Waiting for the wave to break

by Chris Bertram on March 18, 2020

Months at home. Months working remotely. Months during which we may see close friends, family, and even neighbours on a screen. Here in the UK we aren’t at Italian levels of disease and death yet, but we’re getting there.

The streets are getting empty, yet despite government advice, there are still people in pubs and bars and on our local community Facebook page people argue vociferously for the right of publicans to open. After all, “they have a living to make”, and “it is a personal choice.” I doubt people will be saying such things in a month.

In theory we (by which I mean the people in my immediate workplace) are all working from home, but I confess that the anxiety, fuelled by the news cycle, the constant rush of social media updates on CV19 isn’t conducive to concentration. Meetings are happening via Zoom or Skype Business, but a good part of each meeting is taken up with people saying “I can hear you but I can’t see you”, “I can see you but I can’t hear you”, “I think I pressed the wrong button”. There’s alway one person who thinks the sound isn’t working, so you can see them, bemused, trying to fix the problem with someone else in their house, in a loud voice, believing that they are cut off from us all when they’re not. Nice to see people’s pets though, and their bookshelves and decor for that matter.

And books. Well I’ve been stockpiling unread books for years, ready for a moment like this, and now it has come it is frankly hard to concentrate. Novels, in particular, speak of a lost world in which people hug and kiss and go to parties. Is this how people in the trenches remembered La Belle Epoque? Still, I’m ambitious, I’ve brought Tristram Shandy back from the office, and if necessary I’ve got Proust and Joyce lined up, together with some lighter things: I’m reading Ben Lerner’s Leaving the Atocha Station at the moment, but it seem slight and ephemeral compared to the world that lies just beyond the front door.

Meanwhile the borders go up. My sister, in France just beyond Geneva airport is cut off from Switzerland. Lorries are in 40km queues at the German-Polish border, so there’ll be no deliveries to the Polish supermarket round the corner for a while. And people in their various nationalities head homewards to face the crisis in their little national boxes, a crisis uniting humanity in fear and dividing us behind fences all at the same time.

Reports come in of relatives and friends who may or may not be feeling under the weather. Other family members have lost their incomes overnight. There are stories of people being fired and others evicted. Foodbanks and charities who help refugees or the homeless are closing their doors because staff are sick and volunteers are often elderly people who need to self isolate.

Yet the flood is still a rumour of tomorrow, rather than something that’s really here yet. To see the future we look to Italy on the TV screen.

How are things where you are?

{ 73 comments }

1

Chris Bertram 03.18.20 at 8:08 pm

2

monty 03.18.20 at 9:20 pm

Video taken from a balcony:

https://www.youtube.com/watch?v=Jdf5EXo6I68

First comment (800+ votes) is a nice reminder of that old saw about being “better Dead than Red”.

3

BruceJ 03.18.20 at 10:01 pm

The theme song for teachers here, today (first day of online classes):

https://www.youtube.com/watch?v=CCe5PaeAeew

We need to cling to humor to ward off the despair…

4

nastywoman 03.18.20 at 10:29 pm

@
”We need to cling to humor to ward off the despair…”

Hope so…

https://youtu.be/BnzXMRkBjMY

5

nastywoman 03.18.20 at 10:49 pm

– and as all of our work of the last year for Filmfestivals –
which won’t happen –
– we are waiting for the wave to break by adding one Act of the Virus Play to another one –
(and hope they aren’t too cynical?)

Act 2
https://youtu.be/6m22TXYUFPI

Act 3
https://youtu.be/GyPUHlXsjWc

– and see ALL the other ones…

6

Alan White 03.18.20 at 11:12 pm

My county in Wisconsin has no reported cases, though we are surrounded by ones that do. There was a lot of panic buying at local big boxes, and as Harry has reported, UW and all public and privates K-12 have moved to digital delivery. In my smallish city traffic is very light, and most people you see are obviously trying to exercise (as am I). Yesterday I had to go to the local department of motor vehicles to renew my license–I was the only customer there, which is nothing less than astounding. Generally people are taking self-isolation pretty seriously, even if our esteemed Senator Ron Johnson stated yesterday that we tolerate lots of risk like traffic fatalities and still live normal lives–revealing only his chasm of understanding what this is all about. And today he voted against paid leave, bemoaning the stress on small businesses, as he returned to his multimillion-dollar mansion. And don’t get me started on “China virus” President Agent Orange, who today stated again that it came from there–and mocked the pronunciation of “China” while doing so. What an ass.

7

ph 03.18.20 at 11:32 pm

I received an email yesterday from a colleague confirming that the start of classes at his university has been pushed back several weeks. Had there been more discussion, less social-media, and less panic, I expect many other institutions around the globe would have arrived at a similar consensus. We can afford to lose an entire term.

Instead, we’re about to inflict long-lasting damage to the public’s already crumbling faith in academic institutions. We’ve one son in a ‘good’ university and we’re already concerned about indifferent and ill-prepared instruction.

The Khan Academy and other for profit low-cost options are already moving to expand their customer base. Universities seem to believe that the ivory tower is either sacrosanct, or essential.

The inefficacies and lack of professional already on display within meat-space classrooms are now about to be magnified and exacerbated in this too-rushed and poorly-grounded effort to respond to a crisis by individuals whose very justification for existence is sound judgement and data-driven decisions.

Many online options allow users to capture and record the lecture experience for revue at a later date. Which means parents and others paying the bills will have a chance to judge for themselves, perhaps, for the first time just how seriously we take our educational responsibilities.

Most teachers don’t know what’s happening in the next classroom. Now everyone will. Forever. Unless, of course, the universities and teachers attempt to restrict recording and preservation. Which has it’s own problems. See below.

Dissemination and access – is already causing problems for institutions offering online options with students preferring to select online courses from other universities for accreditation. Guess how this debate mutates, (yes, let’s use the term!) as their own schools struggle to provide quality online education to students paying 20-50k per year.

My own meat-space pedagogies already feature ‘distanced’ dialogues and discussions, with students seated or standing two-three meters apart, simply because it helps students practice for public-speaking and presentations, and allows me to more easily monitor multiple conversations.

Simple is always best, if possible. Delay for a few weeks. Don’t be afraid to admit that maybe the ‘new’ delivery system isn’t going to best meet student need, and be ready with workable compromises. Lectures absolutely can and perhaps should be delivered online.

Every other problem can be fixed with a bit of common sense and imagination. And, yes, wearing masks in-class for the duration of the pandemic is on that list.

How many institutions or instructors will admit error, delay or cancel imperfect online instruction (make jokes about failing to meet student need, wtf?), will be an interesting test and one that’s sure to interest the general public.

Best hope we all pass. Early signs are far from promising.

8

Kenneth Oliver 03.19.20 at 12:42 am

It is actually pretty clear that the indirect death toll from the loss of livings and the social isolation is going to dwarf the virus’ direct death toll.

Trade – local, provincial, national and global, interpersonal, intrafirm and interfirm – is what enables the earth to keep 8 billion people alive. Seriously mess with it and …

9

Omega Centauri 03.19.20 at 1:15 am

Bay area we’ve been in “lockdown” for a few days now. As a senior, the guideline to stay in the house came a couple of days earlier. Struggling to work from home. Despite working for a software tech leader, they really hadn’t prepped us for a rapid transition to work from home. You’d think with dozens of high end mech engineers that the exponential function would have been understood, and the timescale of this momentous change would have been anticipated, -but it wasn’t. So its a struggle to get work done.
Bars closed. Restaurants are only open for takeout. Two kids have silicon valley jobs, work from home not a huge deal for them. Other kid is a musician, most kids have vanished. A bit on on line stuff, but maybe one or two hours worth per day. The shutdown in the bay area just expanded from six core areas to include the neighboring several counties as well.
Well one thing that looked encouraging: known cases in my county only went up by two (to 41), instead of 4 or 5. But, the noisiness of small numbers being what it is, its too early to have any assurance that R0 is being pushed downwards.

10

faustusnotes 03.19.20 at 1:28 am

Things look pretty bad in the UK, and the response looks likely to be bungled. Here in Japan things are calm and social isolation is only half in place, but the government and big companies started taking action a month ago. Many events have already been cancelled, schools are closed, and big companies have already set up working from home plans – some as early as a month ago. Many companies in Japan already have an influenza leave policy, so from December to March people with fever are allowed to take 4 days off without it affecting their annual leave. So a lot of things were already in place.

