7 ms·

What Happens Next? Covid-19 Futures, Explained with Playable Simulations

286 points by blopeur 6y ago

isoprophlex 6y ago
Fantastically illustrated once again, ncase if you're reading this, you're one of my internet heroes. The 'masks protect others from you, and wont protect you from others' illustration is very useful, too.
- nkkollaw 6y ago
  It is fantastically illustrated propaganda, but still propaganda.
pathumba 6y ago
While this is a very nice simulation and explanation it has a serious flaw: It assumes a fixed CFR, IFR, and hospitalisation rate. This doesn't seem to be case as evidenced by the large differences between the countries with different response curves. The inability to change the parameters is a major problem with the simulation and invalidates a number of conclusions at the end. What we can observe so far is that CFR is heavily skewed towards the old and frail with significant co-morbidities. Most likely there is another, not yet fully identified, medical cofactor that makes this virus particularly difficult for a very small number of people of any age. Outside of those groups the virus doesn't seem to be very symptomatic for the majority of infected people. Note that symptomatic in the medical sense and common usage is not the same. The latter having a way higher subjective threshold. The simulation should also account for the "weak tree" effect in that the majority of the susceptible will succumb to it on the first contact. In the following years the number of susceptible will be much lower and only go up with the remaining people going into ill health and becoming susceptible, if they haven't developed any immunity from the previous encounters. A simulation to draw real conclusions from must have an adjustable IFR, CFR, the corresponding hospitalisation rates, and the age and health distribution of the population for a region to be modelled.
- yread 6y ago
  Yes, it also assumes no significant mutations/different strains. That's why they're saying actual epidemiological models used to support decision making are much more complicated. But it gives techy lay people (the worst kind of lay people) something to play with and understand a bit more
- chiefalchemist 6y ago
  Strains, as well as who gets the virus. C19 is equally contagious, but far from equal in who it kills. In NJ (where I live) 40% of deaths are to people in extended care. In Philadelphia, same people, but it's 50% of their deaths. We need models that consider the details. We need models that consider that the virus preys on the weak (i.e., elderly and pre-existing conditions). Taking these profiles and applying them across the entire population is inaccurate ans misleading. It might even be dangerous.
  - Retric 6y ago
    COVID-19 has an extremely low mutation rate. The differences are all about random noise and differences in testing. The oldest people also die much faster so the ratio of deaths depend on rate of spread.
    - chiefalchemist 6y ago
      Let me explain a bit better. Who is getting it now and requiring medical attention might not be the same going forward. There are a limited number of high risk people. High risk people is not everyone. For example, I heard a new report that said the Bronx NYC has the highest per capita C19 infaction rate of any community nationally. Freightening? Maybe. How many other communities are similar to the Bronx? Similarly, how many living situations are similar to assisted living facilities. Taking edge and atypical cases and extrapolating that out over 330 million isn't a good model. Yes. C19 is highly contagious. But we also know - from data - it is more likely to kill the weak than the strong.
      - deleted 6y ago
ytNumbers 6y ago
I'm quite impressed with the work that went into these simulations. The folks who put this together did a great job. It would have been a great method to explain to the public how lock-downs save lives by not overwhelming our hospital ICU bed capacity, but for one critical omission. My idea for a way to improve these simulations would be to include what could be the most important public policy issue of them all: In many US states, the governor has forbidden (or greatly restricted) pharmacies from dispensing hydroxychloroquine. How many people could be kept out of the ICU (when the medicine is used in conjunction with azithromycin or zinc) if governors allowed pharmacies to dispense this medicine? I've yet to see a study where hydroxychloroquine, when used in conjunction with z-pak or zinc, was found to be ineffective against COVID-19. Of course, that's not proof of anything, but, with 25% unemployed in some of the biggest US cities, rigorous scientific studies may wind up taking more time than we can afford to wait. Therefore, it seems to me that the best way to find out what works to save lives (and keep people out of the ICU) is to look at what the front-line doctors are doing at one of the most prestigious hospitals in the world: https://www.the-hospitalist.org/hospitalist/article/221558/coronavirus-updates/yales-covid-19-inpatient-protocol-hydroxychloroquine https://www.the-hospitalist.org/hospitalist/article/221558/c...
- gremlinsinc 6y ago
  What about the study clearly showing no benefit, but a higher death rate in the group that DID use hydroxychloroquine? See: https://www.cnn.com/2020/04/21/health/hydroxychloroquine-veterans-study/index.html https://www.cnn.com/2020/04/21/health/hydroxychloroquine-vet... Seems to me the Remesedevir is the better option, and may be the first silver lining. I've told my wife, if I can't make the choice do not let them put me on that chloroquine no matter what. Also no ventilation without sedation/paralytics (in case of shortage, I'd rather die than be vented and wide awake).
  - lbeltrame 6y ago
    The U of Minnesota trial[1] (they aim at recruiting 3000 people, currently 700-ish) will tell if there is any prophylactic effect or not when using hydroxychloroquine. As with remedesivir, the effect size is probably not very large (so no miracles) and thus a lot of patients are needed to determine if the effect is true or only random. [1] https://covidpep.umn.edu/ https://covidpep.umn.edu/
nkkollaw 6y ago
Cool animation, but how reliable are the numbers? There are no reliable tests, governments are not doing a lot of testing, most cases are asymptomatic. How do you even know the death rate, and how many people need ICU? The animation says 1-20, seems crazy.
