COVID COVID-19 Coronavirus Containment Efforts

[russ_watters]

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.
[snip]
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.

Yes, I don't want to speculate much on individual motivations, but suffice to say economic and just general societal disruption issues likely weighed heavily. But only vaguely and qualitatively.

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.

That is an issue of both law and business. Businesses - including sports leagues - essentially have no choice but to remain open until ordered to close. To do otherwise is financial suicide. So "recommendations" from government in that regard are totally pointless.

I'm not clear on what the powers of government are in this regard (the law side), but obviously governments can easily close government functions (such as schools). Ordering businesses to close is harder, but I'm sure there is a mechanism (or several), I just don't know what they are. The city of San Francisco is attempting it, though.

To that end; on Saturday the Mayor of Philadelphia suggested everyone should go out to eat at restaurants (and be sure to tip your wait staff!) and on Monday, the governor of Pennsylvania ordered all of them to close their dining rooms.

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.

Just to be clear: I also believe we are already in a recession. My question was whether the recession would still have happened without those government interventions.

 

[Ygggdrasil]

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.

A vaccine is not going to be widely available for another 1.5 years, and locking down the world for 1.5 years is not a viable strategy.

Rather, here's the rational for a 2-4 week lockdown as I understand it. We know that the virus has a long incubation time and the long inucbation time, combined with the ability of people with no or mild symptoms to spread the disease, contributed to its contagiousness (mathematical modeling studies estimate that 80% of new infections come from people who are undiagnosed).

By implementing a lockdown and social distancing for 2-4 weeks, we are able to halt the transmission of the disease and give carriers of the virus the chance to begin showing symptoms (the median incubation period for the virus is ~5 days, and https://annals.org/aim/fullarticle/2762808/incubation-period-coronavirus-disease-2019-covid-19-from-publicly-reported). Meanwhile, people appear to no longer be infectious ~ 10 days after they begin showing symptoms (though this study is still preliminary and has not undergone peer review). Therefore, a 2-4 weeks of lockdown and/or social distancing should enable us to identify infected individuals for testing and isolation (2 weeks) or eliminate most contagious individuals (4 weeks). These measures could decrease the number of infected greatly, enabling better tracking and quarantine of new infections (assuming widespread testing is available).

Furthermore, we are currently in the middle of a bad flu season, which is taking up a lot of hospitals' capacity to deal with respiratory infections. The nearer we get to summer and the farther away from flu season, the more capacity our healthcare system has to deal with COVID-19 cases.

Will this strategy work? It seems like it would require a global effort as eliminating the virus from one country would not be much help if it persists in other countries. However, there seems to be good evidence that social distancing measures can stop the spread of the pandemic diseases (e.g. from studies of measures taken during the 1918 flu pandemic)

Would the potential lives saved from the intervention be worth the economic costs? I'm not an economist, so I can't make that judgement. However, here's a case from a statistician that maybe we don't have sufficient data to make that call yet.

 

[Klystron]

@Ygggdrasil Thanks for posting this STAT article from post #1,285.

As I understand the premise, the author, an information scientist in my career field, essentially claims Insufficient Data. That if this virus had not been identified and heavily publicized, life would continue as usual for the unaffected.

If we had not known about a new virus out there, and had not checked individuals with PCR tests, the number of total deaths due to “influenza-like illness” would not seem unusual this year.

Information science requires strong skepticism but even as a senior citizen I question whether a virus that does not adversely affect young people should be considered an existential threat to our species.

The vast majority of this hecatomb would be people with limited life expectancies. That’s in contrast to 1918, when many young people died.

The deaths and consequences of the 1918 influenza epidemic remain shrouded in the data from World War I (1914 - 1918) where mobilizations and dislocations also led to increased exposure and transmission. Despite our improved diagnosis and data gathering abilities over 100 years later, the author appears pessimistic that actual infection data will be clearer.

