"So far, successful mitigaions in China/Korea have involved near-complete shutdown, very early in the epidemic, around the time of 100 confirmed cases."
From what I read, South Korea shut down almost nothing but had widespread testing available, including drive-through testing where people could sit in their car, get tested and receive the results via SMS next day. They also had the ability to very proactively search and locate people that had been potentially exposed to the virus via credit card transaction/location data.
But SK also published that location data online for all to see, something the US cannot do because HIPPA. People would make fun of those with the virus, such as one man who was tracked to a hotel associated with prostitution.
The US could do it with one emergency bill. Mockery is better than "widespread ventilator shortages."
I hope public identifying information isn't strictly necessary for the South Korean model but let's keep this in perspective. The alternatives to SK's privacy invasions are total lockdown, or mass unnecessary death.
This didn't help much. It created a false sense of security when it appeared that the first 21 cases were contained. People went to gatherings (which caused the recent spike). It also doesn't help if you know what hotels are infected; plenty of other spots can be infected as well.
Case 26 was blamed as "patient zero" but he had actually shown no symptoms 6 weeks after returning from China. He got infected elsewhere. But the media places unfair judgement on him.
SK published (and is publishing) logs of every establishment the infected people had been to with timestamps accurate to the minute. Like, "this particular Burger King branch from 2:23 to 2:55". For the entire two-week period in which the infected may be infectious. This allowed/forced said establishments to shut down for a day or so while they disinfected every surface. The USA most certainly cannot do this, and not just because of HIPAA. Neither the bureaucratic will nor capability is there.
NSA logs cell metadata and many other sources to build tracking databases, so the capability is there. But it's not supposed to exist, theoretically, so can't really be openly used in the way Taiwan and SK have been doing it.
Speaking 100% from a point of ignorance, how far do you need to "zoom out" to be in compliance with HIPPA? Can the name of the hospitals treating cases be disclosed? The city where the hospital is located? I noticed that many county websites are showing the origin of the case, whether it was travel-related/community spread/etc.. If you could have that level of granularity, maybe you can have some geographic detail (hospital location, for instance) so that people could at least get a better feel for how close to home this is, encouraging them to socially distance.
I remember health insurance companies were capturing this data during H1N1 (voluntary reporting from providers), but of course the data was limited by insurance company and voluntary reporting. So there is some leniency over aggregated data (remember the cost and quality calculators from the mid-2000s?). I wonder what the CDC requires providers to report?
It works roughly like this: Patient number #xxx, diagnosed today. Last Monday, he used a taxi (11:30-12:00) to visit McDonalds next to Hongdae station (12:00-12:50) and then walked to Woori bank nearby (1:30-2:00) and used another taxi to go home. Next Tuesday... blah blah...
And then you find out the taxi drivers, all the McDonalds workers, and everybody who used McDonalds and the bank at the same time, and tell them to go self-quarantine for two weeks. And also test them. The idea is basically catch all the virus before it has a chance to run into more people.
It does help that Koreans carry cell phones and use credit cards everywhere. (And, yes it does raise the question about privacy - which is something we should revisit once the emergency is over.)
History teaches that once you give up rights in time of emergency, it is very, very difficult to get them back. Americans are still not back to their pre-9/11 rights to privacy and at this point will likely never will be. Coronavirus will eventually fade away (even if it's a long, bloody road to get to that point), but the loss of rights will persist for generations.
That's an American thinking. The Korean thinking is that we never gave up our rights - our country was born without one, liberated by greater powers, split into half, ruled by dictators. We won our rights with fight, and because it's ours, and our government serves us, we can let them use our power when the society needs it, like a master trusting the key to its faithful servant.
And if they do not relinquish it later, no problem, we'll fight and get them back again.
How is it possible that SK has performed such an extensive testing, while other developped country state they don't have the technical ability to do more than a few thousands tests a week.. Did SK developp its own technics and device for testing ??
As others have said, nothing magic other than focused attention.
South Korea and Singapore both were hit by the original SARS epidemic, and learned important lessons from it. They're applied those lessons now, for this SARS 2.
Other countries weren't as affected by SARS, and so didn't take as many lessons away from it. When this came, many were caught flat-footed. Some countries (like the United States) were even less-prepared than being flat-footed.
Because you need high throughput machine or it is a very slow manual process. Such machine like the FilmArray from Biomérieux or the GeneXpert from Cepheid will only have their covid 19 add-on at the end of march, for the Cobas from Roche only now. When Korean had the homegrown Seegene one very quickly
Extensive testing needs the appropriate lab infrastructure and governance decisions to properly utilize them. Germany is another example of how to do that [0]
South Korea had no mandatory shutdown, but according to Suki Kim nearly the entire city of Daegu voluntarily self-quarantined shortly after Patient 31 was confirmed positive. (Source: https://www.newyorker.com/news/news-desk/how-south-korea-los... plus personal communication)
SK has also instituted widespread work from home, closed schools, and people voluntarily wear masks and cancel events. Daegu was a ghost town for at least 2 weeks after patient 31 was detected, because each citizen decided to minimize activity.
They’ve also had a dress rehearsal in the less deadly MERS outbreak. I’m sure preparedness and public acceptance of gravity of the situation had a great sway in outcome
As Italian I can confirm you guys should hurry and close everything down sooner. I would however prefer the title said “don’t be like the Italian government” instead of just “Italy”.
Not everybody here is behaving like a moron, luckily.
The Italian government wasn't even that bad in this occasion. Italy's been the first western country to be badly hit, and given the exponential spread of the virus it had very little time to take absolutely unprecedented measures. Other countries have it a little bit easier as they can see what happened in Italy and follow the same road, earlier.
Also, take in account that the Lombardy region and the Milan area are one of the most densely populated in Europe, with a huge traffic of people for business and tourism, as well as the economic center of the country. Preventing and containing the epidemic wasn't easy at all, and the decision to quarantine it extremely difficult given its importance.
Two non-government-related issues that I heard complicated the situation in Italy: just before the shutdown of the north, a lot of people fled the north and moved to other parts of the country, bringing the virus with them. And Italians are very family-oriented, and therefore less willing to socially isolate their elderly. Normally an admirable quality, but in this case it can endanger the most vulnerable group.