Also Japanese people don’t shake hands or touch each other, and hand washing is much more commonly practiced here than in the West. I’ve kickboxed in several places in Japan, the UK and Oz and hygiene practices even at kickboxing (and in gyms generally) are much superior to the west. Also Japan has a large amount of public toilets so hand washing is easy, and most department stores and museums have had a practice of making hand sanitizer available since forever. The big issue here is trains, which are the major way of getting around and although they’re clean and airconditioned you simply cannot make them safe.

There is some evidence the government isn’t testing enough but the standard advice here is to self isolate if you have symptoms and only come in for testing if they last more than 4 days or get serious. I have two friends with headache and fever that broke after two days, so they probably won’t get tested. I’m hoping the epidemic won’t take hold here and the economic cost won’t be too great, because of these early measures.

Also it’s worth noting that Japan didn’t cut off China during the peak of their epidemic, and because they collaborated from the beginning have been able to get advice and support. International cooperation is good!

(I have been kind of forced to self isolate because I badly dislocated my kneecap three weeks ago, and haven’t been able to do much. But I also think I got this virus on the 10th January after a trip to Korea, and may be immune already …)

11

RobinM 03.19.20 at 3:02 am

I’m sorry for what some will surely see as an over-reaction, but I have to say I react extremely negatively to the notion that “In theory we are all working from home, …” Even with the “In theory” thrown in, for it’s just as biassed a view of reality in theory as it is in practice. This isn’t the first time I have heard this in recent days, so I’m not picking on Chris Bertram in particular. Neither am I upset by such a claim only because my daughter happens to be on the front lines, so to speak, as a GP in Australia, though I imagine that contributes to my annoyance at the casual way this claim is so widely broadcast. But what about all those who could never in the foreseeable future, even if all the AI optimists worked full time to try to bring it about, “work from home?” “ALL OF US?” Get real! And acknowledge just how much we all depend on a great many people who actually have to work hard with their bodies every day of their working lives and who are going to be out there, unlike those of us who are more privileged and/or retired, even while the disease spreads.

PS. Greetings to Omega Centauri, my fellow ‘bay arean.” Note Berkeley Safeway is having a special shopping period for seniors where, to belabour my point, we’ll be relying on those who stock the shelves and serve at checkout.

12

MikeN 03.19.20 at 5:45 am

“In theory, we are all working from home….”
By we. of course you mean the comfortable middle and upper class office worker, not the people who actually make things and prepare and deliver food and provide services.

13

nastywoman 03.19.20 at 6:09 am

AND –
there is this… riddle – as about right now:

The UK 2664 infected – 71 death
Italy 35713 infected – 2978 death
France 9054 infected -148 death
Japan 889 infected – 29 death
South Korea 8565 infected – 91 death
Germany – 12327 infected – 28 death

Why are so few deaths in Germany?

And as – supposedly – South Korea and Germany tested ”from the get go” –
and there is this… this… ”rumour” here – that nearly all the ”Infected” got and get… ”identified” – through very thorough testing.
Do the German numbers show: ”the real – infected to death – relation”?

14

MisterMr 03.19.20 at 7:25 am

I live in Italy (Lombardy) so we are in lock down since some time.
Mostly it is very boring.
What I found curious in the story is how many people, me included, had to change their mind from a ‘it’s just a flu’ mindset to a ‘OMG calamity’ mindset.
It is interesting because it shows that what is considered a rational approach largely depends on common sense, aka shared prejudices, and accepted emotional responses.

That said, we are now in a bad situation because we didn’t panic enough at the beginning, meh.

15

Philip 03.19.20 at 7:44 am

I’m an LSA in a special school and still don’t know if we will be closing. It depends on government guidance on vulnerable children and student and staffing numbers. If we do close I don’t if I get paid or maybe sent to cover for care provision for the charity I work for.

One of my sisters works abroad my other sister and parents are local. Yesterday we had a video conference call together yesterday. It’s strange being nearby but having to be isolated.

16

bad Jim 03.19.20 at 8:52 am

Social distancing is a good description of my lifestyle, and it’s gratifying to have it elevated to the status of a virtue. I hardly have to change my routine: drive downtown, walk to the beach, sit on a bench to watch the wildlife, climb up to a higher vantage point just to let my heart know what shape it’s in, watch the wildlife (which is only occasionally on offer; this is the season for whales, and I’ve spotted a few; dolphins are always a possibility).

Shopping now is, for me, an an exercise in amateur anthropology. There is still no toilet paper. Perhaps a good sign? People haven’t been scared shitless? Most shocking to me, when I visited Trader Joe’s today, was the near absence of coffee, a commodity more compact and amenable to stocking. The wine selection was not what I was used to, but nonetheless adequate. Frozen foods were a disaster zone. My most immediate needs, lasagna and whole milk mango yogurt, were satisfied, so I am nearly content.

As the eateries I patronize switch to takeout, I change my orders to compensate for the additional packaging it entails: instead of one small lunch, enough more to nuke for dinner. Hand them a twenty and tell them to keep the change. (I’ve done this once. So far, so good.)

17

Chris Bertram 03.19.20 at 8:56 am

@RobinM & @MikeM I can see that the referent of “we” there has been misconstrued. I meant to refer to the people in my workplace, not to the world in general. I will edit the piece to make that clearer. Thanks for making that necessary point.

18

Leemeade77 03.19.20 at 9:30 am

In Chicago/Illinois, our Governor seems to have gotten it (not the virus), the need for urgency. Our Mayor seems a bit slower on the uptake. She still wants to keep things like the libraries partially open. While our Governor has closed almost all State offices, our city department, Revenue, will also stay partially open for the duration, I’m assuming. The Governor closed all state schools last Friday, don’t think our Mayor was prepared to close Chicago’s schools, despite the teacher’s union asking her to do so.

19

Matt 03.19.20 at 10:25 am

On-line teaching has been part of my normal routine for almost three years now (alas) and I can say with a fair amount of confidence that it’s significantly less good for both students and teachers – more mechanical, more likely to make classes seem like a product, and much more superficial learning. It’s possible that I’m bad at it – I’m certainly less good at it than with in-person teaching – but even in the case of people who are clearly better at it than I am, it seems much worse.

As for meetings, at my place of employment, we are spread over three campuses, so people “dialing in” for meeting is normal, and again, I can report that all of the above problems do not go away with experience. In every single meeting we have these problems, over and over, and they make them even more tedious and annoying than the meeting themselves would be. I will add that this is a bit of evidence against John’s claim, in the last post, that video talks can adequately replace in-person talks. Not only are the informal parts lost, but all these problems exist for video talks, too, and are not likely to be eliminated.

In the present situation, we must all do as well as we can, of course, but my fear is that many will want to use the crisis to push for this being the new normal, and we’ll all loose insofar as that happen.

20

john 03.19.20 at 10:54 am

Re: Nasty woman’s questions. Look at mortality as a rate, %/1000 or 10,000, etc.
See also article in The Conversation (UK) and BBC Inside Science. A lot depends on early response (“It’s a hoax by democrats.”); rational prevention measures (not Bo Jo), the sense of citizenship (see hoax by democrats), and of course a decent affordable healthcare system.
Stay safe, all. Take care of self, family and community.

21

nastywoman 03.19.20 at 11:44 am

@
”Look at…”

We do and did – but as mentioned – it’s such a confusing… picture – as everybody wants to know ”the real mortality rate” –
-(also concerning different age groups – in order to know her – or his chances) –
and as in our area there are so called ”Corona Parties” – where groups of some very stupid and young idiots tell – that they don’t care if they ”get it” –
some… ”rumours” – that if you are young you won’t die –
perhaps never should have been spread?

22

Faustusnotes 03.19.20 at 12:57 pm

Nastywoman, yes, the German and South Korean data show the true death rate. See also the mortality rate in the diamond princess – 1% in a very elderly population. See also the demographics of cases in China – only 1% of confirmed cases are under 10, which is impossible with a respiratory disease. The real mortality rate (crude) is probably 0.1-0.5%. But it probably kills 10-15% of elderly people, and that’s only if the hospital system is not overwhelmed. It’s safe to say there are 10x more cases than were identifying in most countries, and the higher the observed mortality rate the greater the misreporting rate (I have a paper about this under review now). Testing and contact tracing is key!

23

alfredlordbleep 03.19.20 at 2:08 pm

The Leader of the Free World Gives a Speech, and She Nails It
A speech with compassion and forthrightness — imagine that.
BY JUSTIN DAVIDSON

https://nymag.com/

Angela makes her own intervention

24

Marc 03.19.20 at 2:10 pm

We won’t all be confined to our houses for months. I think that the academics, and people who are active online, simply don’t recognize how utterly unsustainable a social quarantine is for extended periods of time.