 

[russ_watters]

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/

Thanks for that, it is aligned with a point I made a few weeks ago:

Reported case fatality rates, like the official 3.4% rate from the World Health Organization, cause horror — and are meaningless...

Projecting the Diamond Princess mortality rate onto the age structure of the U.S. population, the death rate among people infected with Covid-19 would be 0.125%. But since this estimate is based on extremely thin data — there were just seven deaths among the 700 infected passengers and crew — the real death rate could stretch from five times lower (0.025%) to five times higher (0.625%). It is also possible that some of the passengers who were infected might die later, and that tourists may have different frequencies of chronic diseases — a risk factor for worse outcomes with SARS-CoV-2 infection — than the general population. Adding these extra sources of uncertainty, reasonable estimates for the case fatality ratio in the general U.S. population vary from 0.05% to 1%.

The Diamond Princess also had a total of 3700 passengers and crew, or a 19% infection rate in a setting that was as close to perfect for disease transmission as can be imagined.

And on my recent point about economics:

A population-wide case fatality rate of 0.05% is lower than seasonal influenza. If that is the true rate, locking down the world with potentially tremendous social and financial consequences may be totally irrational. It’s like an elephant being attacked by a house cat. Frustrated and trying to avoid the cat, the elephant accidentally jumps off a cliff and dies...

 

[Rive]

Will this strategy work? It seems like it would require a global effort as eliminating the virus from one country would not be much help if it persists in other countries. However, there seems to be good evidence that social distancing measures can stop the spread of the pandemic diseases...

I'm not a big believer of this strategy. Wuhan after the lockdown lifted might still prove otherwise, but I think this thing will just stay with us. Just as the descendants/relatives of the 1918 flu still lingers around.

A vaccine is not going to be widely available for another 1.5 years, and locking down the world for 1.5 years is not a viable strategy.

The key there is the 'partial'. If the goal is not to immediately squash a free-spreading pandemic but to keep one at bay then there is some room to maneuver and adapt.

 

[vela]

Information science requires strong skepticism but even as a senior citizen I question whether a virus that does not adversely affect young people should be considered an existential threat to our species.

I don't think the concern is that the virus is going to wipe out our species. It's that if it's allowed to go unchecked, the severe cases may overwhelm the health care system, like what happened in Italy.

 

[OmCheeto]

I don't see how this is a deadly disease. Has the deathrate in wuhan increased disproportionately? Wuhan has a pop of 11 million people and so far only ppl who died who had the virus were old ppl.

For a serious deadly virus it seems to have a low deathrate compared to the average daily global deathrate.

Perhaps this will answer your question.
This is an extrapolation of the growth of deaths each day, plotted alongside the number of normal number of deaths each day.

The COVID19 plot:

1. assumes everyone on the planet will be infected​

2. assumes the "case fatality rate" turns out to be 1%​

3. excludes data from China​

I think the graph is open to interpretation.
One thing is a fact: 60 million people were going to die this year, mostly from old age, regardless.

--------
reference material
curve fit for COVID19 death rate is derived from 2/21/2018 thru 3/15/2018 data

 

[BillTre]

It's that if it's allowed to go unchecked, the severe cases may overwhelm the health care system, like what happened in Italy.

If it were to overwhelm the health care system, then the death rate would go up for the strongly affected people, increasing the overall death rate and the overall numbers of deaths.

It would likely also lead to increased infections of the health care personnel due to their working under more difficult conditions, which in turn would further stress the health care system and further exacerbate problems for the sick.

Classic vicious cycle and something that should be avoided if possible!
That is why the flatten the curve strategy has received so much attention.

 

[sqljunkey]

OmCheeto I don't understand your plot very well. You said one fact is true and that is that 60 million people are going to die this year for certain, mainly of old age. So I divide 60 million by 365 days and I get an average of 164,383 of mostly old people dying on average daily. If I multiply that by 60 days for the two months we had this year, jan and feb, I get 9,863,013 people who died mostly of old age on average.