> just before the shutdown of the north, a lot of people fled the north
Part of the North had already been in shutdown for a week or so. Unfortunately, a plan to greatly expand the quarantined zone was leaked to the press by a shady journalist-spy-henchman. This resulted in thousands of Milanese rushing to "escape" before the plan had officially been announced. At that point, instead of going ahead with that plan, the government shut down the whole country and instructed local authorities in the South to control and monitor the stream of "escapees".
> less willing to socially isolate their elderly
I think that's a bit of a stereotype - in reality there are plenty of socially-isolated elderly in any major Italian city. It's just that the average age is so high over there, "the elderly" as a category includes __a lot__ of people, very often still working in their 60s or 70s in key roles (or nominally retired but, say, running amateur football clubs or volunteering in other third-sector activities that end up being essential to local life). Socially isolating all of them is simply unfeasible - you'd end up paralizing most regional assemblies and even the national Parliament, for example.
Mexico is poised to beat them all, our president is doing nothing to prevent the spread. A Maduro-like ignorant, stupid and psychopathic president that has left the country without essential drugs.
It's to slow the spread of the virus so that those with serious life-threatening symptoms can get hospital care.
Say you live in a town with 100 hospital beds, it's far better for everybody if they get 100 sick people a week for 10 weeks than 1,000 sick people this week.
That's not how the math works though. Italy is reducing the number of sick people from 1000 to 100, to use your numbers. The way the virus spread those 100 will be 250 in 5 days, 500 in 10 days, and back to the original 1,000 in 15 days.
Reducing the number of infections is only half the battle. The other half is keeping transmissions contained for several months to years.
Virus has spread initially because it got into hospitals and family members visiting brought it around
Italy should have locked down hospitals first, but it's kinda impractical
As for the "stay home" mantra, of course it helps, but radically changing people habits make them also less predictable, so instead of people going to work, we had people who ran away from orange areas and even red, because they could, or gathering for not staying alone, spreading it even more
Sometimes the perfect measure on paper doesn't work the way people imagine
Of course if we talk about military personnel patrolling the streets that could work, but it's a little bit against what a democracy exists for...
> Sometimes the perfect measure on paper doesn't work the way people imagine
This is true. Here in Belgium all restaurants and non-essential shops closed. The day before this took effect, restaurants were packed with people going out while they still could. The day after, people went shopping and dining en masse just over the border in France and the Netherlands, where the same measures had not been taken.
It's amazing how reckless some people can be. Shut down restaurants to stop the spread of the virus, so people go to restaurants further away, to spread the virus even more. You'd think shutting everything down would be a pretty clear signal, but apparently a lot of people just don't care.
It's complacency. People think about the here and now, not what the situation will be 7 days afterwards or more, when these measures will actually have visible effects and may ultimately impact whether they catch the disease and/or can get effective treatment for it.
I think to give these people a minimum benefit of the doubt, we as a species have never before dealt with a virus that can last on surfaces for days, incubate for several weeks, and remain in lungs for over a month beyond a “recovered” patient testing negative. Not to mention the known yet nearly impossible to measure asymptomatic spread.
All of this is new in so many ways all at once. Frankly I think it’s so beyond our expectations of what a virus can be that many people simply don’t believe the facts.
This is why governments should admit Covid19 is a problem that requires strong coordination at EU level. Going alone, as we've done until now, is not going to work - the continent is too small and too joined-up nowadays. Von der Leyen seems to understand this better than most, certainly better than Macron and Merkel.
> "Italy should have locked down hospitals first, but it's kinda impractical"
It's kinda pointless to quarantine people and then let them have visitors. I guess it's obvious in hindsight, but it's still hard to understand how this wasn't already obvious then.
To assume good faith in your question: the point is to slow the spread, and to flatten the curve so that the hospital system is not overburdened and that as few people as possible that need emergency critical medical care fail to receive it.
To go one step further, it's to reduce the mortality rate. Mortality when everyone has access to a respirator is one thing. Mortality when hospitals must deny care to thousands is another.
Distancing slows down the rate so we spend more time in the first scenario. (It's too late, now, to entirely avoid it.)
Mortality rate in Italy was high only for people 65 and up.
But lot more have been brought to hospitals for no real reason, once they were there they couldn't be sent home anymore
In fact home confinement has increased a lot once they understood not everyone was in need of medical attention
Hell, we even tested people with no symptoms at the beginning because they said they weren't feeling fine or one of their acquittance had flu in the previous week's
That of course became immediately problematic for the healthcare system
> Mortality rate in Italy was high only for people 65 and up.
Part of the reason mortality rates are so high among the elderly, though, is the fact that they are de-prioritized in cases when there is a scarcity of beds, ventilators, or other stuff. Doctors are forced to concentrate efforts on people with better survival chances, which are typically the youngest.
> home confinement has increased a lot once they understood not everyone was in need of medical attention
This is a double-edged sword though. My father has some contacts in the health service near Bergamo (he was a nurse himself etc etc), and he was told some cases don't even make it to the hospital - they go from cough to full-on pneumonia in less than two hours, and die on the ambulance. They now refer to late afternoon as the critical shift, when the stream of intakes spikes and ensuring they are all treated becomes extremely hard. A lot of these cases might have been saved had they been monitored full-time in a hospital.
> Part of the reason mortality rates are so high among the elderly, though, is the fact that they are de-prioritized in cases when there is a scarcity of beds, ventilators, or other stuff.
This is absolutely NOT TRUE
They died because prior conditions made them weaker and a pneumonia at 84 is as deadly as a bullet in the head
Nobody is left to die in Italy
My parents have worked in the healthcare for 40 years before retiring, here we try to save everybody at the best of our abilities
There's no current scarcity of beds even in Lombardy. Their capacity is (at present) nearly used up, but it's not completely gone yet. And then there's the hospitals in the rest of the country.
That too is my understanding. Italy really screwed up by turning hospitals into disaster zones. Other countries are not letting people with symptoms near hospitals, even for testing, unless they have severe breathing difficulties
- If we can reduce / avoid overloading hospitals, people who get it after the lockdown will get better treatment and will be less likely to die than if they got it now.