We will almost certainly move to a situation where the elderly and vulnerable really are socially isolated and everyone else works. Not because of cruelty, but because there isn’t any alternative – especially if you’re asking massive sacrifices from people not at direct personal risk. Human nature doesn’t work that way universally – and if it isn’t universal it isn’t going to work.

25

passer-by 03.19.20 at 3:07 pm

@nastywoman & faustusnote: yes, Germany and South Korea, because they both adopted wide-spread (although not on demande) testing from the get-go, probably reflect the “real” mortality rates, provided excellent medical care. The “real” mortality rate in such a context would be under 1% (still 3 to 5 times the usual influenza though).

What is often missed or underplayed is that the real threat of CoVid-19 is not that crude mortality rate, but the very high rate of complications necessitating 8 to 20 days of hospitalization. 10 to 20% of patients (aged 25+!!) will need extensive hospitalization, about 5% will need about 3 weeks of intubation (and remember, the young will recover, but recovering from a 20 day intubation is no fun). Influenza necessitates hospitalization in less than 1-2% of cases, and that hospitalization tends to be much shorter and easier to handle. Influenza season already strains hospitals every year; no medical system would be able to face even an influenza epidemic requiring ten to fifteen times more hospitalizations.

Which takes us back to the “provided excellent medical care” caveat: if the medical system is insufficient to handle the massive case-load (which it is, in most countries in the world) or if it breaks down, the death rate will climb much, much higer, as those who would have recovered cannot be accomodated (and, of course, so will the death rate of many other conditions that will no longer be adequately treated).
So what the confinement policies are doing is saving that medical system, rather than the “lives of the old”; that’s it. If rich countries can keep treating the ill, they will have crude mortality rates of <1% (and yes, tens of thousands of older and sicker people will die). Poor countries will fare much worse though…
Remember, those critical cases are by no means limited to the old and frail. About half of CoVid-19 patients in French ICU's are under 60.

26

ph 03.19.20 at 3:26 pm

Expert opinion (John P.A. Ioannidis is professor of medicine, of epidemiology and population health, of biomedical data science, and of statistics at Stanford University and co-director of Stanford’s Meta-Research Innovation Center.)

“…The data collected so far on how many people are infected and how the epidemic is evolving are utterly unreliable…

..Some worry that the 68 deaths from Covid-19 in the U.S. as of March 16 will increase exponentially to 680, 6,800, 68,000, 680,000 … along with similar catastrophic patterns around the globe. Is that a realistic scenario, or bad science fiction? How can we tell at what point such a curve might stop?

The most valuable piece of information for answering those questions would be to know the current prevalence of the infection in a random sample of a population and to repeat this exercise at regular time intervals to estimate the incidence of new infections. Sadly, that’s information we don’t have… “

It’s a good idea to take precautions, obviously. Worse than World War II? Worse than 9/11? I’m not sure hyperbole of this kind, given the absence of reliable data (see above), is at all warranted, or helpful in any meaningful way.

https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-as-the-coronavirus-pandemic-takes-hold-we-are-making-decisions-without-reliable-data/

27

ph 03.19.20 at 3:30 pm

And this just in from Bloomberg: https://www.bloomberg.com/news/articles/2020-03-18/99-of-those-who-died-from-virus-had-other-illness-italy-says

Healthy people have little to fear it seems, stay safe.

28

Mark 03.19.20 at 3:36 pm

I am in New Orleans and I suspect that a San Francisco or even Italy style lockdown will be coming here soon. We have the second highest per capita rate of infection in the US. The assumption here is that people caught the virus during Mardi Gras and we are now starting the see the consequences of that. Schools were closed last week. All bars, restaurants, nightclubs, etc. in Louisiana have been closed since the beginning of this week. Restaurants can serve drive through/drive-up customers only. This is especially significant here since tourism is by far the largest industry/employer in the city.
We have had a similar situation to what Nastywoman describes – the bars were closed after people decided they had to have St. Patrick’s celebrations over the weekend. The mayor had said that events should limit themselves to no more than 50 people (which still sounded too large to me) but after seeing pictures of packed bars and street parties the governor seems to have decided that people cannot be trusted to police their own behavior (correctly, I think – I saw someone justify keeping bars open on the basis that “some people need to die anyway.”)
Fwiw, a couple of anecdotes: A former co-worker texted last night to say she has the symptoms of Covid-19 – fever, dry cough, difficulty/pain when breathing. She went to get tested but under our “perfect” testing system (as our President describes it) she wasn’t tested because her fever was below the threshold. I think when/if we get an adequate testing system in place, the number of infected will rise rather dramatically.
On a slightly lighter note, after the city asked restaurants to do drive-up service, the parking enforcement officers saw an opportunity. Apparently they are waiting outside restaurants and when someone pulls up, writing a ticket even if they are sitting in the car. No-one here was even slightly surprised to hear this.

29

Will Boisvert 03.19.20 at 7:08 pm

As people have pointed out, the true CV fatality rate is much lower than reported, around 0.1 percent or less, which is comparable to the flu. The infection rate is also about the same as the flu, roughly 20 percent or less.

The problem with mortality rates is that the testing regimes preferentially test severe cases as well as vulnerable old people and people with preexisting conditions. These have a much higher mortality rate than the typical mild or asymptomatic case of CV which is not tested and not diagnosed. If the latter were put in the denominator, the fatality rates would drop dramatically, by an order of magnitude or more.

Germany is reporting fatality rates of 0.2-0.3 percent; Austria, Denmark, Sweden and Norway are almost as low, well under 1 percent. These countries have relatively small outbreaks so their testing regimes aren’t running behind and they can test a much larger percentage of people who come in with milder CV cases, people who then survive. Look for the fatality rates to rise somewhat as their outbreaks grow and outstrip the testing availablity and they start to triage the testing by excluding milder cases and less vulnerable people from testing and diagnosis. That increase will just be a statistical artifact, the true fatality rates will still be very low.

In fact the true fatality rates are much lower than in Germany, because Germany doesn’t test people who are asymptomatic; asymptomatics are at least half of the true CV infections. On the Diamond Princess, the only COVID population that has been fully tested, about half of the 700 people testing positive for CV never developed any symptoms. And that was for an elderly cruise-ship population; a younger, healthier general population probably has a much higher asymptomatic rate. (For the flu, the asymptomatic rate is up to 75 percent.) So for every case reported in Germany, there is at least one more asymptomatic case that won’t be reported, and possibly two or three. Factoring this in, the true German case fatality rate is probably 0.1 percent or below.

Then there’s the CV infection rate, also comparable to the flu. The Diamond Princess had 700 cases among a population of 4,000, an infection rate of about 18 percent. That agrees well with the flu’s typical infection rate of 20 percent among unvaccinated population. Again, CV infection rates in a younger, healthier general population will be lower than among Diamond Princess’s elderly population.

So the CV pandemic is not much different from a bad flu season—roughly the same infection rate, roughly the same fatality rate. The projections of millions of deaths from CV are way too high.

30

Will Boisvert 03.19.20 at 7:09 pm

As Ph pointed out in his link, it’s almost exclusively old and sick people who are dying. Most people have little to fear from COVID.

As of March 17, in Italy, of the 2,500 people who had died by then all but 3 had at least one previous condition, and half had three or more such conditios. 75 percent had high blood pressure, 35 percent had diabetes and a third heart disease.

The average age of fatal cases is 79.5 years. Of the 2,500 fatalities, only 17 were under the age of 50. All fatalities under the age of 40 were men with serious preexisting conditions. (The disease targets men more than women.)

These results are consistent with data from outbreaks elsewhere. The scientific consensus is that in the vast majority of cases a COVID 19 infection produces a mild illness or no illness at all.

There’s no mystery about who is at risk, so we can readily identify them and help them self-isolate without putting everyone else under lockdown.

The vulnerable should be encouraged to stay home and enabled to do so by being provisioned with supplies and financial assistance. Workers who come into regular contact with the old and sick, like health workers and nursing-home workers, should have tight social distancing requirements (with hardship pay) so they don’t catch the virus and transmit it to vulnerable people. Testing should be focused on vulnerable groups and workers who serve them, not on everyone with a sniffle who comes to a drive-through test center.

There’s no need to lock down healthy people and younger people (unless they are caretakers for the old and sick). They should be free to go to work, go to the pub, whatever, because they’re not at serious risk. School closures are insane, because children in particular are almost invulnerable to the disease.

