were coming from - China, primarily Wuhan - and could use that as a starting point. Those failed in most countries. After shrinking the epidemic down, the initial cases are basically just random people who have what looks like a cold. It'd be like searching for a few needles in a massive haystack.
- battery_cowboy 7y agoSouth Korea did just fine, they managed to prevent the exponential curve so far. In the USA, the government just fucked up and did nothing, even actively engaged in disinformation.
- holler 7y agoNot quite, the U.S. began adopting measures almost immediately [0]. 0: https://www.washingtonpost.com/local/trafficandcommuting/travel-ban-halts-flights-between-wuhan-and-us-as-airports-prepare-to-screen-passengers-for-coronavirus/2020/01/23/00c1f1aa-3e22-11ea-baca-eb7ace0a3455_story.html https://www.washingtonpost.com/local/trafficandcommuting/tra...
- battery_cowboy 7y agoHalf measures, if even half.
- humaniania 7y agoBlocking direct flights from a single region? What else?
- skatanski 7y agoIt's not as easy as adding more beds. Each ICU unit has to have specific amount of staff around it, resource, which cannot be easily increased by planned economy. There are workarounds and corners to cut, like making last year students into doctors without exams, moving doctors from other specialities to intensive care. But it's not exactly the same.
- VectorLock 7y agoIts not as good as a doctors or even an RN degree, but I wonder could a crash course for health care workers tailored specifically to the symptoms of this disease be sufficient to fill that gap?
- dirtyid 7y ago>There are nuances when it comes to ICUs and ventilators, etc. But the bottom line is: Even in optimistic flattening the curve scenarios, the curve cannot flatten enough. This always felt intuitively true given exponential growth - realistically flatten the curve was more platitude than practical, an desperate appeal by media in democratic countries to position a "civilized" solution in order to avoid mass panic and draconian measures. Now they're elevating Korea as the exemplar response model when the country is practically an island like Taiwan, Singapore, Hong Kong. It's simply not applicable to geographic realities of most countries where borders can't be simply shut and where a lack of infrastructure investment make the kind of techno-authoritarian solutions that made agile responses in those countries possible. Canada doesn't even have an official Corona dashboard, instead news media as to collate information from an updated table using data from archive.org, people paying in cash, nothing is getting wiped down, minimal mask use etc. If anything, countries without Asian Tiger advantages need to crack down harsher to make up for these deficiencies. No one is going to build enough triage hospitals and medical material to outpace any variant of this curve. No developed country is civilized enough to sacrifice this much for the greater good. This is a stick, not carrot and certainly not rhetoric situation. If Corona is as bad as the numbers project, flatten the curve is going to kill a lot of people in retrospect because politicians can't stomach "lock it down".
- SamReidHughes 7y agoIncrementally flattening the curve does save incrementally many lives. It’s taken hold over “lock it down” because it rings better and is factual. You can accomplish something individually by staying inside instead of being fatalistic because nobody else will do it, and it isn’t just a platitude .
- dirtyid 7y agoIncremental is not a proportional response to exponential. Compared to a lock down, you're not saving incrementally more lives but allowing for exponentially more death. The only rationale for it is to slowly acclimatize the population to embrace more drastic action, i.e. panic management. Even stringent, well organized quarantines in Chinese provinces with less infection is running 6+ weeks with full compliance. Partial compliance means those who adhere will be stuck inside for a long time, it's not tenable even assuming the curve can be flattened in a sensible time frame in first place, which I don't believe it is. Basically we're dragging past the point where shutdown is a viable option with half measures, which will only leave to excess fatalities. Obviously I'm not an expert and hope I'm wrong.
- threeseed 7y agoSurely it's better just to build as many ventilators as we can. And then get old people to stay at home, perhaps with a family member or carer to assist them.
- anthm1988 7y ago> Putting in place measures to conscript anyone who can be useful in this task Go fuck yourself your authoritarian asshole. You'll shoot me before you get me into the military.
- matchagaucho 7y agoDisappointed this article makes no mention accelerating development and distribution of vaccines by relaxing FDA approval processes. Sure, that may take 9-18 months. But preventing the "second wave" is more important than reacting to it.
- raphaelj 7y agoThese approval processes are there for a reason though. If you are going to inject some pathogen to millions of people, you better be sure that it has no strong, even long term, undesirable effect.
- matchagaucho 7y agoIt's not so much the injections, but just allowing the development of alternative processes that may scale much faster than the 70 year old egg-based process. When we look back in retrospective, the CDC and FDA will be under scrutiny to take more preventative measures.