dbattaglia 6y ago
> For policymakers: Make laws to support folks who have to self-isolate/quarantine. I live in NYC, and this is something that still feels like a gaping hole. My wife has been job hunting since before we were on lockdown in February, and its been truly horrifying how many businesses COVID-19 hiring plans have been along the lines of "work from home until the very fist day the governor says we can go back to office". These aren't just "old school" BigCorps either, most have been small tech firms. Even worse, she finally ended up with a "offer" from a government agency I won't name that refuses to give her a start date yet because, even though the rest of the office workers are WFH, they refuse to hire remote because of "taxpayers" (who are ironically funding her to not work via NYS unemployment benefits). It's become quite clear to me that we can't trust businesses to do the right thing here. The desire for "butt in seat at office" from folks making decisions at employers here is going to end up flooding our subways with commuters who have no choice but to come in because they don't want to lose their jobs. Theres no reason office workers successfully working from home shouldn't stay there as long as they feel comfortable, and not make it terrible for folks who truly do need to commute (retail, food service, medical, etc). Maybe I'm just biased because I work for a remote company already, but I'm seriously worried what the big cities in America will look like once the initial restrictions are lifted.
- dahfizz 6y ago
  > its been truly horrifying how many businesses COVID-19 hiring plans have been along the lines of "work from home until the very fist day the governor says we can go back to office". Are you sure you're not reading too much into this? If I was running a company, new hires would be among the first people I would want in the office. Traning them and getting them up to speed would be so much faster in person, whereas most other employees are already set up to WFH. Just because they want new hires to come in asap doesn't mean all employees have to come in asap.
  - dbattaglia 6y ago
    > Training them and getting them up to speed would be so much faster in person I'm curious why this is the case. Is it because of existing processes? Any sort of onboarding that involves pairing / sitting over the other persons shoulder / breaking social distancing sounds risky anyways. As I said earlier, I'm probably just biased due to my current employer being remote where I onboarded just fine; even my in-office "training" was like 6 weeks after I started and batched with 3 months of other new hires, and not at all helpful for my day to day work. I can't remember a single in-office job where I felt like I was onboarded fast, most of them I sat around reading code and docs while everyone else was busy doing their normal job. Btw, I regret any mention of the rest of the country in my original comment. The thing that really scares the hell out of me is the mass transit / subway system here in NYC and opening that back up to office workers (many commuting from outside NYC), new hires or otherwise. I think its an extraordinary situation compared to the majority of the driving to work US and should force companies to adapt in ways others might not have to.
glofish 6y ago
This is simply a non-realistic toy visualization created to propagate the groupthink that is already so pervasive. the problem with this simulation is as with all models, it treats everyone equally likely to need medical care (this is how the ICU bed capacity is drawn). That is not the case a least bit. Millions of people have recovered with minor discomfort and they have all predictable traits (say age) that clearly indicated their preponderance to risk. Show me a model that accounts for this, then I will take it seriously.
- dTal 6y ago
  The model operates on aggregate statistics. The likelihoods associated with any particular individual are not relevant and do not affect the conclusions. Unless of course you want to assert that we should care more about some deaths than others. But that is a political statement, not an epidemiological one.
  - nostrademons 6y ago
    > Unless of course you want to assert that we should care more about some deaths than others. But that is a political statement, not an epidemiological one. That said, I'd love to see a model that does assume the population cares more about some deaths (notably their own, and those of their close friends and family) than others. The starting point for epidemiology and public health is that all life is sacred and worth the same, and we should protect life at all costs. There's pretty ample evidence that much of the general public doesn't actually believe this, though they'll publicly profess to because there's immense social stigma against wishing other people dead. But note how many people make comments in the vein of "It doesn't affect young people", "This is only a big-city disease", "It only affects Asian people", "Yes, yes I hope Trump supporters do drink some bleach", "I hope he dies of coronavirus", or "Good, Darwinism in action." The mods of r/coronavirus had to make a blanket policy against wishing people dead, and regularly lock threads because of it. Public health interventions only work if people follow them, which implies that a.) the citizenry needs to trust public health experts and b.) their goals need to be aligned enough that citizens think it's in their best interests to comply. There's a very common failure mode for other system-design efforts in assuming that the stated goals of the project are the actual goals. I'd love to see a model that assumes people are self-interested actors that respond to fear and greed, rather than one that takes as a given that they'll act for the common good.
wiz21c 6y ago
When Alice sends what she said to the hospital, I'm afraid she's not anonymous anymore. Indeed the hospital (or whoever owns the phone (I'm looking at google/apple)) knows who it's talking to. For Alice to remain anonymous, she must be able to send what she said through an anonymous channel... Am I right ?
- iso947 6y ago
  Not sure why google/Apple would know any more than they know your bank details. Your hospital would now when you ask them for a year, same as they know when they process it.
claudeganon 6y ago
