To Win the CoronaWar, Defense Is The Only Offense

Why does it work this way? 

By Wisdom Seeker, a WOLF STREET Commenter with a physical sciences Ph.D., San Francisco Bay Area:

The bad news is already out: a new coronavirus declared war on Humanity last December. It did a Pearl Harbor on Wuhan in January, blitzed through Iran in February, hit Milan in early March and is now invading the rest of Europe.

The virus spread worldwide, to the U.S. and everywhere else. Singapore and South Korea went on red-alert and have slowed the virus. But elsewhere, most people couldn’t break out of business-as-usual. In another huge victory for the virus, it has spread globally, insidiously, doubling as fast as every three days in many places.

The graph below plots data for 5 battlegrounds in the CoronaWar: Italy, South Korea, the San Francisco Bay Area, King County (Seattle) in Washington, and Westchester County outside New York City. The vertical axis shows cumulative cases per million people in each area. Because the virus spreads exponentially, the graph uses a log scale – this makes the trends show as straight lines. The data for each region have been time-shifted to show the common trend:

The data come from the Johns Hopkins University COVID dataset, supplemented after 3/9 by county reports for the US hot spots.

All 5 regions show the same process:

  1. Detection of early spread of the disease, with testing “catching up” to what’s going on.
  2. Exponential growth with a doubling time of about three days.
  3. Two possible outcomes: either defeat – massive fatalities due to “ICU overload”; or victory – a “bend the curve” taming of the outbreak.

The horizontal dashed line on the graph is an empirical estimate of the “ICU overload” threshold.  It’s based on the level of cases in Lombardy (Milan region of Italy) when media reported overwhelmed hospitals. It’s not exact – each region has its own characteristics. But Lombardy has a good medical system.

Regardless, there’s always a limit, and with exponential growth the difference between systems is only a few days either way.  To stay out of “ICU Overload,” we have to act now to stop the close-encounter social interactions that spread the disease.

Why does it work this way?  

The science of epidemiology is fascinating and can be complex, but for a population with no immunity, the math for the early stage of an epidemic is simple exponential growth. If a typical infected person unwittingly spreads the disease to others, the disease multiplies. And then the newly infected spread it further, and it multiplies again.

In the early stages this process is nearly invisible. But left unchecked, it grows fast and soon becomes catastrophic.

For each region, the tipping point between “really bad flu season” and “thousands dead” occurs if too many patients with COVID pneumonia overwhelm hospitals.

With enough ICUs, ventilators and oxygen support, coronavirus is much less deadly.  But if too many people need those resources, doctors must make life-or-death decisions.  The oldest and sickest get left to die, so that others have a chance to live. “Excess Mortality” spikes up not just among COVID patients, but for all ailments that cannot get full care.

This disaster happened in Wuhan, in Iran, and is now happening in Lombardy (Milan area) in northern Italy.  We must not let it happen anywhere else! There is good news: the world finally responding, and the faster we act, the less overall damage there will be.

Underlying all the shutdowns and closures is one principle: the only offense against this Coronavirus is a great defense.  There’s no cure, and there won’t be a vaccine for a while yet. So the only way to save lives is to prevent infections in the first place, and most importantly to keep the hospitals from being overwhelmed.

Remember the girl who recognized the 2004 Tsunami in Thailand and tried to warn people to get off the beach? How could she convince people the threat was real, when the sun was shining and all the extra beach was suddenly exposed as the water pulled back! Public Health officials face the same challenge today: From a few tiny warning signs, they know disaster is approaching, but no one else understands them.  Hard to persuade an unwitting population living in denial!

But the graph shows that now is the time to act fast to save lives. Key hot spots are within 1-2 weeks of ICU overload unless we “bend the curve.” Globally, even a day’s delay will now cost thousands of lives. Governments need to stop dragging their feed due to the adverse impacts of shutdowns, do the shutdowns anyway, and start mitigating those impacts.  The faster we move, the shorter the shutdowns need to be, and the less economic damage overall.  Perhaps this is why WHO finally declared the global pandemic this week.

Because Defense is the Only Offense, it’s time to Stay Home and Stay Healthy. P.S. For a more detailed version of this type of thinking, see the Open Letter by Purdue University Professor Ninghui Li. By Wisdom Seeker.

How will Canadians service $1.56 trillion in mortgage debt plus other debts such as credit cards? What about tenants who can’t pay their rent? Read...  No One Knows How the Coronavirus Will Impact Canadian Real Estate, But Here Are My Thoughts

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  258 comments for “To Win the CoronaWar, Defense Is The Only Offense

  1. Matt says:

    Part of the problem with this is that hospitals are already overwhelmed – not that COVID-19 is overwhelming the system itself. Some hospitals regularly operate at 95% of capacity. Italy’s aging population doesn’t help. Seattle’s hospitals, like many other in the country already operate at near to constant 100% of capacity.

    I work in the busiest ER in San Diego and I can tell you that on a regular basis, admitted patients sit in a hospital bed for over twenty-four hours because the hospital is already at capacity.

    About two months ago, our hospital had to open up a makeshift ICU because the ICU was already full. This problem is not new to hospitals and providers. Hopefully, after people realize the majority of people who get COVID-19 are going to be just fine, the next realization is the overcrowding of U.S. hospitals that happens on a regular basis.

    • Dawood says:

      What are your thoughts on the UKs apparent herd strategy ?

      • Twinkytwonk says:

        As someone from the UK the herd strategy doesn’t seem to me a good idea as you need a large proportion of the population to be become immune to the virus which will take time. Further to this is the fact that the health care system is on its knees 12 months of the year regardless. In most areas it is virtually impossible to get an appointment at the doctor’s surgery unless you get up at 7am and starting ringing them in the hope you’ll get through. If unsuccessful that day then you can try the same procedure the next day.

        This forces people to go to the walk in center at the hospital, they closed its down a few months back. So this leaves the hospital. My local is hospital is pretty much exactly the same as it was in 1981 when the population was about a third as to what it is now. It, like many hospitals are rated as underperforming and put on special measures ( a government bullshit term to make us think they will fix it).

        I give them three weeks until the system collapses.

        • Kenny Logouts says:

          The UK population wasn’t 1/3rd in 1980.
          56 mill vs 67 mill ~ 5/6th

          A lot of the UK hospitals in 1980 were like porta-cabins or shacks, or based around very old Victorian buildings.
          All those small/medium hospitals have gone now though, replaced with fewer larger setups.

          I read an anecdotal piece about A&E (which you rightly say are overrun with people who should be a doctors etc) and people were asked to stay away unless it was an emergency due to coronavirus, and the A&E was almost empty.

