The United States now has more coronavirus cases than any other country, including China, marking a new stage in the epidemic. As before, feel free to treat this as an open thread for all coronavirus-related issues. Everything here is speculative and not intended as medical advice.
Hammer and dance
Most of the smart people I’ve been reading have converged on something like the ideas expressed in The Hammer And The Dance – see this Less Wrong post for more.
[ed. For summaries of these links, see the following posts.]
Summary: Asian countries have managed to control the pandemic through mass testing, contact tracing, and travel bans, without economic shutdown. The West lost the chance for a clean win when it bungled its first month of response, but it can still recover its footing. We need a medium-term national shutdown to arrest the spread of the virus until authorities can get their act together – manufacture lots of tests and face masks, create a testing infrastructure, come up with policies for how to respond when people test positive, distribute the face masks to everyone, etc. With a lot of work, we can manage that in a month or so. After that, we can relax the national shutdown, start over with a clean slate, and pursue the Asian-style containment strategy we should have been doing since the beginning.
This is the only plan I’ve heard from anybody that doesn’t result in either hundreds of thousands of deaths, or the economy crashing so hard we’re all reduced to eating weeds and rocks.
I relayed some criticism of a previous Medium post, Flattening The Curve Is A Deadly Delusion, last links post. In retrospect, I was wrong, it was right (except for the minor math errors it admitted to), and it was trying to say something similar to this. There is no practical way to “flatten the curve” except by making it so flat that the virus is all-but-gone, like it is in South Korea right now. I think this was also the conclusion of the Imperial College London report that everyone has been talking about. (...)
Japan and other mysteries
Japan should be having a terrible time right now. They were one of the first countries to get coronavirus cases, around the same time as South Korea and Italy. And their response has been somewhere between terrible and nonexistent. A friend living in Japan says that “Japan has the worst coronavirus response in the world (the USA is second worst)”, and gets backup from commenters, including a photo of still-packed rush hour trains. Japan is super-dense and full of old people, so at this point the living should envy the dead.
But actually their case number has barely budged over the past month. It was 200 a month ago. Now it’s 1300. This is the most successful coronavirus containment by any major country’s, much better than even South Korea’s, and it was all done with zero effort.
The obvious conclusion is that Japan just isn’t testing anyone. This turns out to be true – they were hoping that if they made themselves look virus-free, the world would still let them hold the Tokyo Olympics this summer.
But at this point, it should be beyond their ability to cover up. We should be getting the same horrifying stories of overflowing hospitals and convoys of coffins that we hear out of Italy. Japanese cities should be defying the national government’s orders and going into total lockdowns. Since none of this is happening, it looks like Japan really is almost virus-free. The Japan Times is as confused about this as I am.
Some people have gestured at the Japanese being an unusually clean and law-abiding people. Maybe the government has just sort of subtly communicated “don’t do anything that will mess up our Olympics chances” and everyone has been really good at not touching their face. Maybe widespread use of face masks is much much more important than anyone has previously believed. I don’t know.
One way this should affect us Westerners is by making us worried that an Asian-style containment strategy wouldn’t work here. The evidence in favor of such a strategy is that it worked in a bunch of Asian countries like South Korea, Taiwan, Hong Kong, and Singapore. But if there’s something about wealthy orderly mask-wearing Asian societies that makes them mysteriously immune to the pandemic, maybe their containment strategies aren’t really that impressive. Maybe they just needed a little bit of containment to tip them over the edge. I don’t know, things sure seemed bad in South Korea a few weeks ago (and in Wuhan). I am so boggled by this that I don’t know what to think.
Also, what about Iran? The reports sounded basically apocalyptic a few weeks ago. They stubbornly refused to institute any lockdowns or stop kissing their sacred shrines. Now they have fewer cases than Spain, Germany, or the US. A quick look at the data confirms that their doubling time is now 11 days, compared to six days in Italy and four in the US. Again, I have no explanation.
Takeout
So far every US state and local self-isolation order has included exceptions for getting takeout or delivery food. I’m sure restaurants appreciate the business and consumers appreciate getting to keep that particular aspect of a normal lifestyle. But is it actually safe?
All the big organizations say yes. From Forbes:
I am really craving something other than the three or four things I can cook myself, and I have a lot of mutually-quarantined housemates to convince, so if any of you have any clearer estimate of the risk situation, please share.
Ventilator numbers
Britain has 5,000, or one per 12,000 citizens. The US has 160,000, or about 1 per 2,000 citizens (why are these numbers so different?). The head of a small ventilator company says they usually “sell 50 in a good month”.
Elon Musk recently delivered 1,255 ventilators to California from some of Tesla’s Chinese contacts, and promised to make more. Dyson, the British vacuum manufacturer, says it will be able to make 10,000 ventilators in time to help with the crisis – remember, that’s twice what the whole UK has right now. The American Hospital Association says 960,000 Americans may require ventilators during the pandemic – hopefully not all at once.
