COVID COVID-19 Coronavirus Containment Efforts

[Vanadium 50]

To prevent new cases entering, it might like to require all visitors to the county to be isolated upon entry. Would that be possible?

Probably not. The US is big. It looks like if you took ever single person and had them stand sentry around the perimeter, people would be ~100 feet apart, assuming 4 shifts. The population density is 1/500 that of Singapore - imagine Singapore with 10,000 people.

But does it make any sense to lock down a county in the middle of nowhere? Their neighbors also have a very low rate of infection. Within the county, people aren't shoulder-to-shoulder on the subway. There is no subway. Maybe not even buses. So the transmission rate will be far lower as well. Is this the place to be expending resources on?

 

[Ygggdrasil]

As the data shows us, population density is an important factor. Barnwell County, SC has 40 people per square mile. Manhattan has a daytime population density of 120,000. Does it make sense that the same level of precautions be applied? Think Northern Territory far away from Darwin or Alice Springs (I don't even know what the next largest city in the Northern Territory is. Katherine maybe?)

You suggest that regions with lower population density face lesser risks to the disease and therefore lesser social distancing measures are required in these rural regions versus the urban regions which have shown large outbreaks of the disease. Is there data to support these claims?

First, here's an interesting study analyzing recent influenza outbreaks in Australia. They observe that influenza spread throughout the country in two waves, a first wave that spread throughout major cities (where international airports likely seeded infections) and later waves in less populous outlying areas:

Therefore, observing major COVID-19 outbreaks primarily in urban areas is consistent with these data. Later in the outbreak (in the absence of social distancing measures) we would expect COVID-19 outbreaks to spread to more rural regions in the US. Observing early outbreaks only in regions with high population density does not mean regions with low population density will be spared.

What about the spread of the disease in low population density/rural areas? If R for the disease is lower in these areas, then perhaps less restrictive policies are required for these areas to keep R < 1. There are plenty of reasons to think why this could be the case as having fewer people/area would seem to make it harder to spread the disease. However, remember that the disease spreads primarily from close contact between people. Do people in rural areas have fewer close contacts than people in urban areas? Are bars, restaurants, schools and churches less crowded in rural areas than in urban areas? For many of these settings, it seems like the number of social gathering places changes greatly, but not necessarily the number of people/establishment.

What does the data say? Here's a study comparing the transmissibility of influenza in urban vs rural settings in regions of Canada, a country that, like Australia, would also seem to serve as a good model for the geographic vastness of the US. Interestingly, they found that the disease spread faster (had a larger R) in rural regions vs urban regions:

Using published values of the exposed and infectious periods specific to H1N1 infection, corresponding to the average generation time of 2.78 days, we estimated a mean value of 2.26 for R0 (95% CI 1.57 to 3.75) in a community located in northern Manitoba. Estimates of R0 for other communities in Nunavut varied considerably with higher mean values of 3.91 (95% CI 3.08 to 4.87); 2.03 (95% CI 1.50 to 3.19); and 2.45 (95% CI 1.68 to 3.44). We estimated a lower mean value of 1.57 (95% CI 1.35 to 1.87) for R0 in the Winnipeg health region, as the largest urban centre in Manitoba. [...] Influenza pH1N1 appears to have been far more transmissible in rural and isolated Canadian communities than other large urban areas.

While limited, these data suggest that rural communities won't necessarily have lower rates of disease transmission than urban communities.

What about the US? I could not find studies comparing urban vs rural transmissibility of influenza in the US (though I did not do an exhaustive search), but I did find this article from the Washington Post which provides data suggesting that rural communities in the US are more vulnerable to disease outbreaks than urban communities. As others have noted, rural communities often have older populations than urban communities, which means they a higher fraction of people vulnerable to more serious outcomes from COVID-19. However, independent of these demographic differences, rural communities appear more vulnerable; for example, many rural regions show higher flu mortaility among those over 50 years of age versus urban regions:

These data therefore suggest that rural communities face greater risks from the disease than urban cities.

In summary, these data suggest that, in the US, the next stage of the pandemic could be the spread of the disease from urban centers to rural communities, where the disease could spread quickly, overwhelm sparse healthcare resources, and cause greater per capita mortaility than outbreaks in urban regions.

 

[Vanadium 50]

You suggest that regions with lower population density face lesser risks to the disease and therefore lesser social distancing measures are required in these rural regions versus the urban regions which have shown large outbreaks of the disease.

The suggestion is not to avoid social distancing, but that the degree of lockdown should depend on the risk and benefit.

In message 2271 I say:

Illinois has statistics based on ZIP code of residence. I aggregated by county (I am too cheap to buy the demographics by ZIP code) and in some cases city. Roughly, each order of magnitude in population is a factor of 1500 cases per million. It appears to be somewhat non-linear with a trend above the curve for the largest cities.

One very interesting feature is that nearby population density matters. Aurora, Naperville and Rockford are comparably sized. Aurora and Naperville are close enough for people to commute to Chicago, and they have a case rate per million about 950. Rockford really is not, and it's at 350.

I would argue that the relevant number is not directly population density, but the number of people one interacts with. In metropolitan NY, one might take the commuter train in, then the subway and finally a bus, and potential infect (or be infected by) hundreds of people before even getting into work. This seems to me to warrant more attention than buying a pack of vegetable seeds in Copper Harbor, Michigan.

 

[Ygggdrasil]

The suggestion is not to avoid social distancing, but that the degree of lockdown should depend on the risk and benefit.

I know you are not suggesting to avoid social distancing. That's why the section of my text that you quoted says "lesser social distancing measures" and not "no social distancing measures."

However, you keep claiming lower risk in rural communities and benefit from early lessening of social distancing measures. Do you have data suggesting lower risk in rural areas? I just posted evidence suggesting greater risk to rural communities. Similarly, do you have evidence of substantial economic benefits? In our discussion of Sweden, I cited projections suggesting that Sweden's more relaxed social distancing policies did not seem to suggest economic benefits over other neighboring countries with more strict social distancing policies. Others in the thread have also pointed to studies of the 1918 influenza pandemic which suggests that stronger pandemic responses promoted slightly greater economic recovery (discussed in my post on a different thread here). There are of course, many reasons to think that relaxing social distancing would produce many short term benefits to the economy, but if we are to balance risk and benefit, we need good projections of the magnitude of the long-term benefits.