- Over time, we will come up with more effective treatments and perhaps a vaccine. We will likely also have more equipment like ventilators and protective gear at our disposal.
- More people will have had it and built up some level of immunity, and "herd immunity" means it will not spread as quickly.
In the long run we'll have protocols and procedures, and your physician will have seen hundreds of covid cases before treating you, and the fatality rate will (wishfully, possibly) converge to standard seasonal flu.
Surely then it would make sense to only embargo people in identified vulnerable groups? Let the rest of the nation go about their business given they are very very unlikely to have anything bad happen and then, presumably they will stop being infectious even if the virus does get into their system again
And what does it mean to quarantine people? How are they fed? Can they go outside?
You can't get the virus walking down the street past an infected person.
Repost from another topic:
"The professor of intensive care medicine, who himself heads the ICU of the Rotterdam Erasmus MC, emphasizes that it is not only the elderly who are affected by the corona virus. 'What has mainly made the news is that older people die faster. This is about 2.5% of the entire population, while about 15% of the elderly die. But _more_than_half_ of those patients are under fifty years old. It also includes young people."
> Surely then it would make sense to only embargo people in identified vulnerable groups? Let the rest of the nation go about their business given they are very very unlikely to have anything bad happen and then, presumably they will stop being infectious even if the virus does get into their system again
Vulnerable or not, the rest of the nation is a transmission vector. Also, not all deaths happen among the identified vulnerable groups: "they are very very unlikely to have anything bad happen" is completely false.
It's not false. The rates of mortality being quoted are fundamentally wrong because testing is highly selective. I personally know people who likely have it, haven't been tested and so don't get counted. The virus is clearly more widespread than 200k infected who have actually been tested.
> Also, not all deaths happen among the identified vulnerable groups: "they are very very unlikely to have anything bad happen" is completely false.
Even assuming a 4% death rate (too high for the less vulnerable), that's a 96% chance of not having the worst possible consequences. So I'd say that's "very unlikely" for them.
This isn't the flu, and it's possible for even people in their teens to die (true of the flu as well), but let's not act like it's the likely outcome.
I've seen numbers in the 0.2% range for younger (< 39) age cohorts. That's twice as deadly as the flu (0.1%) but IMO not "shut society down" levels of bad for people in that age group.
Not just testing, but treatment. There are a half dozen existing anti-viral drugs currently in testing which can be rapidly deployed if they turn out to be effective because they're already approved and manufactured for other usage.
There are also several new anti-viral compounds and the potential for clonal antibody treatments whos approval might get fast-tracked if they prove highly effective.
Even absent better treatment strong measures taken swiftly will do more than just delay the inevitable. But reducing our critical care saturation we'll save lives. But there is also a very realistic prospect of improved meaningfully treatment in the coming weeks/months.
> Specific goals for implementing NPIs early in a pandemic include slowing acceleration of the number of cases in a community, reducing the peak number of cases during the pandemic and related health care demands on hospitals and infrastructure, and decreasing overall cases and health effects
It reduces the R0 factor sufficiently to give time to get a proper treatment plan in place.
Meaning antivirals that won’t require millions of people being placed in ICUs which the healthcare system currently cannot support neither in infrastructure nor manpower.
For people who are curious what living in China feels like now (video uploaded Mar 14th), from a Japanese director living in Nanjing, China:
https://www.youtube.com/watch?v=YfsdJGj3-jM
Things are getting back to normal, with tons of precautions.
Wow they pretty much thought of and solved every case where human contact could be possible. The elevator transportation in particular is pretty clever. Those Chinese cities are incredibly mobile. I can't even imagine how long it would take any US city to get to that point if ever.
Not to downplay the importance of containment efforts I think there is something uniquely bad about Italy's mortality rates and something really good that the Germans are doing.
Based on the Johns Hopkins CSSE data for March 13
On March 13 Germany had 3675 confirmed cases and only 7 deaths.
Adjusted for respective populations Italy was at this stage 9 days before with 3089 confirmed cases, by which time it has already seen 107 deaths.
This projects 21x COVID19 mortality rate for Italy over Germany - what gives ?
Italy's outbreak is concentrated in Lombardy so maybe weighing for the population of that area rather than the entire country is more appropriate which means Germany is currently 16 rather than 9 days behind Italy but with mortality in Italy still being 13 times higher than Germany.
Possible explanations:
Italy's 3089 confirmed cases 9 days before are selected for severity - only people who arrived with acute symptoms were tested, whereas Germany's 3675 are the results of more proactive testing and are dominated by mild or non-symptomatic cases that would have passed undetected in Italy.
Italy squandered some of its hospital capacity on first-diagnosed-first-hospitalized basis regardless of severity and began triage too late wheres Germany does better job prioritizing hospital vs home treatment from the start.
9 days before Lombardy's hospitals were already over capacity with 3089 confirmed cases while Germany's still aren't today.
Germany has 2.5x the hospital beds per population than Italy, let's assume this holds for ICU beds as well.
If capacity is the sole/dominant factor in this and we say that 9 days before Italy was already over capacity with 3089 cases than Germany will have reached a similar over-capacity at around 10k confirmed cases in a few days and then its mortality rate will begin to climb.
Italy seems to have been a bit blindsided by the fact that it's home to a rather large semi-legal Chinese population [0], to a point where there were direct flights between Rome and Wuhan prior to the Italian government shutting down air-travel to China [1].
The German response has been rather decent, freeing up lab capacities and using private labs to scale up already solid diagnostics capabilities, which helps prevent cases from going terminal. [2]
As somebody working in German healthcare, outpatient care to be specific, we've already seen hospitals free up beds, by releasing non-priority patients to ambulative home-care around 2 weeks ago.
Starting this week schools will remain closed, Germany is going into lock-down with limited border travel and offering companies "unlimited loans" [3] to get through the resulting economic downturn.
Chinese links didn't matter. Patient-0 in Europe was tracked to Germany in January. The most affected Italian areas do not have a particularly large official or unofficial Chinese population - but have massive economic and social links with Germany. The areas where the Chinese concentrate, like the Prato mentioned in your first source, saw no cases - they all voluntarily self-quarantined as soon as the emergency exploded in Wuhan, and kept that discipline going.