Ventilators also require trained staff to operate. I never know how far to trust medical people when they say something requires training. You would think doing a lumbar puncture requires training, but the training I received for this in residency was watching one (1) guy do it one (1) time, and then them saying “Now you do it” – which by the way is exactly as scary as you would expect. This is an official thing in medical education, called see one, do one, teach one. So when people say some medical task requires training, I don’t know if they mean “ten years’ experience and a licensing exam”, “watch it once and then we throw you in the deep end” or “we’re going to make you go through the former, but the latter would have worked too”. Hopefully ventilators are more like the latter and someone can train new people really quickly.
If you’re confused about the difference between ventilators, oxygen concentrators, etc, or you have clever questions like “can we repurpose CPAP machines as ventilators?”, you might like Sarah Constantin’s Oxygen Supplementation 101.
The British reversal
A UK critical care doctor on Reddit wrote a great explanation of their recent about-face on coronavirus strategy.
They say that over the past few years, Britain developed a cutting-edge new strategy for dealing with pandemics by building herd immunity. It was actually really novel and exciting and they were anxious to try it out. When the coronavirus came along, the government plugged its spread rate, death rate, etc into the strategy and got the plan Johnson originally announced. This is why he kept talking about how evidence-based it was and how top scientists said this was the best way to do things.
But other pandemics don’t require ventilators nearly as often as coronavirus does. So the model, which was originally built around flu, didn’t include a term for ventilator shortages. Once someone added that in, the herd immunity strategy went from clever idea to total disaster, and the UK had to perform a disastrous about-face. Something something technocratic hubris vs. complexity of the real world.
Hammer and dance
Most of the smart people I’ve been reading have converged on something like the ideas expressed in The Hammer And The Dance – see this Less Wrong post for more.
[ed. For summaries of these links, see the following posts.]
Summary: Asian countries have managed to control the pandemic through mass testing, contact tracing, and travel bans, without economic shutdown. The West lost the chance for a clean win when it bungled its first month of response, but it can still recover its footing. We need a medium-term national shutdown to arrest the spread of the virus until authorities can get their act together – manufacture lots of tests and face masks, create a testing infrastructure, come up with policies for how to respond when people test positive, distribute the face masks to everyone, etc. With a lot of work, we can manage that in a month or so. After that, we can relax the national shutdown, start over with a clean slate, and pursue the Asian-style containment strategy we should have been doing since the beginning.
This is the only plan I’ve heard from anybody that doesn’t result in either hundreds of thousands of deaths, or the economy crashing so hard we’re all reduced to eating weeds and rocks.
I relayed some criticism of a previous Medium post, Flattening The Curve Is A Deadly Delusion, last links post. In retrospect, I was wrong, it was right (except for the minor math errors it admitted to), and it was trying to say something similar to this. There is no practical way to “flatten the curve” except by making it so flat that the virus is all-but-gone, like it is in South Korea right now. I think this was also the conclusion of the Imperial College London report that everyone has been talking about. (...)
Japan and other mysteries
Japan should be having a terrible time right now. They were one of the first countries to get coronavirus cases, around the same time as South Korea and Italy. And their response has been somewhere between terrible and nonexistent. A friend living in Japan says that “Japan has the worst coronavirus response in the world (the USA is second worst)”, and gets backup from commenters, including a photo of still-packed rush hour trains. Japan is super-dense and full of old people, so at this point the living should envy the dead.
But actually their case number has barely budged over the past month. It was 200 a month ago. Now it’s 1300. This is the most successful coronavirus containment by any major country’s, much better than even South Korea’s, and it was all done with zero effort.
The obvious conclusion is that Japan just isn’t testing anyone. This turns out to be true – they were hoping that if they made themselves look virus-free, the world would still let them hold the Tokyo Olympics this summer.
But at this point, it should be beyond their ability to cover up. We should be getting the same horrifying stories of overflowing hospitals and convoys of coffins that we hear out of Italy. Japanese cities should be defying the national government’s orders and going into total lockdowns. Since none of this is happening, it looks like Japan really is almost virus-free. The Japan Times is as confused about this as I am.
Some people have gestured at the Japanese being an unusually clean and law-abiding people. Maybe the government has just sort of subtly communicated “don’t do anything that will mess up our Olympics chances” and everyone has been really good at not touching their face. Maybe widespread use of face masks is much much more important than anyone has previously believed. I don’t know.