I would argue that the relevant number is not directly population density, but the number of people one interacts with. In metropolitan NY, one might take the commuter train in, then the subway and finally a bus, and potential infect (or be infected by) hundreds of people before even getting into work. This seems to me to warrant more attention than buying a pack of vegetable seeds in Copper Harbor, Michigan.

Yes, I also pointed to the number of close contacts as being more relevant than population density in my post and argued that the number of close contacts may not differ so much between rural and urban communities (e.g. school sizes and class sizes are probably similar between urban and rural communities, which would drive similar transmissible in schools).

I do agree with the public transportation point, however, which may explain why the oubreaks have been more severe in metro areas with good public transportation (e.g. New York & Boston) vs those where people mainly commute by car (e.g. Los Angeles, San Francisco and Seattle).

 

[gmax137]

Why can't the US use the armed forces (like us) to implement the lockdown.

Google this:
Posse Comitatus Act
In the US the individual states are responsible for maintenance of peace, conduct of orderly elections, and prosecution of unlawful actions. The US Army is generally prohibited from police action. This notion has a number of consequences, most of which (IMO) are to the good.

 

[Vanadium 50]

Do you have data suggesting lower risk in rural areas?

Message 2271.

As far as benefits, it certainly is more of a benefit to them.

 

[kadiot]

How much has the healthcare system & medical infrastructure been distracted to prioritize only COVID-19?

Did the incidence of other diseases really fall or are they just "neglected" at the moment?

Are there really very few accidents now or is it because people are asked to stay at home hence less people are driving (~less accidents)?

 

[DennisN]

An Oxford Team (UK) is about to start vaccine trials:

Hancock says Oxford team to start vaccine trials on humans from Thursday (The Guardian live updates, 21 April 2020)

Trials for a Coronavirus vaccine to start on people in Oxford on Thursday, says government

A potential Coronavirus vaccine being developed at the University of Oxford will be trialled on people from Thursday, said the health secretary Matt Hancock. Hancock added that he was making £22m available to Imperial to support their ongoing phase two trials, and providing £20m to the Oxford team to accelerate their trials.

An earlier article about this:
Trials to begin on Covid-19 vaccine in UK next month (The Guardian, 19 March 2020)

 

[bhobba]

Furthermore, it is worth remembering that humankind has survived

I was trying to say we will more than just survive. Scientists from all over the world are working around the clock with unprecedented cooperation, and is making advances against this epidemic at a pace never seen before. They are doing it because they know what is at stake and what is required to defeat it.

Thanks
Bill

 

[chemisttree]

The elderly I'm accompanying for blood checkup will only wear surgical mask. I think I'll cancel the appointment and let him order another set of this so we both wear this.

View attachment 261114

I find it easier to breathe than an N95 mask. Do you have any background in this? Have you tried one yourself? Are cartridges in such devices easier to breathe in than the fabric in N95?

That half face mask with the two P100 filters have almost twice the filtering area of the N95 so you would expect it to be easier to breathe through. 3M touts this in their product literature.

The CFR standard states that if comfort and fitment are less than acceptable, another brand or design will be chosen, so do what pleases you.

Fitment is not a trivial test and almost nobody does it unless their workplace is likely to be scrutinized. I would expect proper fitment to be more likely conducted at someplace like a unionized automobile paint facility and not likely conducted on a private small farm spraying herbicide, for example.

The test - https://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=2edd1a1353c47e0edcc2ae203b7bf16b&ty=HTML&h=L&n=29y5.1.1.1.8&r=PART#se29.5.1910_1134

 

[atyy]

Probably not. The US is big. It looks like if you took ever single person and had them stand sentry around the perimeter, people would be ~100 feet apart, assuming 4 shifts. The population density is 1/500 that of Singapore - imagine Singapore with 10,000 people.

But does it make any sense to lock down a county in the middle of nowhere? Their neighbors also have a very low rate of infection. Within the county, people aren't shoulder-to-shoulder on the subway. There is no subway. Maybe not even buses. So the transmission rate will be far lower as well. Is this the place to be expending resources on?

Well if things are not coodinated, then it is simply something that Barnwell might like to do to protect itself. Otherwise they might go to church service, and an infected visitor attending might cause maybe 5 people at the church to be infected. Or are they confident that they don't get visitors? Or is the population so sparse that the 5 infected people won't pass it to anyone else?

 

[chemisttree]

Or is the population so sparse that the 5 infected people won't pass it to anyone else?

They all shop at the same WalMart. Five would be just the beginning.

 

[atyy]

They all shop at the same WalMart. Five would be just the beginning.

It's probably pretty safe at Walmart in Barnwell, since one can usually be 6ft from other shoppers, and any interactions are transient.

I suppose they could also sit 6ft apart at church if there is space. I'm unsure whether 6ft is far away enough if there is lots of singing.

 

[kyphysics]

Has there been discussion of viral load before in the thread?

It's something I've been hearing about, but don't know if there is anything to it.

Does it seem, at least, logical that the more particles (is that the right word?) of COVID-19 there are, then the more deadly it is to the host? Would having just one virus particle give the body more time to mount defenses vs. having, say, 100 or 1000x that?

 

[atyy]

Has there been discussion of viral load before in the thread?

It's something I've been hearing about, but don't know if there is anything to it.

Does it seem, at least, logical that the more particles (is that the right word?) of COVID-19 there are, then the more deadly it is to the host? Would having just one virus particle give the body more time to mount defenses vs. having, say, 100 or 1000x that?

Yes, it's been discussed. @Ygggdrasil pointed to a preprint, which is now published (but not yet in its final format). It shows using cell culture experiments, that when the concentration of viral particles is low, cells are very much less likely to be infected. See Fig 1g of this paper.

Virological assessment of hospitalized patients with COVID-2019.
Wölfel R, Corman VM, Guggemos W, Seilmaier M, Zange S, Müller MA, Niemeyer D, Jones TC, Vollmar P, Rothe C, Hoelscher M, Bleicker T, Brünink S, Schneider J, Ehmann R, Zwirglmaier K, Drosten C, Wendtner C.
Nature https://www.nature.com/articles/s41586-020-2196-x

There has also been some idea that if the initial infection is due to a smaller dose, then the chance of severe disease is less. I am not sure if this is true although it is plausible (it is also plausible that it is not true).