The blanket lockdowns are crippling the economy and throwing millions out of work for no rational reason.

Even worse, the alarmism surrounding COVID 19 will inevitably fuel xenophobia and permanent immigration restrictions. People who care about migrants and refugees should speak out against the panic.

31

RobinM 03.19.20 at 7:15 pm

Thanks for your clarification and revision, Chris. I imagine most people many a time use such words as “we”, “them”, etc. without really thinking too much about it. I have a vague memory that Michael Billig takes note of that tendency in his book “Banal Nationalism.” So maybe it’s something everyone should think about more than they/we do.

32

Chris Bertram 03.19.20 at 7:46 pm

@Will Boisvert It is a very nasty disease and we don’t yet know whether younger people who fall ill from it will suffer permanent harms. Moreover treating the people who fall sick from it will overwhelm the capacity of our health systems so that people whose lives are in danger from other causes will die unnecessarily because there are no doctors to save them. You write that young people should go to the pub unless they are carers for the old, but that’s ridiculous. Stopping the disease means breaking the chains of infection and reducing the R0 number. The person who goes to the pub may infect a carer who has deliberately abstained from doing so who, in turn, infects an older person, who dies. We are in this together and people have a duty of solidarity to the vulnerable.

33

nastywoman 03.19.20 at 8:58 pm

@
Will Boisvert
”Most people have little to fear from COVID”.

Well – there is this friend of mine – who is working as a doctor in a hospital on the other side of the border in Switzerland – and then there is this other friend of US – who is working in the US in a hospital and – one friend of my parents as a nurse in the UK – and they all always considered themselves – like ”most people” –
AND I NEVER EVER SAW THEM MORE FEARFUL THAN RIGHT NOW!
– as are you aware – what it means to deal with a COVID Patient who doesn’t have just ”the sniffle” –
and I’m NOT talking about –
as you wrote –
some ”average age of fatal cases of 79.5 years” –
I’m talking about all of these patients who are under 50 years old -(like in NY) –
and this friend from NY told US are: ”F… sick as a dog”!

Sooo – ALL of these ”most people” are not as ”FEARED OUT” – as my Italian friends.
That’s true?

They are just pretty much ”FREAKED OUT”!
Capisce??!

34

alfredlordbleep 03.19.20 at 9:11 pm

https://www.vox.com/science-and-health/2020/3/18/21184992/coronavirus-covid-19-flu-comparison-chart

please see hospitalization rate of flu vs. covid-19. Somebody (not me) might check the sources shown for necessary context (!)

35

Omega Centauri 03.19.20 at 9:31 pm

No doubt extreme social distancing is non-sustainable. However hasn’t South Korea demonstrated that a combination of moderate social distancing coupled with extensive testing and aggressive contact tracing might be consistent with control of the epidemic. No the US is uniquely for developed economies here, as Trump’s decimation of our pandemic response capabilities, couple with his extreme NIH syndrome mean we are well behind the curve reconstituting our rebuild of such capabilities.

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nastywoman 03.19.20 at 9:37 pm

AND@
Will Boisvert –
Where are you commenting from?
As I’m commenting from a place which is about three and a half hours from Italy – and I spend the last five Christmas Seasons – AND the New Year of 2020 in Verona –
which is about an hour from Bergamo –
and since two days a friend in Bergamo –
isn’t answering his ”handy” anymore –
and THE FEAR now often is so much more about ALL of the consequences of COVID –
than actually some ”sniffles” it’s the complete and TOTAL PANIC that MY ITALY is DEAD!
as:
The Civil Protection Ministry registered 3,405 COVID-19 deaths by Thursday evening, a rise of 427 deaths over 24 hours, though 48 fewer than Wednesday’s tally of 475. On Thursday, China registered 3,245 deaths, up only eight – another sign that the crisis there was well past its peak.

The number of Italian coronavirus cases rose by an alarming 5,322, taking the total to 41,035, or almost half of Chinese cases. The Italian numbers are all the more dramatic when the relative sizes of the countries are taken into consideration – Italy has less than 5 per cent of the population of China.

The rise in Italy is accelerating. Thursday’s increase was up 14.9 per cent from Wednesday and Wednesday’s increase was up 13 per cent from Tuesday. Tuesday’s rise over Monday was 12 per cent.

Italian Prime Minister Giuseppe Conte said Thursday that the quarantine measures would have to be prolonged, given the leap in numbers; they were to expire on April 3. “The total blockade will go on,” he told Il Corriere della Sera newspaper. “The measures taken, both the closure of [public] activities and the ones concerning schools, can only be extended,” he told the paper”.

The death total was so high in the northern province of Bergamo, the epicentre of the Italian – and European – coronavirus crisis that hospitals were using army trucks to transport coffins to burial sites or crematoriums. At last count, Bergamo had registered 4,465 positive cases, more than Switzerland, Britain or Netherlands”.

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Dr. Hilarius 03.19.20 at 10:22 pm

@ 39: In Seattle I am aware of a physician and a firefighter, both in their 40s, hospitalized with covid-19. The physician is in critical condition. Neither had other health problems.

Evidence is also building that survivors are suffering from significant lung damage, possibly permanent. An acquaintance of mine died on Tuesday. He was elderly but otherwise healthy. Attempts to minimize the risk of this virus are irresponsible.

38

Dr. Hilarius 03.19.20 at 10:26 pm

should be “@ 30”

39

faustusnotes 03.20.20 at 1:16 am

Will Boisvert is spreading dangerous misinformation here, and needs to be corrected. First of all the “infection rate” is not a thing – the 700 people infected on the Diamond Princess yield a final size of the virus of 0.18, which Will says is similar to the 20% observed in influenza. Except that the Diamond Princess cruise ship was under a very strict quarantine, so that final size cannot be compared to a normal flu. In fact using the equation linking final size with basic reproduction number we can derive a basic reproduction number during quarantine of 1.09, which indicates that even with quarantine the virus population only stabilized after it burnt itself out – even that quarantine was insufficient to drive it to extinction.

The basic reproduction number for flu is between 1.3 and 1.5, but this virus is more likely between 4 and 5. Early estimates from the Imperial College crew put it at 2.5 and those estimates are the basis of the government’s 60% figure for herd immunity but they are wrong – the early published estimates of this virus’s epidemicity were wrong by a factor of almost 2. In fact the best fitting models to the Chinese data suggest much higher values, and those early published estimates generate epidemic curves that undershoot the true curve significantly.

Next, Will says the mortality rate is similar to influenza but this is also not true. This is because the data we have suggests that this disease does not affect children, and we don’t have properly standardized estimates. It appears that this disease is much more dangerous in elderly people than influenza and a larger proportion of cases are in elderly people, so it is likely much more dangerous. The only complete sample we have is in the Diamond Princess, with an elderly population receiving good quality health care, and they had a mortality rate of 1%.

You can do some simple calculations in Japan with this kind of information. With the known R0 we can expect a large proportion of the population to be affected, but let’s assume for conservatism that it’s 50%. At the 1% death rate observed on the Diamond Princess that means 60 million infected and 600,000 deaths. There are about 1 million deaths a year in Japan. You’re looking at a 50-60% increase in the total number of annual deaths in your country if you treat this like influenza. And that’s before taking into account the points passer-by made about hospitalization.

When Will and ph say that only the old and sick will die, they are basically saying you should throw your grandparents under the bus so you can go to the pub. Is this the level of respect western populations now have for our elders? They also show again that conservatives are simply incapable of understanding and assessing risk. This disease kills 10-15% of all the grandparents it infects, and it will infect all of them if their children and grandchildren just choose to wander about like it’s nothing special.

If you’re not a psychopath you should be taking this seriously and doing what you can to limit your exposure. It’s not apocalyptic but it’s definitely not normal.

40

faustusnotes 03.20.20 at 1:20 am

Also I’ll point out that Will Boisvert was underestimating the final proportion of a population infected with flu. Which is unsurprising, given how ignorant the rest of his comments were.

41

engels 03.20.20 at 1:28 am

The idea some commenters have that when the health care system is under siege from a viral epidemic anyone who isn’t vulnerable to it it will just be able to rely on it as normal is really, really dumb.