Yes, it’s become obvious that this whole situation is not so much a threat to white-collar work, but to the necessity of the hierarchy and authoritarian control structures that define American workplaces.
- Roritharr 6y ago
  I sadly have to agree. A good entrepreneur friend of mine asked me what he can do to better monitor his employees working from home. His questions got creepy quickly until I had to tell him to ask someone else because I felt uncomfortable, but let's just say Office 365 can quickly turn into a mighty tool for the ill intentioned.
  - deleted 6y ago
    [deleted]
  - h_cube 6y ago
    Sigh. I've had to deal with this as well now that our engineering org is full remote. What it comes down to is that our leadership doesn't trust us, even though we consistently and repeatedly deliver releases on time and on budget. If our engineering leadership was comfortable with compensating us for the desired outcomes they want to generate value for the company, this wouldn't be an issue. Somehow I'm guessing they feel uncomfortable that we could all be getting our work done in 4 hours every day and then going outside to play.
    - jacquesm 6y ago
      They're not uncomfortable about it, they see that as breach of contract and would like you to either take a pay cut or work the full 8. We get paid 'by the hour' and not by a contracted amount of work no matter how much time is spent. Our whole regular workforce is structured around hourly wages, full time and/or part time employment in something described as a 'job'. If you start upending that it is important to realize that employers have a dominant position right now and that upsetting that position may not end well for those that really only do four hours of actual work during an 8 hour day.
gns24 6y ago
A great explanation of a lot of things, but this looks wrong to me: "To put a number on it: surgical masks on the sick person reduce cold & flu viruses in aerosols by 70%. Reducing transmissions by 70% would be as large an impact as a lockdown!" Reducing the amount of virus in aerosols won't reduce the number of infections by the same amount. If a cough produces ten times the infective dose, then with the mask that's still three times. Masks are still likely to help (and maybe having a smaller dose will make the disease milder if someone does catch the virus), but it's not possible to make a statement like this about the effect on R.
- H8crilA 6y ago
  Just read the next 4 short paragraphs.
- gilbetron 6y ago
  From what I've read it's the opposite effect. Wearing masks has a greater effect on reducing propagation (R-value) than expected. https://www.ijidonline.com/article/S1201-9712(08)01008-4/fulltext https://www.ijidonline.com/article/S1201-9712(08)01008-4/ful...
- cactus2093 6y ago
  I can’t really imagine a mechanism by which a mask would still let the same cloud of particles from a cough disperse in exactly the same way, but uniformly remove 70% of them. Surely if it is blocking that many particles it’s also disrupting the spread of the remaining particles. Or it could very well be the opposite of what you’re saying, maybe blocking that 70% of particles is enough to stop even more than 70% of the transmission opportunities. That wouldn’t be crazy if the spread is mostly via large droplets (most likely to get stopped by a mask) rather than aerosolized particles, which has been suggested. I think your argument is that it’s just not scientifically proven, but we have to make decisions today with the best information we have. Wearing masks still appears to be a good idea, has very low cost, and has been shown to help for a long time for all kinds of respiratory diseases.
  - gns24 6y ago
_red 6y ago
This somewhat a classic Strategy vs Tactics problem: The best Strategy is to do nothing The best Tactic is the complex array of shutdowns, mask, social distancing, pharmaceuticals.
hedora 6y ago
The simulation doesn’t take into account new strains. Coronavirus mutates at least once a year. It’s likely there will be strains that are similarly contagious, but with higher or lower case fatality rates. Prior pandemic case fatality rates were 10x what we’re seeing with COVID-19. Also, in 1918, shelter in place contributed to a W shaped pandemic, where the second wave was much more deadly, and also killed lots of kids and young adults. If more people in those age groups had been infected in the first wave, many fewer people would have died in total.
- kolinko 6y ago
  The first two paragraphs you said are blatantly false.
deegles 6y ago
Isn't it a big assumption that immunity is permanent? How would it affect the herd immunity threshold if a person can be reinfected every year?
- mmmrtl 6y ago
  See fig 3 here: https://science.sciencemag.org/content/early/2020/04/24/science.abb5793 https://science.sciencemag.org/content/early/2020/04/24/scie... Short answer, if the immunity is as short lived as current seasonal coronaviruses, it would be expected to recur in 2022 (hopefully with milder symptoms, but we can't know that yet).
  - rootusrootus 6y ago
    Assuming immunity is both short-lived and predictably so for everyone. If the amount of immunity varies significantly by individual, then it’ll just be an ongoing slow burn and not another spike of infections. And that also assumes that at a slow burn it would be able to maintain R0 > 1.0.
    - mmmrtl 6y ago
      Good point. If seasonal effects are strong enough, though, it might still recur in periodic spikes.
  - dehrmann 6y ago
    Is it possible to give someone known to have antibodies an live virus booster every six months?
    - SpicyLemonZest 6y ago
      In principle it might work, but there's no realistic chance doctors would get permission to administer or even test such a thing.
- nuclear_eclipse 6y ago
  If you read down far enough, the site covers that!
strken 6y ago