          Simply put, lots of UK people are at doctors or A&E for hurty knees, or a cough, or sniffles, or self inflicted woes due to crap diets, drinking, smoking etc.
          And suddenly they’re ok to not need support when a bigger nastier lurgy is present.

          The NHS is struggling, but it’s a great deal to do with daft people who abuse it, and who abuse their own bodies.

          I think the UK plan is sensible.

          Restrict the most vulnerable and let everyone else make the decision that fits their needs.
          Ask people who seem ill to stay at home for a week.

          The transmission rate should fall hard if we do that, and the most vulnerable who clog up health care should be near zero if they stay safe when asked to.

          The success all revolves around people being sensible, and you’re more likely to get that if you trust people.
          Those who can’t be trusted won’t make up enough numbers to probably make much difference any way.

        • John Seddon says:

          As a retired practitioner, the Corana virus pandemic is going to be bigger than Spanish flu one hundred years ago because today the global population is far larger and more mobile than ever. Early signs in most countries indicate that doctors are already having to select younger infected patients to nurse and let the over sixties possibly die. Over sixties tend to more likely suffer work related or self inflicted or genetic illnesses.
          This virus is currently deadly and will take out the elderly weak despite any intensive care. Intensive care is a very limited resource not available for many people as Italy and Spain are finding where warehouses are being turned into temporary nursing facilities.
          I dread to think what the lack of health care capacity in the US is going to do to the uninsured masses of low income families. At least most Europeans enjoy health service support but the question is going to be how far and for how long this will cope when the epidemic peak in around three months affects at least fifty per cent of every population.
          If you want the medical background on this virus, google up The Lancet, a leading U.K. and Europe medical publication for the latest non fake news situation.
          My personal advice is if you are over fifty and it is financially practical, seek self isolation until July, when the virus should be in decline. If you are under fifty the chances are that when you catch it, it will statistically probably not kill you, unless you have other complications.

      • Xabier says:

        Herd strategy = lemmings, cliff.

        The arguments by epidemiologists against it seem quite compelling, to say the least.

        A wonderful fantasy, to go for a short sharp shock, cremate the mostly elderly dead, and go back to work with an immunised younger workforce, but as false as most fantasies.

        But not only false, highly dangerous.

        • Cas127 says:

          Xavier,

          Explain why.

          Otherwise, it is just a bald claim.

          You say there are expert arguments against herd immunity. Please provide them or link to them

        • VintageVNvet says:

          I agree with Cas, Xabier; please give links to your referenced drs, epidemiologists, etc.,
          As a 75 yr old with marginal immune system remaining after a life of adventure, one bad accident, many bad encounters with modern toxic chemicals, I am unable to take vaccines or any heavy duty meds, so rely on the herd concept as well as the most stringent hygiene protocols I can stand, plus Vitamin C as proven by Linus Pauling for maintenance and remedial protection/cure.
          As such, I am prepared with months of food, plenty of gas to cook with, and back up wood if needed ditto, and very good water filter working every day.
          My only concern at this point is that i may not have gone long enough on wine futures if this latest event plays out for months instead of weeks as I estimated when I first saw it coming in Jan. Fortunately, in this day and age, wine futures can be ordered delivered!!
          ( OK Wolf, I must confess here that I meant the physical wine futures, not the paper or ” digital” kind, though my bro in law has made a ton on those kind, as one of his specialty markets investments… )

    • anon says:

      I don’t understand how this is an ‘all is well’ explanation.
      A ‘majority of the people…’ sounds okay. But when you have a large population of people with this virus, there will be a large number of people that will not ‘be okay’.
      And if hospitals are already overwhelmed on a regular basis, this still means it won’t even take a large number of patients to overwhelm the system thus promoting more infection. No?

      • Wisdom Seeker says:

        I read Matt’s comment as trying to prevent outright panic – it’s true most people will be fine and won’t need hospitalization – while being pessimistic about the system’s capacity for those that do get the severe pneumonia and need hospital care.

        Hospitals are required to have pandemic “surge” plans tucked away. Medical friends in my area say they’ve been working through those. Italy’s hospitals are providing surge care (albeit imperfectly) at well over 100% of nominal capacity. There should be some headroom in the US system if we get desperate.

        Another advantage in the US is that the virus, at least right now, is spotty. If less-impacted states act fast to prevent further outbreaks, they might have spare capacity to take patients from the hot spots.

        And the military, which has to plan for wartime casualty surges, should have some capacity as well, which we’ve seen in the repatriated passengers.

        But we need to avoid forcing doctors to triage and be literally forced decide who has to die because they can’t help them all.

        • Realist says:

          Keep in mind that the health care system in northern Italy is regarded as one of the best in the world and northern Italy has one of the highest living standards in the world.

          Another completely different breed of cat is southern Italy.

    • Bobber says:

      I wonder if there are any effective treatments that can be administered in the home, in one’s own bed. If so, that information should get out there.

      • Marie says:

        There are no specific treatments for this illness, at least none that are commonly agreed-upon yet. Home treatments are all going to be about mitigating symptoms. For me, if/when I get sick I’m gonna stay home as long as I can breathe well, take Tylenol and tamiflu, stay away from everyone else, and hope I can ride it out without needing to go to the hospital for oxygen.

        • axel de pailllerets says:

          Please DO NOT take Tylenol if you have a fever < 40~41°C. Your immune system works best at feverish temperatures so all medicine that make your fever drop will make your recovery worst.

      • Wisdom Seeker says:

        Hey Bobber, that’s a great question to take to your medical provider (and your loved ones should be asking as well). Everyone’s situation is different, but it might be valuable to inquire whether having an inexpensive pulse oximeter for the family would be worthwhile.

        • cas127 says:

          I know that oxygen deprivation is nothing to mess around with and that a pulse oximeter is a good tool for objective measurement, but I wonder what your opinion is of these techniques,

          https://www.healthline.com/health/home-treatments-for-shortness-of-breath

          for people at home who may lack all other C19 symptoms (elevated temp, etc.) and are looking to buy time to confirm symptoms before getting tested/going to a hospital (which may be a focal pt of infection and innundated by demand).

          Ditto for buying time waiting for medical pickup and/or waiting for oxygen supply/ventilators once in the hospital.

          The positioning aspect beings to mind the proning/positioning options sometimes suggested for ARDS (which are relatively low resource/sophistication approaches)

        • Wisdom Seeker says:

          @cas127, I’m a physical scientist who knows how to plot exponentials and has picked up a bit about COVID epidemiology and behavior, but I’m not a medical-treatment expert, so I can’t comment intelligently.

        • Cas127 says:

          WS,

          Fair, honest answer. Thank you.

          Any medical personnel on the board?