 

[Vanadium 50]

Otherwise they might go to church service, and an infected visitor attending might cause maybe 5 people at the church to be infected.

Sure, they might. One can always add supposition on top of supposition. Nonetheless, I maintain:

The risk is lower for our resident of a small town far away from "civilization", one with a low incidence of Covid, than a NYC subway rider.
The threat to others is also lower for our resident of a small town far away from "civilization", one with a low incidence of Covid, than our NYC subway rider.

Given that (and my conclusion is opinion, not fact, and not everyone will agree - although I think they should), we should be directing our resources where they will do the most good, and not (e.g.) on the selling of vegetable seeds in Copper Harbor, Michigan.

 

[atyy]

Sure, they might. One can always add supposition on top of supposition. Nonetheless, I maintain:

The risk is lower for our resident of a small town far away from "civilization", one with a low incidence of Covid, than a NYC subway rider.
The threat to others is also lower for our resident of a small town far away from "civilization", one with a low incidence of Covid, than our NYC subway rider.

Given that (and my conclusion is opinion, not fact, and not everyone will agree - although I think they should), we should be directing our resources where they will do the most good, and not (e.g.) on the selling of vegetable seeds in Copper Harbor, Michigan.

The main point in my question is - coordination - who will coordinate who does what, what is enforced, how is contact tracing etc done across county and state borders? Thus although it may be true in general that a resident in the small town far away from civilization is less of a threat to others, if that small town has insufficient restrictions, and is getting a lot of undetected cases, and some of those cases travel to New York City, then they are a risk for a second wave in NYC if NYC brings things under control and starts to relax its restriction. So there has to be coordination. I mnetioned New Zealand, because that is a place with low density, great success to date in managing COVID-19, but it is a country with central coordination. This central coordination seems to be much trickier at present in the US, but here are some efforts in that direction.

https://www.wired.com/story/state-alliances-are-leading-the-us-fight-against-covid-19/
State Alliances Are Leading the US Fight Against Covid-19
The Western States Pact and a council of northeastern states have formed public health coalitions while the federal government does … whatever it’s doing.

https://edition.cnn.com/2020/04/16/politics/midwest-governors-reopening-pact/index.html
7 Midwestern governors announce their states will coordinate on reopening

https://www.tennessean.com/story/ne...used-covid-19-reopening-scenarios/5146522002/
Tennessee's 'Big Four' mayors create task force focused on COVID-19 reopening scenarios

https://ny.eater.com/2020/4/14/21219123/new-york-coordinated-economic-reopening
New York Partners With Nearby States to Coordinate Economic Reopening

https://www.washingtonpost.com/heal...eated-plan-reopen-america-heres-what-it-says/
CDC, FEMA have created a plan to reopen America. Here’s what it says.
Document is part of White House plan being drafted to allow Trump to reopen parts of the country within weeks

 

[russ_watters]

@Vanadium 50 , @Ygggdrasil good debate today...

It appears to me that much the differences between your positions are really regarding timeframes, level of "social distance" and what that means for "flattening the curve" vs extinction -- so I think there's a certain amount of talking past each other going on.

The way "flattening the curve" was described to the public was that we're all going to get exposed, but if we "flatten the curve" by "social distancing" at least the medical system won't be overwhelmed and some moderate fraction of the 2 million supposedly inevitable American deaths will be avoided. How much, I'm not sure; 20%? 50%? Still a calamity.

The actual goal of "social distancing" is much more aggressive: effectively; extinction. This has been achieved in China. Time will tell if anywhere in the West can achieve it, but if we do, we'll end up with ~60,000 deaths and not much of a rush for a vaccine. We're not trying to "flatten" the curve so much as we're trying to cleave-off the back 90%+ of it. We'll see if we're capable of achieving that.

The difference as pertains to population density and the flu is that we don't do any on-purpose "social distancing" to slow the flu, so eventually most people will be exposed, more in-line with the way "flattening the curve" has been described (or the virus hitting in waves). It takes a longer time to reach the boonies due to the actual distancing of the lower population density and literal distance from the hotspots. The impact of the actual distancing of lower population density seems pretty self-evident, at least in the short term.

So it makes sense to me why the infection is spreading slower in rural areas, and lagging behind higher population density areas. It also means the if extinction is achieved in higher population density areas, some lower population density areas or areas otherwise far from major hotspots will never see a wave of infections. Again, see: China.

The issues to me are:

1. Resources for testing/contact tracing. Many smaller, even medium-sized counties in PA for exmple don't have their own health departments.
2. Consistency of criteria for the approach. The decision-making of politicans can be all-over the map but at least on the larger scale you can usually vote/average-out most of the outliers (though we've seen variations between states...). But for small towns, there are going to be a wider variation of approaches and some may not be sensible.
3. High percentage impact of a small number of cases in a small town. That's both a statistical issue and a local impact issue. Soux Falls, South Dakota isn't tiny (182,000), but with 640 cases linked to one employer, it's responsible for 40% of the cases in the state. This issue will be more pronounced in smaller one-factory towns. Fortunately (?) these towns tend to be lower income and very low mobility, so the likelihood of someone returning from Italy to start a cluster of infections is really low. See: "Allentown".

 

[russ_watters]

We also have two cruise ships where everyone was tested: the Diamond Princess and the Greg Mortimer. The Diamond Princess had <20% infected and the Greg Mortimer with ~60%. The Diamond Princess has a population density about the same as Manhattan, and the Greg Mortimer even higher. (However, the daytime density in NYC is higher, and that is likely an important factor)

You've pointed this out several times, but if anything I think you are under-stating the issue. If your theory held, we should have seen at least 20% of the population of Manhattan infected weeks ago. The Diamond Princes departed on its fateful trip on January 20, with one infected passenger, all the passengers departed by Feb 24 and the crew had departed by March 1.

The infection tore through cruise ships and peaked in just a few weeks, with an R0 of almost 15 on the Diamond Princess. Why the difference? I think it is because you are using area density instead of volume density. There aren't any 40-story cruise ships, and everyone living even in a tiny NYC apartment has their own kitchen and normal refrigerator. On a cruise ship, most passengers don't have much more personal space than prison inmates, and the crew likely have less (and on Navy ships, less still...). Due to the much lower volume density, the normal/everyday interaction in a city is much lower than on a cruise ship and the social distancing much more capable due to the larger actual distance...and infrastructure.

