COVID COVID-19 Coronavirus Containment Efforts

[kyphysics]

The test that @peanut was referring to was (I think) a test related to immunity (but one may not be using it as the sole test on which a decision is made; and one may be using it for diagnosis, rather than to certify immunity). In principle, one could also get a false positive on an immunity test, which would make one think one is immune when one is not. So if one is trying to use it to certify immunity, one would also like to know the false positive and false negative rates.

Oh, I see.

If so, that's a bit more concerning. The article I posted, though, was on false negatives on a COVID-19 carrier test (not immunity).

I do think doctors seeing OBVIOUS COVID-19 symptoms + a negative on the carrier test should instruct patients to act as if they have it. From a spreading standpoint, that helps. From a coding standpoint, it's harder to say what to do. Maybe come up with a new category: "negative, but presenting with positive symptoms" ??

 

[atyy]

What makes you think that economic judgements are not value judgements? A few simple ones may not be, but most are.

I mean the terms in the context of the discussion. In the broadest sense, all judgements are value judgements, so it doesn't make sense to say that any judgement is not a value judgement.

 

[phinds]

I mean the terms in the context of the discussion. In the broadest sense, all judgements are value judgements, so it doesn't make sense to say that any judgement is not a value judgement.

I don't see where context has anything to do with it. Can you be more specific? That is, what part of the discussion could make an economic judgement not be a value judgement? I'm not trying to extend this as an argument, and I'm willing to be wrong, but I can't see it.

 

[atyy]

I do think doctors seeing OBVIOUS COVID-19 symptoms + a negative on the carrier test should instruct patients to act as if they have it. From a spreading standpoint, that helps. From a coding standpoint, it's harder to say what to do. Maybe come up with a new category: "negative, but presenting with positive symptoms" ??

The protocol varies from place to place, and from time to time as we get a better idea of how to handle things. In a sense most cases already escape a little bit, because people are infectious just before they become symptomatic and when they have only mild symptoms, at which point they may not realize that they should be isolated as a precaution. Here is an interesting article about a case where they did multiple tests to ensure a true negative, and all the while keeping the person in isolation until they were pretty sure it wasn't COVID-19: https://www.asiaone.com/singapore/n...ed-covid-19-case-shares-behind-scenes-details

 

[kyphysics]

It depends on the country. You can look at China and South Korea for examples that seem to be succeeding. Here in Singapore, we've been open to various degrees most of the time, until last week when it seemed that there might be an increase in the number of cases beyond the reach of contact tracing. The idea is that the latest much stricter measures can start to be relaxed when that threat seems to have passed. Of course there's a long way to fully relaxing all measures. For example, elective medical procedures have been postponed for many months now - eventually they must resume, but only when it seems there is not a threat on supplies for medical emergencies.

The stricter measures buy you time to prepare so that you can reopen. The measures don't work unless people understand them and there is buy-in from society at large. Some of the things that might be done to prepare to relax social distancing are to increase contact tracing capability (maybe the effort by Apple and Google to coordinate the contact tracing apps will help), and build up medical supplies.

Surprised Singapore got a spike in cases (233 on April 12: https://www.cnbc.com/2020/04/13/coronavirus-live-updates.html).

Your country has been a model thus far (still is). Hoping not a trend and things go back down.

 

[kyphysics]

Yes, which is why I don’t think we can afford as much as a two month lockdown. That is too long for people to be out of work. People in Italy are already organizing raids on grocery stores in Italy. It could get very ugly in the US with such an armed population.

a.) Can we address that with adequate stimulus checks to every American?
b.) Can we have a lockdown, but with a delivery (of goods) infrastructure built?

What I mean for the second point is, suppose everyone stays in except essential workers. Could we have a delivery system, whereby people order what they need from home and just have delivery workers bring it to them (instead of going out)?

I will say that the biggest issue in my mind is how to address schooling interruptions. I cannot envision a prolonged lockdown, given the need for students to continue on with their educations. College students, in particular, are in no-man's land. No job. Yet, technically adults and not supported by their parents anymore. Online education might not work well for some students.

 

[atyy]

Surprised Singapore got a spike in cases (233 on April 12: https://www.cnbc.com/2020/04/13/coronavirus-live-updates.html).

The spiking began some time ago. Most of it is due to construction workers living in dorms in which social distancing is very difficult. So as temporary measures, new housing has been set up eg. housing some of them in military camps, so that social distancing is possible. It's a huge logistical effort as there are 20,000 workers. My own guess is that this part of the spike is not that worrying, as the cases are all linked by contact tracing, and manageable in time. Also, construction workers tend to be fit (but there is one worrying case from much earlier, a 39 years old construction worker who was (is?) in critical care for months now - his wife in Bangladesh gave birth while he was (is?) still under sedation - all of us really hope he gets to see his baby boy and makes a full recovery).

The more worrying part is that there is also an increase in the number of cases where contact tracing does not find a link to earlier cases. This suggests things may be getting out of control, which is why we now have everyone (except essential businesses) working from home.

Your country has been a model thus far (still is). Hoping not a trend and things go back down.

Yeah, me too.