From the article: "Masks don't stop you getting sick" From the article's source (https://www.sciencedirect.com/science/article/pii/S0196655307007742 https://www.sciencedirect.com/science/article/pii/S019665530...): "None of these surgical masks exhibited adequate filter performance and facial fit characteristics to be considered respiratory protection devices" Well, what's "adequate filter performance and facial fit"? For filter performance, they measured how good the surgical masks were at blocking tiny latex spheres that approximated an aerosol, and found that masks ranged from less than 1% penetration (best) all the way to 80% penetration (worst). For facial fit, they told subjects who "were not screened for previous use of masks or respirators" to wear masks and then sprayed an aerosolised bitter substance on them, and found all of the subjects could taste it after their first try. The article is making the claim that masks don't stop you getting sick, based on a source that indicates some masks don't filter aerosols completely and that nobody wears masks correctly anyway. This is a bit of a stretch - their source says nothing about larger droplets, it says nothing about side effects like touching your face less, it says nothing about masks encouraging other people to socially distance, it says very little about how masks reduce the viral load that reaches you. I don't think there's enough evidence to categorically state that masks do not stop you getting sick. I think it's irresponsible to make such a firm statement without better evidence.
- lalsdjsdlafsdk 6y ago
  Then why the fuck is it an "order" to wear a mask!?
- jccooper 6y ago
  Yeah, there's science and then there's science. I'm sure they're correct about aerosol protection, but if this virus is mostly spread via respiratory droplets (as seems likely) that's an entirely different question and answer. In such a case even poor masks will be useful against exposure via casual contact. So long as you're not wearing them on your chin, as I see so often.
  - Johnjonjoan 6y ago
    It's such a blatant doublethink right? I feel like the masks don't work rhetoric is political maneuvering born from the fact that governments had little to no reserves of them and that health professionals desperately need them. Whilst I'm sure some seasoned bureaucrats or advisors think the (subjectively) white lie is the right thing to do; because health professionals need them more. The fact is if we all supported EVERYONE wearing masks, large scale domestic production would have to begin in every country and health care professionals would be swimming in masks. Not to mention it could play a part in reducing transmission. Masks for everyone is a win win.
augustt 6y ago
What's the reasoning behind this incredibly strong statement: "Most epidemiologists expect a vaccine in 1 to 2 years." ?
- slicktux 6y ago
  I would assume maybe because of the phenomenon: https://en.m.wikipedia.org/wiki/Antibody-dependent_enhancement https://en.m.wikipedia.org/wiki/Antibody-dependent_enhanceme...
- SpicyLemonZest 6y ago
  My understanding is that vaccine development efforts went very well for SARS, and we never "got a vaccine" just because there was nowhere with an active outbreak to perform the trials that would prove it works. So much of that knowledge should transfer, and there's strong reason to expect some of the vaccines currently in development and testing will end up working.
- lbeltrame 6y ago
  Because they take into account not only the development, but also the production constraints, which is not just turning a dial. That said, approaches are kind of different compared to traditional vaccine development. If efficacy is demonstrated, there will be a huge pressure to scale up production to get it around ASAP. That's why institutions like the Jenner Institute in Oxford (which develops one of the vaccines further ahead in the race) is seeking partnerships everywhere (at risk, because for now no one knows if it works). No single entity can make billions of doses. P.S.: All these measures and reasonings seem to forget the eventual availability of effective pharmacological treatment, which might reduce the medical impact of this disease.
squidproquo 6y ago
If anyone has been doing Covid-19 simulations for the United States. I'm crowdsourcing forecasts on this site: https://www.unitarity.com/app/challenges/us-coronavirus-outbreak/events/may-20 https://www.unitarity.com/app/challenges/us-coronavirus-outb...
jdkee 6y ago
FWIW, I found this thread by Jeremy Konyndyk enlightening and depressing. https://threader.app/thread/1256090422188953600 https://threader.app/thread/1256090422188953600
dvt 6y ago
It's such a shame that COVID-19 has become so politicized, it's hard to even find scientific sources that are being wholeheartedly honest. Here's a few statements that are blatantly misleading: > Around 1 in 20 people infected with COVID-19 need to go to an ICU (Intensive Care Unit). That statistic is contingent on infection rates. No one has these due to lack of testing. Therefore, the statistic is misleading at best, and wrong at worst. > However, pandemics are like poker. Make bets only when you're 95% sure, and you'll lose everything at stake. This is highly alarmist. Pandemics aren't like poker because you're not going "all-in" on a 95% bet. Awful analogy, and just bad rhetoric. > (Rant about the confusion about pre-symptomatic vs "true" asymptomatic. "True" asymptomatics are rare.) Let's be real. In the study cited, N was like 900 (with asymptomatics = 4; 1.9%). We have no idea how "rare" asymptomatics are, and citing this study is just bad science. I don't understand why not just be honest.
- Symmetry 6y ago
  For the hospitalization ratio we don't have enough testing in many places but for those countries that are successfully pursuing test and trace strategies we can be pretty sure they're at least discovering the majority of contagious infections. So we can guess at the rough number even if we don't have it nailed down precisely.
  - dvt 6y ago
    Iceland is leading testing rates at almost 146 per 1,000 people[1]. This is extremely low for a hyper-contagious pathogen like COVID-19. No one is "pretty sure they're at least discovering the majority of contagious infections" -- let's call a spade a spade and build models that actually make sense. [1] https://ourworldindata.org/covid-testing https://ourworldindata.org/covid-testing
    - Symmetry 6y ago
      If you use contact tracing to find out who sick people interacted with you only need to test those people rather than everyone and you can get by with far less testing overall. Then it's about the number of tests per case rather than the number of tests per capita. The percent positive rate on tests is a very important metric there as well and it seems that countries that control the spread get that down far enough that false positives outnumber true positives.

