COVID COVID-19 Coronavirus Containment Efforts

[wukunlin]

And if we have to follow complete lockdown like in Wuhan. We still have to contend with 80,000 infections and 3000 deaths?

That will depend on how many people are already infected and running around before the lockdown happened. Unfortunately . Wuhan was such a mess because the lock down was a bit late, and it was new Chinese New Years where people are seeing each other and there are lots of travellers through Wuhan.

 

[vxiaoyu18]

Please scrutinize if the following procedure is correct. In our complete lockdown we have this guideline:

My English is not good, is to use the translation software to chat with us. Each country has the basic conditions of each country. Wuhan in our country is a relatively large city in China, where there are many community service centers or community property management offices, which serve their respective communities. So after the outbreak, they worked with the government and the police to serve the community, and in some places they collected the demand from the instant messaging software, and then they purchased it and distributed it to the families. Also some places is every two days can come out a purchase, come out must wear good mask to measure the temperature, some places come back when the spray disinfection can go into the community. Your country's situation is different, what measures to adopt to block the virus, to follow the advice of your country's medical experts. Do not gather activities, go out wearing masks, frequent hand washing is the most basic method in all countries.Droplets are the most contagious, and masks are worn for mutual safety.

 

[PeroK]

And if we have to follow complete lockdown like in Wuhan. We still have to contend with 80,000 infections and 3000 deaths?

That's only sounds bad if you ignore the normal death rate for a large country. It's about 1400 people per day in the UK. Half a million people die every year in the UK. It must be much the same in Italy.

If the UK or Italy could get out of this with only 3000 (additional) deaths, that would be like a miracle now.

The risks are hundreds of thousands (or even millions) of additional deaths per country and/or complete economic meltdown - which may take large parts of the health service with it.

 

[chirhone]

My English is not good, is to use the translation software to chat with us. Each country has the basic conditions of each country. Wuhan in our country is a relatively large city in China, where there are many community service centers or community property management offices, which serve their respective communities. So after the outbreak, they worked with the government and the police to serve the community, and in some places they collected the demand from the instant messaging software, and then they purchased it and distributed it to the families. Also some places is every two days can come out a purchase, come out must wear good mask to measure the temperature, some places come back when the spray disinfection can go into the community. Your country's situation is different, what measures to adopt to block the virus, to follow the advice of your country's medical experts. Do not gather activities, go out wearing masks, frequent hand washing is the most basic method in all countries.Droplets are the most contagious, and masks are worn for mutual safety.

In the initial days of lockdown in Wuhan. It's also like this (where crowds converge at checkpoints)?

https://newsinfo.inquirer.net/1243304/checkpoints-lead-to-crowds-chaos

 

[russ_watters]

As I understand the Chinese position it is that once a region is cleared there are literally no active cases of the virus remaining. And, this could be achieved globally. The virus could be completely eliminated.

However, the news reports in the UK suggest that there is no way out of a national lockdown. As soon as we come out again, the virus may flare up again.

Also, it seems, the longer a national shutdown lasts, the harder it would be to sustain the emergency health measures. Sooner or later vital supplies and government money must run out - if people generally are not at work.

If it takes 18 months, say, to find a vaccine, I find it hard to believe that western society could survive that long in lockdown. It's a difficult question whether that represents something worse than a national pandemic.

Yes, these are the sorts of questions I think need to be answered. In my area, most shutdowns have been announced to have 2-weeks duration. That's just not realistic. Two months? We're probably still ok. But 18 monts? Yes, that's civilization-collapse level of disruption.

 

[vxiaoyu18]

Luckily, our government closed the city before the Spring Festival, otherwise the Spring Festival is the peak of Chinese passenger flow, it will be out of control. We still don't have enough care and care for the new virus. Human beings want to live in peace with nature, and there is still a lot to learn.