...my conclusion is opinion, not fact, and not everyone will agree - although I think they should...

Everyone should always agree with the statement that everyone should agree with my opinion. Otherwise, what good are opinions?

 

[russ_watters]

The main point in my question is - coordination - who will coordinate who does what, what is enforced, how is contact tracing etc done across county and state borders? Thus although it may be true in general that a resident in the small town far away from civilization is less of a threat to others, if that small town has insufficient restrictions, and is getting a lot of undetected cases, and some of those cases travel to New York City, then they are a risk for a second wave in NYC if NYC brings things under control and starts to relax its restriction. So there has to be coordination.

I agree this is a big problem, and I just said something similar in post 2568. A lot of the power to act in the US is local, but it doesn't necessarily do well across county and state lines, and that's where strategy coordination at the state and federal level is key. It doesn't do us much good to even have local contact tracing (if small towns are even capable of it), if someone returns from the Jersey Shore to Allentown with Coronavirus and nobody tracked their exposure.

There shouldn't be any more "new"/un-tracked cases.

[edit]
Btw, this is being pushed as more of a partisan political issue in the US than it really is. One side protests for "freedom" and they're being excoriated in the news (and my facebook feed) right now, but the other side, which advocates for "privacy" is in alignment against contact tracing. Apple and Google (political stance; obvious) are working on a voluntary app to aid in contact tracing, but they really don't need to make it voluntary, nor do they really even need an app since they make their own OS. They already track our every move and push us notifications whenever they feel like it, for whatever reason, so there's really nothing to do appwise. They just have to mesh their databases and connect to medical records, and share the data.

 

[mfb]

How much has the healthcare system & medical infrastructure been distracted to prioritize only COVID-19?

Did the incidence of other diseases really fall or are they just "neglected" at the moment?

Are there really very few accidents now or is it because people are asked to stay at home hence less people are driving (~less accidents)?

Traffic is down a lot, that reduces accidents. Elective procedures are delayed. Fewer people go to hospitals for minor health issues.

The actual goal of "social distancing" is much more aggressive: effectively; extinction. This has been achieved in China. Time will tell if anywhere in the West can achieve it, but if we do, we'll end up with ~60,000 deaths and not much of a rush for a vaccine. We're not trying to "flatten" the curve so much as we're trying to cleave-off the back 90%+ of it. We'll see if we're capable of achieving that.

We won't eradicate it worldwide that way, we need ongoing changes to our daily lives and we need to keep watching for new clusters. The vaccine is still needed to get back to normal.
China reports zero local transmission, but it's unclear how reliable that is. They still get new imported cases from air travel the whole time. Some fraction of them will go undetected at the airport - if China would go back to normal in every aspect (only testing at borders) they would get new outbreaks quickly.

 

[russ_watters]

We won't eradicate it worldwide that way, we need ongoing changes to our daily lives and we need to keep watching for new clusters.

I said "effectively" because I recognize that ongoing management is needed. True extinction/eradication means you no longer need to do anything at all, not even a vaccine (see: smallpox). As I've said, once you've reached "effective" extinction (single digit cases with no obvious traceable origin), it's contact tracing and individual isolation that keeps the case-count very low.

However...

The vaccine is still needed to get back to normal.
China reports zero local transmission, but it's unclear how reliable that is. They still get new imported cases from air travel the whole time. Some fraction of them will go undetected at the airport - if China would go back to normal in every aspect (only testing at borders) they would get new outbreaks quickly.

...if you are saying that some level of social distancing is needed until we get a vaccine, I do disagree with that. As far as I understand, South Korea has never implemented widespread/mandatory social distancing and has succeeded through contact-tracing and individual quarantine alone in bringing their new case-count down into the single digits per day. Even if they can't get much below 10 cases per day, it would still take about 3 years for the next doubling in their case count.

And China, as far as I'm aware has not gone away from "normal" either in most of the country.

The back-end is much more difficult than the front end because:

• Emotions aren't focused so heavily on attacking the virus despite the social/economic consequences.
• The impact of a week of additional "social distancing" is much, much smaller on the back-end than the front end, and decreases over time.
• Even partial "social distancing" efforts will be economically catastrophic if implemented for a long time. E.G., very few restaurants beyond fast-foods or other takeout/deliver ones (or museums, minor league baseball teams, concert venues, etc.) could survive 18 months of a mandatory halving of their occupancy. Their profit margins are far too low.

I think most people would agree that saving 2 million lives in 6 months (true or not) is worth a short-lived but higher intensity version of the Great Recession. But I don't think most would agree that saving (speculative) 60,000 lives over 2 years is worth a repeat of the Great Depression.

 

[Vanadium 50]

? I think it is because you are using area density instead of volume density.

I think both are proxies for "number of people one interacts with". I would suggest that the probability of infection is some number p, and if you interact with N infected people, you have N shots at getting it. But we don't have access to these numbers. Heck, we don't even have good estimates of daytime populations for most places.

However, I think both the risk and the threat is less for a place like Pig's Knuckle, Arkansas (not a real place) than NYC.

I'll go out and make a prediction: San Francisco will be hit harder than San Jose. Washington DC will probably be hit harder than Baltimore.

 

[russ_watters]

I think both are proxies for "number of people one interacts with". I would suggest that the probability of infection is some number p, and if you interact with N infected people, you have N shots at it. But we don't ahve access to these numbers. Heck, we don't even have good estimates of daytime populations for most places.

Yes, I agree, I'm just saying the difference -- cruise ships over cities -- are probably a lot worse than area density proxy indicates. Both in the "normal" operation and in "social distancing" mode.

 

[atyy]

Apple and Google (political stance; obvious) are working on a voluntary app to aid in contact tracing, but they really don't need to make it voluntary, nor do they really even need an app since they make their own OS. They already track our every move and push us notifications whenever they feel like it, for whatever reason, so there's really nothing to do appwise. They just have to mesh their databases and connect to medical records, and share the data.

Would it be different if the federal government mandated that Apple and Google pushed their app onto every phone?

Also, what if the federal government mandated that they be able to access information from your phone for contact tracing, say location information?