          Lower tech, intermediate step, DIY interventions may become more valuable as time goes on, so an informed opinion would be useful.

          Bueller, Bueller?

      • Ed C says:

        I recently started using a CPAP machine for sleep apnea. Can this kind of equipment be useful for people struggling with this disease. Is this the ‘poor man’s’ ventilator?

        • Wisdom Seeker says:

          Ed C, that’s another great question to take to your doctor, and it might be a good tool!

        • Vivien says:

          No it is not. Ventilators are needed for life threatening forms of pneumonia and ECMO (extracorporeal membrane oxygenator) for those whose lungs and heart need a rest from the work of breathing. The problem IMHO in the US is not only that hospitals are run at capacity but also the numbers of people not covered by HMOs or have extremely high co-pays who will avoid going to a hospital or even seeing a physician because of the cost involved.

      • rhodium says:

        Grapefruit seed extract is rough stuff. I would not ingest it “in larger doses” unless you want to potentially give your stomach a chemical burn. You might as well say that drinking rubbing alcohol would help. As far as ingesting immune stimulators, there probably isn’t much harm, and maybe some good, however, sometimes healthy people die from viruses not because their immune system isn’t strong enough but because it’s too strong, and what is known as a cytokine storm is what kills them. There has been worry that immune stimulating supplements could make this outcome more likely in some people, so you’re playing a roulette either way with these things.

      • VintageVNvet says:

        While none are going to come from the allopathic side, one such allopathic doc, MD and PhD, full med school prof, etc., RIP, and the most widely read person that I have ever met so far, told me long ago Vitamin C, as per the protocols proven by Linus Pauling…
        I think you will be able to find a lot on the net re his findings, many proving the original concepts of the 1930 era, his actual personal practices after those findings, and the general concept of the Vitamin C ”flush,” remedy.
        After 50 years of doing what Pauling indicated, I can testify that, so far, it has worked for me every time, as he suggested it would.
        Having written that, as per always, buyer/user beware, and i suggest tread very lightly in the beginning, as I did, including researching the very clear delta between Ascorbic Acid and Calcium Ascorbate.
        Good Luck, and may the Great Spirits help us all, once again

        • Cas127 says:

          VVN,

          Don’t disagree with you on the front end, mild case 80 pct – immune strengthening via various techniques is worth looking into.

          Only a caveat, for ICU patients with ARDS, cytokine storm can be seen as a paradoxical reaction of the immune system and traditional immune system strengthening may be counterproductive…although other simple drug/nutritional interventions may be beneficial.

          It is worth spending some time browsing ARDS on Pubmed.

      • Cas127 says:

        MC/RH,

        Both of you seem to be interested in drug approaches and so might be interested in spending some time on Pubmed (online database of accessible medical research papers).

        While there will be very little on C19 per se (far too soon), there will be a fair amount on ARDS/cytokine storm – the high danger end stage that requires ventilation (standard trmt – but also resource intensive).

        Various drug oriented (and some positioning oriented) approaches have been proposed (after preliminary success) but not made it to std trmt status (subsequent negative results, slow moving nature of critical care adoption, etc.).

        Given the possible ventilator support bottlenecks, the world could probably use the maximum number of eyes reviewing lower-intensity drug approaches to ARDS/cytokine storm (which also occur in non C19 circumstances).

        The highest critical care stage is no place for ill-informed experimentation…but…if things approach a worst case scenario and mortality triage starts to become a common necessity, then the more people knowledgeable about the history of ARDS/cytokine storm trmt options the better.

      • Michael Church says:

        Rhodium – Every medication can be overused and cause problems. Antibiotics – a life saver against bacteria – can cause long term problems with gut health. Things that kill viruses are by their nature ‘rough’. Rubbing alcohol is a poison that will make you blind and brain damaged so the point you are making is ridiculous and ignorant and shows an inability to reason. Grapseed extract has supported scientific evidence and should be used as described on the bottle ie always dilute and do not take more than the recommended does (e.g. up to 15 drop well diluted).

    • Unamused says:

      Some hospitals regularly operate at 95% of capacity.

      It’s efficient, but it leaves no capacity for dealing with an emergency. Profit maximisation and just-in-time have definite limitations and are inappropriate in the context of public health, which requires a significantly different paradigm.

      This what happens when you have a ‘health care system’ devoted to next quarter’s financial results and not to delivering health care. And that’s a function of a political system devoted to self-serving corporate greed and power and not to the good of the public.

      It’s not as if the likelihood of a disastrous pandemic was not understood: the US has major outbreaks of novel diseases almost every year, often more than one a year. So what has happened to epidemiologists and risk managers who have been sounding the alarms? They get ignored and marginalised, and their staff and budgets cut, because they’re inconvenient, and they’re unprofitable, and they’re a cost that needs to be minimised. And now that the worst has happened they’re hopelessly overmatched.

      • Iamafan says:

        Ironically, Lombardy, San Francisco, Seattle, and Westchester Co. are where some of the richest people live. This virus does not choose its host.

        • c smith says:

          Actually, it does. International mixing is the key. Milan is a major center of Chinese offshore manufacturing of luxury goods. Prior to the outbreak, there were many daily direct flights between various Chinese cities and Milan. Wealthy people move around a lot. Aspen, CO has a caseload far out of proportion with its population, for example.

        • Iamafan says:

          @ c smith

          I thought that was Prato, China-Italy.

          Kidding aside, I have yet to check if my classmate is really dying of coronavirus in Paris.

      • Matt says:

        Very true about max profits. Here in San Diego the biggest area in need is the eastern part of the county. One hospital has the entire patient catchment area from the east side of the city all the way out halfway to the border of Arizona.

        No other healthcare organizations want to build another hospital in that area because East County serves some of the most underfunded people. Instead all the organizations are building urgent care facilities throughout central San Diego to maximize working middle/upperclass insured. This is just one city but I can’t imagine this doesn’t happen in other metros across the U.S.

        • Realist says:

          It will be “interesting” to see what will happen if or when the virus strikes the homeless population and run down city areas

        • One high risk group (E SD County?) is science deniers, and flu hoax conspiracy theorists. (Yes they are already blaming Democrats for using the virus to defeat Trump). This is the first demographic I don’t trust when it comes to likely exposure.

      • axel dep says:

        You are very critical of the profit oriented american healthcare system, but trust me, the french socialized system is no better in term of capacity. It’s overcrowded most of the time

      • Happy1 says:

        Hospitals operating at or near capacity is NOT a phenomenon limited to for profit health systems.

        The NHS, in the UK, is known worldwide as being the least prepared for the annual winter flu, a simple Google search will confirm this. It is an entirely nationalized system run by a central bureaucracy.