286 points by blopeur 6y ago

Fantastically illustrated once again, ncase if you're reading this, you're one of my internet heroes. The 'masks protect others from you, and wont protect you from others' illustration is very useful, too.

nkkollaw 6y ago
It is fantastically illustrated propaganda, but still propaganda.

pathumba 6y ago

While this is a very nice simulation and explanation it has a serious flaw: It assumes a fixed CFR, IFR, and hospitalisation rate. This doesn't seem to be case as evidenced by the large differences between the countries with different response curves. The inability to change the parameters is a major problem with the simulation and invalidates a number of conclusions at the end. What we can observe so far is that CFR is heavily skewed towards the old and frail with significant co-morbidities. Most likely there is another, not yet fully identified, medical cofactor that makes this virus particularly difficult for a very small number of people of any age. Outside of those groups the virus doesn't seem to be very symptomatic for the majority of infected people. Note that symptomatic in the medical sense and common usage is not the same. The latter having a way higher subjective threshold. The simulation should also account for the "weak tree" effect in that the majority of the susceptible will succumb to it on the first contact. In the following years the number of susceptible will be much lower and only go up with the remaining people going into ill health and becoming susceptible, if they haven't developed any immunity from the previous encounters. A simulation to draw real conclusions from must have an adjustable IFR, CFR, the corresponding hospitalisation rates, and the age and health distribution of the population for a region to be modelled.

yread 6y ago
Yes, it also assumes no significant mutations/different strains. That's why they're saying actual epidemiological models used to support decision making are much more complicated. But it gives techy lay people (the worst kind of lay people) something to play with and understand a bit more
chiefalchemist 6y ago
Strains, as well as who gets the virus. C19 is equally contagious, but far from equal in who it kills. In NJ (where I live) 40% of deaths are to people in extended care. In Philadelphia, same people, but it's 50% of their deaths. We need models that consider the details. We need models that consider that the virus preys on the weak (i.e., elderly and pre-existing conditions). Taking these profiles and applying them across the entire population is inaccurate ans misleading. It might even be dangerous.
- Retric 6y ago
  COVID-19 has an extremely low mutation rate. The differences are all about random noise and differences in testing. The oldest people also die much faster so the ratio of deaths depend on rate of spread.
  - chiefalchemist 6y ago
    Let me explain a bit better. Who is getting it now and requiring medical attention might not be the same going forward. There are a limited number of high risk people. High risk people is not everyone. For example, I heard a new report that said the Bronx NYC has the highest per capita C19 infaction rate of any community nationally. Freightening? Maybe. How many other communities are similar to the Bronx? Similarly, how many living situations are similar to assisted living facilities. Taking edge and atypical cases and extrapolating that out over 330 million isn't a good model. Yes. C19 is highly contagious. But we also know - from data - it is more likely to kill the weak than the strong.
    - deleted 6y ago

ytNumbers 6y ago

I'm quite impressed with the work that went into these simulations. The folks who put this together did a great job. It would have been a great method to explain to the public how lock-downs save lives by not overwhelming our hospital ICU bed capacity, but for one critical omission. My idea for a way to improve these simulations would be to include what could be the most important public policy issue of them all: In many US states, the governor has forbidden (or greatly restricted) pharmacies from dispensing hydroxychloroquine. How many people could be kept out of the ICU (when the medicine is used in conjunction with azithromycin or zinc) if governors allowed pharmacies to dispense this medicine? I've yet to see a study where hydroxychloroquine, when used in conjunction with z-pak or zinc, was found to be ineffective against COVID-19. Of course, that's not proof of anything, but, with 25% unemployed in some of the biggest US cities, rigorous scientific studies may wind up taking more time than we can afford to wait. Therefore, it seems to me that the best way to find out what works to save lives (and keep people out of the ICU) is to look at what the front-line doctors are doing at one of the most prestigious hospitals in the world: https://www.the-hospitalist.org/hospitalist/article/221558/coronavirus-updates/yales-covid-19-inpatient-protocol-hydroxychloroquine https://www.the-hospitalist.org/hospitalist/article/221558/c...

gremlinsinc 6y ago
What about the study clearly showing no benefit, but a higher death rate in the group that DID use hydroxychloroquine? See: https://www.cnn.com/2020/04/21/health/hydroxychloroquine-veterans-study/index.html https://www.cnn.com/2020/04/21/health/hydroxychloroquine-vet... Seems to me the Remesedevir is the better option, and may be the first silver lining. I've told my wife, if I can't make the choice do not let them put me on that chloroquine no matter what. Also no ventilation without sedation/paralytics (in case of shortage, I'd rather die than be vented and wide awake).
- lbeltrame 6y ago
  The U of Minnesota trial[1] (they aim at recruiting 3000 people, currently 700-ish) will tell if there is any prophylactic effect or not when using hydroxychloroquine. As with remedesivir, the effect size is probably not very large (so no miracles) and thus a lot of patients are needed to determine if the effect is true or only random. [1] https://covidpep.umn.edu/ https://covidpep.umn.edu/

nkkollaw 6y ago

Cool animation, but how reliable are the numbers? There are no reliable tests, governments are not doing a lot of testing, most cases are asymptomatic. How do you even know the death rate, and how many people need ICU? The animation says 1-20, seems crazy.