What is the current regulation in South Korea regarding their contact tracing app? Currently in Singapore, the contact tracing app is not (yet?) compulsory for everyone. We have a huge spike in cases, but contact tracing is still ok because the spike is among construction workers living in dorms so it's one huge cluster, not many smaller ones - so this is not obviously generalizable to other places.

 

[atyy]

...if you are saying that some level of social distancing is needed until we get a vaccine, I do disagree with that. As far as I understand, South Korea has never implemented widespread/mandatory social distancing and has succeeded through contact-tracing and individual quarantine alone in bringing their new case-count down into the single digits per day. Even if they can't get much below 10 cases per day, it would still take about 3 years for the next doubling in their case count.

South Korea did have mandatory social distancing (the rules have changed with time, with very strict rules imposed on March 21), so it was not through contact tracing alone. However, I do think it remains true that one can have social distancing that is far below China lockdown levels if one has very strong contact tracing. The start of the big outbreak from the Shincheonji Church of Jesus was in late February, and it was being brought under control by mid March (maybe even early March), ie. before the strictest social distancing rules were imposed. I'm not sure why they imposed the stricter rules after the number of new cases had decreased. I'm guessing that they simply wanted to return to a situation before the Shincheonji spike, when they had pretty exceptional control of case numbers, with some rather minimal (relatively speaking) social distancing.

See the graph of Daily New Cases in South Korea
https://www.worldometers.info/coronavirus/country/south-korea/

Late Feb: https://www.theguardian.com/world/2...s-huge-jump-cases-china-hubei-wuhan-outbreak-

Early April: https://www.reuters.com/article/us-...each-50-daily-coronavirus-cases-idUSKBN21M02P

Mid-April: https://www.channelnewsasia.com/news/asia/covid-19-coronavirus-south-korea-social-distancing-cases-12656516

 

[mfb]

Contact tracing is great but that alone won't be sufficient. Even South Korea closed schools, banned large events and similar things.
Social distancing doesn't have to mean closing down everything. You can do a lot just with people more aware of what comes with an infection risk. Mandatory regulations can be added if necessary.

What is the current regulation in South Korea regarding their contact tracing app?

Voluntary as far as I understand. But combined with measures that would be very, very unpopular in western countries.
If you are ordered to stay at home another app is mandatory.

 

[bhobba]

The main point in my question is - coordination - who will coordinate who does what, what is enforced, how is contact tracing etc done across county and state borders?

Without going into details that is one of the main problems we have in Aus. Fortunately it did not seem to stop us getting on top of it - Queensland - zero cases - again. Maybe it will be eradicated and give us a chance to do even more testing to slow its return.

Another issue is unions like the teachers union are really jumping up and down about having to work (in the teachers case teach), despite other front line workers in a similar situation having to go to work. This is exasperated by a very basic and simple fact that seems to escape many people - unions exist to help their members - in this case teachers - not the students - it's not a nice thing to say - and many (likely even the vast majority) of teachers, care deeply for their students - but they are secondary to the union's purpose. Of course they always present their aguments not in those terms, because if they admitted the obvious, people would see through them straight away, but instead couch it in terms of the effect on students. This has led to a 'huge' amount of confusion and heated debate.

So parents individually decide if to send students to school or homeschool them - front line workers are given priority in being schooled - the rest is up to the school to negotiate - at least I think that's what is going on - as I said it's still a bit confused. The homeschooling app rolled out over the school holidays crashed Monday, crashed yesterday, and I have heard nothing yet about today. Obviously a lack of proper stress testing and capacity planning. I pointed this out - and the response I got was - how would you do that? I just shook my head and said there are a number of ways eg trial runs or software you can get for that purpose, but it all should have been sorted out by the department's capacity planner. From that point basically blankout - you get the feeling - what's a capacity planner. To be fair I do not expect the general public to understand such things - but the department should, and those responsible suitably 'chastised'.

Thanks
Bill

 

[russ_watters]

Would it be different if the federal government mandated that Apple and Google pushed their app onto every phone?

Also, what if the federal government mandated that they be able to access information from your phone for contact tracing, say location information?

Different from what, exactly? The fact that I've seen little or no discussion of mandatory contact tracing by either the federal government or companies that are capable of doing it tells me the stomach for it is very, very low.

Heck, I bet Google/Apple could diagnose Covid-19 on their own if they chose to, using their Big Data, and without actual testing.

What is the current regulation in South Korea regarding their contact tracing app? Currently in Singapore, the contact tracing app is not (yet?) compulsory for everyone. We have a huge spike in cases, but contact tracing is still ok because the spike is among construction workers living in dorms so it's one huge cluster, not many smaller ones - so this is not obviously generalizable to other places.

Hmm...I stated in several previous posts that Singapore needed to be excluded from country data because it is more a city-state than a country. That's not meant as an insult, just as a description of the reality that the rules of science that apply to China, South Korea or the USA don't necessarily apply well to Singapore. Indeed, it seems like what is happening there now is not unlike the second-wave outbreak in small, isolated towns discussed yesterday.
https://www.bloomberg.com/news/arti...re-flipped-from-virus-hero-to-cautionary-tale

So I'm going to set it aside except to point out that "mandatory" can apply to some people, but not everyone...and also "encouraged" is a thing too:
https://www.aljazeera.com/news/2020...navirus-won-stop-buzzing-200408074008185.html

Drawing on the experience of countries that are effectively using technology for contact tracing, the first step — and a requirement — is to encourage, or, better yet, mandate, the installation of tracking apps on phones. In East Asian countries, this has been more mandatory than voluntary. In Singapore, a country known for its efficiency and no-nonsense government, citizens are encouraged by the government to install TraceTogether, which exchanges Bluetooth signals between mobile phones in close proximity. This is a modern counterpart to the traditional and time-consuming contact-tracing method, which relies on fallible human memory. A government poll reported in Nikkei Asian Review found that more than 70% of respondents supported this move. Hong Kong, which has also seen effective containment, recently implemented a mandatory 14-day quarantine upon entry for all overseas arrivals. To enforce this, the Hong Kong government required each new arrival to download the StayHomeSafe app and gave them a paired wristband that uses geofencing technology to help catch violators, and, as reported in Quartz, warned anyone violating the quarantine that they could face up to six months in prison and a $3,200 fine.