Italy simply pays the price of a very elderly and weak population, coupled with a decades-long shrinking of public healthcare. Even in Lombardia, one of the best regions for healthcare, intensive-care units in public hospitals were instructed "in peace time" to run close to capacity as much as possible, in order cut beds and save money. This is how we ended up with less than a third of the capacity of Germany, and when shit hit the fan, it wasn't enough.
(Also, Germany is kinda fudging the numbers. They don't record deaths as Covid-related unless covid was absolutely the only health issue a patient experienced. That's not how victims are recorded in most other countries.)
Looking at German news, most reported deaths are reported as having prior complications or having died of other related illnesses, so the blanked statement about "don't record deaths" is clearly not true. If you have sources that it's happening partially, I'd be interested in those though.
There are other reports of hundreds of deaths that were simply not tested for the virus, whereas in Italy they've tested pretty much every death since the outbreak in February. Considering that Patient-0 was infected at the end of January, the theory that there might be some under-reporting going on is not unrealistic. Germany probably just had the capacity to deal with this "under the radar" for longer than Italy.
This is hardly unique to Germany, btw - each country has adopted different methods to test and report, it will likely take time to get some decent convergence at European level.
Cases slipping under the radar, sure, I expect that's happened everywhere to varying degree. But also quite different from not reporting someone that's known to be infected "unless covid was absolutely the only health issue a patient experienced".
Second: in a follow up he seems to say (using google translate):
> It is EXACTLY what I meant: they charge the deaths to other pathologies present. I don't see many other possible explanations.
So he doesn't have proof or even a statistic to point to? He just doesn't see an alternative explanation? Is the newspaper he is working for yellow press?
> Patient-0 in Europe was tracked to Germany in January.
At the end of January, was then promptly isolated and all the contacts informed, also afaik didn't have any history of traveling to Italy [0]. At that point, there were still direct flies going from Wuhan to Italy, as those were only stopped after the German case was discovered.
That's why the first positive hit in Italy were two Chinese tourists, on 31 January, who had been in Milan since 23 January [1].
There are 2 countries and several hundred kilometers between the Bavarian January case, and Codogno and Veneto. While those two countries between, Switzerland, and Austria, only started reporting cases late February, a month later.
So I don't really ascribe to the idea that COVID-19 came to Italy trough Germany, it probably came there by multiple channels, such is the problem with a pandemic.
> (Also, Germany is kinda fudging the numbers. They don't record deaths as Covid-related unless covid was absolutely the only health issue a patient experienced. That's not how victims are recorded in most other countries.)
That's not just fudging that's outright misleading, any source for this ?
- Italy has a large fraction of the population over 70.
- The proportion of smokers is larger in Italy.
- The amount of close contact between the “mobile” part of the population (in schools and offices) and elderly people may be higher.
Not sure what the statistics are in Germany vs Italy on that final point but if I were to guess I’d say elderly taking care of grandchildren or even living together with the younger generation is a phenomenon that still exists in Italy.
Both Germany and Italy have fairly standard developed world population pyramids, they're actually so similar you could't tell one apart from the other without the number scale [1][2]. Same for smoking, both countries are nearly identical [3][4]. I see no reason to suggest the third point is wildly different either.
There is a rather significant difference in "% of adults 65+ living with their children" across Europe, with southern and eastern Europe significantly higher than northern and western Europe.
I think the main reason for the difference is that probably different country don't measure the cause of death in the same way.
For example in Italy right now any person that dies that resulted positive to covid-19 test before or after death is considered a victim of covid-19, regardless if there were other preconditions. This may be different in other countries.
If one excludes people with preconditions, the number of deaths in Italy becomes much smaller (don't remember the exact amount, but I think it was in the tens).
Also, while Italy started late with testing, at the moment it has performed 80000+ tests for COVID-19, which is behind only to China and South Korea (see for example [1], altough a 3 days old).
I couldn't find any official number about tests performed in Germany, though, but unless germany tested at S.K. level I don't think that the number of tests explains the difference
You have a lot of trust in how health orgs report statistics to the WHO. The WHO cannot fundamentally enforce anything, all activity is fundamentally voluntary.
I've read (unconfirmed, citation needed) that Italy has been pathologically testing all fatalities for covid, and other countries don't. That may significantly skew the numbers.
Would it though ? It implies a significant number of misdiagnosed hospital deaths during a time period where COVID19 was aggressively looked for in people with the symptoms.
Many of the deaths (especially the first ones) were linked to covid after testing the cadaver and had many other health issues (as in very advanced cancer, and/or very old age). I don't know if other countries are testing cadavers
I don't think that cadavers would skew this much, only if a country is cheating by counting say a diabetic patient who died of covid19 as a diabetes death and not covid19 death.
To be honest, at the start of this epidemic it wasn't that clear how dangerous the virus was or how easily it would spread. First it happened to Wuhan and we all thought that it wouldn't happen to us, then it happened in Italy and we still thought that we would be fine.
Thinking that it won't happen to you won't make it go away unfortunately, your country isn't special, if no drastic measures are being taken like full quarantine this will happen to you too.
My country is in full lockdown and still a lot of people don't see the gravity of the situation. People dismissing it as less dangerous than influenza are misinformed.
This pretty much describes the approach Japan is taking. We’re special, it doesn’t apply to us, it won’t happen here. Deeply ignorant approach. I’ve got a family - including a mother-in-law with a pre-existing lung condition - to worry about.
How do you measure "less dangerous than influenza"? Honestly I think it is likely in some jurisdictions to be in the final analysis less dangerous (raw population wide deaths over the season) than influenza. But I think it's worth being cautious (and am contributing and setting an example by self-isolating), because there's a small but worrisome chance it's way worse than influenza.
Why is this important? Because if knowledge authorities go around talking about severity with scary talking points, and in the end, it doesn't turn out to be so, then we wind up in a "boy who cried wolf" situation next time.
This is just a general comment about all of these (really quite nice) data visualizations: they're based on confirmed cases.