 

[vxiaoyu18]

If everyone cooperate with the government and epidemic prevention departments, do not use so long, the virus infection cycle is generally within 24 days, as long as we stay together for 3-4 weeks, can isolate the infected people received hospital treatment, the hospital outside the people are much safer, can gradually resume work. So, this needs everybody's joint effort very much. I also spent a month in isolation at home and have been back at work for over a month now. Wuhan area is also gradually lifting the blockade. If the infection in your country is not serious, it is feasible to isolate for 2 weeks. In our country, people who come out from the key epidemic areas are also arranged to be quarantined for 2 weeks, and then they can move freely. Don't be afraid of this virus, just try to do a good quarantine.

 

[russ_watters]

Various US agencies put the cost of a human life at several millions.
Without a slowdown in the spread and overwhelmed hospitals the US will probably look at millions of deaths, or tens of trillions of USD by that metric.

Ok, well at least that's some numbers; ~$5-$10M. We'll use the top one.

For additional reference; the flu kills around 35,000 people in the US every year (highly variable). Can we say that flu prevention measures save an additional 100% or another 35,000? At $10B direct and $87B indirect costs, that's $285,000/$2.4M per death or life saved. We're erring on the side of life there (cost savings is less than the value placed).

The Great Recession stimulus package was $830B and the recession itself had a lifetime cost of $24 trillion ($70,000 ave per American, 350M Americans).
https://www.washingtonpost.com/busi...4b76ba-af10-11e8-a20b-5f4f84429666_story.html

In other words, according to the $10M value, it would be worth avoiding another Great Recession to let 2.4 million Americans die. But by comparison to the flu prevention benefit, it would be worth allowing 10 million deaths.

I'm not saying we should, I'm just saying it should be talked about. And part of the difficulty in that discussion is that the costs and lives are mostly separate groups of people.

 

[wukunlin]

China is going to start Human trials of vaccines.

https://www.physiciansweekly.com/china-gives-go-ahead-for/

 

[mfb]

In other words, according to the $10M value, it would be worth avoiding another Great Recession to let 2.4 million Americans die.

I'm quite sure we'll get a worldwide recession no matter what. It's not like a large share of the population being sick at the same time would come without any impact. The question is how strong it will be. Do you have estimates for different scenarios?

But 18 monts? Yes, that's civilization-collapse level of disruption.

Europe survived 6 years of world war. And yes, "your workplace was hit by a bomb last month, your neighbor's house was hit last week, your house might be hit any day as well" is more disruptive than "you need to keep some distance to others in public". My grandparents lived through this.

Here is an up to 2.2 million death estimate if the US does nothing serious.

 

[kyphysics]

By what mechanism could this virus stop spreading and die out? A reduction in new cases each day means that the curve was flattened. Fewer new cases per day, does not necessarily mean fewer cases in the indefinite future.

Maybe not die out, but lockdowns/social distancing/self-isolation hope to buy time for:

a.) a vaccine
b.) having more hospital beds and respirators capable of dealing with a potential giant fallout
c.) having less people get infected all at once

Even if the SAME # get infected over time, there's a difference between it happening all in 2 months vs. over the course of 12 months (spread out evenly).

We cannot handle the # of people needing hospital beds and critical care if too many get infected and need hospitalization at all once. That's why we need to flatten the curve. If there are 100 hospital beds and 150 COVID19 patients needing them + gunshot victims + burn victims + workplace injury people, etc. that could jeopardize human life at a significant scale.

If we buy time, we can have it ideally so that people who need hospital services don't all go in at once and overwhelm the institutions.

 

[kadiot]

Oh no!

https://www.wsj.com/articles/singap...oronavirus-cases-11584445836?mod=hp_lead_pos3

 

[chemisttree]

The checkpoint could use big sack to cover each person and insert the thermometer in the anus. But the problem is, the vagina is very near the anus. Some as short as 1 inch. If there is wrong insertion, it could cause Urinary Track Infection.

Hence it is decided to initiate Wuhan style Total Lockdown.

Your logic is inescapable.

 

[anorlunda]

I understand flattening the curve. I'm trying to judge the claim that 40-70% of all people will be infected eventually, with corresponding deaths. I'm also trying to judge the news that the UK says that the crisis and the lockdown will last for a year; whereas people here keep saying 2 weeks.