        The health systems in Germany and the Netherlands, on the other hand, are also comprehensive, but are based on employer provided health insurance, and there are a mix of government, not for profit, and private for profit hospitals, in Germany, 1/3 of hospitals are private.

        This private competition makes the care in Germany better and less prone to “winter crisis” than the system in the UK.

        I know your posts relating to health care are largely geared toward projecting your political beliefs, but the facts of different health systems as they relate to COVID-19 are very complicated. Profit motive and competition makes health care better than it would be otherwise. The problems in the US have to do with the non-comprehensive nature of care, and of course the regulatory capture of the entire system by large corporate and more particularly non-corporate entities, but that is a story for another day.

        • Cas127 says:

          Happy1,

          Thank you for the additional context. There is definitely politicking/”let no crisis go to waste” one-sided storytelling going on in the board.

          As it is (in all its mediocre splendor), the US medical system (20 pct of huge GDP) is already fairly socialized, with approx 50 pct of all health care expenditures coming from gvt sources.

          That level of gvt involvement/private sector “genius” in the Healthcare system has yielded us the inadequate “meh” of today.

          I think that sweeping promises of the new Millennium by shifting funding all one way or the other should take a back seat to a forensic analysis of where exactly the pathologies of the system are *now* – before misallocating trillions more in resources based on promised miracles of improved performance.

        • Rahul says:

          Well said

    • Cobalt Programmer says:

      (with PhD in Biological Sciences)

      The real problem is that current medical facilities can treat only a set number of patients with specific problems. For example accidents, cardiac arrest, baby delivery and other problems. When this COVID-19 overwhelms the medical resources (doctors, nurses and paramedics), every one will be dealing with Wuhan flu. The routine accidents, slips, heart problems will not be treated as usually. This is another reason to stay safe inside.

      The COVID-19 is going to spread before subsidies. The incidences are very low now because only a few are tested. Even among those with symptoms are not tested. Think about the carriers and incubation period. When the real number of infected comes out, the economy and stock-market will be the last things we worry about.

      Nationwide quarantine is the only way to break the chains of transmission.

      • otishertz says:

        How will the estimated 40 million people in the US without medical services, commonly referred to as insurance, fare when they can’t “ask thier doctor” because they have no doctor?

        Serious question.

        How can a pandemic be contained with so many millions out there who can’t access the medical system due to intermediary gatekeepers making medical decisions acorrding to their desired financial results or who can’t afford insurance.

        How does insuring the inevitably of illness even make any sense. No one gets out of here alive.

        • Matt says:

          “No one gets out of here alive.”

          Most people will get out of here alive. Take some acetaminophen for a fever > 38 and try a cough suppressant as needed. Stay hydrated. Remember to take walks to help expand the lungs.

        • Wolf Richter says:

          Matt,

          I think what otishertz meant with “No one gets out of here alive” is that we all will die someday, of something, including of old age. I read it in that sense.

        • Here Today says:

          Get some sunshine.

          Most of the places that this virus flourishes is cold&wet, or smoky bars with air-cond

          The guy is right, fresh air, walks in the park, get a dog, have a reason to walk.

          Stay warm, drink lots of hot-liquids if you are in a cold place, be sure to wash hands&body frequently with warm-water.

          Lot’s can be done. I’m amazed talking to friends, most are still flying, and still going out to restaurants.

          This thing will pass in 4-6 weeks, just stay away from people.

          Let’s look at the major outbreaks, Chinese factorys in Iran, Italy, & Wuhan, places where people work 7 days a week, 12 hours a day, and never see sunshine. Most of these people brought in from China to Iran-Italy are paid very little, lots of them historically supplement their real income with prostitution. When the factory’s in Iran-Italy were closed in January, lots fell back to prostitution, again dark cold bars, icy-drinks, casual un-protected sex with locals.

          In my own Italian family everytime my sisters son gets extra cash, he heads to a prostitute, its a normal italian guy thing to do, but here’s the catch, he’s 45 years old and lives with his mother, now guess who get’s sick when he brings home the virus?? This is why I think you see so many sick in Lombardi.

          Anyway staying healthy is staying out of the bars, get sunshine, and just avoiding the seedy districts of the world. I’m sure Homeless-USA is going to get hit hard.

        • axel dep says:

          Matt your advice is going to kill people. DO NOT REDUCE FEVER (unless critical temperature), fever helps your immune system fight the virus.
          Cough is also useful to expel all the crap from your lungs

        • Happy1 says:

          The short answer is that people without health insurance in the US with serious illness who present to an ER are treated in the same way as everyone else.

          The majority of people who contract this disease will have a cold or flu like illness and whether or not they seek medical care or testing at this point, where containment is over and mitigation has begun in most states, is irrelevant.

          There are some who argue that seriously ill people without insurance will avoid the ER because of concern about receiving a bill later on. There is some research suggesting this is the case for chronic illness.

          I am unaware of any research that shows this is the case in acute illness, and my own clinical experience in an urban level one trauma center for 19 years suggests that acutely ill people go to the ER regardless of their insurance status.

        • Happy1 says:

          So in short, there is no “gatekeeper” in the ER for people who are seriously ill.

          But it is a tragedy that we have not found a way to provide some form of health insurance for all. And it does complicate health efforts generally. I don’t know the solution, but employment based insurance efforts such as in Germany or Switzerland supplemented by a baseline low income plan seem best.

      • Twinkytwonk says:

        These are my thoughts entirely. People need to be prepared to take better care of themselves and not put themselves at risk of having an accident to ensure they stay out of the system. Unfortunately, the majority who have never studied virology and disease ( also have a PhD in genetics) have no idea and the government’s are doing everything they can to ensure business as normal.

    • DR DOOM says:

      The medical cartel which owns congress is terrified that it will be exposed . American corporations are terrified of losing their ability to off shore any thing and ever- thing . Just like the medical cartel they have paid good money for their congressional lap dogs. Government is terrified that the American people might demand massive changes. I remember vividly and first hand the war material we scuttled when we bugged out of Vietnam. We overwhelmed Germany and Japan with war production in WW2 . My father was in the 6th Marine Expeditionary Force. When they got to and occupied Toyko the massive amount of material in the rear was in his own words , “beyond reason” . When we go to war we spare nothing due to constant war planning and aquisition. Not so when it’s for the health of the Nation. As I understand it we have 75,000 ventilators facing a virus that kills by respiratory distress brought on by a cytokine storm from our own immune system complicated by bacterial pneumonia. The captains of industry and government are terrified of the video of triage between a 70 year old and a 12 year old child for ventilator access .This is War and we ain’t prepared because we have let our government ,for decades , disarm us .

