COVID-19

[AnalyticalEngine]

Did you all see the latest US press conference? I can't say it's a bad idea, but drive through viral testing in the Walmart parking lot feels somewhat post-apocalyptic.

[jacob]

They do drive through testing in South Korea. In Denmark they set up such a station in Aarhus immediately after locking the country down. You roll the window down. Someone jams a Q-tip up your nose, and you get the result via secure email---there's a government two-factor system that's used for all official and "serious" (financial) communication---a few days later telling you how to proceed.

[IlliniDave]

On that note, has anyone read anything worthwhile that suggests the virus does poorly in warm climates?

It seems more convincing that it's just a lack of testing in those areas or due to stronger preventative measures.

I happened across an interview with a Dr who relayed esults of research he reviewed that this virus has essentially the same susceptibility to heat as influenza viruses. I don't know how much can be extrapolated from that, however. But here in the southeast once the temps get into the 80s and above (soon, many years we hit that in early March but not this year) I'll worry less about picking it up on outdoor surfaces. I might also be slow about cranking up the a/c in April and May if I'm still alive.

[AnalyticalEngine]

Cold/flu viruses tend to go away in the summer is for a few reasons:

1. Viruses last longer in the cold.
2. Sunlight kills viruses.
3. People are jammed inside in the winter which allows for more spread.
4. Schools are released for the summer, and schools are typically amplifiers of these illnesses.
5. Viruses start at the beginning of the winter and the epidemic curve peaks in the middle. By spring, it's naturally falling due to herd immunity.

So they are hoping these factors reduce COVID-19 transmission. However, given the whole population is vulnerable, these factors may not matter since it can spread so rapidly. So we can hope that it reduces in the summer but we can't rely on it.

[thrifty++]

I thought this was a good video explaining why diseases like this keep coming out of China. The practices are really disgusting https://www.youtube.com/watch?v=TPpoJGYlW54&t=408s

I think that there needs to be some serious consequences for China out of this whole thing. I think that at least there should be global trade sanctions against China. The world needs to take their practices seriously to make sure China does also.

[Bankai]

Not sure if this was linked already but it's quite in-depth analysis of why the West is doing it wrong and will pay very heavy price.

https://medium.com/@tomaspueyo/coronavi ... d3d9cd99ca

[Seppia]

@thrifty
I would also tend to believe that many diseases come from China because

1- China is home to a large % of the world's population
2- chinese people and goods come in contact with many people as the are the "world's factory"

[Ego]

I believe there is very little chance of this shut down lasting long enough to be effective. Will the closures last through March 30 or April 1?

That may give us enough time to figure out how to quarantine those at high risk, but I doubt it. I expect that by next Monday or Tuesday we will begin to see people demanding that the old and vulnerable go into lockdown so that everyone else can go back to normal.

People love simple narriatives for complex problems. Most will see it as torpedoing the economy for the sake of saving the elderly.

I hope I am wrong. My bit of cheer for the day.

[AnalyticalEngine]

@Ego - I believe in the US, all it will take is one state's healthcare system collapsing a la Wuhan to scare the rest of the country. There's this 'can't happen here' bias that's going to get popped in short order. Given WA is maybe ~2 weeks from this point, I can see other states extending the closures.

This is also why the government disinformation is so frustrating. I know they're trying to prevent panic but saying 80% of cases are mild or that it only kills elderly is misleading the population. People aren't thinking that 80% mild means one in five hospitalized or that it killing 'elderly' means people over 50.

Now I'm hearing outrageous claims like '50% are asymptomatic' or 'death rate is 0.2%' I'm willing to believe these things if there was evidence. But it seems like everyone and their mother is pulling data out of thin air, and that includes government officials.

[IlliniDave]

I believe there is very little chance of this shut down lasting long enough to be effective. Will the closures last through March 30 or April 1?

Not sure what closures you are talking about. Here in Alabama we just had our first 6 confirmed cases reported over the last 24 hours. So far it appears they've closed schools in my area until April 03, at which time they'll reevaluate whether to extend it. Haven't heard of any business closures yet. Toilet paper is available in a few places. I ran up to the store first thing this morning (a normal Sat AM activity) and there was quite a few people there (buying a lot of toilet paper too, haha) and a lot of perishable stuff was sold out or nearly so. I must be the only one buying a few extra long shelf-life items. Some of the surge is because the announcement of school closures came pretty late yesterday. I also saw a mask-wearing person for the first time. I gave him a wide berth.

I'm skeptical we'll be able to much more than flatten the curve a little. Best chance for only a moderately severe outcome I think rests in the changing of the seasons, and it's uncertain whether that will have any impact.

[IlliniDave]

Now I'm hearing outrageous claims like '50% are asymptomatic' or 'death rate is 0.2%' I'm willing to believe these things if there was evidence. But it seems like everyone and their mother is pulling data out of thin air, and that includes government officials.

0.2% is probably too low but there is some evidence based on what happened on one of those quarantined cruise ships that it's slightly <1% in a population biased towards being older by about 10 years. I don't recall the percentage on the ship who were never infected, but it was nontrivial.