42

ph 03.20.20 at 1:59 am

People have every right to be concerned. Re: those of us who are more relaxed. This month is the anniversary of the Great Tohoku Earthquake. To get a sense of what March-April 2011 and after was was like check out this animation. The time line in the lower right gives a sense of the kind of ‘jolts’ we received hourly: https://www.youtube.com/watch?v=SjfWBnSeDik

The first major after-shocks began within minutes of the original quake and were every bit as frightening. The quakes continued daily for months and months after. Every time the house started shaking again, I relived the original. Not fun. At the same time, we were failing badly at responding to the challenge of protecting the nuclear reactors at Fukushima. Within days nuclear reactors exploded live on camera:

https://www.youtube.com/watch?v=haUawwm7l4k

The government assured us, don’t worry! Nothing to worry about! We got you covered! So, take the protective measures you feel necessary. Avoid the infection of despair, if you can.

Stressing excessively isn’t going to help. The last three years of hysteria has conditioned many to expect the worst. The vast majority of people in Japan survived, and the vast majority of those infected look to remain healthy, based on the limited information available now. As it turns out, exposure to low-levels of radiation has not had the horrific impact many of us feared. But that doesn’t mean I’ll be vacationing in Fukushima yet, But, some do, for what that’s worth. Great strawberries I’m told.

Peace

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Omega Centauri 03.20.20 at 3:55 am

faustus notes.

R0 is not some fixed quantity of the (unmutated) virus, but depends strongly upon the human environment. Chinese cities are normally pretty cramped, and that aids spread. So R0 for Wuhan before steps were taken was much higher than it would be in places that are less dense. Japan while being crowded is said to not be into cultural stuff like handshaking, with the big risk factor being crowded commuter trains. Nevertheless the slope of LOG(infections) versus time had about half the slope that was seen in Europe and America. Now that Korean sect that drove the early exponential phase in that country had practices that were near ideal for spread, and R0 was probably 10 or more for that subpopulation. Clearly China and probably Korea have been able to drive R0 below one. China, which hasn’t reported a new infection in two days is now switching to containment of infections outside of their borders.

But the reality is any country/region/town has numerous subpopulation, each with its own R0, and various levels of cross contamination with the other subgroups. Simplistic analysis of aggregate infection numbers can miss the fact that over time, the subpopulation(s) with the highest R0 will become the drivers of the epidemic in the near future.

In the US it looks like the 20-54% age group is becoming the subpopulation driving the overall numbers. Reportly 40% of hospital admissions are now in that age group. Warnings that something like 20% of the infected in that age group need extended hosptalization have become the new frontline in the battle.

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faustusnotes 03.20.20 at 4:46 am

ph’s latest comment (42) is really disingenuous and a really good example of how conservatives cannot understand risk. The Great East Japan Earthquake and Tsunami killed 16,000 people and was a national catastrophe, but it would have killed 10 or 100x as many people if Japan did not have the world’s strictest building codes and were not constantly practicing for this day. Japan is constantly over-reacting to natural disasters, which is the only reason most people in the area are alive today. What ph thinks was scary was actually way less dangerous than it would have been if we all took his attitude.

ph then says the government warned us not to worry about radiation, as if this is a sign that things the govt says can’t be trusted, and says he wouldn’t go to Fukushima. Precisely 0 people have died from the radiation, and the govt was 100% right not to worry – unlike ph they did a proper risk assessment. ph won’t go to Fukushima 10 years later in case he gets exposed to something with a 0% fatality rate, yet wants us all to chill and relax our behavior in response to a disease that has a 1% fatality rate.

(I mean, to the extent you can infer any conclusion from his comment).

Don’t take risk assessment advice from conservatives, people, it’ll get you killed, along with all your grandparents.

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notGoodenough 03.20.20 at 7:39 am

With apologies to the OP for a long ramble.

[First a disclaimer: While I am a scientist with a reasonable understanding of statistics, etc. I am not an expert in diseases, and so base – to the best of my knowledge – my understanding on the current evidence. If and where I am wrong, I’m sure it is possible to point that out and I will welcome evidence based correction.]

I’m not sure it is particularly helpful to attribute emotional states to the responses, but I must admit that I am confused as to why some people seem to think:

“Let’s follow the advice of the relevant global scientific community, and – as much as possible – minimise contact to slow the spread, and thus ‘flatten the curve’” = hysterical overreaction,

while

“Let’s carry on as usual to avoid any harm to the economy, and the sick and weak will have to be isolated (or if that isn’t possible just take their chances on dying)” = calm and rational wisdom.

However, to try and organise my usual ramblings a little:

Social isolation/distancing – do we really have to stay in indefinite isolation?

As far as I am aware, no expert is proposing the current recommended measures will prevent infection, or that they must or should continue indefinitely. The idea is to – as much as possible – slow transmission and spread. This is important for two reasons:

Firstly, as others have noted, this will help alleviate the strain on health systems so there is not a huge number of ill people requiring triage at the same time as having to continue all the usual work which will still be ongoing. This is critical to a) not killing our healthcare professionals trying to cope with the sheer volume of extra work all at once and b) not killing people (including those with unrelated but urgent medical problems) who have to wait because our ability to even examine and triage is completely overwhelmed.

Secondly, it slows things down to give us more time to plan and react. Much of the coronavirus is still a question mark. We have some examples of what happens when action isn’t taken in time (e.g. Wuhan, Italy, etc.), but the full extent, damage, reinfection, etc. is still being understood. The argument that it won’t affect the young and healthy and there is nothing to worry about is, therefore, a little premature to say the least. Buying time to study, understand, counteract, and put in place measures to mitigate as much as possible is, one would hope, fairly obviously rather valuable.

For what it is worth, in my part of the world there isn’t – as far as I can tell – anything like panic or hysteria. There are measures in place – sanitizers in public, limiting social gatherings, people being asked to not get too close to each other, staff in supermarkets wearing gloves and limiting interactions, etc. – but these are hardly extreme. There are no riots, no mass hysteria, people are just trying to limit contact and reduce the spread. And where I am is, currently, the epicentre and ground zero in thise country for an epidemic.

Again, as far as I can tell, it is not suggested that we all bunker down for 1 year and hope our tins of beans las long enough, but rather that we limit what we can (i.e. work from home where possible, and reduce our public exposure) in order to reduce exposure for those who still have to work (i.e. the people who have to keep the food and medicine flowing). While it is a purely personal opinion, of course, if my choice is to try to work from home as much as possible and only buy what I need vs. keep going out to restaurants and bars, the former doesn’t seem like much of a sacrifice if it helps the people who don’t have that luxury.

But what about the economy and workforce?

Gratifying though it is to see a purported concern for the working class from hitherto highly unexpected directions, it is rather interesting that it takes the case of “these people could lose their houses, so we must ensure they continue to work” rather than, for example, “these people could lose their houses, so let’s prevent that from happening”.

Now, that’s not to say there are no essential services – again, the argument is not “everyone must be in isolation forever” – but rather to say that non-essential services are..well..non-essential.

It seems to me that one way to look at it is to take the two cases

1) By adopting public health measures, we have an economic problem of the economy tanking and people facing loss of income. Let’s find an economic solution[1].

2) By not adopting public health measures, we have the problem of our healthcare service buckling and people facing an unknown degree of illness or even death. Let’s deal with this by letting people be sick and hope that it doesn’t prove to kill too many people or have any unexpected nasty side effects.

Now, I am not an economist and would welcome their input, but it does seem odd to me that of these two the first is considered an insolvable problem while the second being trivial. Particularly as the USA –hardly a bastion of socialism – managed to find a spare trillion or so for those poor and needy people scraping a living on Wall-Street (even though it has proven mysteriously problematic to find that amount as financial relief for those who are not hedge-fund managers). Maybe I am just missing the obvious.

Final comment

Once again it is apparent that in a time of crisis the people who are having the most impact – and are most at risk – are typically speaking the workforce (doctors, nurses, checkout staff, delivery drivers).

Reassuring though it is that so many are evincing great concern for stress levels (though how they supposedly know my state of mind better than I apparently do is also a mystery), I must confess I don’t feel particularly nervous or under any appreciable strain. I was under the impression I was calmly taking steps to try and be socially responsible – clearly that must just be my hysteria talking.

Perhaps it will prove that the measures being put in place were a vast overreaction (though the differences between China and South Korea, too early though it is to be definite, seem to suggest the reverse). Time will no doubt tell. But it is perhaps worth considering that even should this prove a storm in a teacup, some potential problems in many countries’s approaches to handling epidemics would seem to have been highlighted. Maybe, rather than being sanguine, it is worth considering how to address these better in future and to consider lessons we can learn[2]?

Quite why so many people seem invested in promulgating that we should treat a global pandemic as nothing to trouble us and we should keep business-as-usual is, perhaps, an exercise best left for the reader.