 

[atyy]

I don't see where context has anything to do with it. Can you be more specific? That is, what part of the discussion could make an economic judgement not be a value judgement? I'm not trying to extend this as an argument, and I'm willing to be wrong, but I can't see it.

Not what I was thinking and not important - it's just semantics - let's just change terminology to try to be clearer about what we mean - the discussion is about how to weigh the things (that are not necessarily independent) like lifespan, ability not to collapse the health system, access to healthcare, ability to earn a salary, ability to go to concerts, in different age groups across the whole population and over various time scales.

 

[russ_watters]

I'm not sure that is universally the case - if by value judgements we mean non-economic judgements.

Yes, I believe @bhobba was referring to moral value, and that's what I was responding to.

I would be extremely surprised if the actions taken in China and South Korea did not have a large element of economic consideration - bring or keep things under control so that as much of normal daily life - normal economic activity - can go on.

I guess it's possible, but it would surprise me. In the West we're seeing people even recently essentially claiming the moral-to-economic value conversion of a human life is infinity dollars. In that way, it doesn't matter that the actionable death estimates a month ago were probably wrong by a factor of 10: the financial value of saving 200,000 or 2,000,000 lives is the same; infinity. As people have said, that makes the judgement easy. Because if we actually tried to use financial value it would be harder than people think because the early estimate of the loss of life were way too high.

In the US and in this forum we've called people crazy for making moral-moral value judgement on liberty vs life that didn't pick life. But we'll see if people still feel that way if the federal government pushes a tracking-app to everyone's phone as if we were all just released from prison on bail (as S. Korea did).

Current estimates are for something on the order of 60,000 deaths in the US. Perhaps if we'd done our shutdowns a week or two earlier we could have cut that in half. And perhaps if we rolled tanks into every city and put a Humvee on every suburban street corner with a few soldiers armed with machine guns (as some have also suggested, and China did) we could have cut it in half again. In China, the government doesn't even blink at such actions; liberty has very little value to them. But here I think people would put a lot more thought into the value of their liberty if they saw armed soldiers patrolling their streets in an effort to save 15,000 lives.

 

[kyphysics]

Yes, I believe @bhobba was referring to moral value, and that's what I was responding to.

I guess it's possible, but it would surprise me. In the West we're seeing people even recently essentially claiming the moral-to-economic value conversion of a human life is infinity dollars. In that way, it doesn't matter that the actionable death estimates a month ago were probably wrong by a factor of 10: the financial value of saving 200,000 or 2,000,000 lives is the same; infinity. As people have said, that makes the judgement easy. Because if we actually tried to use financial value it would be harder than people think because the early estimate of the loss of life were way too high.

In the US and in this forum we've called people crazy for making moral-moral value judgement on liberty vs life that didn't pick life. But we'll see if people still feel that way if the federal government pushes a tracking-app to everyone's phone as if we were all just released from prison on bail (as S. Korea did).

Russ, et. al:

Would the response "calculus" change for you if the deaths from COVID-19 were primarily children?

Sandy Hook was a national tragedy, which claimed the lives of 20 children. This is an act of nature and certainly not comparable in kind to the actions of a deranged murderer. But suppose, nonetheless, that COVID-19 affected children under 12 the most and we had 15,000 of the 20,000 U.S. deaths thus far be children.

Would that warrant the current and/or greater clamp down response for you all?

 

[atyy]

I guess it's possible, but it would surprise me.

Well, I don't have any hard evidence either, but for Lunar New Year (in Singapore at least, and I think in China and among American-Chinese too) it is a traditional to wish others a healthy and prosperous year ahead - so that is at least anecdotal evidence that prosperity is an important consideration in Chinese culture. And it's just practical. If people starve, they obviously won't live (so if one life has infinite value, then we'll have to be subtracting infinities here, like pre-Wilsonian quantum field theory ...).

@wukunlin and other people more familiar with Chinese culture in China, please correct me.

 

[atyy]

In the US and in this forum we've called people crazy for making moral-moral value judgement on liberty vs life that didn't pick life. But we'll see if people still feel that way if the federal government pushes a tracking-app to everyone's phone as if we were all just released from prison on bail (as S. Korea did).

So far in Singapore use of the app https://www.tracetogether.gov.sg/ is not compulsory. We'll see whether that works. Right now there seem to be more and more cases that contact tracing cannot link to earlier cases, which suggests things could be getting out of control.

 

[wukunlin]

Well, I don't have any hard evidence either, but for Lunar New Year (in Singapore at least, and I think in China and among American-Chinese too) it is a traditional to wish others a healthy and prosperous year ahead - so that is at least anecdotal evidence that prosperity is an important consideration in Chinese culture. And it's just practical. If people starve, they obviously won't have live (so if one life has infinite value, then we'll have to be subtracting infinities here, like pre-Wilsonian quantum field theory ...).

@wukunlin and other people more familiar with Chinese culture in China, please correct me.

From what I saw, the wishes of prosperity is quite ceremonial and in some regions it gets religious. The Chinese government really hasn't said much about the assessment of economic impacts. The message is along the lines of get back to work as long as this city's daily new cases are reduced to almost zero. In the case of Shenzhen with population of ~20mil, we were cleared to return to work when daily new cases are down to single digits. My employer actually tried to make us go back to the office before they were cleared (every business had to submit an application for the office to open). Everyone got sent home with the boss getting a stern warning from the local CCP representative...