Similar in Korea https://asiatimes.com/2020/03/why-are-k ... es-so-low/

Supposedly death rate estimates in these epi/pandemics are usually much higher at the outset, primarily because the sample is pretty biased until widespread testing starts and an accurate denominator is established.

Surge capacity in medical infrastructure is an area the US will be tested. Since the gov't is involved I'm afraid the normal bureaucratic inefficiency and political infighting might result in an outcome more tragic than necessary. I'm assuming if I get it I'm toast, so I'm getting all the important stuff gathered in an easy to find place. Quite an uplifting weekend activity.

[AnalyticalEngine]

SK is the best possible outcome imo. And given not all their cases are resolved, their CFR will probably go up. So if we combine the cruise ship and SK, I think 0.5% to 1% is technically feasible.

I'm just worried the US and other countries are setting ourselves up for an Italy experience rather than an SK experience. The paradox is you have to overreact when it looks mild to get the mild outcome. Underreacting and filling the populace with disinformation gets you the worse outcome.

[Ego]

UK Chief Scientific Adviser. The UK is taking a different approach. It will be interesting to see how this plays out.
https://youtu.be/2XRc389TvG8

[jacob]

If 0.9% (SK's current CFR) is the true death rate for a non-overwhelmed(*) system, then we can estimate what the spread was 3-4 weeks ago (the time it takes to get infected and die) in countries where the system has not been overwhelmed. For example, in the US, there would have been 39/0.009 = 4333 true cases in mid February, because there are 39 deaths now.

For doubling time, the 4 day estimate is based on the number of confirmed cases growth rate outside of China. Since much less aggressive testing has happened in most place but some systems have been in place to determine who got tested---those systems are a test in itself---I think the 4 day doubling time is a good estimate for the true doubling time. (<- This is the weakest assumption in this calculation.)

If so, there are 4333*2^(30/4) = 554624 cases walking around in the US right now(**). This means that 4 weeks from now, there will be ~5000 deaths which are already baked into the cake now. The US has some 95000 ICU beds and will thus still not be overwhelmed as such. That will happen two weeks later ... around end of April creating the beginning of triage. (I'm here presuming that the ICU units will all be taken over by COVID cases. In reality, many are already being used for other patients. The 95k number is NOT reserve capacity.)

(*) The true death rate for an overwhelmed system is much higher, since people who would survive with ICU access no longer will.

In 60 days, about half the US population will be infected and herd immunity will begin to create material negative feedback to the growth rate.

(**) If the true CFR is low, then the engine driving this pandemic is mostly asymptomatic spreaders! That is a very important point, especially politically and behaviorally, because the ultimate death count depends utterly on people's willingness to change their behavior to save other humans in the future, that is, a few weeks from now. As we know, that is a very big ask for the average person.

Obviously, this is just back of the envelope stuff. Change the numbers a bit and get different results. It actually doesn't matter that much how many deaths we have now as what the doubling time is. The doubling time is heavily influenced by social behavior (voluntary and forced distancing).

Add: There are now 50 US deaths. Recalculating is left as an exercise for those interested.

[ertyu]

UK Chief Scientific Adviser. The UK is taking a different approach. It will be interesting to see how this plays out.
https://youtu.be/2XRc389TvG8

Bonus shitstain points if they engineer a cataclysmic overwhelm and use it as an occasion to privatise the nhs

Edit: well, not engineer. Allow.

[7Wannabe5]

I am reading “Viruses:A Very Short Introduction” by Crawford and “A Journal of the Plague Year” by Defoe. Highly recommend. The first will make you smarter. The second will make you wiser. If you are already secluded, you can download copies of both for less than $7.

My current estimate is that I am likely to read 150 books before this is “over.” I made a quick run on Wednesday to my non-peopled storage locker to pick up about 30.

[jacob]

@7wb5 - Also The Plague by Camus. It's amazing how the development in the book parallels what's happening now.

[bostonimproper]

I think the UK is making the calculation that flattening the curve will also result in a more prolonged stranglehold on the economy which is not sustainable if this is an endemic virus. I'm surprised countries aren't employing targeted quarantines of senior citizens and allowing all the young folk get infected first. At some point, I imagine governments will want this to be over with, and a vaccine may be a long time coming.

Nice chart on event risk given number of infected and event size.

[J_]

@Jacob: thanks for your calculation, I will use those figures to decide where to go or stay in the coming months.

Now recent reports are coming in from Italy (Lombardy) from acting docters and nurses: It is devastating, not enough equipment and personell, because of quarantine no family or friends are allowed so the dieing are on there own. Staff is asking for minipads to give to the dieing so at last they can have contact with relatives to say goodbye. Patients are sorted at the entry and getting only help if they have life-expectency. Also young people are victim. Staff is asking the outside world: take every care to avoid the virus.
Seppia? can you give more info?

[fiby41]

2 dead.
Known infected: 84 in country, 18 in state, 2 in city.
New cases confirmed today were from Greece, France and USA.
State shuts schools, colleges and other educational institutions until 31st March.