- nostrademons 7y agoIt'll be interesting to see how Italy (lockdown) compares with the UK (just let it infect everyone) compares with South Korea (extensive testing & contact tracing, plus social distancing) in a couple months. My sense is that the UK will probably fold and institute a lockdown once their ICU capacity gets overwhelmed and healthy young people start dying in the streets. Either that or they'll face a revolution and then have a lot more problems. Of course, by the time it gets to either of those points it'll be too late to effectively change course. But it's interesting to see at least one country take the position that "Hey, we're going to let this run its course, take our lumps now, and try to get back to business as usual ASAP." I could be wrong, and maybe this is a genius application of heartless logic. Time will tell. RemindMe!2months ;-)
- tacomonstrous 7y ago>My sense is that the UK will probably fold and institute a lockdown once their ICU capacity gets overwhelmed and healthy young people start dying in the streets. Either that or they'll face a revolution and then have a lot more problems. Of course, by the time it gets to either of those points it'll be too late to effectively change course. Looks like that's already happening: https://www.buzzfeed.com/alexwickham/coronavirus-uk-strategy-deaths https://www.buzzfeed.com/alexwickham/coronavirus-uk-strategy...
- deleted 7y ago[deleted]
- chrisseaton 7y ago>My sense is that the UK will probably fold and institute a lockdown once their ICU capacity gets overwhelmed and healthy young people start dying in the streets. Either that or they'll face a revolution and then have a lot more problems. Of course, by the time it gets to either of those points it'll be too late to effectively change course. > Looks like that's already happening Is UK ICU capacity overwhelmed and are young people dying in the streets? No. Don’t spread rumours in this situation.
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- notJim 7y agoIt's sort of weird to hear everyone talking about how social distancing is now the norm, when in the last few days up through today, there have been viral videos of massive crowds at airports, bars, and beaches. The governor of West Virginia just held a press conference encouraging people to go out to eat at restaurants. Several states are supposed to have democratic primary elections tomorrow. I didn't watch the debates, but apparently candidates were encouraging their supporters to go out and vote.
- Waterluvian 7y agoThat's still happening at a massive scale. I think it's fair to say that advising social distancing is the norm. But actually doing it very much isn't yet.
- anchpop 7y agoTelling the population to do social distancing and hoping they actually follow through is a fool's game. Several states have realized this and started taking measures into their own hands. This includes closing all resturaunts, schools and movie theaters. What they should do next is give the police P95 masks and disposable gloves and train them to use them. This would allow them to have the police drive around and distribute food to families that need it so they don't have to go to the store. They should also heavily incentivize all businesses to give their employees time paid off right now, or allow their employees to work from home.
- kazagistar 7y agoIt's up to the states to either postpone the elections or ramp up infrastructure to ensure they can be done safely (more polling places for no long lines, multi day elections to reduce the rush, lots of cleainging supplies with cleaning between votes, etc). But saying people shouldn't vote at all is antidemocratic. Why not shut down the national election as well and just give it to (candidate you dont like)?
- deleted 7y ago[deleted]
- asiachick 7y agoI'm curious what happened / is happening in Japan. Here in Tokyo it looks almost like business as usual. Some companies are letting people stay at home but most are not. While cities in the USA are banning gatherings of 100 or more, here in Tokyo every train ever 3 minutes during rush hour has 8 to 16 cars stuffed with 100+ people per car. I have no idea what the actual infection rate here is or the ICU usage rate. 2 weeks ago Japan was considered the place to avoid. Now it's the USA and Europe. Japan hasn't seemed to have taken any drastic measures so far or maybe I'm just not paying attention.
- bsaul 7y agowhat you're saying is extremely surprising. I'd love to have more infos on the situation in japan. Last time i read something about it, it seemed the japanese gvt wasn't very open on what they were doing.
- stevenwoo 7y agoAFAIK they are doing very little testing in Japan, so there is no problem that can be reported, the USA and UK as far as we can tell were copying that until the UK got called out on it after that PM press conference and the states got testing approved independently of the CDC test. https://www.upi.com/Top_News/World-News/2020/03/10/Japanese-doctor-warns-Tokyo-against-limited-COVID-19-tests/6281583857586/ https://www.upi.com/Top_News/World-News/2020/03/10/Japanese-... This has an infographic on testing - Japan was next to last (on the chart at least) per person testing for industrialized countries as of March 4. https://www.vox.com/science-and-health/2020/3/12/21175034/coronavirus-covid-19-testing-usa https://www.vox.com/science-and-health/2020/3/12/21175034/co...