 

[Vanadium 50]

In the West we're seeing people even recently essentially claiming the moral-to-economic value conversion of a human life is infinity dollars.

But this doesn't work and not just for the reasons you've stated.

Jobless claims are up 11%. There is a rule of thumb that each 1% increase in unemployment corresponds to a 1% increase in the suicide rate. If that's correct, that's an additional 5000 deaths. There appears to be a rise in domestic violence as well, including at least one murder-suicide.

The problem with subtracting infinities is that you have 5000 suicides from the shutdown on one hand, and (to use your numbers) 15000 on the other. You can't save both.

If the answer of who to save is "obvious" one could also look at the metric "years of life saved", which is about 1.5 million with the intervention at a cost of 2 million lost to suicide.

I'm also not sure 15000 isn't too high. The story is "flatten the curve" - keep the number of infections constant, but spread them out over time. That is helpful because it prevents hospitals from being overwhelmed. However, there seems not to be much of this, at least in the US. One could argue that this is simply prudence, which is fair, but we shouldn't avert our eyes from the consequence of this prudence is 5000 people.

 

[atyy]

But this doesn't work and not just for the reasons you've stated.

Jobless claims are up 11%. There is a rule of thumb that each 1% increase in unemployment corresponds to a 1% increase in the suicide rate. If that's correct, that's an additional 5000 deaths. There appears to be a rise in domestic violence as well, including at least one murder-suicide.

The problem with subtracting infinities is that you have 5000 suicides from the shutdown on one hand, and (to use your numbers) 15000 on the other. You can't save both.

If the answer of who to save is "obvious" one could also look at the metric "years of life saved", which is about 1.5 million with the intervention at a cost of 2 million lost to suicide.

I'm also not sure 15000 isn't too high. The story is "flatten the curve" - keep the number of infections constant, but spread them out over time. That is helpful because it prevents hospitals from being overwhelmed. However, there seems not to be much of this, at least in the US. One could argue that this is simply prudence, which is fair, but we shouldn't avert our eyes from the consequence of this prudence is 5000 people.

Can you really not save both?

 

[Vanadium 50]

If lockdown contributes to unemployment and unemployment contributes to suicide, a consequence of lockdown is a higher suicide rate. I don't think there is a question that this is qualitatively true, but it is hard to quantify: in part because why someone commits suicide is seldom simple or a single factor.

I think the broader point is true: we treat the lockdown as an inconvenience, nothing more. That is not completely correct, and the longer it goes on, the less correct it becomes.

 

[mfb]

the actionable death estimates a month ago were probably wrong by a factor of 10

You are again using the impact of actions to argue against these actions. That argument doesn't work, and it's getting a bit repetitive to see it again.
The deaths are not as high as the "do nothing" scenarios estimated because we did something (we as in: basically every place that has something like a government). That was the whole point of doing something. That the US has 20,000 deaths now and not 200,000 (using your factor 10): That's the impact up to today. And the difference is growing every day, looking at the deaths so far is underestimating the impact.

The scenario of a large-scale spread in the population (as in: most people get it in 2-3 months) is still the absolute worst case scenario. And no, the economy won't look good in that scenario either.

Current estimates are for something on the order of 60,000 deaths in the US. Perhaps if we'd done our shutdowns a week or two earlier we could have cut that in half.

Yes, the US could have cut down that in half. It would also have meant the US could loosen the restrictions earlier as the case count doesn't have to drop as much any more. 30,000 lives saved and a shortened period of severe economic impact at the same time. Win/win scenario. It doesn't reduce the time until a vaccine is available, of course.

But we'll see if people still feel that way if the federal government pushes a tracking-app to everyone's phone as if we were all just released from prison on bail (as S. Korea did).

Do you have a source that South Korea did that, outside of confirmed cases?

including at least one murder-suicide.

One above the base rate is statistically significant?

 

[kyphysics]

But this doesn't work and not just for the reasons you've stated.

Jobless claims are up 11%. There is a rule of thumb that each 1% increase in unemployment corresponds to a 1% increase in the suicide rate. If that's correct, that's an additional 5000 deaths. There appears to be a rise in domestic violence as well, including at least one murder-suicide.

The problem with subtracting infinities is that you have 5000 suicides from the shutdown on one hand, and (to use your numbers) 15000 on the other. You can't save both.

The counter-argument to the 1% rise in unemployment = 40,000 deaths is that those deaths occur, due to alcoholism, suicide, drug abuse, etc. from the depression and loss of hope from economic suffering.

If you sufficiently BAILOUT small businesses and workers to GIVE THEM MONEY during this time, then they would be less likely to hurt themselves. Historically, the U.S. has cared more about Wall Street and corporations vs. the "little guy." So, that is a problem.

But, I wouldn't think the "rule" discussed is set in stone. It depends on how things are handled.

 

[Vanadium 50]

GIVE THEM MONEY

In the US, we do. It's called unemployment insurance. We still have an increase in suicide rates when there is an increase in unemployment.

 

[Vanadium 50]

That the US has 20,000 deaths now and not 200,000 (using your factor 10): That's the impact up to today

How were these deaths avoided?