      • JohnnySacks says:

        Wait until the insurance bankruptcies start flowing in and people start getting billed at 200-300% for the services. I assume this situation isn’t part of any actuarial calculation? If course Congress, being Congress, will bail out the insurance companies rather than force Medicare rates down to providers to bail out the people. We must revert to business as usual rather than gain any structural change.

        • Happy1 says:

          Medicare rates are under the current cost of providing hospital care, you would essentially bankrupt the hospital industry if you did this.

      • California Bob says:

        re: ‘When they got to and occupied Toyko the massive amount of material in the rear was in his own words , “beyond reason” .’

        Maybe because we were prepared for a massive invasion of Japan and millions of casualties before we dropped The Bombs?

    • David Hall says:

      China has closed the last of their temporary hospitals. The number of actively infected people has been dropping for weeks. The ratio of recovered to infected increased.
      https://www.businessinsider.com/wuhan-medical-workers-remove-masks-after-last-temporary-hospital-closes-2020-3

    • Happy1 says:

      Speaking of hospitals operating over capacity, their is probably no system more infamous for this than the NHS of the UK. Google “NHS overwhelmed every winter”, the first article is from the Guardian, dates 12/2/2019, before Wuhan, here is the lease quote,

      “The NHS is heading into winter in unusually bad shape”

      There has been a chronic physician and staff shortage in the NHS that is worse during flu season for many years. The summer and fall of 2019 were the all time peak of shortage for that time of year. If COVID-19 is not immediately contained in the UK their ICU capacity will be quickly overwhelmed, as it is a fraction of the ICU capacity in the US.

    • Baypoor says:

      This is what you get with a for-profit healthcare system. There is no slack built into the system.

      • Cas127 says:

        And in purely socialized systems, you get “bridges to nowhere” where projects are quite often almost nothing but “slack” – existing not to serve actual needs, but to provide opportunities for political graft…leaving alleged project beneficiaries worse off.

        • Suzie Alcatrez says:

          China built new hospitals as needed to deal with influx of patients.

          While in the US, hospitals are working overtime trying to figure out how they are going to bill the insurance companies and government.

        • Cas127 says:

          Ms. Alcatrez,

          You might not credit a long time Righty outlet like the New York Times…but the Chinese response has not been uniformly applauded…

          https://www.nytimes.com/by/li-yuan

    • Thomas Manning says:

      It may sound simplistic until you do some reading but mega-doses of IV (intravenous) Vitamin C has a history of killing viral infections. Dr. Klenner (in the 1940’s) cured polio. (Look it up) And you might remember that Australian guy whose family begged their hospital to use a Vitamin C drip to cure their father of the Swine Flu. The doctors initially refused, preferring to let the patient die than risk “quackish” medicine. Dr. Levy wrote a book titled The Primal Panacea. It in he points out that Vitamin C has never met a virus it cannot kill. It just takes enough to do the job. But an IV drip? That’s too easy. I read that the Chinese are running a test with a small group of infected patients using the IV drip.

  2. Wisdom Seeker says:

    This was my first posting, and I want to thank Wolf for publishing the article.

    I’ll be checking in frequently this weekend so please ask questions if the article isn’t clear.

    There is more I can share on this topic as a scientist, if anyone is interested. If there’s a nation or US state whose progress you’d like to see, just ask, and I’ll provide additional graphs one way or another.

    • Unamused says:

      If there’s a nation or US state whose progress you’d like to see, just ask, and I’ll provide additional graphs one way or another.

      Some of my recent comments have indicated that the situation has moved the response from containment to mitigation because of a lack of resources, particularly in California and Washington. Informational resources have also been in short supply, despite Silicon Valley’s vaunted reputation for such things.

      Any clarity you could provide would be helpful.

      The US federal government is presently blocking states from expanding Medicaid in response to coronavirus as well. Know anything about that? Politics, say I, sneeringly.

      Estimates of economic impact would also be helpful. Estimates of decline in US economic activity from my side range from 3% to 6%, but that is also largely conjectural because data needed to make valid inferences hasn’t become available. In Italy it’s at least double that. And China is just a guess.

      • Wisdom Seeker says:

        Hey Un, my take is similar to yours. The US needed to begin testing for COVID in unexplained pneumonias at about the same time we applied the travel bans, and then tracing contacts like mad. I think that’s how Singapore has stayed ahead. But we had structural issues (stupid regulations are also a disease!) and maybe some tactical technical errors that cost us too much time. Testing is expanding rapidly and will help, but most of all we have to slow down the rate of infection by keeping people apart.

        I have just a little insight about economic impact at this time. A full lockdown might get the virus back under control in the US within 2 months (as it did in most of China, more or less). But that won’t restore social-interaction based economic activity; people will be very wary. I also think the US will be slower than that, though hopefully faster than Europe. But elsewhere in the world it will take longer.

        Until its contained worldwide, everyone faces “outbreak risk” from travelers from other nations. There’s also “mutation risk” – another strain could emerge and start a fresh round. These are going to impact economic activity.

        Against that, we actually do have a lot of new opportunities. Employers will need surplus staff to support more robust modes of operation (so an enterprise isn’t derailed by an outbreak). You see that with banks and the tech titans spreading out their operations. Delivery services and anything over the internet will grow, albeit at the expense of restaurants, spectator sports, bars, movies, theater, etc. There will be other growth areas too.

        There’s going to be a lot of dislocation and, if we’re too slow to completely eliminate the virus, there will be some deep structural changes. Typically the destructive phase come

        • VintageVNvet says:

          Also, SCMP reported today that some people can be carrying this virus and transmit it up to 37 days before showing any symptoms. Please comment on that possibility, with likely percentage of such folks.

          Thank you.

          This confirms IMO, once again, Wolf’s efforts to be on the ball!

        • Wisdom Seeker says:

          @Vintage – some of those reports get sensationalized. Out of thousands of confirmed cases, to know that one person was “only” infected 37 days ago (and not more recently) is pretty tough. This virus is really insidious. I will most likely only be a few extreme cases like that. If we get the rest under control and the 20-days-plus are all we have to worry about, it’ll be time for a victory lap. Gonna be a while though.

      • Happy1 says:

        In Colorado, the 3 or 4 major health systems are no longer testing patients in the ER unless they are ill enough to require hospitalization, all others with URI symptoms are sent home to 14 day self isolation. Containment has been abandoned and mitigation is the rule. The health system where I work has several ICU cases now, and has plans to eliminate all elective procedures Monday.

        CO is 5th for total number of COVID-19 cases (as of yesterday AM, haven’t checked today yet) and per capita, is 3rd only behind WA and MA, ahead of NY and CA.