dbattaglia 6y ago

> For policymakers: Make laws to support folks who have to self-isolate/quarantine. I live in NYC, and this is something that still feels like a gaping hole. My wife has been job hunting since before we were on lockdown in February, and its been truly horrifying how many businesses COVID-19 hiring plans have been along the lines of "work from home until the very fist day the governor says we can go back to office". These aren't just "old school" BigCorps either, most have been small tech firms. Even worse, she finally ended up with a "offer" from a government agency I won't name that refuses to give her a start date yet because, even though the rest of the office workers are WFH, they refuse to hire remote because of "taxpayers" (who are ironically funding her to not work via NYS unemployment benefits). It's become quite clear to me that we can't trust businesses to do the right thing here. The desire for "butt in seat at office" from folks making decisions at employers here is going to end up flooding our subways with commuters who have no choice but to come in because they don't want to lose their jobs. Theres no reason office workers successfully working from home shouldn't stay there as long as they feel comfortable, and not make it terrible for folks who truly do need to commute (retail, food service, medical, etc). Maybe I'm just biased because I work for a remote company already, but I'm seriously worried what the big cities in America will look like once the initial restrictions are lifted.

dahfizz 6y ago
> its been truly horrifying how many businesses COVID-19 hiring plans have been along the lines of "work from home until the very fist day the governor says we can go back to office". Are you sure you're not reading too much into this? If I was running a company, new hires would be among the first people I would want in the office. Traning them and getting them up to speed would be so much faster in person, whereas most other employees are already set up to WFH. Just because they want new hires to come in asap doesn't mean all employees have to come in asap.
- dbattaglia 6y ago
  > Training them and getting them up to speed would be so much faster in person I'm curious why this is the case. Is it because of existing processes? Any sort of onboarding that involves pairing / sitting over the other persons shoulder / breaking social distancing sounds risky anyways. As I said earlier, I'm probably just biased due to my current employer being remote where I onboarded just fine; even my in-office "training" was like 6 weeks after I started and batched with 3 months of other new hires, and not at all helpful for my day to day work. I can't remember a single in-office job where I felt like I was onboarded fast, most of them I sat around reading code and docs while everyone else was busy doing their normal job. Btw, I regret any mention of the rest of the country in my original comment. The thing that really scares the hell out of me is the mass transit / subway system here in NYC and opening that back up to office workers (many commuting from outside NYC), new hires or otherwise. I think its an extraordinary situation compared to the majority of the driving to work US and should force companies to adapt in ways others might not have to.

glofish 6y ago

This is simply a non-realistic toy visualization created to propagate the groupthink that is already so pervasive. the problem with this simulation is as with all models, it treats everyone equally likely to need medical care (this is how the ICU bed capacity is drawn). That is not the case a least bit. Millions of people have recovered with minor discomfort and they have all predictable traits (say age) that clearly indicated their preponderance to risk. Show me a model that accounts for this, then I will take it seriously.

dTal 6y ago
The model operates on aggregate statistics. The likelihoods associated with any particular individual are not relevant and do not affect the conclusions. Unless of course you want to assert that we should care more about some deaths than others. But that is a political statement, not an epidemiological one.
- nostrademons 6y ago
  > Unless of course you want to assert that we should care more about some deaths than others. But that is a political statement, not an epidemiological one. That said, I'd love to see a model that does assume the population cares more about some deaths (notably their own, and those of their close friends and family) than others. The starting point for epidemiology and public health is that all life is sacred and worth the same, and we should protect life at all costs. There's pretty ample evidence that much of the general public doesn't actually believe this, though they'll publicly profess to because there's immense social stigma against wishing other people dead. But note how many people make comments in the vein of "It doesn't affect young people", "This is only a big-city disease", "It only affects Asian people", "Yes, yes I hope Trump supporters do drink some bleach", "I hope he dies of coronavirus", or "Good, Darwinism in action." The mods of r/coronavirus had to make a blanket policy against wishing people dead, and regularly lock threads because of it. Public health interventions only work if people follow them, which implies that a.) the citizenry needs to trust public health experts and b.) their goals need to be aligned enough that citizens think it's in their best interests to comply. There's a very common failure mode for other system-design efforts in assuming that the stated goals of the project are the actual goals. I'd love to see a model that assumes people are self-interested actors that respond to fear and greed, rather than one that takes as a given that they'll act for the common good.

wiz21c 6y ago

When Alice sends what she said to the hospital, I'm afraid she's not anonymous anymore. Indeed the hospital (or whoever owns the phone (I'm looking at google/apple)) knows who it's talking to. For Alice to remain anonymous, she must be able to send what she said through an anonymous channel... Am I right ?

iso947 6y ago
Not sure why google/Apple would know any more than they know your bank details. Your hospital would now when you ask them for a year, same as they know when they process it.

claudeganon 6y ago

Yes, it’s become obvious that this whole situation is not so much a threat to white-collar work, but to the necessity of the hierarchy and authoritarian control structures that define American workplaces.