[1] Perhaps, for the sake of a purely random example, a massive redistribution of wealth downwards paid for by an increased tax on the ultra-wealthy. Who knows, if ti works maybe we could even keep it.

[2] At the risk of politicising this, perhaps – just as an example – we might consider whether or not making cuts to your public epidemiologists might be helpful?

46

Chris Bertram 03.20.20 at 7:43 am

I’ve deleted 6 further comments from @Will Boisvert who is no longer welcome here.

47

Rob 03.20.20 at 9:40 am

It is plausible (I make no estimate of likelihood) that we will discover that COVID-19 is less dangerous that some of the current models suggest. This will prompt a difficult question: how much less dangerous does it need to be before we consider relaxing the lockdown, given that the lockdown’s economic cost will ultimately also be measured in human lives?

I’m not sure that anyone wants to answer that. The UK government’s volte-face was at least partially driven by the desire to avoid making such a calculation in public. We don’t have the data to make such a calculation reliably, and so the precautionary principle applies for the time being. Serological testing will give us a much better idea of how many people remained asymptomatic throughout, which is currently the largest unknown factor.

Either way, the cultural changes that need to happen involve hygiene and sensible social distancing: mask-wearing during “flu” seasons, more and more thorough hand-washing, fewer unnecessary large meetings or gatherings, less international travel. These sorts of things can be sustained indefinitely at very little cost (and may indeed be an overall benefit on any metric you care to name). Does anyone have thoughts on how that kind of cultural shift might work?

48

faustusnotes 03.20.20 at 11:01 am

Omega Centauri, of course you’re right, and in many ways Japan is prepared for this virus through past practices in ways the west is not. But don’t overestimate this, because Japan took a lot of action 3-4 weeks ago in preparation for the inevitable (recall Japan did not close its borders to China at any point, and expected imported cases). This action bought the time Japan needed to avoid really desperate measures now (hmm, that sounds like a model for climate change mitigation, doesn’t it?)

Regarding the 20-54 year olds in the USA driving the epidemic, actually about 75% of Korean cases were in this age group. This age group drives all respiratory epidemics, because they’re determined primarily by how many people you contact and it is the working/socializing population that does all the contacts. The reason it appears that the distribution of cases in Italy and China is older is that they weren’t doing widespread testing, and so did not catch the mildly symptomatic 20-40 year olds, who are the ones sustaining the epidemic. This is exactly why the social distancing and canceling events, working from home, self isolation are so important.

I have a post on my blog now describing some of these aspects of the epidemic, and some population health considerations that arise from what we now know about the disease.

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ph 03.20.20 at 12:05 pm

More on what we don’t know can’t hurt us. Japan’s non-testing approach, which will perhaps anger some. https://www.straitstimes.com/asia/east-asia/a-coronavirus-explosion-was-expected-in-japan-where-is-it

Re: Fukushima. I’ve no interest in debates of any kind over the event. Five years after the event, some way wish to poo-poo the Tepco disaster. At the time, I don’t recall anybody not terrified watching the reactors explode. Germany was one of the best sources of data because they’d dealt with Chernobyl. I’ve no idea, really, why these discussions have to turn into points scoring.

Returning to the virus, Dr.. Ioannidis says we don’t have reliable data and given his job title and cv, I’m going to rely on his authority over that of any amateur.

The issue for me isn’t the current virus, but those which will follow next year. These bugs mutate and aren’t going to disappear.

Finally, ff you’re interested in hearing an academic argument for mandatory testing, multiple times, badges of good health to be worn at all times and checked by soldiers in the street this may be your cup of tea: https://bloggingheads.tv/videos/58468?in=00:01

I’ve no problem admitting I was terrified during Fukushima and still worry about the impact staying in Tokyo may have upon our kids, long-term. So, if the virus gives the jitters, you’ll get nothing but sympathy from me. My own approach may be suicidal, but I’ll let my immunes system handle the bugs. Best wishes to all, this looks to be with us for a while.

50

Zhou Fang 03.20.20 at 2:18 pm

@nastywoman , others.

Germany might have a low fatality rate so far because their cases are being diagnosed early, and it’ll take some time before deaths result. Time between onset of symptoms and death has been estimated to be between 2 and 8 weeks. Of the current 17k German cases, 97% are less than two weeks old.

Speculation that Germany shows the “true rate of death” is extremely premature. Of the 227 cases with an outcome, 47 died and 180 recovered.

51

Faustusnotes 03.20.20 at 2:51 pm

It was 9 years ago not five, and the best source of data is Japan. You really are incredibly ignorant, ph.

52

notGoodenough 03.20.20 at 4:13 pm

I hope this will be taken as the FYI it is intended, rather than as an attempt at point scoring (I don’t have too much interest in scoring points with people I don’t know over the internet, as the prizes are rarely worthwile!).

Firstly, I am very glad to see reference to Dr John Ioannidis – he is (in my opinion) an immensely respectable figure who has done sterling work in shining a critical, if often uncomfortable, light on the many real issues with the way science is carried out. To me, and wishing no disrespect for his other achievements, his work at the Cochrane institute is vital, and I wish more people were interested. Indeed, I first came across his contributions in Bad Pharma and Bad Science (collections of articles from Ben Goldacre, books which I feel I recommend pretty much any time there’s a chance to as they are good starting points if you want reasonable evidence based criticism of science-as-it-is-practiced).

I touched on the fact that much of the coronavirus is a questionmark in my previous post, but perhaps it is worth diving into a little more detail.

It is absolutely worth considering the opinions of experts in the field. It is worth noting – as I am sure Dr Ioannidis himself would be the first to – that his work is as someone who analyses data – not as an epidemiologist. In this way, it is perfectly possible for there to be insufficient data to reach good, firm conclusions, and also that we have enough data to have good reason to believe it is important to engage in social measures as quickly as possible.

For those with the time, I would like to bring to attention this article from a professor of epidemiology at the Harvard T.H. Chan School of Public Health and director of Harvard’s Centre for Communicable Disease Dynamics:

https://www.statnews.com/2020/03/18/we-know-enough-now-to-act-decisively-against-covid-19/

From this, it would seem that the gap between Dr Ioannidis’s comments and the prevailing advice is not as great as perhaps imagined. As far as I can tell – and certainly I don’t wish to speak for any of the experts – nothing Dr Ioannidis has said is particularly contrary to the currently prevailing wisdom. It is true that sustaining current measures for months or years is highly problematic (likely impossible). However, as I have said before, I don’t believe that this is being proposed. Indeed, one of the reasons it is important to minimise contact as much as possible now is because we don’t have forever in which to do so and to try and flatten the curve.

Indeed, perhaps it is worth considering this:

1) As far as I can tell, the official recommendations from most governments is relatively measured. Try to: avoid contact as much as possible, wash your hands, don’t touch your face, don’t cough over other people/thing. These don’t seem to be things which are exceptionally unreasonable to do for a few weeks (well, perhaps the washing hands and not coughing over people should, one would hope, be standard practice by anyone with a reasonable standard of hygene). It certainly seems to be the case that the better this is carried out, and the better the testing, the sooner the curve can be flattened. That doesn’t mean “everything is over”, it means we have spread the cases sufficiently to – as much as possible – buy time for the experts to do their work.

2) Given that we don’t, as pointed out by Dr Ioannidis, know enough about the coronavirus, it seems odd to take the view “well we don’t know much about it – therefore let’s just hope it is something which will be harmless”. We don’t know – it may be harmless, it may inflict long-lasting damage on even very fit and healthy people. Again, it is just personal opinion, but for me if it is a case of social distancing for a month vs. spreading a disease which is a huge unknown, I’m not sure that the latter is the more sensible choice.

As Dr Lipsitch notes in the article:

“Waiting and hoping for a miracle as health systems are overrun by Covid-19 is not an option. For the short term there is no choice but to use the time we are buying with social distancing to mobilize a massive political, economic, and societal effort to find new ways to cope with this virus.”

For myself, acting in accordance with the best models we currently have available is (while by no means a guarantee that the response is proportionate, sufficient, and the best possible) all I can do – perhaps future information will change what the best response is (and if so I will alter my position accordingly), but following the currently best available advice would seem to be the sensible course of action.

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notGoodenough 03.20.20 at 4:21 pm

Further to my most recent post, re-reading shows a lack of clarity which could be misinterpreted. I should note that when I say:

“…Dr Ioannidis himself would be the first to – that his work is as someone who analyses data – not as an epidemiologist.”

I meant specifically that the comments being made regarding the lack of data are made as an expert on data analysis – I don’t mean to imply that he has does not have expertise or has not made significant contributions to the field of epidemeology (which perhaps my poor phrasing implies).