        Metro Seattle and SF and NYC (especially Westchester County) are the metros with the highest number of per capita cases. Although Aspen does have a very large cluster for such a small town, almost all from a group of Australian travelers.

        COVID-19 spread very quickly here from ski travelers and other travelers, mostly from Europe, to the urban Front Range. So far we don’t have large nursing home outbreaks.

        Others who work in healthcare in other states can probably chime in, health systems generally are in a panic about this and are communicating daily with their staff about the pandemic.

        The testing numbers for the next several weeks will be very incomplete because people won’t be tested unless they require hospitalization in many places.

        There is certainly a place for optimism however. We are far behind the response curve compared with South Korea, Japan, Singapore, and HK, but those societies are authoritarian and many of them were tested severely by SARS in a way that the US wasn’t.

        But we are far ahead of Italy and Spain and France in terms of social isolation when compared with the early phase in those countries. Spain is now almost caught up with Italy and only started serious social isolation in the last few days.

        I would be that the curve in the US starts to bend in 2-4 weeks for the most affected areas.

        • Cas127 says:

          Depending upon the level of care taken, nursing homes can either be fortresses or oubliettes.

        • Wisdom Seeker says:

          Happy1 – thanks for the update! Colorado will be in my next graph, for the others here – glad to see you are getting the relevant data already. Sorry to hear the system has had to drop elective surgeries so soon but at least they’ve got heads out of the sand and are readying for action.

    • cb says:

      Thank you, Sir. Very generous and decent of you.

    • VintageVNvet says:

      Thanks Wisdom Seeker.
      1. BBC reported yesterday that all new cases in 10 towns in northern Italy stopped when they were ”locked down;” please verify that if possible with some indication of likely reliability.
      2. SCMP reported today that Chinese scientist, likely epidemiologists, have determined ”patient 1” in Wuhan was infected, or recognized, November 17; please verify that information if possible, and let us know the implications for any changes of the rate of transmission if that date is used instead of some time in December.
      3. Please let us know your thinking, obviously much more well informed than the talking heads/politicians, regarding the origins of this virus, putting to bed as many of the rumours on the net as possible.
      4. I have seen graphs of mortality rates by age cohorts, ( not remembering where,) please show those if possible.

      Thanks again for your work on this.

      • Wisdom Seeker says:

        Hey VW –

        Regarding your point (1), I’d expect it to take a couple of weeks for the lockdown to really work. Virus will still run through households for a bit. And lockdowns take a while to take full effect, not everyone “gets with it” and complies immediately.

        For (2), I’ll look for more information like that, but I’ve been burned by SCMP relaying preprints that were then retracted. A 2-week shift in the date of first infection is of interest for many reasons. But I think we have enough real-time data now to know what we practical actions we need to take immediately.

        For (3), I’ve learned not to rule anything out, and until we really trace back Patient 0, or get a full genetic fit, we won’t really know. We may not ever really know. But at some level it doesn’t matter whether or not it was a natural animal-to-human transmission; there’s no doubt everyone regrets it. And we all need to work together now to stop it.

        For (4), we don’t really know and it depends on population and how impaired the hospitals get. But the CDC has their best-estimate information in their US clinical guidance (link below), and it goes like this for older people:
        Ages 50-59: 1.3%
        Ages 60-69: 3.6%
        Ages 70-79: 8%
        Age 80+: 14.8%

        There’s a widespread misconception that this means “kids and young adults are immune”. This is far from the truth. The Chinese data so far show 0.2% mortality for infected people ages 10-39, and 0.4% for 40-49. That’s 20x worse than flu and would make COVID one of the leading causes of death in that age group if it spreads far. I tell my kids that if half the local high school got infected (2000 students total, 1000 infected) then 2 would die. Once death is seen as a possibility the kids wake up (slowly…)

        https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html

        • ewmayer says:

          There’s a widespread misconception that this means “kids and young adults are immune”. This is far from the truth. — And perhaps even more importantly than the still-much-higher-death-rate-than-seasonal-flu even for these younger cohorts, this is underscoring the importance of mass school shutdowns and social distancing – the young tend to get milder symptoms, which makes them all the more likely to want to stay in school and continue normal interactions, thus rendering them potentially highly effective transmitters.

          Of course, speaking of economic knock-on effects, the problem with school closures is that so many poorer kids get crucial nutrition from school meals, and their parents – more likely to be working multiple jobs and ones of the kind where they can’t “telecommute” – depend on the childcare aspect of the schools in order to be able to work. Very tough times for these folks.

        • james wordsworth says:

          For the scientists here and those that like stats this site is incredible: https://nextstrain.org/ It tracks the genetic mutations as the covid-19 virus travels around the world. So far there have been a number of small mutations which allow the observant to see how it has spread.

          Also it has the best description of how to wash your hands that I have seen: “Wash your hands “like you just chopped a jalapeno and have to change a contact lens”.”

        • KYnativeNotDeplorable52 says:

          WisdomSeeker
          Thank you for your helpful posts. I’ve looked at the link provided and am trying to identify where exactly the 0.2% mortality rate for the 10-39 years of age cohort figure is in the CDC report linked (or in the Zhonghua (2020) article the CDC is basing the fatality rates by age ). Zhonghua is referenced in the CDC report at “only 2.1% were aged <20 years, and no deaths were reported among those <10 years of age" but I don't see the 0.2% figure for ages 10-39. Can you explain how/where this figure was calculated? (This would be helpful data for convincing a skeptical local college administrator to shut down campus!)

        • CreditGB says:

          Question. How can one honestly publish a % of Covid 19 mortality rates by age group, when in fact the actual number of Covid 19 cases is as yet, completely unknown.

        • Cas127 says:

          CreditDB,

          “the actual number of Covid 19 cases is as yet, completely unknown.”

          Actually, the total number of infections (and therefore the absolute fatality rate) will never be known…because the large majority of infections appear to be so mild as to not require medical intervention (testing/hospitalization – and therefore tracking).

          Post event there may be random sampling of the entire population to *estimate* the total infection rate and resultant fatality rate.

          What people are calling fatality rates today are actual the fatality rates for the more severe cases (which show up in testing and especially hospitalization).

          The immediate problem seems to be the possibility of a compressed surge in very severe cases requiring finite ventilator support. That is the essence of the whole self-isolate, “squash the curve” project.

        • Wisdom Seeker says:

          For KYnativeNotDeplorable52:

          The source for the 0.2% etc. is a China CDC report from 14 Feb:
          http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51

          See Table 1 in that article.

          The statistics are poor (not many cases in the 10-29 age group in the Chinese database at that time) so the 0.2% could be off by a substantial amount. But it’s promising that there were relatively few young people in the case logs at that time.