- solidasparagus 7y agoA little off topic, but I found this sentence to be incredibly odd - "by we I mean the generation who were adults in World War II" So all the people who are 90+ years old?
- playpause 7y agoIt threw me at first, but I think it is supposed to make this point: Although this kind of forced economic shift would feel very new for most of us, humans have managed it before. Specifically, and most recently, in WW2.
- cloudwizard 7y agoIt seems like the countries that are doing the best are Taiwan, Singapore, and HK. https://time.com/5802293/coronavirus-covid19-singapore-hong-kong-taiwan/ https://time.com/5802293/coronavirus-covid19-singapore-hong-... Taiwan can produce 10M masks per day in country of 23M https://abcnews.go.com/Health/taiwan-sets-world-fight-coronavirus/story?id=69552462&cid=social_twitter_abcn https://abcnews.go.com/Health/taiwan-sets-world-fight-corona...
- jfnixon 7y agoSingapore and HK are cities, really, and the Singapore approach, aggressive contact tracing with mandatory stay at home orders, doesn't scale. Taiwan and Japan are outliers so far, and they are monocultures, with famous compliance rates. Korea is somewhat similar to Japan, but took a hit early, and has managed to beat it back. China appears to have peaked, but did this with massive application of governmental policies which would never fly in the West. Flatten the curve doesn't change that a large number of people are going to get this disease. The best news is danger increases with age, unlike the Spanish Flu. Africa is very young (media age), the US and China are roughly the same, while the EU in general is older (Italy and Germany especially). What matters is not hospital beds per capita, but ICU beds per capita. The US does much better by that measure. You don't need an ICU bed to give oxygen, which is what most serious clinical cases require. MIT Sloan gave a prize last year for a less expensive, simpler ventilator designed for most cases in countries with limited resources. We have options that aren't explored yet.
- Noumenon72 7y agoI don't see why contact tracing doesn't scale. The only thing preventing Google and Apple from producing a contact history for everyone is privacy laws and people without phones.
- softwaredoug 7y agoIsn’t part of reducing cases now so we have time to get on a war footing for those things? At least I hope to god that’s what they’re thinking.
- partiallypro 7y agoGiven that so many people are now staying home, working from home etc, I can't see how we can't slow the virus. Right now, I assume the people coming forward are those that have been possibly exposed a week ago before all the lock downs. I have hopes that this thing is thwarted quick, when the President (with info from the CDC) said this could last into July, I genuinely became worried about the state of the world after this. The state of the economy, I can't even say I'd have a job if it lasted that long.
- GoodJokes 7y agoAh yes, an article written by a scientist with lots of data.
- saurik 7y agoThis same argument process--that to "flatten the curve" in the way all the cutesy diagrams show isn't going to be sufficient to avoid chaos unless we maintain social distancing for years, and that we are deluding everyone into thinking this is "the solution" and that life is somehow going to go back to normal in a couple months (which is where most of the people I know--normal people, not all of my super paranoid friends ;P--are with their mental timelines) to the point where we are not concentrating any effort on anything else (to the point where believing "flattening the curve" is some panacea is maybe even a "dangerous delusion"), including capacity expansion and explicit tracing--was made by someone in an article on medium a few days ago. The prior article had the same little modified graphs showing the true problem, but had actual math to back up their back of the envelope calculations for why it will take years. FWIW, that article was shat on... hard... by people here on Hacker News, and was even flagged, because people even here are apparently so bought into the narrative that they take arguments that it isn't sufficient as somehow "so don't do it: social distancing is bad" (which is bullshit, and not what either of these arguments were/are saying). It is absolutely frustrating how much of an uphill battle it is to even get people to analyze this stuff quickly: we keep having to wait until things get notably worse and then we are willing to look at something only slightly more drastic. I have had friends making this same argument for like a month now and everyone just treats them as if they were literally insane or something :(. https://news.ycombinator.com/item?id=22575356 https://news.ycombinator.com/item?id=22575356 https://news.ycombinator.com/item?id=22581950 https://news.ycombinator.com/item?id=22581950
- smallgovt 7y agoI think you're conflating what the general public believes with what those in control believe. It is in the public's best interest for the general public to only worry about what is within their control (so as to avoid panic). Therefore, the general public is being led to believe that all is going to be OK after a couple months of social distancing. I guarantee you behind the scenes, those in control are scrambling to take immediate and drastic action to ramp up our medical treatment capacity.