Given the many issues with the limited availability of testing this of real concern as it makes it much harder to judge the accuracy of "X days behind", etc.
Also this is very different per nation. E.g. Germany has labs in most university clinics and a tight network of private commercial labs, which are nearly all able to test for COVID-19, while the situation in Italy regarding tests was much much worse, so they didn't see it comming at all.
So how can one really compare the numbers between nations when their testing capabilitied are so different?
The ground truth is certainly deaths - if you know the mortality rate if the virus you can infer from the number of deaths how many people had been infected at some point in the past.
Of course it would be much better to have an idea how many people are infected now, so you can base your decisions on it..
The dangerous thing about viruses is that they grow in a logistic curve and the first part of that curve is exponential. So things can grow out of proportion literally overnight, like they did in Italy.
The general response to this would be that the amount of testing can shift the prognosis by couple of days. Is New York 14 days behind Italy, or 10 days, or 20 days? Doesn't matter if no action is taken, and the best results will be achieved by taking action immediately.
Forecasting Germany as if it were Italy isn't entirely fair, given that Germany has only had 9 deaths with 5000 confirmed cases while Italy had close to 200 deaths by the time they managed to confirm 5000 cases.
As far as I can tell the situation does seems to be developing at the same rate, but going by the confirmed deaths I'd place Germany about 2 weeks behind Italy, not a mere 7 days. Which for exponential growth matters a lot.
Edit: Also note that forecasting countries as if they were South Korea has the opposite problem as the fatality rate of South Korea has remained low compared to other countries (though not as low as Germany's and those of Scandinavia).
Right now the official explanation is that we're quite good with testing and isolating cases so far, which would mean that the confirmed count right now is much closer to the actual count than in Italy (or the US).
On Twitter the opinion seems mostly to be that the death cause is doctored.
I'm kinda hoping for the first, right now, because the projections aren't pretty (even if we're a bit further behind Italy). We only now started shutting down schools, and most events and even that is spotty as every state does its own thing and sometimes even every city.
I think it's a mixture of both. Underreporting of deaths and relatively strict lockdowns in known outbreak areas (basically municipial governments can call for that in Germany - so think the S...-County in Washington going on total lockdown by some local politicians authority). Looking at the Italian data this thing really seems to ravage through the elderly and although it's very sad that they now won't get ICU and co. my personal, subjective opinion (samplesize n=3) is that in this age-group hospitalisation for non-chronic, dire stuff basically just is a death-sentence anyway. People go through rehab, home-care to the hospital again where they succumb to some resisant bacteria in coma... It's sad they'll now die fast from pneumonia but ultimately that's life and judging from the n=3 samples, I'd much prefer a relatively fast, morphine-assisted death by suffocating (not sure how bad it feels with morphine) at this age to the comatose, 15-meds a day mushing up your brain-situation, which is typical.
Disclaimer: I'm aware, Italy is not doing palliative care anymore (which is really bad!) and also that this is not just a flu and also younger people die, but hopefully the rates here are closer to the real flu (which, talking from family experience again...) can kill a 20-something as well.
To be honest at first I found it suspiciously low, but now that the Scandinavian countries are very low as well it would require quite the conspiracy to keep this up.
The German virulogist who developed the first test for COVID-19 speculated that based on the numbers Italy must have had more deaths earlier on, but might have mistaken them as old people dying from the flu (which happens all the time and therefore didn't raise any eyebrows in the medical system).
The US might be undercounting but they are still reporting a high proportion of deaths compared to infections. In my mind it is more likely that mild or asymptomatic cases are being missed than that deaths are being missed. So the number of deaths seems more likely to give an accurate indication of how far the outbreak has progressed.
But indeed it's possible that those countries are simply not testing people suspected of having developed regular pneumonia, it's always tricky to compare these kinds of statistics when each country might use their own definitions and methods.
It is still gamesmanship and internal politics (do not add to panic) in France and Germany, their numbers for Western Europe zone that is heavily interconnected with Northern Italy (the unfortunate guinea pig of the entire West, also for a number of local and central government inefficiencies and incompetence) just do not add up... it was the same in Spain until yesterday too, but they went tits up and opted for full transparence. The United States seem further behind in that respect, but the Fed just went full bazooka with printing money and Trump can now deploy any given artillery in full.
Mortality rate is very dependant on age and health. The initial infection in Italy was in an hospital and so the initial propagation was in older population and in the medical staff which have a lot of contact with old people and people with bad health.
On the other side, people in Germany who gets the virus were very often young people travelling to Italy and they contaminate their young and healthy German friends when they come back in Germany.
This is probably enough to explain the initial difference in mortality.
People presuming that there’s a difference in viral behavior between countries and that’s why some countries, in these early days, are showing statistical differences.
But this is folly. There is no evidence that some “peoples” fare better and that some countries have “better” health systems. Evidence out of Seattle indicates that the illness rate and death rate from China are showing up here as well.
Don’t kid yourself that your area will be less hit and that’s why you can keep on living a normal life.
>Forecasting Germany as if it were Italy isn't entirely fair, given that Germany has only had 9 deaths with 5000 confirmed cases while Italy had close to 200 deaths by the time they managed to confirm 5000 cases.
I think it's fair, Italy's population just happens oldest in Europe and more likely to suffer fatalities.
I submitted this as a new story but it's worth repeating here: here in Seattle, we're already Italy [0]. The hospitals are having to provision ECMO machines based on demographic prognosis, and the respirators are probably only a couple days behind. Presumably this will be the situation in every major American city 2 weeks from now.
"Scott Mintzer
Brain
@scott_mintzer
UPDATE: I have been contacted by a couple of people who say that this thread doesn’t not entirely paint an accurate picture of the whole Seattle area situation.
I do not want to delete and leave no trail, but anyone there other info should by all means report what’s going on."
I went to pick up an to-go order yesterday and was surprised to find the local mall parking lot still full (U village) and people sitting in restaurants, with no care for keeping distance from each other. Ditto for the grocery store.
I guess people still aren’t taking it seriously, even though Seattle schools and libraries are closed for a month+.