Has this number drastically changed from last year, during the same months? By at least a million, I know the aging population is growing globally, and perhaps that may affect these numbers.

So far we know that less than 10,000 people who had the corona virus who were also in their twilight years have passed away during these two months. If I divide that by the 10 million people who already died, who were mostly old, I get 0.001%.

I did this in another post already, but I will do it here also for reference, Wuhan has a population of 11 million and statistics show that 7 out of 1000 people die a year in china, mostly of old age. If I extrapolate that to Wuhan, in a rather crude way I get that 77,000 people die on a yearly basis in Wuhan mostly of old age. Dividing that by twelve and multiplying the answer by 2 months gets me 12,833 people who probably died of old age in Wuhan this or last year during the first two months on average.

Dividing that with the current GLOBAL, not local to Wuhan, but GLOBAL corona death reported numbers gives me, 10,000 / 12,833 = 0.78 or 78%. So if we were to use this number even, which is probably a ridiculous number, I find that it is less than the 100% total of people who probably died in Wuhan these past months of old age. Even here I see that, the total corona deaths have been less than expected in Wuhan alone.

But I don't know the numbers of total death in Wuhan for these two months, I don't know who keeps track of them. Maybe the doctors are and are not showing it. Maybe you have it OmCheeto, and if we get it we can see better whether this virus has indeed claimed more lives than the usual expected death rate in the aging population.

 

[OmCheeto]

OmCheeto I don't understand your plot very well.
...

sqljunkey I don't understand the "..." portion of your post.

hmmm...

 

[sqljunkey]

omCheeto, give me the number of deaths in the past two months in Wuhan. Less people probably died than last year in the last two months. Because of increased life expectancy, but I don't know since I don't have the numbers.

 

[Dr. Courtney]

The flatten the curve strategy makes sense to me, but some of the government efforts don't compute:
1. The mayor of New Orleans didn't just close bars and restaurants, she banned transportation of alcohol and firearms. Prohibition ain't going to help.
2. Many counties in the SF Bay area have given "shelter in place" orders for THREE weeks. Folks are already resisting. Orders need compliance to work.
3. When issuing recommendations and orders, governments keep saying "this is the new normal", "it might last longer." Flattening the curve shouldn't require extreme measures longer than a few weeks. First of all, we'll know in a couple weeks if the curve has been flattened in a given geography. Secondly, compliance will dwindle the longer measures are extended.

 

[phinds]

I have it from a so-far accurate source (he told me the NY restaurants would be closed then day before Cuomo closed them) that Cuomo is going to shut down the NY borders to all but essential travel (mail, food, gas, etc deliveries) in and out. I can't decide whether I hope that's just a rumor or think it's a good idea. I'm leaning to good idea if it doesn't go on for too long. What do you all think?

Apparently the closing of borders must have been a NYC Mayor De Blasio idea that was at least mooted because it was specifically shot down by NY State Governor Cuomo in this statement today saying that De Blasio does not have the authority to call for a "shelter in place" order for the city, as that would have to be statewide and he (Cuomo) has no plans to do that or shut the state borders or any city borders.

 

[OmCheeto]

omCheeto, give me the number of deaths in the past two months in Wuhan. Less people probably died than last year in the last two months. Because of increased life expectancy, but I don't know since I don't have the numbers.

pffft!
Do your own maths and research.
Interpolate, where necessary.
And include references for data.

Otherwise, it's the big "IGNORE" button for you...

 

[sqljunkey]

I thought you had the numbers. You made a plot. I saw an exponential curve going up. sorry.

I hope marco rubio, who is against the marshall law has these facts and figures at least.

 

[BillTre]

Here is a Science magazine news review article on the seasonality of diseases.
Its a complex problem (many diseases with different seasonality characteristics). Different diseases peak at different times of the year.