A vaccine 12-18 months into the future would cut it short, but that's a long way away.

Dr. Anthony Fauci said on TV that he hoped to both flatten the curve and shorten the duration. That's the opposite of flattening the curve which prolongs the duration. I'm trying to judge the credibility of that claim. What possible actions both flatten and shorten?

 

[russ_watters]

I'm quite sure we'll get a worldwide recession no matter what. It's not like a large share of the population being sick at the same time would come without any impact. The question is how strong it will be. Do you have estimates for different scenarios?

Well, the actions taken so far may cause the recession (and there's a huge difference between "a recession" and "The Great Recession"), but I don't think it is self-evident that the "do nothing" case would have. The flu costs about $100B a year, mostly over 1 quarter, and doesn't cause a recession every year. Annual GDP is about $19.4 T and growth has been 2%, so spread over 2 quarters, it would have to cost at least twice what the flu costs in lost productivity and direct spending. Maybe it would have,

Europe survived 6 years of world war. And yes, "your workplace was hit by a bomb last month, your neighbor's house was hit last week, your house might be hit any day as well" is more disruptive than "you need to keep some distance to others in public". My grandparents lived through this.

Wars are local and severe impact, so it is hard to judge them in such qualitative terms -- but I don't agree that "Europe survived".

In terms of global deaths statistics impact, the Spanish Flu was much, much worse; something like an order of magnitude worse. In terms of economic impact, I'm not sure. I haven't looked at the cost of WWII or Spanish Flu.

 

[chemisttree]

I'm in guangzhou, China. On the second day after academician li lanjuan proposed to the state on January 22 that "wuhan must be closed down", China resolutely took measures to close down the city, which prevented the outbreak of the epidemic in the first place. Thanks to the right decision, the outbreak in our country is now pretty clear and almost under control. So the best way to deal with this outbreak is for everyone to stay at home and be quarantined and work together to stop the source of infection and get this virus over with. Our country and people are very friendly and will try our best to help people around the world fight the virus during this time of crisis. Good luck to all of you.

Are y’all still locked down?

 

[anorlunda]

if the US does nothing serious.

What are Sweden and Switzerland doing that's more serious than the US? I just checked svd.se and saw nothing serious on the front page.

 

[kadiot]

There's been so much flip-flopping about airborne vs droplet infection.

Let's just assume that it's airborne so that we don't miss out on any safety precaution.

https://www.cnbc.com/2020/03/16/who...udy-shows-coronavirus-can-survive-in-air.html

 

[atyy]

I understand flattening the curve. I'm trying to judge the claim that 40-70% of all people will be infected eventually, with corresponding deaths. I'm also trying to judge the news that the UK says that the crisis and the lockdown will last for a year; whereas people here keep saying 2 weeks.

A vaccine 12-18 months into the future would cut it short, but that's a long way away.

Dr. Anthony Fauci said on TV that he hoped to both flatten the curve and shorten the duration. That's the opposite of flattening the curve which prolongs the duration. I'm trying to judge the credibility of that claim. What possible actions both flatten and shorten?

I think we'll have to see what happens when China starts relaxing its measures. Will things bounce back worse than before, or will relaxing some measures with strengthened contact tracing and quarantines of close contacts be able to keep things under control. If it is the latter, then in a sense the curve would have been flattened and the duration shortened. For example, could they switch to something more like the South Korean strategy?

 

[chemisttree]

Europe survived 6 years of world war. And yes, "your workplace was hit by a bomb last month, your neighbor's house was hit last week, your house might be hit any day as well" is more disruptive than "you need to keep some distance to others in public". My grandparents lived through this.

I don’t think so. Russ was referring to an 18 month lockdown. Lockdown means nobody working. Nobody making anything.

Farming? Forget it.
Mining? Forget it.
Transportation? Forget it.
Electrical generation? Forget it.

No, your grandparents didn’t live through an 18-month total lockdown like this.