Sunday afternoon the long distance trains in Germany had many Army and Navy personnel in uniform (which gets them free travel; may have been more in civvies paying their own way), including old reservists. We asked: they're preparing to institute mass isolation/quarantine, patrolling streets to "remind" people to stay at home.
It isn't a question of "if" such measures will become necessary, it's just when will a country accept this, and how many extra deaths will be caused in that interval.
Is there a source to corroborate? A guy with historical tweets corroborating he works in a hospital in Seattle says he just finishes his shift and this is BS
Wow not giving ECMO to BMI 25+ is really something.
I am fairly skinny and it wouldn't take much for me to reach 25.
They should consider revising the cutoff especially since Chinese people can be of thinner frames. 25 may be slightly overweight for them but normal for others.
As an Italian living in one of the red areas I feel it's pretty hard to do better than Italy in the west if you are hit first
South Korea had Seegen almost single handedly testing the population, China is not a standard of what a liberal democracy can do
We did everything we could, I've been staying home for 3 weeks as of now, but we couldn't predict the virus spreading from the hospitals of small cities hitting hard on the elderly population
80% of the deaths are >75, 98% are >65, the avreage age of the deceased is 79.4 years old but if we look only at women their average age was 84.2 years (South Korea life expectancy is 82 years) and we counted every death as a coronavirus related death if the patient tested positive, but most of them died for pre-existing conditions, while other countries are not counting them if other conditions where already present (and I imagine old people at the hospital are there because they are already ill)
So I must say that despite our own indiscipline, bad luck was a very strong factor in what happened
BTW Spain is already looking worse than us at their same day
Where we can do better than Italy is learning from your experience and taking measures earlier: we aren't first.
Even measures less aggressive than your lockdowns would be more effective if they were simply taken earlier.
This isn't a criticism of Italy. Getting the political will to shut things down when there are few cases and no deaths is extremely hard. But the experience of Italy is showing all of us what our unwillingness to do so will cause.
But I bet nobody will, because you know nobody wants a lynch mob looking for them
UK is still having giant music shows with thousands of people, Germany is not counting people with previous conditions, France had even a smurf convention (sigh!)
We all have a family member living in one of the EU countries and are all calling home sick worried because nobody is doing anything because “The Italians, any old excuse to, you know, shut down everything and stop work for a bit and have a long siesta.” (it's not a joke, a British TV personality really said that)
So maybe be like Italy and not like everybody else this time.
Seriously, I've been confined 3 weeks and am fine, but my friends calling me from abroad are crying for help, because they want to come back, but can't.
Italy last is a special case - not that everyone else doesn’t need to take exceptional action. To be sure social distancing, closures of places of congregation is in order, and safety practices like washing hands often are necessary. But Italy is a special case...
- Italian leather manufacturing is by and large run by Chinese ownership today.
- Many of the employees in these shops are from China as they will work for much less.
- Italian population skews very old - a very vulnerable population.
- Italian culture has close families that meet near daily, have generational family living together, and populations are proximal.
- The wide Chinese population in north Italy went back and forth to infected areas of China during the Chinese New Year.
- When they came back there were many “patient 0’s” in the region.
- Because of this, numerous exponential functions were set off at the same time.
- Because of the closeness of Italian culture the virus had the necessary engine to propagate.
It’s not Italy’s fault. They got a perfect storm here. They are managing the best they can.
That's trivially disproved by simply taking JHU daily data of Italy and other countries, and plotting it as date x log(cases). You can see that most Western countries follow the exact same path.
We don’t even know what “cases” really means. So many people have been infected and not tested by this point. It is estimated over 200k have been infected in the USA and have not required medical help or felt symptoms.
Italy has had a more rapid and intense breakout coupled with a vulnerable population and social customs that spread things more quickly.
I’m not British but their strategy of lock away the weak (old people and other vulnerable) and let the young/healthy take the brunt and burn the virus out is pretty smart. Unless in reinfected of course.
I'm not buying the British strategy. I feel they're trying to do a suicide burn[0][1]. But with insufficient testing coupled with all that's unknown about the virus - including how long the immunity lasts - I don't think they can control the infection rate anywhere near well enough to pull this off.
The question I ask when I see these graphs indicating “days behind Italy” is why is Italy ahead? As if cities like NYC didn’t have anyone from Wuhan enter while sick?
We all had essentially the same “day 0”. We are moving much slower than Italy. There are other reasons (and not Italian incompetence) why they are in a greater crisis than others in the West.
Most countries are well ahead of them in this regard. The UK strategy is sound in that you don’t need testing - the hospital numbers indicate and can be extrapolated.
> Because of this, numerous exponential functions were set off at the same time.
This doesn't make much difference, other than complicating contact tracing, etc. Italy doesn't appear to be too different from other countries based on the data so far.
It doesn’t indeed until you consider the differences in how people live together, the fact this was building well before Italy became a crisis, and the age of their population.
I’m not trying to sugarcoat anything and we need to take drastic evasive action. But Italy is different when you consider the proximity to each other, population demographics, and onset parameters.
What about the part of having a ton of people go to the original sick zone and back before it’s noticed? The leather factories of north Italy matter a lot in this equation.
How are California and Washington "behind" Italy, when both states had infections reported before Italy? Sorry, trying to understand the methodology here.
Or are you just basing this off of raw case counts?
I'm sorry to sound so cynical, but I have never seen so many statisticians and virologists pop up on the internet drawing all sorts of graphs and estimates.
For all we know this person got their numbers by just guesstimating. Most countries have differing "exposure vectors" so to say, which means that just comparing other countries to Italy is nonsense.
> "Day 1" is when a country reaches 100 cases. A country is "X days behind Italy" if they reached 100 cases that many days after Italy did.
Before 100 cases, the evolution of the epidemic is noisy, but it becomes pretty regular afterwards with 20-30% daily growth (in the absence of strong control measures).
The lockdown must be kept until the health system can cope with everyone's health problems. Then, you slowly lift it to ensure it doesn't saturate again, as that would mean a need for another full lockdown.
First you allow all shops to be opened, then few weeks later open public places like gyms, museums etc, another few weeks later you open borders again, even later allow some mass events etc.
After every lift you wait at least two weeks to see how much it increases number of new cases and you balance it so that healthcare system does not get overwhelmed.