- saurik 7y ago
- VectorLock 7y agoThis is something that I've been afraid of for a while. I know a few nurses that work in some of the most best staffed, well funded Magnet hospitals and they say they run at 90% capacity on the best of days.
- kiney 7y ago> It is very clear that capacity expansion has to be the priority now. It has not seriously been addressed by any government as near as I can tell. Germany _did_ address this. Currently there are 25k beds with ventilator, the federal government ordered 10k ventilators more from the largest local supplier (Drägerwerke) and explicitly bypassed normal procurement laws. That company is now extending manufacturing capacity, but it won't be fast enough.
- kiney 7y agoAnother thing they do is recruiting med students as emergency staff, but this seems to be in an early phase. And we're still comparatively early in the pandemic. In my perception our government is actually handling the situation surprisingly well until now. We even overcame years long blockades of our federalism.
- wwarner 7y agoThis article is really important. He is not making an economic argument about the value of social distancing. What's not being said often enough, because it's pretty scary to hear, is that no matter how much we lower the curve, everyone will be infected with COVID-19. Angela Merkel stated it very clearly last week, and this is why policy makers come to Jesus so quickly when experts and eye witnesses explain to them what is going on in China and Italy. Normal flu has some resistance in the population, but this novel coronavirus does not, and so, to put it very plainly, without emergency medical intervention 3% of the population will die. Curve flattening alone doesn't change that in the slightest. Flattening the curve, as the author of this article says, buys critical time right now, and we need to use it to increase targeted emergency medical capacity right now.
- kazinator 7y agoArticle misses the angle that we could flatten the curve and get herd immunity via a vaccine.
- bitL 7y agoHow much would mandatory use of mask reduce R0/virus spread? I see in all Asian countries everybody with a mask by default and am wondering what % of spread reduction could be attributed to that factor alone. Are there any data on this?
- nl 7y agoIt's pretty clear that the economic impact of this is much bigger that the 2008 GFC, than 9/11 and the 1987 stock market crash. 2008 and 1987 were financial/market crises which caused issues elsewhere. 9/11 shutdown the US economy for a couple of days. This is shutting down production for weeks and global demand for many thing for months. It's completely unprecedented that I can think of.
- antirez 7y agoIt it was possible to have a very reliable predictor of who will take the infection in an asymptomatic way, or with very trivial symptoms, a plan could be to infect all those, that are believed to be at least 50% of the population, to create a solid immunity base in the society.
- seemslegit 7y agoThat's basically the UK "herd immunity" which experts think is kinda crazy, also it's not even known that a long-lasting immunity is created for this virus in people who are infected either symptomatically or not. iirc it requires numbers closer to 2/3rds of a population.
- antirez 7y agoNope it's very different than the UK pseudo plan (apparently they don't really have such plan). I mean, if there was a simple way to test _before_ people get infected, if they'll develop just very mild symptoms, we could do it. Even if you need more than 50%, 50% is still a lot of a barrier that lowers the virus R0 a lot.
- seemslegit 7y agoEven if there was - testing and controlled-infecting 50% of the population would be a huge effort and probably not shorter than isolating old people and allowing an uncontained infection to burn through. But the big problem is that it might not even help, the worst case scenario is that absent a vaccine the virus becomes just a more infectious and deadlier cold that people risk getting every season.
- adrianmonk 7y agoIt's an interesting idea, but seems like that proposal would have to compared to the alternative of vaccination. There's already a vaccine which has been created and which entered the first phase of trials today (https://www.mercurynews.com/2020/03/16/first-stage-of-covid-19-vaccine-testing-gets-under-way/ https://www.mercurynews.com/2020/03/16/first-stage-of-covid-...). If we're going for a radical plan (which, hope you're not offended, is how I'd characterize your proposal), then just skipping those trials and going straight to giving people that vaccine should be on the table. So then you'd have to compare safety and efficacy of that against this vaccine. I'm not an expert at all, but it seems like we basically don't know the answer to any of those questions. * We think that you can't get reinfected once you've had COVID-19. But we aren't sure. * I don't think a method of predicting symptom severity (like you suggested) has been created, so we don't know its reliability. * We also don't know if any of the new vaccines are safe. * Nor do we know if any of the new vaccines are effective.