One way this should affect us Westerners is by making us worried that an Asian-style containment strategy wouldn’t work here. The evidence in favor of such a strategy is that it worked in a bunch of Asian countries like South Korea, Taiwan, Hong Kong, and Singapore. But if there’s something about wealthy orderly mask-wearing Asian societies that makes them mysteriously immune to the pandemic, maybe their containment strategies aren’t really that impressive. Maybe they just needed a little bit of containment to tip them over the edge. I don’t know, things sure seemed bad in South Korea a few weeks ago (and in Wuhan). I am so boggled by this that I don’t know what to think.
Also, what about Iran? The reports sounded basically apocalyptic a few weeks ago. They stubbornly refused to institute any lockdowns or stop kissing their sacred shrines. Now they have fewer cases than Spain, Germany, or the US. A quick look at the data confirms that their doubling time is now 11 days, compared to six days in Italy and four in the US. Again, I have no explanation.
Takeout
So far every US state and local self-isolation order has included exceptions for getting takeout or delivery food. I’m sure restaurants appreciate the business and consumers appreciate getting to keep that particular aspect of a normal lifestyle. But is it actually safe?
All the big organizations say yes. From Forbes:
“Takeout food seems to pose a very minimal risk of passing on coronavirus. Here, virology experts explain why….”There is no evidence that SARS-CoV-2 can be transmitted by eating food. I imagine that if this is possible, the risk is extremely low,” said Angela L. Rasmussen, PhD, a virologist in the faculty of the Center for Infection and Immunity at the Columbia Mailman School of Public Health, adding that she is not aware of any human coronaviruses that can be transmitted through food.And the San Francisco Chronicle:
With dining in restaurants off the table, many Americans are wondering if take-out and delivery food options are still viable in the age of coronavirus. Luckily for people tired of their own home cooking, the answer is, by and large, yes.
According to the CDC, transmission of COVID-19 primarily happens person-to-person, so your largest risk is not in the food but in human interaction. Keep your distance as much as possible when picking up food, or request that delivery workers leave the food on your doorstep. As with other in-person interactions, remember to avoid touching your face and be sure to wash your hands thoroughly as soon as you can.
“It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads,” the CDC says.On the other hand, all of my friends who are actually worried about getting the condition are avoiding delivery food like, well, the plague. Their argument is that we know the virus can survive on surfaces for a while, so all you need is one food worker to cough on your food after it’s been cooked (or on food that doesn’t get cooked at all), and you’re screwed. Restauarants are supposed to follow sanitary precautions, but people familiar with the industry say these precautions are not so strong to 100% (or even an especially high percent) ensure you get un-coughed-on food. The CDC telling food workers they don’t need face masks does not exactly inspire confidence here.
I am really craving something other than the three or four things I can cook myself, and I have a lot of mutually-quarantined housemates to convince, so if any of you have any clearer estimate of the risk situation, please share.
Ventilator numbers
Britain has 5,000, or one per 12,000 citizens. The US has 160,000, or about 1 per 2,000 citizens (why are these numbers so different?). The head of a small ventilator company says they usually “sell 50 in a good month”.
Elon Musk recently delivered 1,255 ventilators to California from some of Tesla’s Chinese contacts, and promised to make more. Dyson, the British vacuum manufacturer, says it will be able to make 10,000 ventilators in time to help with the crisis – remember, that’s twice what the whole UK has right now. The American Hospital Association says 960,000 Americans may require ventilators during the pandemic – hopefully not all at once.
Ventilators also require trained staff to operate. I never know how far to trust medical people when they say something requires training. You would think doing a lumbar puncture requires training, but the training I received for this in residency was watching one (1) guy do it one (1) time, and then them saying “Now you do it” – which by the way is exactly as scary as you would expect. This is an official thing in medical education, called see one, do one, teach one. So when people say some medical task requires training, I don’t know if they mean “ten years’ experience and a licensing exam”, “watch it once and then we throw you in the deep end” or “we’re going to make you go through the former, but the latter would have worked too”. Hopefully ventilators are more like the latter and someone can train new people really quickly.
If you’re confused about the difference between ventilators, oxygen concentrators, etc, or you have clever questions like “can we repurpose CPAP machines as ventilators?”, you might like Sarah Constantin’s Oxygen Supplementation 101.
The British reversal
A UK critical care doctor on Reddit wrote a great explanation of their recent about-face on coronavirus strategy.
They say that over the past few years, Britain developed a cutting-edge new strategy for dealing with pandemics by building herd immunity. It was actually really novel and exciting and they were anxious to try it out. When the coronavirus came along, the government plugged its spread rate, death rate, etc into the strategy and got the plan Johnson originally announced. This is why he kept talking about how evidence-based it was and how top scientists said this was the best way to do things.
But other pandemics don’t require ventilators nearly as often as coronavirus does. So the model, which was originally built around flu, didn’t include a term for ventilator shortages. Once someone added that in, the herd immunity strategy went from clever idea to total disaster, and the UK had to perform a disastrous about-face. Something something technocratic hubris vs. complexity of the real world.
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