If it's curve flattening, all we have done is postponed 180,000 until later.

 

[russ_watters]

You are again using the impact of actions to argue against these actions. That argument doesn't work, and it's getting a bit repetitive to see it again.
The deaths are not as high as the "do nothing" scenarios estimated because we did something (we as in: basically every place that has something like a government). That was the whole point of doing something. That the US has 20,000 deaths now and not 200,000 (using your factor 10): That's the impact up to today. And the difference is growing every day, looking at the deaths so far is underestimating the impact.

No, I'm not. The "do nothing" scenario on which actions were based was 2.2 million deaths in the US. And it was a literal "do nothing", as in not just the government does nothing, but also the general public does nothing on their own. When that scenario was released, it was already a false premise. It was never possible, because the general public was already acting on their own, and would have acted more even without government intervention.

Moreover, "doing something" for the government, has a lot of different levels as well. These will be studied in detail, and it is hard to speculate on how many lives the current approach saved vs anyone of several levels of less, vs even the "[government] do nothing". About all we know for sure is that it is nowhere close to the 2.2 million lives originally forecast to be lost.

On the other end (assuming the 60,000 is the final number), we also know that nothing more we could have done could save more than 60,000 lives. That includes a full-fledged military lockdown, which some people here argued for.

Yes, the US could have cut down that in half. It would also have meant the US could loosen the restrictions earlier as the case count doesn't have to drop as much any more. 30,000 lives saved and a shortened period of severe economic impact at the same time. Win/win scenario. It doesn't reduce the time until a vaccine is available, of course.

It's different in different places in the US. New York screwed-up badly and that's what's costing us the most (more than half of the deaths in the US are in NY or neighboring New Jersey). And yes, I agree that the start timing has a clear-cut impact on the lives saved and length of the restrictions. But so does the end timing.

Deciding when the restrictions should end is much more difficult to pin-down because unlike the front-end decision it requires thought instead of just raw emotion since now we have real data and have seen the real impacts. And to make it harder, as @Vanadium50 said, the number of people saved drops over time on the back-end. Wuhan just lifted their lockdown last week, after effectively driving their death rate to zero. They chose to probably save a few hundred lives instead of reopening five weeks earlier.

 

[atyy]

If lockdown contributes to unemployment and unemployment contributes to suicide, a consequence of lockdown is a higher suicide rate. I don't think there is a question that this is qualitatively true, but it is hard to quantify: in part because why someone commits suicide is seldom simple or a single factor.

I think the broader point is true: we treat the lockdown as an inconvenience, nothing more. That is not completely correct, and the longer it goes on, the less correct it becomes.

No, of course it is wrong to treat lockdown or even the lesser measures like social distancing (eg. allow restuarants to operate, but enforce a lower density of customers) as inconveniences with no serious consequences. But try to find solutions. The 2 trillion stimulus bill passed by congress is one attempt. Other countries are trying other things.
Here is an article about Denmark's attempt https://www.theatlantic.com/ideas/archive/2020/03/denmark-freezing-its-economy-should-us/608533/
Here is an article about South Korea's attempt https://www.thestar.com.my/news/regional/2020/04/08/south-korea-tops-up-economic-stimulus-package

 

[russ_watters]

If it's curve flattening, all we have done is postponed 180,000 until later.

IMO "curve flattening" was sold wrong, and that's the reason why. If taken literally it doesn't actually save any lives and just costs a lot of money for not much benefit. By social distancing, though, we should actually be able to save lives by reducing the total number of people exposed.

 

[BillTre]

If it's curve flattening, all we have done is postponed 180,000 until later.

Well not really.

The flattening of the curve does two positive things that I can think of:

1. Avoids overwealming hospital resources and therefore keeping the death rates of those infected down. These are deaths of infected people that will not happen even if everyone in the country were to eventually get infected. They are therefore saved from that kind of death. In addition, patients with other diseases will get better treatment.
2. By extending the period when people get infected into the future, flattening the curve buys time for new treatments to be develped; vaccines and anti-coronavirus drug treatments. These possible treatments will also save lives, but only if not everyone has been infected by the time they are developed. It will also allows time to make more tests and PPE.

 

[mfb]

How were these deaths avoided?

If it's curve flattening, all we have done is postponed 180,000 until later.

No, the total deaths go down as the hospitals don't get overwhelmed. In addition the total number of people to get the disease can go down if the curve is flattened into the vaccine availability. But we can do better than just flattening the curve anyway. We can keep it low until we have a vaccine, avoiding most deaths.

No, I'm not. The "do nothing" scenario on which actions were based was 2.2 million deaths. And it was a literal "do nothing", as in not just the government does nothing, but also the general public does nothing on their own. When that scenario was released, it was already a false premise. It was never possible.

So what is your favorite scenario that avoids these deaths? You get "hospitals are overwhelmed, 2 million deaths" for a large range of actions.
To avoid it you need to limit the spread of the virus significantly. And that's the point where you claim it's more expensive than the deaths. But instead of using the 2 million deaths as comparison you seem to use some much lower number of (to me) unclear source. Where is this magical scenario that ends up with under a million deaths without government regulations comparable to what the US has now?