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Cranky Observer 03.20.20 at 5:08 pm

Prior to my getting dispersed last Friday I discussed with some of the cleanroom engineers at work the idea that any ordinary human being could train themselves to “not touch their face”. Let’s say it was a nice moment of levity for them in a not-great week.

55

William S Berry 03.20.20 at 5:37 pm

Fellow who has been known to write a dozen five-paragraph comments in a single thread on how safe nuclear power is thinks we have little to fear from COVID-19.

Quelle surprise!

56

nastywoman 03.20.20 at 5:54 pm

@50
”Speculation that Germany shows the “true rate of death” is extremely premature. Of the 227 cases with an outcome, 47 died and 180 recovered”.

Thank you – while – does ”with an outcome” – mean – we have to wait for some kind of ”ultimate outcome” -(and will there be one?)

AND after finally reaching our friend in Bergamo –
(whose cell-phone was stolen) – he told us that his Priest died – and that in all of Italy already 18 priests died – as they were – and are – like doctors and nurses and anybody in these hospitals – exposed to the patients – like nobody else.

57

ph 03.20.20 at 11:28 pm

I think most readers can get the point: we lack the data we need to make informed decisions about a real threat. The linked Ioannidis article is expert assessment on the reliability of the current data, which presents us with a situation I see as quite similar to the one Japan faced in 2011. Let me be clear.

The Japanese government knew within days one or two of the reactors would probably blow up. The reactors did blow up, and the government didn’t have reliable data about the health risks. The government had two sets of data: one directly connected to the health of the populace, the other connected to the health of the economy, with knock effects to the health of the populace. In the end, the decision, then and now, was to make decisions based on knowable data.

The national government decided to (white) lie to the public, as the government often does, and deny the obvious – the reactors had exploded (see linked video above). Which, at the time, meant turning to outside sources for clarity and fact. (The best modelling then available to the public was done and disseminated by academic teams based in Germany – see Chernobyl. Their concerns were two-fold, monitoring environment damage from Fukushima and replicating a Fukushima event in Germany.)

The Japanese government in 2011 had (ahem) reliable data confirming short-term exposure to high levels of radiation was fatal. The effects of long-term level exposure are/were far more difficult to assess,

The data regarding the economic impact of shutting down the northern half of Japan, and relocating significant parts of the population and industry was much clearer. Catastrophic damage to the economy and to Japan’s international reputation. (Radioactive water containment at Fukushima is currently failing and a topic of intense international scrutiny and concern. The government insists today that ‘all necessary and possible’ efforts are being made to address the water containment problem.)

Five years after the event, a much clearer picture of the health effects of the disaster could be formulated. Most of the damage to public health was related to imperfect government actions treating those who’d lost homes, or been relocated. Hindsight is 20-20.

Then, as now, tempers flared. Leave or stay. My own view is to respect both choices. Were I single I’d have relocated within Japan, as many of my friends did. Or left entirely, as others did. Living through the after-shocks was almost worse than the earthquake itself. Factor in nuclear reactors blowing up and government lies? Yes! Moving dd and still does seem the brighter move. Family roots in Japan meant setting aside my personal concerns.

I abhorred the ‘cut and run’ epithet and ‘fly-jin’ a play upon ‘gai-jin’ (outside person) which circulated then as much as I abhor the ‘virus denier’ slur currently being bandied about now.

Right now Japan is formulating it’s own response to the virus threat in much the same way it dealt with Fukushima. Given that we don’t know, yet, what the health impact of the virus will be on populations (see Ioannidis), and that we can calculate the costs of shutting down the economy, the best decision for Japan is to keep calm and carry on, and that means minimal public testing. https://www.straitstimes.com/asia/east-asia/a-coronavirus-explosion-was-expected-in-japan-where-is-it

Others, especially in America it seems, believe that mandatory testing, long-term quarantines, and creating a ‘new normal’ of repeated tests, badges, and inspections by soldiers in the streets is the better move. That’s Italy right now.

This ‘new normal’ of martial law is advocated by Laurence Kotfkoff (Boston University) in the earlier linked discussion with Glenn Loury. Over-reaction, or the right response? https://bloggingheads.tv/videos/58468?in=00:01

Folks are making choices. Based on all the evidence, available to me, Japan is taking the more sensible approach – selective closing, delaying events, sensible cautions, but otherwise business as usual. It’s a beautiful spring day here in Tokyo and I’m looking forward to a long walk in the sun. Bad me.

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faustusnotes 03.21.20 at 2:01 am

That Ioaniddis article is lazy and speculative and shouldn’t be taken too seriously. It’s nice that the author standardized the cruise ship data to an American population and found a lower mortality rate, but look at the imprecision around his estimate, and consider the health system burden he’s not talking about. Also standardization to a US population doesn’t work because you need to standardize to the infected population, not the susceptible, to get its true CFR. I think Ioanniddis article reads like the work of someone who understands data but isn’t familiar with the policy issues in preparing for infectious disease epidemics. For example his speculation about the impact of flattening the curve is not great.

I find it amazing that the right wing knob-ends who have spent the last 3 years telling us that China doesn’t care about its people at all and treats them like expendable slaves are now trying to tell us we should ignore a disease that this supposedly callous and slave-driving government was willing to shut its entire economy to stop. Yes, the Chinese govt looked at this virus and saw it as an enormous threat to its country, and was willing to shut down its economy to do it. But we should ignore these people who we are being told don’t care at all about the lives of their people, and treat their response as an overreaction? Some people need to get their story straight.

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Faustusnotes 03.21.20 at 3:41 am

Ph’s description of what happened in 2011 is completely wrong, as is his assertions about what govts knew about health risks and what the health risks are now. His interpretation of the reasons for Japan’s low testing rate is also completely wrong. Almost everything he says is ignorant and misleading. We do know what the consequences of the virus will be for populations, contra Ioannidis complaining, because we have clear evidence from Wuhan and Italy. We know exactly how fast it spreads (though a lot of people are being misled by some early low estimates) and there is now clear evidence it is not just bad flu. It’s really just astounding watching the way right wing people willfully assess risk so badly.

Also next time people try to claim anti-nuclear is a left wing ideology let’s all remember ph being terrified of a nuclear accident and advocating evacuating half of Japan’s agricultural land, with the likely deaths of thousands during evacuation. Good work ph, please make sure you never go near a decision-making body!

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ph 03.21.20 at 6:24 am

The form of this CBC piece is infantile, but does contain expert responses to Ioannidis:

” …In one corner, influential Stanford University epidemiologist John Ioannidis, who wrote a commentary asking whether taking such drastic action to combat the pandemic without evidence it will work is a “fiasco in the making.”

Across the mat, prominent Harvard epidemiologist Marc Lipsitch punched back with a defiant response titled: “We know enough now to act decisively against COVID-19.”

https://www.cbc.ca/news/health/coronavirus-covid-pandemic-response-scientists-1.5502423

I encourage those interested in Fukushima to examine the records for themselves. I happen to be pro-nuclear myself, not that it matters, and still believe we need “clean nuclear” especially if the alternative is coal.

The history of Japan’s handling of the crisis is available in English via filtered searches of news articles during the periods in question, and folks can follow for themselves the decision-making and information management flows both inside and outside the nation. There is now a wide literature on Fukushima and ongoing responses to Fukushima. For me, the parallels in the Japanese handling of Fukushima and co-vid 19 crisis are at least worth considering.

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nastywoman 03.21.20 at 7:57 am

@ph
”That’s Italy right now”.

Italy ”right now” is a completely overwhelmed Health Care System – where for the Tsunami of cases and patients who have to be treated in hospitals – there are neither enough beds – nor enough helpful equipment or doctors or nurses.

AND if that isn’t the case (yet) in Japan – or never will be the case in Japan –
(and or helpful were I’m currently reside too) – we will see if ”minimal testing” is the more helpful… idea?

As very thoroughly testing and trying to catch every case from ”the get go” helps NOT to overwhelm even the utmost well working Health Care System.

And HOW TRUE: folks are making choices. Based on all the evidence, available to me, Germany was/is taking the more sensible approach – by testing about ten? times more than Japan – but otherwise business NOT as usual.
Today it’s overcast here – but it was a whole beautiful spring week here on the Lake of Constance and I took a long bike ride every single day – and I’m looking forward to a long ride today.

So – ”Bad me – TOO”?