For South Korea:

What hasn’t been so widely reported is the country’s heavy use of surveillance technology, notably CCTV and the tracking of bank card and mobile phone usage, to identify who to test in the first place. And this is an important lesson for more liberal countries that might be less tolerant of such privacy invading measures but are hoping to emulate South Korea’s success...

If these patients can’t be found, testing capacity doesn’t mean much. This is where smart city infrastructure comes in. The aim is to work out where known patients have been and test anyone who might have come into contact with them. There are three main ways people are tracked.

First, credit and debit cards. South Korea has the highest proportion of cashless transactions in the world.

Second, mobile phones can be used for the same purpose. In 2019, South Korea had one of the world’s highest phone ownership rates (there are more phones than people). Phone locations are automatically recorded with complete accuracy because devices are connected to between one and three transceivers at any time. And there are approximately 860,000 4G and 5G transceivers densely covering the whole country.

Crucially, phone companies require all customers to provide their real names and national registry numbers. This means it’s possible to track nearly everyone by following the location of their phones.

Finally, CCTV cameras also enable authorities to identify people who have been in contact with COVID-19 patients. In 2014, South Korean cities had over 8 million CCTV cameras, or one camera per 6.3 people. In 2010, everyone was captured an average of 83.1 times per day and every nine seconds while travelling. These figures are likely to be much higher today. Considering the physical size of the country, it is safe to say South Korea has one of the highest densities of surveillance technology in the world.

https://theconversation.com/coronav...-due-to-its-acceptance-of-surveillance-134068

Not only is the map there for citizens to check, but the South Korean government is using it to proactively send regional text messages warning people they may have come into contact with someone carrying the virus.

The location given can be extremely specific, the Washington Post reported a text went out that said an infected person had been at the "Magic Coin Karaoke in Jayang-dong at midnight on Feb. 20."

Some texts give out more personal information however. A text reported by The Guardian read: "A woman in her 60s has just tested positive. Click on the link for the places she visited before she was hospitalised."

The director of the Korea Centers for Disease Control and Prevention, Jeong Eun-kyeong, acknowledged that the site infringes on civil liberties, saying: "It is true that public interests tend to be emphasized more than human rights of individuals when dealing with diseases that can infect others."

https://www.businessinsider.com/cou...-asked-citizens-to-download-an-invasive-app-3

This is a level of surveillance that George Orwell would have had trouble imagining.

 

[russ_watters]

What is the current regulation in South Korea regarding their contact tracing app?

Voluntary as far as I understand. But combined with measures that would be very, very unpopular in western countries.
If you are ordered to stay at home another app is mandatory.

What is a contact tracing app/what would it even look like/do? You guys are aware that Google and Apple already track your every move as an integral part of the phone OS, right? All they have to do is provide that data to the government, and then the government can do whatever it wants to track you -- no app needed. The only real value of an app is to provide you with a user experience, which obviously isn't required. In South Korea for example, the government tracks phone locations, credit card data and does facial recognition. And citizens get push-notifications of contact and get fined/punished if found outside without their phones. Avoidance has been a problem (link below), so in order to defeat people leaving their phones at home, they've added tracking bracelets for certain grouops.

To me, the only thing an app does is provide a pretty interface for access by the user. For example, the location history function of the Google Maps app. But there is no actual need for it.

At its simplest, digital contact tracing might work like this: Phones log their own locations; when the owner of a phone tests positive for COVID-19, a record of their recent movements is shared with health officials; owners of any other phones that recently came close to that phone get notified of their risk of infection and are advised to self-isolate.

https://www.sciencemag.org/news/202...d-help-stem-spread-coronavirus-privacy-price#

https://www.businessinsider.com/sou...irus-catch-people-dodging-tracking-app-2020-4

Article 76-2(2) of South Korea’s Infectious Disease Control and Prevention Act (IDCPA), for instance, was amended in the aftermath of MERS to equip the minister of health with extensive legal authority to collect private data, without a warrant, from both already confirmed and potential patients. The article expressly mandates that private telecommunications companies and the National Police Agency share the “location information of patients … and [of] persons likely to be infected” with health authorities at their request. This is in addition to Article 76-2(1), which already enables the health minister and the director of the Korea Centers for Disease Control to require “medical institutions, pharmacies, corporations, organizations, and individuals” to provide “information concerning patients … and persons feared to be infected.”

https://www.lawfareblog.com/lessons-america-how-south-korean-authorities-used-law-fight-coronavirus

 

[Jarvis323]

Earlier in the thread a paper was mentioned that made some comparison with HIV, but I think the resemblence is superficial since SARS-CoV-2 doesn't seem to replicate in the immune cells.

I cited that paper. It's an accepted Nature paper, but it turned out to be controversial. There has been a lot of criticism of it on reddit and twitter as far as I could tell. I don't know what to make of it at this point.

The news article that reported it also made a lot of claims based on anonymous sources.

I guess I shouldn't have been so quick to post it.

Side rant: This crisis is a major awakening for many people to the scientific research process. News articles typically treat hearsay as fact, let alone un-peer reviewed publications. It may come as a shock also to many that even accepted peer reviewed papers could have flaws, or even have false conclusions without technical flaws, and that even mainstream theories (e.g. big bang) are not matters of fact.

Even most Journalists claiming to be fact checking and combating misinformation are blatantly doing the opposite (likely without even realizing it).

Lack of critical thinking skills is showing to be a major world crisis, that is negatively affecting all areas from research, to public policy and action, politics, and public belief/opinion. I mean, I'm no exception. We just really need to do a better job in the future teaching people how to think critically.

In my opinion, current culture and systems thrive/operate way too much based on manipulation, and incentivize dumbing down, and mis/under-informing the general population. I think this will lead our species and planet to ruin in the long run if we aren't careful.

 

[atyy]

Different from what, exactly? The fact that I've seen little or no discussion of mandatory contact tracing by either the federal government or companies that are capable of doing it tells me the stomach for it is very, very low.

Different from if Apple & Google decided to just make it a mandatory update on their OS?