          Be prepared to be surprised as more data come out. France in particular seems to be having a different experience than China, though the case counts are still too low to draw strong conclusions.

    • The artist formerly know as Marcus says:

      This was very well done. Thanks for bringing the science to WS. One of the reasons I like this site, is because Wolf is the only economics voice who acts like a scientist. He’s rational and makes arguments based on reliable data. It’s refreshing.

      To add to your excellent points (PhD, Microbiology and Immunology), I’d like to say that many people are spouting off the inaccurate statement that this virus is the same as the common cold – as a means to dismiss the seriousness. While it’s true that some coronaviruses cause mild cold-like illnesses, this is not one of those viruses. Within the coronavirus family, there are four subgroups (genera). The beta-coronavirus illnesses are SARS, MERS and COVID-19 (the present pandemic). All three are remarkably more dangerous than any common cold. They make up an evolutionarily distinct clade. This is a common occurrence in virology. Many virus families have genera that cause no disease and others that are serious or lethal. So, the fact that coronaviruses can cause mild illness has zero meaning for the current outbreak.

      • Wisdom Seeker says:

        Thanks, artist-formerly-known-as-Marcus!

      • Cas127 says:

        “So, the fact that coronaviruses can cause mild illness has zero meaning for the current outbreak.”

        Does the relatedness of the viral family have any implications for the accuracy of the various tests used?

        Is it possible for false positives for Covid 19 specifically to be generated?

        • The artist formerly know as Marcus says:

          Good question. Ten or fifteen years ago, the relatedness would be a challenge. Now, with the speed of modern sequencing and explosion of novel molecular biology technologies, we can accurately detect specific viral species even when they are closely related. Much of this capability was born from research on HIV, influenza, cancer, and human genome sequencing. This is a good lesson in why it’s critical to fund all biomedical research fields. A rising tide lifts all ships. For example, the Gilead drug being tested for coronavirus is quite similar to drugs that were invented to treat HIV.

      • Cas127 says:

        How were similar outbreaks by other beta subgroup members stopped more quickly?

        What Covid 19 characteristics distinguish it from other beta members, causing it to expand more widely this time?

        Why have other beta members not caused subsequent outbreaks?

        • Realist says:

          It seems that SARS and MERS were more efficient killers, thus those viruses did not spread as effectively through out the population as the current virus does.

        • The artist formerly know as Marcus says:

          Another great question. One major factor is that this virus is unique in that it can be spread for days before a person shows symptoms. And I’ve read reports that children might never show symptoms while spreading the virus. That’s different from SARS where the virus is most infectious when a person is symptomatic. So, with this outbreak, it’s much harder to isolate people who are infected before they infect someone else.

        • Cas127 says:

          Realist/Artist,

          Thank you for your responses.

          I think a stepwise discussion of the various aspects of the disease will help people understand the issues better.

          There is a reason why FAQs and Top 10 lists are popular on the internet.

        • Happy1 says:

          SARS and MERS were less contagious.

    • Stephen C. says:

      Thank you Wisdom Seeker for this article and the offer to answer questions.

      Yesterday and today I’ve been trying to help my wife (a therapist in Marin county, just north of San Francisco) predict when she can expect to be put out of business, temporarily, by government action. (I’m currently in Southeast Asia, navigating my own social distancing and visa-airline travel problems.)

      As far as she is concerned, it’s not about the budget only but dovetails with her wanting to be socially responsible. Yeah, if we were wealthy she would have closed her practice last month.

      My question: have you plotted out when the San Francisco Bay Area is going to shut down? I know this is impossible to know for sure, given it’s a political decision, with so many forces that drive political decisions, but might it be possible to estimate in a way that is more of guess? You are smarter than I am, or at least have a far better math background, even if in this case it amounts to game theory or probability theory, so that’s why I ask.

      Please feel free to lambaste me if it’s a totally irrational question. In my defense I think there are millions of self-employed people who are, today and this week, trying to figure this out.

      Thank you,
      -S

      • Wisdom Seeker says:

        Stephen, I don’t have all the practical business-world psychology to know how people will behave, but in terms of things shutting dow:

        1) All the major data companies are in work-from-home mode already.

        2) All schools on the Peninsula and most in the East Bay are shutting down this weekend.

        3) If she’s doing social work rather than physical therapy, I recommend she stay open – people are going to need a lot of help – but advise her clients that she will be shifting to phone/internet appointments only. Any objects needing to be exchanged to go through the mail or a delivery service, with disinfecting wherever possible. And so on. Put the clients minds at ease and don’t put them in any risk.

        4) If it’s physical therapy, I would shut down now, except perhaps for a couple of exceptional clients (e.g. retired couples who never go out). The level of close contact required for P.T. to be effective is becoming risky given the possible-to-probable number of actual infections out “in the wild” in the Bay Area today. Standard surgical masks have been shown to be less than adequate for those going through repeated exposures.

        I suspect your wife’s peace of mind will be much greater once she’s established a “safe space” at home. From that safe base it’s then possible to figure out what works and what doesn’t as the situation evolves. We just did this for my house (as school was FINALLY shut down) and I’m finally de-stressing a bit after a month of red-alert mode.

    • HowNow says:

      W S, thank you for sharing your knowledge. And thank you, Wolf, for creating this platform for reliable and helpful information.

    • Lisa_Hooker says:

      Wisdom – thank you very much. I have two questions that I have not been able to answer after extensive web searching.

      1) How many days will someone infected but asymptomatic be contagious before sufficiently remarkable symptoms appear?

      2) How long is SARS-CoV-2 viable on various surfaces? E.G. metals, paper, fabrics. (I’ve found estimates for corona viruses anywhere from 4 hours to 28 days.)

      3) How many mutations of the SARS-Cov-2 been identified?

      Many thanks in advance for what you have.

  3. 2banana says:

    And the successful techniques used were exactly what?

    Tight border controls? Drive through testing centers? Tracking those infected by GPS?

    “Singapore and South Korea went on red-alert and have slowed the virus.”

    • Wisdom Seeker says:

      2banana – my understanding is that they are using every tool they have short of locking people in their residences. Not quite as extreme as what China did in Wuhan. But Wuhan was far gone by the time China wok up, and my sense is that they had no better option to avert an even greater catastrophe.

    • Happy1 says:

      People in east Asia have self isolated to a degree we haven’t yet here. Testing is better also but the real difference is that schools, work, meetings, sports, etc are shut down and people are staying home. Remember they lived through a SARS scare in HK, people take this kind of thing very seriously there.