- mxcrossb 7y agoI have also been thinking about having the military come in and start building hospitals. The president seemed to have no qualms about using that power for his wall. But on the other hand, doing so might greatly decrease military readiness. Let’s not add a major war to the list of catastrophes. But I’d love to hear what military buffs think.
- cogman10 7y agoYou know what I'm interested in? What will the effect be on non-corona diseases with already lower RE? Are we going to see some disease, such as measles, eliminated? What about chicken pox? The flu? I'm really curious as to how this ends up affecting disease in society. I don't know if it will be enough to eliminate corona, but this may be enough to kill off other diseases.
- mirimir 7y agoTFA closes with an interesting proposal, but somehow I doubt that we'll get there before social collapse and martial law. > Immunity from Covid-19 is still an open scientific question but, let’s assume that is more likely to be true than not. Huh? What's the basis for that? > The concerns are that China, Japan, and South Korea may have actually pushed social distancing too far. Israel and now Italy are going even further to keep the virus out altogether. I see no date on TFA, but this statement implies that it's maybe a week old.
- ComputerGuru 7y agoThere have been sufficient reports of people who either got reinfected or else had an extremely long “false recovery” period to cause the question of whether or not immunity can be relied on to be debated. Various explanations are available but none are as of yet proven.
- mirimir 7y agoI was unclear. Sorry. I was wondering why we even expect persistent immunity.
- ComputerGuru 7y agoI agree, no one that knows that they are talking about expects persistent immunity; the number I’ve heard floating about is along the lines of six months’ immunity after recovering from the illness. I’m not clear on whether the article is written with that definition of immunity or not (and based off its suggestion that this would prevent a second wave next year, etc, I’m assuming not) but I assumed it was questioning whether even six months of immunity was on the table.
- jokoon 7y agoFor now I think governments should think about maintaining the essential necessities: food, water, electricity, while shutting down everything else. Stopping long range transports, including cars, should be a priority. Anything that is not growing or transporting food or useful to treat patients should be shut down. It's difficult to say this, but sometimes you have to treat citizens like children. This is such a case.
- snori74 7y ago"we ....the generation that were adults during World War Il..." Ummm he's 98?
- mgleason_3 7y agoCertainly, it seems like there's more bad information than good. E.g. The beds are already full EVERY flu season. Do the researcher's know this? The flu has killed over 12,000 people every year in the US for the last 10 years. 2 years ago, the flu killed 61,000 people in the US. So, the logical question might be: Why haven't we been "flattening the curve" for years? Roll forward to Coronavirus and a news media publicizing a "novel" flu that spreads and kills and maims at about the same rate and suddenly we're all running around like crazy trying to destroy the economy and our livelyhoods to "flatten the curve". Our politicians, who literally have no plan, are making grand pronouncements bravely shutting down everything they can think of because they completely f'd-up the testing and tracking of the coronavirus and literally have no idea what else to do, but know they don't want to be the one at the center of one of those circles showing the number of sick in each city. *Source: https://www.cdc.gov/flu/about/burden/index.html https://www.cdc.gov/flu/about/burden/index.html.
- dabeeeenster 7y ago"a "novel" flu that spreads and kills and maims at about the same rate" It's nowhere near "the same rate"?
- dboreham 7y agoAnd it's not a flu.