Once you have large scale testing available, you can do heavy testing in a region to determine the risk, and then you can release quarantine on regions where there are no infections.
Control is much easier if testing is cheap and ubiquitous, and quarantines can start to become a lot more targeted as opposed to widespread.
if you look at what happened in china, specific manufacturing hubs were opened first then slowly other core economic areas finally ending with travel restrictions being lifted. the aftermath is that the populace is still fearful of infection so movement is still limited and thus spread of infection is much much lower to almost nonexistant
By lifting the most adversely impacting parts, and monitoring infection on a wide-spread basis while maintaining measures that lower the how contagious it is without negative effects.
That's what I'm asking myself too. It's way too early for any kind of herd immunity, and you only need a handful of people who have broken the rules (or simply due to delayed intrafamilial infection) to have a few infectious people back out in the wild, and we're back to square zero.
Is the plan for a lockdown to completely eliminate the disease? Are we hoping the heat of the summer will stop it? Or does flatten the curve really mean that eventually 60-70% of the population will get infected. If so, we're in for a rough 2020.
The numbers I've seen so far are assuming 40% to 70% total infections over the next several months.
The current efforts are just trying to take some energy out of the first wave of hospitalizations, to buy time for more supplies and staffing and to get the current infected out of health care as new cases come in.
After a few weeks, it may turn out that hospital capacity and more widespread testing allows some restrictions to be lifted. Or, it may turn out that the situation in the US is far more severe than expected, and the restrictions will only worsen by then.
I'm hoping for the former but betting on the latter.
Not back to square zero - you have the core of a new outbreak amidst wide-spread monitoring for it and a population that is generally practicing better infection control. So perhaps a few dozen are infected before the flames are doused again.
Flatten the curve _does_ mean that 60-70% of the population will get it.
But it also means that the peak will be lower do that hospitals are less overwhelmed. It also pushes more infections later in time, so that we have more time to develop and deploy a vaccine.
Looks like it will work like that. This may lead to some undetected transmission, but hopefully the amount of more serious cases should be low enough that the healthcare system will be able to cope. More severe measures can be restored quickly in areas where community transmission is detected.
It is a bit like comparing interest rates on your credit card balances while still spending more than you earn: we may not get much choice about what is done in 21 days, but we have to stop the bleeding now either way.
The difference between a slow and a fast outbrake is that the fast outbreak overwhelms the health system which has all sort of negative side effects, aside from more deads.
I know humans usually have a hard time grasping exponential growth, but you need to grasp it to understand what is going on. Exponential growth means that on one day you say: "This is fine" and only two days later you have to introduce the triage and send people home to die, because there is no capacity for them.
And even if you had enough beds — will you have enough healthy professionals to staff them? If they have kids will they be able to come? Who watches for them? Grandparents who have a ≥20% of dying once they got infected?
The idea of quarantine is a numbers game: slow down the spread enough so the health system (and amthe rest of civilisation) can cope better If you have no vaccine the only way to deal with this is reducing the chances for the virus to transmit. And you do that by not having people cough in each other faces, touch everything, breath everything in etc. or even more effective: don't have them interact at all. If we all would manage to perfectly isolate for two weeks the thing would be gone after that two weeks.
So until we will develope a cure at some point this is the only thing we can do.
China may be able to do regular lockdowns. I can’t see that happening in the west. Lockdown needs to be a one time shot at the right time, but getting the right time is painfully hard when there is no way to know how many have the virus but not yet testing positive or showing symptoms.
> China may be able to do regular lockdowns. I can’t see that happening in the west. Lockdown needs to be a one time shot at the right time
People keep saying this, but I've yet to see any real argument or evidence. The WHO used to think that locking down entire cities or wide regions (60M people or so in Hubei alone) would be impractical in the West, but Italy managed it quite nicely and now other countries in the Western world are following along. Long-term lockdown is going to be the same thing.
I keep hearing this, but why though? If cases start rising again after the end of a quarantine, I'm sure that there will be support in the community to go back in quarantine if it will save lives.
Not sure there will be - I've been scared of this since the New Year, and even I'm all too aware that I'm trading off _having a life_ so people over 70 with pre-existing conditions don't have a couple of years shaved off. Right now, like literally starting this weekend, it turned hip to say you're staying home. We'll see how that looks in 6 weeks, when there's no end in sight and mass layoffs
Please, for the love of God, give me the benefit of the doubt on this comment folks. I'm not saying it's right, only that I doubt this sedate state will persist, given the effects of said state.
Didn’t work that way in the 1918 flu pandemic. No city kept the public health interventions going long enough to avoid a second peak in deaths after they stopped them.
Good point, and that's why you can't simply lift every restriction overnight. But the 1918 flu pandemic was literally over 100 years ago, I'd like to think we have learned something in the meantime about how to control disease outbreaks.
We did learn things and it caused us to develop a national health care infrastructure. Things have started to decay on that front over the last couple decades though, at least in places like the US which haven't had a SARS outbreak. It's almost like we have to relearn lessons every 4 generations or so, as the older generation dies off and we forget their experiences. Strauss-Howe Generational Theory, here might be our Crisis...
This is calling for a full shutdown, not self quarantine. We’re talking checkpoints, military presence to ensure compliance, protected supply chains and rationing.
The model has to account for a long term strategy (6-12 months) to keep the mortality rate down and the global economy operating, or we open ourselves to even greater risks.
Lets be clear, the economy will not survive anything like that for even one month. We are desperately hoping that after 2-3 weeks herd immunity, better medicine and first wave passing we can reopen.
I agree we need to follow South Korea. I said this is what we are hoping for, not meaning it is in any way a smart thing to do.
I don’t think the economy can survive 1-2 months in full lockdown. There are just too many vulnerable living paycheck to paycheck, and the financial system artificially boosted already and is ready to come crashing down.
I think it is impossible to speculate what will happen after that, but it looks like the big money wants this thing to go down from what is happening in the UK and in the US senate. Could be in for scary times in the west.
That's the bit I don't understand. The virus jumped from a handful of infected people on a market in china to hundreds of thousands all around the world in a few weeks. Unless we eliminated 100.0000% of the virus, how will it not pop up again as soon as we lift the curfew?