Hmm...I stated in several previous posts that Singapore needed to be excluded from country data because it is more a city-state than a country. That's not meant as an insult, just as a description of the reality that the rules of science that apply to China, South Korea or the USA don't necessarily apply well to Singapore. Indeed, it seems like what is happening there now is not unlike the second-wave outbreak in small, isolated towns discussed yesterday.
https://www.bloomberg.com/news/arti...re-flipped-from-virus-hero-to-cautionary-tale

Yes, I agree, Singapore's experience is not generalizable (or at least not obviously). And don't worry, I've never understood any of your statements to be an insult, but thanks for the note on that. Even what is happening here now is not generalizable - I doubt it is like a second-wave outbreak that some worry about for small towns in the US. The huge spike in Singapore now is among construction workers living in quite densely packed dorms (10 people in a room), so that is totally unlike a small town in the US. These workers are now being moved to temporary housing which is less dense, and the government and various organizations are trying to make sure their welfare is taken care of despite having to suddenly live in new temporary housing. So far (fingers crossed) there hasn't been an increase in ICU cases, possibly because construction workers are usually fit and have only a mild illness. But one can't take that for granted, as we had a construction worker who got COVID-19 several months ago, before this spike in cases, and it took 2 months in ICU before he was well enough to be moved out.

 

[atyy]

What is a contact tracing app/what would it even look like/do? You guys are aware that Google and Apple already track your every move as an integral part of the phone OS, right? All they have to do is provide that data to the government, and then the government can do whatever it wants to track you -- no app needed. The only real value of an app is to provide you with a user experience, which obviously isn't required. In South Korea for example, the government tracks phone locations, credit card data and does facial recognition. And citizens get push-notifications of contact and get fined/punished if found outside without their phones. Avoidance has been a problem (link below), so in order to defeat people leaving their phones at home, they've added tracking bracelets for certain grouops.

Yes, in principle location information can already be pulled from your phone service provider (eg. to help emergency services locate a caller).

But the current apps envisaged by Apple and Google are use a different idea and hope it works on voluntary basis. The idea is that if two people have the app and allow its use, their phone will use bluetooth to figure out when they are close contacts (eg. when they are less than 6 ft apart for 10 minutes), and the app logs these close contact incidents. When one of the people is confirmed and enters it into the system, the app will inform close contacts, who can then self-isolate and get tested.
https://www.theverge.com/interface/...-coronavirus-api-public-health-app-challenges

 

[DennisN]

I don't enjoy sharing these gloomy news articles, but I thought these worries concerning the near future was too important not to mention:

• CDC chief warns of 'even more difficult' wave of Coronavirus next winter (The Guardian, 21 april 2020)
• Fears of prolonged Coronavirus downturn and second wave of US cases (The Guardian, 22 april 2020)
  And I guess the possibility of a second wave accompanied by a flu season applies to more countries than US.
• Coronavirus pandemic 'will cause famine of biblical proportions' (The Guardian, 21 april 2020)
  Maybe the title is worded a bit too definitive, but here's a quote:
  

  More than 30 countries in the developing world could experience widespread famine, says David Beasley, chief of the UN’s food relief agency.

 

[russ_watters]

Yes, in principle location information can already be pulled from your phone service provider (eg. to help emergency services locate a caller).

But the current apps envisaged by Apple and Google are use a different idea and hope it works on voluntary basis. The idea is that if two people have the app and allow its use, their phone will use bluetooth to figure out when they are close contacts (eg. when they are less than 6 ft apart for 10 minutes), and the app logs these close contact incidents. When one of the people is confirmed and enters it into the system, the app will inform close contacts, who can then self-isolate and get tested.

Right, so that requires that a substantial fraction of people who get sick voluntarily report it to the app, in a timely fashion. Otherwise, it won't work. And I think it's highly unlikely happen. In other countries that have successfully implemented contact tracing, that feature isn't part of the app and isn't optional; the government provides the test results directly to the phone/software companies. That "user experience" feature (self-reporting) doesn't exist because it's a very ineffective way to get the key data.

Think about a counterexample: navigation and traffic. Nobody downloaded an app or consciously opted-in to be tracked for it. It works so well precisely because it doesn't require the user to opt-in (they're just in).

 

[peanut]

This World Earth Day, let's remember that the story of SARSCoV2 COVID19 is the story of SARS, MERS, etc. All are zoonotic diseases: they come from other species. As humans continue to encroach on animal habitats, more such diseases are likely to emerge.

 

[Astronuc]

LA Times reports, "Autopsies reveal first confirmed U.S. Coronavirus deaths occurred in Bay Area in February," which is repeated by other media, e.g., Yahoo, Washington Post, NBC, . . . .

Officials previously had said the first Silicon Valley death was March 9. But the Santa Clara County medical examiner revealed Tuesday that people who died Feb. 6, Feb. 17 and March 6 also died of COVID-19.

"These three individuals died at home during a time when very limited testing was available only through the [U.S. Centers for Disease Control and Prevention]. Testing criteria set by the CDC at the time restricted testing to only individuals with a known travel history and who sought medical care for specific symptoms,"

Santa Clara County press release - https://www.sccgov.org/sites/covid19/Pages/press-release-04-21-20-early.aspx

The Medical Examiner-Coroner performed autopsies on two individuals who died at home on February 6, 2020 and February 17, 2020. Samples from the two individuals were sent to the Centers for Disease Control and Prevention. Today, the Medical Examiner-Coroner received confirmation from the CDC that tissue samples from both cases are positive for SARS-CoV-2 (the virus that causes COVID-19).

The victims were tested posthumously, and the results returned 75 days and 64 days, respectively, after death! Date of autopsy (specimen collection) is not mentioned.

Clearly early detection (and testing) is necessary.

"The County of Santa Clara is reporting a total of 1,922 cases and 83 deaths." on April 20.
https://www.sccgov.org/sites/covid19/Pages/press-release-04-20-2020-dashboard-cases-reporting-process-update.aspx

"Santa Clara County has so far reported 88 coronavirus-related deaths, including five new deaths reported Tuesday. The county now has 1,948 confirmed cases."
https://www.mercurynews.com/2020/04...s-in-bay-area-occurred-in-february-not-march/

Also, I read a brief headline that the government of Wuhan had revised their number up by the end of last week.

 

[Astronuc]

Fortunately (?) these towns tend to be lower income and very low mobility, so the likelihood of someone returning from Italy to start a cluster of infections is really low. See: "Allentown".

Interesting example. I had a colleague who lived and worked in Allentown (PPL), and he used to travel frequently to Europe for work (supplier audit). If that was still happening, he could potentially bring Coronavirus into the community. Certainly, the more remote a town (Mauch Chunk, Mahanoy City, Hazelton, or Sayre), the less likely of exposure, but it could happen.