- pmoriarty 7y agoFrom a Penn State epidemiologist (note that the quote below speaks of the "infection fatality rate", which is different from the "case fatality rate", the difference is explained in the article)[1]: "Scientists working at the London School of Hygiene and Tropical Medicine, Imperial College London and the Institute for Disease Modeling have used these approaches to estimate the infection fatality rate. Currently, these estimates range from 0.5% to 0.94% indicating that COVID-19 is about 10 to 20 times as deadly as seasonal influenza. Evidence coming in from genomics and large-scale testing of fevers is consistent with these conclusions. The only potentially good news is that the epidemic in Korea may ultimately show a lower CFR than the epidemic in China. ... "On balance, it is reasonable to guess that COVID-19 will infect as many Americans over the next year as influenza does in a typical winter -- somewhere between 25 million and 115 million. Maybe a bit more if the virus turns out to be more contagious than we thought. Maybe a bit less if we put restrictions in place that minimize our travel and our social and professional contacts. "The bad news is, of course, that these infection numbers translate to 350,000 to 660,000 people dying in the U.S., with an uncertainty range that goes from 50,000 deaths to 5 million deaths. The good news is that this is not a weather forecast. The size of the epidemic, i.e., the total number of infections, is something we can reduce if we decrease our contact patterns and improve our hygiene. If the total number of infections decreases, the total number of deaths will also decrease." This analysis is a little old, however (from March 9th, a week ago), and assumes that the rate of infection of COVID-19 is comparable to seasonal influenza. A recent This Week in Virology podcast[2] had another epidemiologist, Ralph Baric, of the University of North Carolina Chapel Hill, who had this to say: "The R0, or the number of people who become infected from an infected individual, is estimated somewhere between 2.5 and 3.2. That's actually quite high. That means that for every case there is two and a half to three additional cases. Contemporary flu is much closer to 2 or 1.8, 1.6. So this is very explosive spread and rapid transmission. It's even more explosive because you have rare individuals or maybe not so rare individuals who are superspreaders, who can infect 15, 20 people just passing through a room."[3] "In Canada there was one example of a superspreader who simply walked through an emergency room that was packed that was fairly packed with individuals and infected 19 people in the less than the 15 seconds they were in the emergency room as they walked through it."[4] With such explosive growth, the health care systems stands a very good chance of being overwhelmed, causing substantially more deaths. For instance, those 10% to 17% of severe cases that might have otherwise survived had they gotten care in an ICU could well die because they can't get that care. In addition many other, non-infected people who need critical care may not be able to get that care either and die, raising the overall death toll even higher. [1] - https://www.marketwatch.com/story/why-this-epidemiologist-is-more-worried-about-coronavirus-than-he-was-a-month-ago-2020-03-09 https://www.marketwatch.com/story/why-this-epidemiologist-is... [2] - http://www.microbe.tv/twiv/twiv-591/ http://www.microbe.tv/twiv/twiv-591/ [3] - about 8 minutes in to the program [4] - about 38 minutes in to the program
- RivieraKid 7y agoThis plan has several serious drawbacks: many deaths, possible long-term effects, the fear and anxiety of getting an illness with a 1% fatality rate, the discomfort and pain of being ill, overloaded healthcare system even if you build hospitals because then new bottlenecks like medical staff appear. And probably more, this is just quick out of my mind. Here's a better approach: Hardcore lockdown for 2 weeks, which stops the spread and reveals the vast majority of cases. Then switch to high-volume testing and targeted interventions (with would be much more efficient than now because many of the processes can be improved).
- wwqrd 7y agoFirstly, is a physical shortage of beds the problem? Capacity is not just physical, where do the doctors come from? As for building additional capacity with a WW mindset... how about just annex the currently empty offices and buildings? ...now to train some doctors!
- microtherion 7y agoThe part of the article I did not find compelling is handing things over to the military. The army that I served in is not exactly led by the best and the brightest, and armies in other countries can be actively malicious entities.
- js8 7y agoI think "flattening the curve" is often misunderstood, because on diagrams it looks like both scenarios will lead to similar number of infected people. But in reality, the flatter curve can actually lead to significantly less people infected overall, because exponential growth is difficult to control if the disease is everywhere. So it is even possible, it seems to me, that the countries that flatten the curve more vigorously will actually deal with the problem faster. But, as other people noted, we will see.
- sershe 7y agoThis actually sounds great. Why not basically have war economy for this, esp given how many people are becoming jobless - forcing a dramatic capacity increase could be a significant Keynesian stimulus.
- blackrock 7y agoI think we’re going to be in for a rough ride. The mass exodus from Europe is going to bring back a bunch of infected and asymptomatic people to America. Nobody wore a mask, or used gloves, or probably even sanitized their hands. They were just all in one giant Petri dish at JFK. This, and flights from Seattle have been going on for over a month now, that infected people were already traveling all over the country, and the world. By the time 1 person is confirmed infected by a test, they have probably already infected 10 to 20 other people, depending on their rate of social interaction, within the past 5 to 14 days. The average number of days before displaying symptoms is about 4 days. And it could go as high as 13 days. The only way to stay safe is to avoid other people. And when you interact with someone new, it restarts the clock again. In another week, America might not have 1 Wuhan sized epicenter, instead, it might have 50! And all the people rushing to Costco and Target, to hoard toilet paper, are just going to make things worse. It’s your local Petri dish, from just waiting in line, and re-breathing the same infected air from the recirculating HVAC. If you can wear a mask in public, I would highly advise you do so. It may be imperfect, but it will at least help block something. This virus is airborne.