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nastywoman 03.21.20 at 8:04 am

”Bad me TOO”

– and we even had time for this:

https://youtu.be/xhwHXDhTZ9k

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Collin Street 03.21.20 at 9:51 am

Based on all the evidence, available to me, Japan is taking the more sensible approach – selective closing, delaying events, sensible cautions, but otherwise business as usual.

Nothing says “business as usual” like “please do not travel between osaka and kobe”.

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ph 03.21.20 at 12:43 pm

@ 63 Thank you, worth noting. Our local community sports club is closed until 3/31 and may remain closed in April. The school term may start later than usual this year. e.g.:https://www.japantimes.co.jp/news/2020/03/11/business/tokyo-disney-resort-closure-coronavirus/#.XnYBP25S9E4 More on selective closings:

Suspended rail service in west Jp: https://global.trafficinfo.westjr.co.jp/en/chugoku/
Partial suspension of service: https://railwayinfo.jp/en/20de0b6b3a764c7092.html

Trains are otherwise running across Japan, people free to travel, visit, share spaces. Both our adult kids are out tonight (Saturday) with friends in bars, movie theatres, and restaurants like many across Japan. So, yes, pretty much the usual adult behavior.

The OP addresses issues of real concern. People in the US, Britain, and Europe may start pulling together during this crisis. This comments thread – the hostility, personal attacks, argumentative rhetoric suggests otherwise. Dismissing the concerns of those we disagree with, be they ‘fly-gin’ or ‘virus deniers’ has real world consequences. Trump won. Brexit passed. Boris won. Sanders is practically done.

The practice of picking fights and denouncing opponents as fascists or racists a/isn’t fair b/ isn’t working c/ doesn’t resonate with large segments of the populace d/ feeds the right-wing press keen to portray people on the ‘left’ as cranks who hate their fellow citizens.

Both sides of any question matter. The single biggest complaint during the Brexit debacle came from ordinary voters who persistently asked for clear arguments and instead only received partisan fear-mongering from both camps.

The left is losing the middle ground and many of the most important arguments. Blaming the voters doesn’t cut it. And the knee-jerk responses and insults levelled at legitimate concerns and questions confirms most clearly a lack of sincerity and maturity. Sorry.

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Faustusnotes 03.21.20 at 2:15 pm

Business as usual in japan: schools closed, museums closed, all musical events canceled, sumo with no audience, all JICA volunteers recalled globally, university commencement delayed and all ceremonies cancelled, and discussion about postponing the olympics.

Tell me ph, do you have any references on Fukushima to share?

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nastywoman 03.21.20 at 4:51 pm

And that might become the decisive Data?

”Hospital beds per 1,000 people:

Japan 13.05
South Korea: 12.3
Germany: 8.0
France: 6.0
China: 4.3
Italy: 3.2
United States: 2.8
UK 2.45”

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Collin Street 03.21.20 at 9:51 pm

Business as usual, with notably rare exceptions.

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nastywoman 03.21.20 at 10:30 pm

@64
”People in the US, Britain, and Europe may start pulling together during this crisis”.

They do –
Very much so –
also in their… let’s call it: ”hostility” to the hostility and personal attacks and the general hate Right-Wingers… emanate.

And the hostility for the hate fascists and/or racists emanate is working so… so…
am I allowed to say: ”well”? – and resonates with such large segments of the whole Worlds populace – that –
for example –
Trump has become – ”The Most Hated Idiot in the World” –
even if WE are doing everything to tell the people – that WE are just ”hostile” to the hate Trump emanates.

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Faustusnotes 03.22.20 at 12:57 am

Ph, nobody is denouncing you as a fascist or a racist. We are pointing out that you are wrong about every single thing you write. You literally never produce a fact that is correct. Pointing out your mistakes isn’t an “attack” and it isn’t “not fair”. You’re like a broken record, always falling back on “don’t call me racist.” No one here is! Just once in your life try admitting you are wrong about something and all this pain will go away!

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nastywoman 03.22.20 at 1:49 pm

– and from Dipti S. Barot:
-(a primary care doctor in the San Francisco Bay area)

”I want to tell you about a few people in my life, that I know or have worked with, who are forced to risk their lives because of the dysfunction of our government leaders, because of the utter failure of a health care system that is based on profit and not people. I want to plead on their behalf the way people on TV will implore the shooter brandishing a gun in their face to have mercy because they have two small children and a mom with Alzheimer’s, hoping that if the shooter sees them as a real person, maybe they’ll survive. I want you to see them not as faceless health care workers but as humans behind their reused masks. They are the ones who will pay the price of terms like “Democratic hoax.”

Amy is a brilliant general surgeon who taught herself to play the ukulele in her call room during training; now, as head of her department, she ends 72 hours on call by heading straight to the beach with her surfboard. Bhakti is an indefatigable family doctor who once deployed as a Navy doctor and now works at Urgent Care, a fierce patient advocate who is a graceful dancer and loyal friend with a sweet infant daughter and a 9-year-old son with whom she grows vegetables in the community garden plot. Douglas is a tireless nurse practitioner who works in primary care and an ER who just sent his eldest to college earlier this year and is as beloved a clinician as you can meet. Nikhil is a compassionate pulmonary critical care doctor who serves an underserved population at his hospital, is known for his wicked sense of humor, and is expecting twins later this year. Megan is a gem of a geriatrician and mom of two little ones who works at a teaching hospital and educates the next generation of doctors with patience and kindness and visits the family Christmas tree farm on weekends to see her aging parents.

There is a shooter looking down the barrel of a gun that points straight at each and every one of these people ― and every front line health care worker in this country. Once they are taken out, our first line of defense will be eroded. Many of us will get sick and more of us will die. This is a crime — and there are people directly responsible for it. Blood will be on the hands of those who have sent health care workers to war without armor, to fight battles brandishing pool noodles instead of swords”.

– with all our love to M. who got infected.

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David J. Littleboy 03.22.20 at 3:22 pm

FWIW, I remember a discussion on the Japanese TV shortly after Fukushima comparing Japanese radiation standards to the reality in the rest of the world. New Jersey and Rome have higher background levels than are allowed in Japan. The TV station sent reporters to Rome, measured said levels, and asked local officials for comments. Said local officials were not amused.

Another remembrance from that time: they found a place in Tokyo that was over said limits and washed everything down in the area and measured again. Still over the limits. It took a while, but what they finally found was that a house on that street had been the site of a watch/clock maker, and some radium paint had been buried in the garden.

At any rate, diesel exhaust is grossly carcinogenic. Worrying about nuclear is nuts. And it’s of course completely insane that it’s legal to manufacture and sell cigarettes…

Also the reactors didn’t really “explode”: the reactors themselves remained intact despite the meltdown. The buildings above the reactors were blown up by escaping hydrogen. (Hydrogen explosions are preventable. Tepco saved money by not installing platinum scrubbers. The whole Fukushima thing was basically corporate malfeasance on parade: everything that went wrong didn’t have to. And didn’t at the Onagawa site (1/2 the distance from the epicenter), which shut down normally and was used as emergency shelter for several hundred local residents who lost their homes.)

And most (but not all) of the “radioactive wastewater” is processed with just tritium remaining. There’s no scientific reason not to just dump the tritium-only wastewater in the ocean. The local fishing industry opposes that, though, so it’s collecting and becoming a disaster.

The Go meetings I attend were all cancelled (at 67, I’m usually the youngest one in the room at Go clubs), and the bowling center measures your temperature before letting you in and has hand-sanitizer at every lane. The jazz things with older blokes were cancelled but my guitar lessons (private, teach is 10 years younger than I) and guitar teacher’s performances (at a small bar, usually with an audience of 10 or 12 mostly fellow students, mostly much younger than I) are still happening. I need to see my GP/PCP once a month, and in January, the place was crowded and I had to wait in a room full of sneezing coughing folks. And came down with a cold 5 days later. In March, said doc’s office is empty. (I.e., people are staying home with their colds.)

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Cranky Observer 03.22.20 at 5:59 pm

= = = Also the reactors didn’t really “explode”: the reactors themselves remained intact despite the meltdown. = = =

Whether or not the reactor vessels in Units 1, 2, and 3 technically remained ‘intact’ is a bit of a moot point; when the fittings at the bottom of a reactor vessel melt and molten corium comes oozing out (a “core on the floor” incident in the jargon) the reactor vessel portion of the containment system has failed.

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alfredlordbleep 03.22.20 at 7:27 pm

In Germany, Chancellor Angela Merkel has been placed under quarantine after a doctor who administered a vaccine to her on Friday tested positive for the novel coronavirus.

Convergence. Combining multiple concerns in one headline.

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