Deciding when the restrictions should end is much more difficult to pin-down because unlike the front-end decision it requires thought instead of just raw emotion since now we have real data and have seen the real impacts. And to make it harder, as @Vanadium50 said, the number of people saved drops over time on the back-end. Wuhan just lifted their lockdown last week, after effectively driving their death rate to zero. They chose to probably save a few hundred lives instead of reopening five weeks earlier.

If you just say "that's the end, back to usual now" then you better prepare for the next outbreak. Unless you eradicated it in that place and strictly control everyone coming in - a scenario that is probably not feasible in the US (without a vaccine).

 

[Vanadium 50]

That the US has 20,000 deaths now and not 200,000 (using your factor 10): That's the impact up to today.

Also, it's hard to argue that the US did everything right here. Half the cases are in New York, which waited until they had 15,000 cases before acting. That's more than Austria has. Today.

 

[russ_watters]

No, the total deaths go down as the hospitals don't get overwhelmed.

By a lot? We're being told that the death rate of people put on ventilators is something like 80%. So a ventilator shortage could only result in deaths of another 25% of people who should have been on ventilators. So are we really saving many lives by putting people in hospitals vs quarantining at home?

Note: 2.2 million deaths is about 0.7% of the US population. It's basically a 40% infection rate and 2.4% death rate. That death rate is in-line with estimates from a month ago, and there doesn't seem to be any factor taken into account for overwhelming the medical system.

In addition the total number of people to get the disease can go down if the curve is flattened into the vaccine availability. But we can do better than just flattening the curve anyway. We can keep it low until we have a vaccine, avoiding most deaths.

By an 18-month stay-at-home order? Yikes.

So what is your favorite scenario that avoids these deaths? You get "hospitals are overwhelmed, 2 million deaths" for a large range of actions.

No, you really don't. You seem to be assuming (as with the flattening the curve scenario) that nothing we do can actually affect the final infection rate and death toll unless it stalls until we get a vaccine. China and South Korea imply that that's way, way wrong.

My "favorite scenario" isn't too far from what we have now, but includes planning for a back-end where we switch to a testing and contact tracing mode, which keeps the total case count low.

Let me be clear about my position: I'm not against government-mandated social distancing, and I think it has been implemented reasonably well in the US. Some did it too early - which gets little noticed - and a few did it too late, like New York. What I am against is some of the more aggressive measures many people have advocated, such as a military lockdown. And I'm also against leaving the social distancing on too long on the back-end, and I expect I will be unhappy with how long it lasts.

To avoid it you need to limit the spread of the virus significantly. And that's the point where you claim it's more expensive than the deaths. But instead of using the 2 million deaths as comparison you seem to use some much lower number of (to me) unclear source. Where is this magical scenario that ends up with under a million deaths without government regulations comparable to what the US has now?

Unfortunately as far as I know, nobody has created such a model, because it's difficult to do. Sweden might give us the best real-world example to create a model from, though. All we really know is that scenario was never possible -- we just don't have a good idea of how wrong it was.

Are you really telling me you believe nothing we could/would have done as individuals could have had a significant impact? It seems like that's what you believe -- it even kind of seems like you believe that even with strict social distancing, the total can't be reduced (just delayed until we get to a vaccine).

If you just say "that's the end, back to usual now" then you better prepare for the next outbreak. Unless you eradicated it in that place and strictly control everyone coming in - a scenario that is probably not feasible in the US (without a vaccine).

I don't see why this should be feasible in South Korea, but not in the US. Yes, I think we should be preparing for a test, track and quarantine scenario like they are doing. We need to prepare now, because we're only a few weeks away from that strategy being viable if we're going to do it.

 

[russ_watters]

Also, it's hard to argue that the US did everything right here. Half the cases are in New York, which waited until they had 15,000 cases before acting. That's more than Austria has. Today.

Agreed - there are a few places, with NYC being the worst, that are outliers on the "bad" side. But in my opinion, some did well. When Pennsylvania shut down (2 days earlier than NY) we had 268 cases with 2/3 the population of NY state.

 

[Ygggdrasil]

And this article is the one censored by the Chinese authorities.

Please get your facts straight before you post here. That article was not censored by Chinese authorities. It was taken down after significant criticism from the scientific community, including a letter published in the journal the Lancet:

A group of 27 prominent public health scientists from outside China is pushing back against a steady stream of stories and even a scientific paper suggesting a laboratory in Wuhan, China, may be the origin of the outbreak of COVID-19. “The rapid, open, and transparent sharing of data on this outbreak is now being threatened by rumours and misinformation around its origins,” the scientists, from nine countries, write in a statement published online by The Lancet yesterday.

https://www.sciencemag.org/news/202...-conspiracy-theories-about-origin-coronavirus

Here's an excerpt from the letter:

We stand together to strongly condemn conspiracy theories suggesting that COVID-19 does not have a natural origin. Scientists from multiple countries have published and analysed genomes of the causative agent, severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) and they overwhelmingly conclude that this Coronavirus originated in wildlife as have so many other emerging pathogens. This is further supported by a letter from the presidents of the US National Academies of Science, Engineering, and Medicine and by the scientific communities they represent. Conspiracy theories do nothing but create fear, rumours, and prejudice that jeopardise our global collaboration in the fight against this virus. We support the call from the Director-General of WHO to promote scientific evidence and unity over misinformation and conjecture.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30418-9/fulltext

Literally, the only piece of data that the ResearchGate article presents in support of its hypothesis is a screenshot from Google maps. At this point, the origin of the virus remains unknown, so we can't rule out such an accidental transmission scenario, but I do not see any evidence supporting the involvement of the lab in the origin of the outbreak.