The virus "jumped" because people were clueless about it, and missing even the slightest precautions. No washing hands, no wearing masks, no social distancing even among total strangers, etc. etc. There's no way this will happen again with the same ease.
You can avoid packing people in the trains to that extent, for starters. Take temperature readings at all stations, so that the people with the worst symptoms (who are at the highest risk of spreading the virus) can be kept out. And spread out "peak hour" by having people enter and leave workplaces with flexible hours, while others just stay home altogether.
It's been 4 months already since early December, so not a few weeks. A few weeks is enough time to control a small spread, see Singapore or Taiwan for example for what great results can be achieved with diligent testing. You keep testing people aggressively and follow up on any positives. Contact tracing is enough to stop the spread if you do it early enough, and like I said, proof is in Singapore and Taiwan. The problem in the west is no testing so there's nobody to follow. RIP potentially millions for that failure.
This won’t work. The virus is in over 100 countries, some sufferers are asymptomatic and many have symptoms comparable to a cold. To make matters worse there’s already community transmission in every Western country I’m aware of. It’s too late for contact tracing to be a long term solution. The last time that was possible was when the virus was confined to Wuhan. This is going to infect 60-70% of the population in every country unless they adopt Israel style two week quarantine for all international travelers or North Korea style killing everyone who gets the virus, or just close the borders completely.
It's too late for contact tracing NOW. Contact tracing is the "relaxed" solution after we bazooka the virus with a quarantine such that the virus dies in 99% of current hosts. That brings the numbers down to a manageable level so that contact tracing will be effective.
no you quarantine to slow the spread so you slowly infect everyone and the hospital system keeps up. then you release quarantine and boom herd immunity saves you. or a vaccine.
In pressure cooker environments, bacteria are known to mutate at higher rates. When we kill enough of a species, infections typical of that species tend to jump species.
We've never had 7 billion people on the planet before. I (very unscientifically) feel like this is turning global in a way that I haven't seen previously.
The world is in all new territory. I wouldn't count on things working like anything we have seen previously.
please calm down. the laws of physics haven't changed. we'll likely have a vaccine in a few years at worst. we survived the flu of 1918 without all this new-fangled technology.
well the epidemiologists do think they can predict the course and make useful suggestions. South Korea basically beat this thing already. Meanwhile non-scientific beliefs that "things are different this time" are usually wrong.
We Pulse-Wide-Modulate a case rate that is just soo below what the strained public health system can take, prioritize the most important economic systems slowly back to life and hope that the vaccazines come just in time to end this nightmare.
Fortunately, as time goes on we'll improve our ICU capacity and it's likely that some anti-viral treatments will turn out to be effective, which should diminish the ICU load.
We could within half a year-- given massive impact from deaths and shutdowns encouraging bypassing some amount of protocol-- have clonal antibody treatments that prevent hospitalization in a large portion of infections.
China had people dying in the streets, but we're now at the point where the quarantine has had effect, so it's successful mitigation. They also initially quarantined only the area of the initial outbreak (Wuhan), and only later expanded lockdown measures to most of the country (covering 800 million people at the peak, IIRC). And of course the quarantine leaked enough that the infection spread to the entire world.
But sure, thank you CPC, a model response from a model government.
> And of course the quarantine leaked enough that the infection spread to the entire world.
It spread prior to the quarantine being put in place.
> at this point it's run its course, so it's successful mitigation
Only ~80,000 people out of 11,000,000 in Wuhan were infected. For a disease this contageous, that we don't have herd immunity for, that's hardly 'run its course'.
I'm not saying the quarantine had no effect. What I mean is that there is a time delay between when the quarantine is put in place and when you see the detected infections start decreasing. China is now at that point, but it's like all commenters have suddenly forgotten what happened before.
To be honest I don't really want to criticize China here, but rather the slipshod way in which countries are being compared. Wuhan has been in lockdown for almost two months now. Italy's national quarantine is only a week old. The number of detected active infections is delayed with respect to the actual number of infections, so it takes time for the effects of a quarantine to be visible in the data. What is the point of taking two countries at different points in the curve and presenting one as a shining success story and the other as the worst-case scenario?
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Korea will have to remain on alert, forever, as their population has no established immunity. A vaciine may never come - there is no influenza vaccine (it mutates every season).
Plus, there are grim, yet economic, benefits if the sickest and most elderly die from Coronavirus, in the form of long-term savings on pensions and healthcare. This should be taken into account in strategic national planning.
The UK approach seems the most sensible - keep the economy and society functioning, and recommend that the most vulnerable practice self-isolation. Better to isolate those who are not participating in the productive economy (ie. the sick and elderly) than the entirety of the population.
If you consider a simplistic economic model then there should be no public pensions or healthcare at all. The moment that somebody's direct economic output falls below a defined threshold, be it due to retirement, illness, lack of retraining in a changing job market, then they represent a liability to be efficiently removed.
Fortunately more sophisticated approaches are generally followed, since in practice humans aren't simply worker ants or feedstock for Solyent Green.
Cannot disagree more strongly with your point! No, the economic benefit of “having the sickest and most elderly die” should most definitely not be taken into account in strategic national planning.
Every life is precious. This line of thought is exactly what lead the Nazis to murder hundreds of thousands they considered an economic burden.
I live in a small town in the mountains of Central Arizona. Since we get 1.5 million tourists a year, I expect things here to be similar to large cities in the US elsewhere.
Most friends in town have adopted a fairly complete social distancing protocol in the last few days. This happened abruptly, no one seemed to be doing it a week ago.
While social distancing helps, we should have had testing infrastructure in place much sooner. I am happy to blame Trump, and democratic and Republican Congress critters for that. A good six minute interview: https://twitter.com/azeem/status/1238734048018792449
EDIT: I posted this comment hoping to see comments from other people in the US on whether or not people were largely social distancing in their communities.
From what I read, South Korea shut down almost nothing but had widespread testing available, including drive-through testing where people could sit in their car, get tested and receive the results via SMS next day. They also had the ability to very proactively search and locate people that had been potentially exposed to the virus via credit card transaction/location data.