 

[chemisttree]

Simulations for the spread of a coronavirus.

https://www.washingtonpost.com/graphics/2020/world/corona-simulator/

 

[DennisN]

What are Sweden and Switzerland doing that's more serious than the US? I just checked svd.se and saw nothing serious on the front page.

I can't speak about Switzerland, but here in Sweden we haven't gone into a major lockdown yet. But it has now been recommended that high schools, colleges and universities should be temporarily closed and students should study at home via the computer. I don't rule out that we could come to a point where a complete lockdown would be needed, but our government estimates that we are not at that point yet.

Even if people reading this may be aware of it, I'd like to say that comparing Sweden or Switzerland to the entire US may not be entirely useful. The US is much, much bigger and has got a much larger population. I think it is better to compare Sweden to a US state. But I don't know which one. Our population is about 10 million.

 

[chemisttree]

Even though you probably are aware of it, comparing Sweden or Switzerland to the entire US may not be entirely useful. The US is much, much bigger and has got a much larger population. I think it is better to compare Sweden to a US state. But I don't know which one. Our population is about 10 million.

That would be Georgia or North Carolina. Wow! I must be infected and it’s affecting my brain. Now I’m comparing Georgia and North Carolina to Sweden.

 

[gmax137]

I think it is better to compare Sweden to a US state. But I don't know which one.

Now I’m comparing Georgia and North Carolina to Sweden.

yeah, I'd go with Minne-soota

 

[Ygggdrasil]

But that doesn't change the fact that -as far as I can tell - weighing the economic cost hasn't been part of the conversation at all.

People are still talking about the lifetime of economic damage done to millennials by the great recession. I haven't heard anyone say the same for the next generation.

If one truly believes this disease would kill tens of millions of people, then it is probably worth "containment at all costs", but only probably, and it should be said: "sorry guys, we know we are likely dooming you to a lifetime of economic underachievement/hardship, but we believe it is worth it."

One could argue that until maybe a week ago, decision makers had been weighing too heavily on the side of avoiding economic costs (I'm speaking mostly from the perspective of decisions made in the US), and that has contributed to the point we are at now. Major sports leagues were going against recommendations to hold games without fans right up until the point that a player in one of the leagues was diagnosed with the virus, which forced the NBA to shut down, and other leagues followed. Similarly, the Presidential administration had seemed to focus mostly on downplaying the risks of the Coronavirus to avoid panicking the markets versus warning the nation of the potential for severe disruption.

However, while there has been a lot of news coverage over the potential health consequences of the coronavirus, I agree that I have not seen too much coverage forecasting the potential economic consequences, so I do agree that there should be more discussion of the costs/benefits.

I'm quite sure we'll get a worldwide recession no matter what. It's not like a large share of the population being sick at the same time would come without any impact. The question is how strong it will be. Do you have estimates for different scenarios?

I agree here. The economy is global and interconnected. The Coronavirus has already done huge amounts of damage to the Chinese economy, and the effects of the virus and lockdowns in Europe are likely damage the global economy further, so this would have to also be considered in judging the effects of policy and its effects on the economy.

Edit: for those skeptical of the current response to the coronavirus, here's a good read: https://www.statnews.com/2020/03/17...e-are-making-decisions-without-reliable-data/

 

[Ygggdrasil]

There's been so much flip-flopping about airborne vs droplet infection.

Let's just assume that it's airborne so that we don't miss out on any safety precaution.

https://www.cnbc.com/2020/03/16/who...udy-shows-coronavirus-can-survive-in-air.html

STAT News had a useful piece on the issue:

Now there are conflicting reports on whether the new Coronavirus can. The studies suggesting that it can be aerosolized are only preliminary, and other research contradicts it, finding no aerosolized Coronavirus particles in the hospital rooms of Covid-19 patients.