Lehigh County reports 2295 confirmed cases and 49 deaths.
https://www.health.pa.gov/topics/disease/coronavirus/Pages/Cases.aspx

In the near future and longer term, it would be useful to understand how different areas of the nation/economy are affected by mobility.

There is only one county in Washington state that reports 0 cases, and it is the least populated county. One adjacent county has at least one case, and two other adjacent counties have 13 and 14 cases.

 

[atyy]

Right, so that requires that a substantial fraction of people who get sick voluntarily report it to the app, in a timely fashion. Otherwise, it won't work. And I think it's highly unlikely happen. In other countries that have successfully implemented contact tracing, that feature isn't part of the app and isn't optional; the government provides the test results directly to the phone/software companies. That "user experience" part doesn't exist because it's a very ineffective way to implement the key feature.

Think about a counterexample: navigation and traffic. Nobody downloaded an app or consciously opted-in to be tracked for it. It works so well precisely because it doesn't require the user to opt-in (they're just in).

So just to make sure I understand you - you wouldn't mind if the South Korean contact tracing system could be implemented in the US (say if Congress legislated it and the President approved)?

 

[gmax137]

Also, what if the federal government mandated that they be able to access information from your phone for contact tracing, say location information?

I would turn my phone off. And maybe remove the SIM card when not in use.

 

[kyphysics]

https://www.bloomberg.com/news/arti...weeks-earlier-than-first-thought?srnd=premium

The U.S.’s first deaths from the new Coronavirus came weeks earlier than was previously known, suggesting the virus may have long been spreading outside of health officials’ attempts to contain it earlier this year.

Two residents of Santa Clara County, California, who died at home on Feb. 6 and Feb. 17 were infected with the virus, according to a https://www.sccgov.org/sites/covid19/Pages/press-release-04-21-20-early.aspx by the county’s public health department.

The first death is 20 days earlier than what was previously thought to be the first U.S. fatality, and about three weeks before health officials identified the first Covid-19 infection without a known tie to other cases. The deaths were also weeks before cities and states began implementing widespread social-distancing measures.

 

[bhobba]

Just an interesting aside. Everyone this year, correctly, is getting a strengthened Flu jab, so much so it is in short supply, but the government is ensuring everyone who wants it (and as I said that is everyone this year) will get it May at the latest. But doctors have noticed with the Coronovirus measures the Flu has plummeted to a trickle even though not everyone has been vaccinated yet. Just imagine how much better Flu season would be in a normal year if everyone got the Flu jab and did simple measures like washing hands and basic social distancing.

Thanks
Bill

 

[DennisN]

Good news from Germany:

Germany approves first human trials for vaccine

A clinical test of a Covid-19 vaccine has been approved in Germany, the country’s Federal Institute for Vaccines has said. In the first part of the trial, 200 healthy people between 18 and 55 will receive several variants of the vaccine. The vaccine candidate was produced by biotech firm BioNTech, and is an RNA vaccine.

Source: The Guardian live update (22 april 2020)

 

[russ_watters]

So just to make sure I understand you - you wouldn't mind if the South Korean contact tracing system could be implemented in the US (say if Congress legislated it and the President approved)?

Yes.

I don't think the contact-trace-and-quarantine technique can succeed without it, and it can only be implemented on a national/federal government level (I'm not sure how, legislatively). My concern/expectation/prediction is that after we lift mandatory social distancing, we'll just get another spike/wave. Perhaps after a second wave, people/government will decide it's important to do.

 

[hmmm27]

IMnsHO, opt-in.

I normally go out of my way not to give Google/M$/Apple/etc. the time of day - mostly because they don't ask and are pretty weaselly in general but, if they're doing it strictly for "we're all in this together" publicity, dump the data at the end, and I won't find myself on the arse end of a spam flood in perpetua, then "I hereby give permission..." is forthcoming.

 

[russ_watters]

Interesting example. I had a colleague who lived and worked in Allentown (PPL), and he used to travel frequently to Europe for work (supplier audit). If that was still happening, he could potentially bring Coronavirus into the community. Certainly, the more remote a town (Mauch Chunk, Mahanoy City, Hazelton, or Sayre), the less likely of exposure, but it could happen.

I was born in Allentown; my dad worked for Air Products and both parents for Bethlehem Steel, and that was a reference to the Billy Joel song (circa 1982). The song accurately describes much of my extended family. It may not apply as well anymore, as Allentown seems to have become something of a suburb of Philadelphia.

 

[russ_watters]

I would turn my phone off. And maybe remove the SIM card when not in use.

What if you would be fined $8,000 or arrested and given a non-removable tracking bracelet for turning your phone off to break a curfew?
https://www.businessinsider.com/sou...irus-catch-people-dodging-tracking-app-2020-4

 

[Astronuc]

I was born in Allentown; my dad worked for Air Products and both parents for Bethlehem Steel, and that was a reference to the Billy Joel song (circa 1982). The song accurately describes much of my extended family. It may not apply as well anymore, as Allentown seems to have become something of a suburb of Philadelphia.

I've been through Allendown many times, and I've seen it change (like many other places) since the 1980s. I've met folks from Lehigh University in Bethlehem, and I interacted with a well-known professor of materials science and engineering about 3 decades ago. For me, it's a sentimental and historic place because of the LVRR and other connections.

 

[kadiot]

New Zealand is flattening the curve. R0 less than 1. Disease will eventually die out.

 

[Astronuc]

Regarding the spread, USA Today reports on an investigation of the meat packing industry in which dozens of facilities report outbreaks of Coronavirus and cases of COVID-19, e.g., Smithfield plant in SD and Tyson plants in several states.
https://www.usatoday.com/in-depth/n...y-force-choice-worker-health-food/2995232001/
Wa state - https://www.tri-cityherald.com/news/coronavirus/article242117246.html

Washington Post reports on differences between Rhode Island and Kentucky with respect to impact of Coronavirus and testing.
https://www.msn.com/en-us/news/us/in-two-states-a-vast-testing-gap-shows-what-it-means-to-have-no-national-strategy/ar-BB130p7D
https://www.washingtonpost.com/health/2020/04/21/kentucky-rhode-island-coronavirus-testing (subscription required)