Roritharr 6y ago
I sadly have to agree. A good entrepreneur friend of mine asked me what he can do to better monitor his employees working from home. His questions got creepy quickly until I had to tell him to ask someone else because I felt uncomfortable, but let's just say Office 365 can quickly turn into a mighty tool for the ill intentioned.
- deleted 6y ago
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- h_cube 6y ago
  Sigh. I've had to deal with this as well now that our engineering org is full remote. What it comes down to is that our leadership doesn't trust us, even though we consistently and repeatedly deliver releases on time and on budget. If our engineering leadership was comfortable with compensating us for the desired outcomes they want to generate value for the company, this wouldn't be an issue. Somehow I'm guessing they feel uncomfortable that we could all be getting our work done in 4 hours every day and then going outside to play.
  - jacquesm 6y ago
    They're not uncomfortable about it, they see that as breach of contract and would like you to either take a pay cut or work the full 8. We get paid 'by the hour' and not by a contracted amount of work no matter how much time is spent. Our whole regular workforce is structured around hourly wages, full time and/or part time employment in something described as a 'job'. If you start upending that it is important to realize that employers have a dominant position right now and that upsetting that position may not end well for those that really only do four hours of actual work during an 8 hour day.

gns24 6y ago

A great explanation of a lot of things, but this looks wrong to me: "To put a number on it: surgical masks on the sick person reduce cold & flu viruses in aerosols by 70%. Reducing transmissions by 70% would be as large an impact as a lockdown!" Reducing the amount of virus in aerosols won't reduce the number of infections by the same amount. If a cough produces ten times the infective dose, then with the mask that's still three times. Masks are still likely to help (and maybe having a smaller dose will make the disease milder if someone does catch the virus), but it's not possible to make a statement like this about the effect on R.

H8crilA 6y ago
Just read the next 4 short paragraphs.
gilbetron 6y ago
From what I've read it's the opposite effect. Wearing masks has a greater effect on reducing propagation (R-value) than expected. https://www.ijidonline.com/article/S1201-9712(08)01008-4/fulltext https://www.ijidonline.com/article/S1201-9712(08)01008-4/ful...
cactus2093 6y ago
I can’t really imagine a mechanism by which a mask would still let the same cloud of particles from a cough disperse in exactly the same way, but uniformly remove 70% of them. Surely if it is blocking that many particles it’s also disrupting the spread of the remaining particles. Or it could very well be the opposite of what you’re saying, maybe blocking that 70% of particles is enough to stop even more than 70% of the transmission opportunities. That wouldn’t be crazy if the spread is mostly via large droplets (most likely to get stopped by a mask) rather than aerosolized particles, which has been suggested. I think your argument is that it’s just not scientifically proven, but we have to make decisions today with the best information we have. Wearing masks still appears to be a good idea, has very low cost, and has been shown to help for a long time for all kinds of respiratory diseases.
- gns24 6y ago

_red 6y ago

This somewhat a classic Strategy vs Tactics problem: The best Strategy is to do nothing The best Tactic is the complex array of shutdowns, mask, social distancing, pharmaceuticals.

hedora 6y ago

The simulation doesn’t take into account new strains. Coronavirus mutates at least once a year. It’s likely there will be strains that are similarly contagious, but with higher or lower case fatality rates. Prior pandemic case fatality rates were 10x what we’re seeing with COVID-19. Also, in 1918, shelter in place contributed to a W shaped pandemic, where the second wave was much more deadly, and also killed lots of kids and young adults. If more people in those age groups had been infected in the first wave, many fewer people would have died in total.

kolinko 6y ago
The first two paragraphs you said are blatantly false.

deegles 6y ago

Isn't it a big assumption that immunity is permanent? How would it affect the herd immunity threshold if a person can be reinfected every year?

mmmrtl 6y ago
See fig 3 here: https://science.sciencemag.org/content/early/2020/04/24/science.abb5793 https://science.sciencemag.org/content/early/2020/04/24/scie... Short answer, if the immunity is as short lived as current seasonal coronaviruses, it would be expected to recur in 2022 (hopefully with milder symptoms, but we can't know that yet).
- rootusrootus 6y ago
  Assuming immunity is both short-lived and predictably so for everyone. If the amount of immunity varies significantly by individual, then it’ll just be an ongoing slow burn and not another spike of infections. And that also assumes that at a slow burn it would be able to maintain R0 > 1.0.
  - mmmrtl 6y ago
    Good point. If seasonal effects are strong enough, though, it might still recur in periodic spikes.
- dehrmann 6y ago
  Is it possible to give someone known to have antibodies an live virus booster every six months?
  - SpicyLemonZest 6y ago
    In principle it might work, but there's no realistic chance doctors would get permission to administer or even test such a thing.
nuclear_eclipse 6y ago
If you read down far enough, the site covers that!