The weight of the evidence suggests that the new Coronavirus can exist as an aerosol — a physics term meaning a liquid or solid (the virus) suspended in a gas (like air) — only under very limited conditions, and that this transmission route is not driving the pandemic. But “limited” conditions does not mean “no” conditions, underlining the need for health care workers to have high levels of personal protection, especially when doing procedures such as intubation that have the greatest chance of creating Coronavirus aerosols. “I think the answer will be, aerosolization occurs rarely but not never,” said microbiologist and physician Stanley Perlman of the University of Iowa. “You have to distinguish between what’s possible and what’s actually happening.”

https://www.statnews.com/2020/03/16/coronavirus-can-become-aerosol-doesnt-mean-doomed/

In other words, the precaution largely applies to health care workers as certain medical procedures performed on people in respiratory distress can create aerosolized virus. In most everyday situations, however, the virus is unlikely to spread through aerosols. Indeed, contact tracing of known infected individuals provides very little evidence of significant amounts of spread of the virus through aerosols. Again, from the STAT news piece:

“If it could easily exist as an aerosol, we would be seeing much greater levels of transmission,” said epidemiologist Michael LeVasseur of Drexel University. “And we would be seeing a different pattern in who’s getting infected. With droplet spread, it’s mostly to close contacts. But if a virus easily exists as an aerosol, you could get it from people you share an elevator with.”

According to the Centers for Disease Control and Prevention, that is not happening. Earlier this month, CDC scientists reported that the rate of symptomatic infection among a patient’s household members was 10.5%. The rate among other close contacts was 0.45%. In the case of one particular patient, none of his five household members, although continuously exposed to the patient during the time he was isolated at home, tested positive for the virus.

Even if the virus infects only a small fraction of those who come into contact with it, the extremely low rate among close contacts and the absence of infections in some household members of patients suggests that it rarely exists as an aerosol in most real-world situations.

 

[Ygggdrasil]

Italy is under comlete lockdown but it records 350+ deaths in single day. How is virus transmitted during complete lockdown? Our groceries and essentials remain open (all else are close) and there are long lineups with customers close to one another. Is this the mode of transmission in Italy?

The virus has a quite long incubation period, so even after a complete lockdown, those infected before the lockdown will begin to show symptons during the lockdown. More people getting sick during the lockdown does not mean that the lockdown has failed; it just reflects the incubation preiod of the virus.

Here's a paper that studies the incubation period of the virus:

There were 181 confirmed cases with identifiable exposure and symptom onset windows to estimate the incubation period of COVID-19. The median incubation period was estimated to be 5.1 days (95% CI, 4.5 to 5.8 days), and 97.5% of those who develop symptoms will do so within 11.5 days (CI, 8.2 to 15.6 days) of infection. These estimates imply that, under conservative assumptions, 101 out of every 10 000 cases (99th percentile, 482) will develop symptoms after 14 days of active monitoring or quarantine.

https://annals.org/aim/fullarticle/2762808/incubation-period-coronavirus-disease-2019-covid-19-from-publicly-reported

This means that people who were infected before the lockdown began would begin showing symptoms up to about two weeks after the beginning of a lockdown.

This also means that if you start showing symptoms of the disease, it's not due to anything you did yesterday, but what you were doing ~5 days ago.

 

[BillTre]

1.) Contagion (virus movie)

I highly recommend this movie for non-scientists. It parallels the corona virus situation pretty well (different symptoms, but similar problems with spreading, lack of supplies and hospital space).
I watched it with my wife (not a scientist) and afterward she said that it helped a lot for her in making sense of the current situation.
Probably helped that I was watching it with her and could answer questions.

The movie is on HBO now which makes it easy to watch if you get HBO.

 

[DennisN]

That would be Georgia or North Carolina.

Interesting!
And regarding land area, I just checked and saw that Sweden is about the same size as California.
But Sweden has much worse weather and it's way much colder here!

 

[Rive]

Oh no!

Well, not exactly unexpected.

We do know that a lockdown is effective and can squash an outbreak. So the task is, to maintain some kind of partial lockdown with acceptable economic consequences what can keep the number of cases within the manageable level - till some vaccine becomes available.