There several possible reasons that different diseases may do better or worse during different seasons, such as temperature of humidity affecting different diseases differently, differences in the immune system during different seasons, different structures of a virus (have a membrane of not).
Some corona viruses seem to "go away" later in the year, which is encouraging for our current situation, but far from definitive.

 

[StoneTemplePython]

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.

I think you have some of the better posts on this thread, but this can't possibly be right. Estimates of infections of spanish flu are $\frac{1}{2}$ billion and estimates of deaths are $20-100$MM. Death estimates in USSR alone in WWII are $20-30$MM, including an estimated $5-7$MM with St Petersberg. Spanish flu cannot be an order of magnitude higher than all European deaths in WWII.

 

[BillTre]

According to this Science magazine news article, social isolation can also have negative effects on humans:

Over long periods of time, social isolation can increase the risk of a variety of health problems, including heart disease, depression, dementia, and even death. A 2015 meta-analysis of the scientific literature by Julianne Holt-Lunstad, a research psychologist at Brigham Young University, and colleagues determined that chronic social isolation increases the risk of mortality by 29%.

Technologically based interactions may overcome some of these problems.

Just another of the many facets of dealing with the corona virus problem.

 

[vxiaoyu18]

Are y’all still locked down?

My home is not in wuhan area, so I began to work from February 13. When I'm at home, I basically don't use any protective gear. To avoid going near others, I only wear a mask when I go shopping in the supermarket. Most of our young people use mobile phones for payment. Wuhan has been closed since January 23, and the blockade of nearby cities has been gradually lifted. Our company's colleagues near wuhan have come out to prepare for work, and once they arrive at the workplace, they will still be subject to 14 days of self-isolation. They can't start work until they have no symptoms.

------news-------
Recently, the number of newly diagnosed pneumonia in wuhan has remained in single digits for several consecutive days. Li lanjuan, a member of the Chinese academy of sciences, said in an interview with China news service on Thursday that the epidemic prevention and control in wuhan has entered a "sprint" stage. The number of new diagnoses is expected to be zero by around March 20, and will be monitored for another two weeks. If there is no more newly diagnosed patients, wuhan can gradually return to work and labor.

 

[Vanadium 50]

I get an average of 164,383 of mostly old people dying on average daily. If I multiply that by 60 days for the two months we had this year, jan and feb, I get 9,863,013 people

Good heavens. Please use significant figures. Think of it as an opportunity to show off your numeracy.

The average Chinese death rate is 7.402 per 1000 people per year. The population of Hubei is 58 million, so the number of deaths in the last two months is something like 72,000, so Coronavirus is a 5% effect - i.e. 7.4 is now more like 7.8. (China last saw a death rate at that level in 1976, however, extrapolations based on the aging population suggest that number will again be reached around 2023).

Italy's death rate is about 10.5 (it's population is, on average, older than China's). It has 60M people, So over the last month, about 53,000 people died, so again, it's about a 5% effect on the death rate.

A 5% effect in the US death rate over two months is 24,000 additional deaths. (This is not a prediction of any sort; it's merely to provide context) That would be a ~50% uptick in influenza/pneumonia deaths (but concentrated in two months and not spread over 12) and by itself around #22 (Leukemia) or #23 (Falls) in causes of death.

 

[vxiaoyu18]

omCheeto, give me the number of deaths in the past two months in Wuhan. Less people probably died than last year in the last two months. Because of increased life expectancy, but I don't know since I don't have the numbers.

As of March 17, wuhan:
Cumulative diagnosis: 50004
Cumulative death: 2,480
-------------
Outbreak statistics from around the world can be found at:
https://voice.baidu.com/act/newpneumonia/newpneumonia/?from=osari_pc_1

 

[wukunlin]

There are still new cases in Wuhan, coming out of quarantined residential areas, which is worrying, thought they got them all.

 

[Klystron]

I don't think the concern is that the virus is going to wipe out our species. It's that if it's allowed to go unchecked, the severe cases may overwhelm the health care system, like what happened in Italy.