If the virus were indeed being studied at the institute, it is likely that it would be easy to match the RNA sequence of the SARS-CoV-2 virus to viruses under study at the institute. Instead, the SARS-CoV-2 genome has a number of unique features not found in other coronaviruses from bats or other species (see this paper in Nature Medicine and my post here for a more detailed discussion). In particular, the virus shows signs of recombination between bat Coronavirus strains and pangolin Coronavirus strains, so it is not clear whether the outbreak required direct bat-to-human transmission (note that pangolin scales are used in traditional Chinese medicine). Furthermore, a recent paper in Science showed that the virus is able to infect a number of other animals in close contact with humans (such as domestic cats), providing other plausible avenues for the virus to enter into human populations. There is precedence for feline species acting as vectors for coronaviral diseases as the 2003 SARS outbreak was though to involve transmission from civet cats.

 

[atyy]

I don't see why this should be feasible in South Korea, but not in the US. Yes, I think we should be preparing for a test, track and quarantine scenario like they are doing. We need to prepare now, because we're only a few weeks away from that strategy being viable if we're going to do it.

What's your view of how the federal government and/or states can help to coordinate within the US - both for social distancing (including when to have strict stay-at-home rules and when to relax), and for contact tracing, since what one region does or fails to do will affect other regions? As an example internationally, I suspect that while China did hope their measures would enable their economy to recover, they probably did not (or at least I did not) calculate that the US response would be so suboptimal (CDC had a great reputation internationally, so it is surprising that it has done so poorly this time), and the crisis (resulting in large part from the CDC's failure) in the US is probably hampering China's economic recovery.

Also, will Google and Apple's efforts to coordinate contact tracing apps help?
https://techcrunch.com/2020/04/13/apple-google-coronavirus-tracing/
https://www.theverge.com/interface/...-coronavirus-api-public-health-app-challenges

There have been a few efforts, but as many people as possible need to be on the same app for this to work well.
https://www.covid-watch.org/
https://www.media.mit.edu/projects/safepaths/overview/
https://nexttrace.org/about

EU's thinking on the issue:
https://techcrunch.com/2020/04/06/e...alized-approach-to-covid-19-contacts-tracing/

 

[mfb]

My "favorite scenario" isn't too far from what we have now, but includes planning for a back-end where we switch to a testing and contact tracing mode, which keeps the total case count low.

But that's what everyone wants to do. So why are we having this discussion?

The question is how much we need in addition to tests and contact tracing if that alone is not sufficient to keep the disease under control.

By a lot? We're being told that the death rate of people put on ventilators is something like 80%. So a ventilator shortage could only result in deaths of another 25% of people who should have been on ventilators. So are we really saving many lives by putting people in hospitals vs quarantining at home?

~50% for people in ICU, even lower (~20%?) for people being hospitalized in general. We can expect everyone in the first category to die without a hospital, that's at least a factor 2. For the second category I don't know, but they are sent to a hospital for a reason.

Are you really telling me you believe nothing we could/would have done as individuals could have had a significant impact? It seems like that's what you believe -- it even kind of seems like you believe that even with strict social distancing, the total can't be reduced (just delayed until we get to a vaccine).

Of course it has an impact what we do as individuals. But as we can see, mere recommendations lead to many people ignoring them. Even mandatory restrictions lead to several people ignoring them. Yes, in an ideal world everyone would avoid spreading the disease as much as possible, and the virus would have died out in the two weeks after people knew that there was a virus. But we don't live in such a world, and we shouldn't make plans based on such a world.

I don't see why this should be feasible in South Korea, but not in the US. Yes, I think we should be preparing for a test, track and quarantine scenario like they are doing. We need to prepare now, because we're only a few weeks away from that strategy being viable if we're going to do it.

Privacy concerns are very different in the US, that's at least one difference. How many Americans would be fine with the government having access to the phone location at any time? Even if you think this is a price worth paying for the pandemic: You think the government would stop using that after the pandemic?

 

[BillTre]

No, the total deaths go down as the hospitals don't get overwhelmed.

No, I'm not. The "do nothing" scenario on which actions were based was 2.2 million deaths in the US. And it was a literal "do nothing", as in not just the government does nothing, but also the general public does nothing on their own. When that scenario was released, it was already a false premise. It was never possible, because the general public was already acting on their own, and would have acted more even without government intervention.

Maybe you don't understand what happens when a hospital is "overwealmed".
The demand for quality services is exceeded by the demand. As a result the quality of care suffers. This is not just limited to ventilators. It will affect other aspects of care, as well as care for patients with other health issues.
In addition, patients (and health care professionals) will have a increased probability of getting infected with coronavirus, due to the increased concentration of infective virus in the hospital.
In addition, a lack of PPE (which seems to be part of being overwealmed as things are now) will make any virus concentration present that much more of an infective threat.