strken 6y ago

From the article: "Masks don't stop you getting sick" From the article's source (https://www.sciencedirect.com/science/article/pii/S0196655307007742 https://www.sciencedirect.com/science/article/pii/S019665530...): "None of these surgical masks exhibited adequate filter performance and facial fit characteristics to be considered respiratory protection devices" Well, what's "adequate filter performance and facial fit"? For filter performance, they measured how good the surgical masks were at blocking tiny latex spheres that approximated an aerosol, and found that masks ranged from less than 1% penetration (best) all the way to 80% penetration (worst). For facial fit, they told subjects who "were not screened for previous use of masks or respirators" to wear masks and then sprayed an aerosolised bitter substance on them, and found all of the subjects could taste it after their first try. The article is making the claim that masks don't stop you getting sick, based on a source that indicates some masks don't filter aerosols completely and that nobody wears masks correctly anyway. This is a bit of a stretch - their source says nothing about larger droplets, it says nothing about side effects like touching your face less, it says nothing about masks encouraging other people to socially distance, it says very little about how masks reduce the viral load that reaches you. I don't think there's enough evidence to categorically state that masks do not stop you getting sick. I think it's irresponsible to make such a firm statement without better evidence.

lalsdjsdlafsdk 6y ago
Then why the fuck is it an "order" to wear a mask!?
jccooper 6y ago
Yeah, there's science and then there's science. I'm sure they're correct about aerosol protection, but if this virus is mostly spread via respiratory droplets (as seems likely) that's an entirely different question and answer. In such a case even poor masks will be useful against exposure via casual contact. So long as you're not wearing them on your chin, as I see so often.
- Johnjonjoan 6y ago
  It's such a blatant doublethink right? I feel like the masks don't work rhetoric is political maneuvering born from the fact that governments had little to no reserves of them and that health professionals desperately need them. Whilst I'm sure some seasoned bureaucrats or advisors think the (subjectively) white lie is the right thing to do; because health professionals need them more. The fact is if we all supported EVERYONE wearing masks, large scale domestic production would have to begin in every country and health care professionals would be swimming in masks. Not to mention it could play a part in reducing transmission. Masks for everyone is a win win.

augustt 6y ago

What's the reasoning behind this incredibly strong statement: "Most epidemiologists expect a vaccine in 1 to 2 years." ?

slicktux 6y ago
I would assume maybe because of the phenomenon: https://en.m.wikipedia.org/wiki/Antibody-dependent_enhancement https://en.m.wikipedia.org/wiki/Antibody-dependent_enhanceme...
SpicyLemonZest 6y ago
My understanding is that vaccine development efforts went very well for SARS, and we never "got a vaccine" just because there was nowhere with an active outbreak to perform the trials that would prove it works. So much of that knowledge should transfer, and there's strong reason to expect some of the vaccines currently in development and testing will end up working.
lbeltrame 6y ago
Because they take into account not only the development, but also the production constraints, which is not just turning a dial. That said, approaches are kind of different compared to traditional vaccine development. If efficacy is demonstrated, there will be a huge pressure to scale up production to get it around ASAP. That's why institutions like the Jenner Institute in Oxford (which develops one of the vaccines further ahead in the race) is seeking partnerships everywhere (at risk, because for now no one knows if it works). No single entity can make billions of doses. P.S.: All these measures and reasonings seem to forget the eventual availability of effective pharmacological treatment, which might reduce the medical impact of this disease.

squidproquo 6y ago

If anyone has been doing Covid-19 simulations for the United States. I'm crowdsourcing forecasts on this site: https://www.unitarity.com/app/challenges/us-coronavirus-outbreak/events/may-20 https://www.unitarity.com/app/challenges/us-coronavirus-outb...

jdkee 6y ago

FWIW, I found this thread by Jeremy Konyndyk enlightening and depressing. https://threader.app/thread/1256090422188953600 https://threader.app/thread/1256090422188953600

dvt 6y ago

It's such a shame that COVID-19 has become so politicized, it's hard to even find scientific sources that are being wholeheartedly honest. Here's a few statements that are blatantly misleading: > Around 1 in 20 people infected with COVID-19 need to go to an ICU (Intensive Care Unit). That statistic is contingent on infection rates. No one has these due to lack of testing. Therefore, the statistic is misleading at best, and wrong at worst. > However, pandemics are like poker. Make bets only when you're 95% sure, and you'll lose everything at stake. This is highly alarmist. Pandemics aren't like poker because you're not going "all-in" on a 95% bet. Awful analogy, and just bad rhetoric. > (Rant about the confusion about pre-symptomatic vs "true" asymptomatic. "True" asymptomatics are rare.) Let's be real. In the study cited, N was like 900 (with asymptomatics = 4; 1.9%). We have no idea how "rare" asymptomatics are, and citing this study is just bad science. I don't understand why not just be honest.

Symmetry 6y ago
For the hospitalization ratio we don't have enough testing in many places but for those countries that are successfully pursuing test and trace strategies we can be pretty sure they're at least discovering the majority of contagious infections. So we can guess at the rough number even if we don't have it nailed down precisely.
- dvt 6y ago
  Iceland is leading testing rates at almost 146 per 1,000 people[1]. This is extremely low for a hyper-contagious pathogen like COVID-19. No one is "pretty sure they're at least discovering the majority of contagious infections" -- let's call a spade a spade and build models that actually make sense. [1] https://ourworldindata.org/covid-testing https://ourworldindata.org/covid-testing
  - Symmetry 6y ago
    If you use contact tracing to find out who sick people interacted with you only need to test those people rather than everyone and you can get by with far less testing overall. Then it's about the number of tests per case rather than the number of tests per capita. The percent positive rate on tests is a very important metric there as well and it seems that countries that control the spread get that down far enough that false positives outnumber true positives.