Concur. I intended to react to the existential societal implications of the Stat article, not the existence of humanity as a species. Certainly strained health care affects our entire society; a subject addressed in other articles.

A virus that kills primarily the elderly while not affecting young people in large numbers should not have a deleterious effect on our species; particularly now that knowledge is preserved beyond individual living contributors.

I also acknowledge the issues expressed by @russ_watters and other posters that the economic and social repercussions of mitigation efforts will affect young workers, students and children now, and in their future, even if the virus does not directly affect their immediate health. Thanks.

 

[sqljunkey]

I agree that this is all numerology. But how did you get to the 5% for the Hubei population vanadium? Because 58,000,000 multiplied by 0.007402 is equal to 429,316 and if I multiply that by 2/12 I get 71,552 which is roughly what you said, 72,000.

And of that 72,000 roughly 3,000 were found to have the virus prior to death.

And I guess the total number of deaths in Hubei could have also gone down, the world death rate has gone down from 7.8 to 7.5 for 1000 persons between 2010 and 2017 because of advances in the medical field. Which is a decrease of 0.042 every year if I were to take the simple yearly average. Now if I was so bold to extrapolate that to China's deathrate per 1000 person and also assume, for sake of argument that your 7.402 rate was last year's rate I will end up with a deathrate for this year of 7.361 for every 1000 live persons, which after tedious calculations would indicate a 2020 deathrate of 426,938 in Hubei which in turn is 71,156 for the two last months. Which would be a small but nonetheless significant decrease in deaths.

So in lieu of actual numbers I'm reduced to numerology which does show a decrease in deaths in china as of now.

 

[sqljunkey]

https://www.cdc.gov/heartdisease/facts.htm

 

[russ_watters]

I think you have some of the better posts on this thread, but this can't possibly be right. Estimates of infections of spanish flu are $\frac{1}{2}$ billion and estimates of deaths are $20-100$MM. Death estimates in USSR alone in WWII are $20-30$MM, including an estimated $5-7$MM with St Petersberg. Spanish flu cannot be an order of magnitude higher than all European deaths in WWII.

Thanks, and you're right; it looks like I may have mistaken the number ill for the number dead. Those numbers put the Spanish Flu actually in close alignment with each other. The worst (best?) I could get to by scaling against the population is perhaps double.

You also imply substantial local/national differences, which is valid as well. Right now the dire projections people are making for Europe and the US don't seem to be in alignment with what happened in China and South Korea, the only two countries I'm aware of where the virus is declining (though that may be an anomaly in S. Korea). China has only had 3,200 deaths in a population of 1.86B so far, a number they hit by 2am on a normal day. If they are all concentrated in Wuhan city, of 11 million (I'm not sure of the geographic distribution), that's a normal couple of weeks. If the total flatlines at 4,000 this ends up being kinda bad for Wuhan (basically a worse than average flu season) but an insignificant statistical blip for the whole of China. It's hard to get from there to Spanish Flu for the rest of the world unless for some reason the rest of the world does a substantially worse job of containment than China did.

[edit] ...oh, I see that's the thrust of @Vanadium 50's post.

 

[kadiot]

There are still new cases in Wuhan, coming out of quarantined residential areas, which is worrying, thought they got them all.

Second wave?

 

[wukunlin]

Second wave?

Not sure, probably people without symptoms living among these places.

 

[morrobay]

uh... myth busted
View attachment 258830

So if viruses were on the hands then it is assumed they touched a surface with the virus with transfer, then the risk of infection by touching face. While it is of course in order to take precautions washing hands. It is questionable if there would be enough of the virus to infect with this chain of indirect contacts. The CDC has reported no documented infections from surfaces. https://www.cdc.gov/coronavirus/2019-ncov/community/election-polling-locations.html
See middle first paragraph

 

[kadiot]

A BIT OF HOPE: PLAQUENIL, the anti-malaria medicine, could help treat COVID19 patients; lab trials are promising, declares SANOFI .