I don't see why this should be feasible in South Korea, but not in the US. Yes, I think we should be preparing for a test, track and quarantine scenario like they are doing. We need to prepare now, because we're only a few weeks away from that strategy being viable if we're going to do it.

I don't think it is feasible in the US because I don't see the current administration as showing any tendency or capability for quality long term planning on this issue.

The thoughtful strategy you are proposed (preparing and planning ahead!) is not (IMHO) the course that will be taken.
Why is there no overall strategy by now?
They can barely get it together enough to get refrigerator trucks to NY to hold dead bodies that have overwealmed the morgues and mortuaries.

 

[vela]

Deciding when the restrictions should end is much more difficult to pin-down because unlike the front-end decision it requires thought instead of just raw emotion since now we have real data and have seen the real impacts.

The front-end decision required thought too. NY doesn't find itself in the position it does now because the leaders reacted based on raw emotion. They delayed efforts to slow down the infection because they were worried about the impact of the measures on the economy. In hindsight, we see it was a really poor decision, but the outcome isn't particularly surprising.

It seems to me any talk of reopening the economy is premature until fast, accurate, and widespread testing becomes available.

 

[dlgoff]

update to

It seems to me any talk of reopening the economy is premature until fast, accurate, and widespread testing becomes available.

Agreed. ...fearing a second wave may be possible?

 

[atyy]

China approves two experimental Coronavirus vaccines to enter clinical trials
https://www.channelnewsasia.com/new...al-covid-19-vaccines-clinical-trials-12639116

 

[bhobba]

If lockdown contributes to unemployment and unemployment contributes to suicide, a consequence of lockdown is a higher suicide rate.

Here in Aus they initially increased the unemployment benefits, but that simply led to long lines, often not with social distancing, to claim the benefit. They asked people to do it online - but it crashed. They doubled capacity, and it crashed again and this went on for a few days. I have zero idea who was advising them, but I would have started with a 10 times increase, and even then I think it would eventually have been increased well above that. But then they hit on another idea, instead of waiting for people to be sacked the organisation simply advised the government who they were going to sack, (which they were doing for payroll tax purposes anyway) and paid the unemployment benefit to the employer who then paid it as the wage of that person - no sacking required. Much much better idea administratively IMHO, and the person feels a lot better because they are still actually employed, with a regular, but reduced (well in nearly all cases anyway - ironing out those kinks I think is still in progress) wage from their employer. Their new job is to stay home and not infect anyone.

For those interested in the details its called the JobKeeper program. It's estimated to cost over the next 6 months $130 Biliion - our government is certainly not being stingy in tackling this problem.

Thanks
Bill

 

[kadiot]

Please get your facts straight before you post here. That article was not censored by Chinese authorities. It was taken down after significant criticism from the scientific community, including a letter published in the journal the Lancet:https://www.sciencemag.org/news/202...-conspiracy-theories-about-origin-coronavirus

Here's an excerpt from the letter:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30418-9/fulltext

Literally, the only piece of data that the ResearchGate article presents in support of its hypothesis is a screenshot from Google maps. At this point, the origin of the virus remains unknown, so we can't rule out such an accidental transmission scenario, but I do not see any evidence supporting the involvement of the lab in the origin of the outbreak.

If the virus were indeed being studied at the institute, it is likely that it would be easy to match the RNA sequence of the SARS-CoV-2 virus to viruses under study at the institute. Instead, the SARS-CoV-2 genome has a number of unique features not found in other coronaviruses from bats or other species (see this paper in Nature Medicine and my post here for a more detailed discussion). In particular, the virus shows signs of recombination between bat Coronavirus strains and pangolin Coronavirus strains, so it is not clear whether the outbreak required direct bat-to-human transmission (note that pangolin scales are used in traditional Chinese medicine). Furthermore, a recent paper in Science showed that the virus is able to infect a number of other animals in close contact with humans (such as domestic cats), providing other plausible avenues for the virus to enter into human populations. There is precedence for feline species acting as vectors for coronaviral diseases as the 2003 SARS outbreak was though to involve transmission from civet cats.

It is likely that the virus is zoonotically transmitted from bats to humans. But since there are no bats sold in the Wuhan market, and that bats are not naturally found near the market, and that the lab is using live bats for research, which are the claims of the other study, it is possible that the real place of first infection are the labs, where the virus infected a lab worker, and not the market.

 

[OCR]

Lol. . . that would work for me. . ✔[/size]

Their new job is to stay home and not infect anyone.

.

 

[bhobba]

Lol. . . that would work for me. . ✔

Lol - it may burst your bubble to know there is talk of deploying this vast army into things like delivering meals to the elderly. Personally I would love that - I am in the group where I am supposed to stay home all the time - but is not compulsory. You can still go out for things like getting the flu jab, going to the chemist, or getting dinner - thinking of having KFC tonight for a change. Fortunately these are very low risk activities, but it would be better if someone in a lower risk category could do it.

Thanks
Bill

 

[OCR]

Wait. . . !

Their new job is to stay home and not infect anyone.

Lol. . . that would work for me. . ✔

I need to rephrase that. . .

Lol. . . I would work for that. . ✔[/size]

.

 

[DennisN]

thinking of having KFC tonight for a change

Personally I can't remember having wanted to go to a restaurant as much as I do now (and eat there).
When this thing is over I am going to go to a great restaurant and have a really great meal.

 

[OCR]

You can't really mean. . . ?

. . .delivering meals to the elderly.

I would deliver meals to myself. . . ? .

.

 

[atyy]

thinking of having KFC tonight for a change

Keep 2m from the servers. In Singapore we had a tiny cluster at McDonald's.
https://www.channelnewsasia.com/new...ds-employees-diagnosed-outlets-close-12635516

 

[Jarvis323]

Some more bad news.

To the surprise of the scientists, the T cell became a prey to the Coronavirus in their experiment. They found a unique structure in the virus’ spike protein that apparently triggered the fusion of a viral envelope and cell membrane when they came into contact.

A doctor who works in a public hospital treating Covid-19 patients in Beijing said the discovery added another piece of evidence to a growing concern in medical circles that the Coronavirus could sometimes behave like some of the most notorious viruses that directly attack the human immune system.

“More and more people compare it to HIV,” said the doctor who requested not to be named due to the sensitivity of the issue.
In February, Chen Yongwen and his colleagues at the PLA’s Institute of Immunology released a clinical report warning that the number of T cells could drop significantly in Covid-19 patients, especially when they were elderly or required treatment in intensive care units. The lower the T cell count, the higher the risk of death.

This observation was later confirmed by autopsy examinations on more than 20 patients, whose immune systems were almost completely destroyed, according to mainland media reports.

Doctors who had seen the bodies said the damage to the internal organs was similar to a combination of Sars and Aids.

https://www.scmp.com/news/china/soc...uld-target-immune-system-targeting-protective

 

[mfb]

The front-end decision required thought too. NY doesn't find itself in the position it does now because the leaders reacted based on raw emotion. They delayed efforts to slow down the infection because they were worried about the impact of the measures on the economy.

Indeed. And as result increased the death toll and almost certainly also the impact on the economy.

The Australian model for unemployment payments sounds nice. It's still a decrease in income for the people affected, but people also spend less money these days. I would expect that approach to limit suicides, too.It looks like it will be very difficult to estimate the overall death toll. China's numbers have been discussed, that New York and Italy are missing some cases has been discussed, but it looks like it's even worse in some other countries.
Ecuador's official death toll at the moment is 355. Now compare this to this news and this one. They can't keep up removing dead bodies from the streets. We don't know how many of these deaths were from COVID-19 and how many were from other causes (but couldn't go to a hospital), but 355 doesn't capture the impact of the pandemic in Ecuador at all. It's also completely unclear how that will evolve in the future. Will so many people get it that the disease ends from a lack of susceptible people? Or do they get it under control before? They closed their borders, but it was too late. They "banned all public activities" in mid March, but I don't see more actions that would have slowed the spread in March.

 

[DennisN]

It looks like it will be very difficult to estimate the overall death toll. China's numbers have been discussed, that New York and Italy are missing some cases has been discussed, but it looks like it's even worse in some other countries.

Speaking of that I recently read two articles from a couple of weeks ago:

http://edition.cnn.com/2020/03/24/americas/coronavirus-latin-america-presidents-intl/index.html
(CNN, March 25, 2020)

http://www.bbc.com/news/world-latin-america-52080830
(BBC, 29 March 2020)

I also read another interesting article about leaders in apparent denial during this crisis, but regretfully I can't find it at the moment. Denial is a powerful but also sometimes dangerous psychological defense mechanism...

Furthermore, I am not updated about the current situation in Brazil, Mexico and Nicaragua which were the countries mentioned in the articles above.

 

[DennisN]

Some more bad news.
https://www.scmp.com/news/china/soc...uld-target-immune-system-targeting-protective

That was a quite disturbing read...

 

[kyphysics]

That was a quite disturbing read...

Here was one quote from the piece I didn't understand:

The gene behind the fusion function in Sars-CoV-2 was not found in other coronaviruses in human or animals.

But some deadly human viruses such as Aids and Ebola have similar sequences, prompting speculation that the novel Coronavirus might have been spreading quietly in human societies for a long time before causing this pandemic.

How are they extrapolating that this novel Coronavirus may have been spreading among humans "for a long time"?

 

[Jarvis323]

Sorry, here's one of the papers.
https://www.nature.com/articles/s41423-020-0424-9

 

[DennisN]

Here was one quote from the piece I didn't understand:

The gene behind the fusion function in Sars-CoV-2 was not found in other coronaviruses in human or animals.

But some deadly human viruses such as Aids and Ebola have similar sequences, prompting speculation that the novel Coronavirus might have been spreading quietly in human societies for a long time before causing this pandemic.

How are they extrapolating that this novel Coronavirus may have been spreading among humans "for a long time"?

I don't know. It seems they might be comparing with the history of Aids and Ebola. But there may be additional reasons for the speculation, I really don't know.
I am way out of my comfort zone here, biology/virology is definitely not my strong side.
Maybe some other more knowledgeable thread participants could offer some perspective...