    • Paul says:

      That is correct and I would like to quote Nathan VanderKlipp Asia reporter for the Globe&Mail in his article 2 days ago. Probably imho his reporting is one of the best.
      “Both Hong Kong and Singapore were hit early by the virus, but have kept the number of cases in each place below 200, through the widespread use of masks, aggressive contact tracking and effective use of individual quarantines. In Hong Kong, some 12,000 people were in isolation at one point. In South Korea, widespread testing for the virus has helped bring about a rapid decline in its expansion. On Friday, the number of recoveries outpaced the number of new cases.”

      The Globe&Mail has removed the paywall for their coverage.

      https://www.theglobeandmail.com/world/article-china-touts-wuhan-lockdown-as-key-to-taming-covid-19-spread/

      Wolf you are doing a great service.

  4. Satya Mardelli says:

    Taiwan and Singapore seem to be weathering the storm just fine. When this thing is over we should ask those two countries how they did it

    • Cobalt Programmer says:

      Taiwan, S Korea and Singapore are very smaller in terms of size and population compared to US.

      S Korea repeatedly perform wartime drills, Taiwan is also an Island which is easy to restrict access to foreigners.

      • Cas127 says:

        “Taiwan is also an Island which is easy to restrict access to foreigners.”

        Yeah, but it is also smack next to China, with huge inter-traffic these days (well, until a few weeks ago) and it is very densely populated.

        But its published C19 stats appear to be pretty good.

        Why? How?

        • Happy1 says:

          Self isolation.

        • Cas127 says:

          Happy1,

          Maybe…but the Taiwan numbers (given its setting) are very good…

          https://www.worldometers.info/coronavirus/

          (Scroll down to get individual ctry stats)

          Given the disparate results by country, I wonder if there aren’t recording/tracking/methodological issues going on in addition to general surge chaos.

          Presumably the fatality numbers are the most accurate, but post mortem causal analysis may not be a priority right now.

          For instance are we sure that the reported C19 numbers (in all places) are the excess above the baseline expected death rate from all causes?

    • Unamused says:

      They have public health systems that aren’t dysfunctional profiteering free-for-alls. This being Asia, it’s happened before, so they prepared. Unlike the US, they recognise the need for it to ensure the integrity of their economies. By comparison, the US approach to minimise upfront costs is about to backfire humonguously.

      • RagnarD says:

        Big secret:the Asian tigers are not socialist utopias. Nor are they Multiracial cornucopias of multiculturality.

        Talk to a Canadian who needs a hip replacement.

        • timbers says:

          Indeed.

          I just renovated a bathroom. The guy who did my tile is Vietnamese. He told me real estate in Vietnam is skyrocketing but you can still get land for $50k or a nice condo for $250k (and an American can get nice wife too but I’m gay so no bonus for me on that front) but soon all that will be out of reach an unaffordable.

          I’ve read Vietnam has deceit healthcare at reasonable rate, unlike America’s Third World Hegde Fund managed inferior healthcare.

          My bathroom tile guy said lots of Americans are moving to Vietnam. I asked north or south? He said south…it’s like Florida.

        • Cas127 says:

          Timbers,

          “America’s Third World Hegde Fund managed inferior healthcare.”

          And yet so many hospitals qualify for non-profit status.

          How?

          Is there no oversight by career gvt personnel?

      • Happy1 says:

        The nature of their health system isn’t the thing. Italy also has a government sector health system and they are failing massively.

        The difference is an authoritarian culture and experience with SARS for some of these places.

    • JM says:

      Rather simple everything completely closed and all confined to the house, the opposite of the UK that wants to do nothing, or the UK government knows something we don’t know or is completely irresponsible.

      • ML says:

        It’s a combination of what stage the virus is at and the political ideology. Here in the UK, we don’t have a dictatorship, but a democracy. Whether what our government is doing or not is irresponsible is not necessarily a given.

        I reckon that the worst will be felt in high density urban areas, cities and large towns mostly. And amongst people that regularly go to events that attract crowds.

      • Xabier says:

        The very lame argument has been deployed in the UK , supported by ‘behavioural scientists’ (ie a BS discipline) that the British people simply wouldn’t stick with severe restrictions and show civic responsibility over a prolonged period.

        I happen to think they are mostly made of much better stiff than that, but it is of course the argument that the govt. seek to support their insane herd immunity aim.

        Rather like Blair going to the one UK lawyer who would endorse the Iraq war for a legal opinion – a customer of mine, as it happens.

        After this, let’s hang all the behavioural scientists, and save their grant money….

      • Happy1 says:

        Yes, schools, sports, meetings shut down. This is the correct response and the US is just starting to do this. The UK is at very high risk and the NHS is completely inadequate to the task, may God protect the people from what is about to happen there.

    • Wisdom Seeker says:

      Satya, I think the time to ask what they’re doing is right now. And then replicate it as best we can, as fast as we can.

      But I can tell you that the only thing that will stop the virus is keeping infected people apart from all non-infected people. You can do that by testing, finding infections, and then testing all the contacts of those infections. More than once since the virus has an incubation time. But when there are too many infected, the test-and-trace approach becomes too slow. Then you have to go with physical separation – have everyone stay home and healthy. And then mitigate the challenges that creates for families.

      • Unamused says:

        You can do that by testing, finding infections, and then testing all the contacts of those infections.

        California, despite its scientific capabilities, doesn’t have the reagents needed to make the test kits. They’re already running out. Similar situations obtain in other states. The suppliers are scrambling. The just-in-time paradigm has backfired.

        I’m old, it’s late, and tomorrow is another day.

        • Wisdom Seeker says:

          Yes, that’s why the post says everyone should just stay home – absolutely as much as possible for your circumstances – rest and stay healthy.

          Once i did that my stress level dropped and I could sleep again.

        • Thomas Roberts says:

          There are a lot of problems with everyone stay home approach though. While, It is easy shut schools, restaurants, and other gathering places.

          The problems that it would cause to the economy will be massive, many places will shutdown and never reopen. supply chains will die out. A very large number will lose their jobs.

          There are long term consequences “and a huge amount of unforeseen consequences” with the everyone stay home approach, such as long term social damage and health damage. If for months “especially with the spring approaching” to over a year+, people don’t leave their home “some will go to work, some won’t”. People might become lazier and less active in the future. Some people might for instance “these people already do this every year”, camp or do sports in the summer; if they have to skip this year, will they go out next year? What about all the kids? Those kids/teens were already getting lazy, fat, and antisocial watching their phones/tablets. A huge number of them will be put on the path to become Hikikomori “reclusive adolescents or adults who withdraw from society and seek extreme degrees of isolation”. Almost none of those kids/teens are vulnerable to coronavirus, but, they are sacrifices to slow the coronavirus spread. For everyone though, there will be a lot less interaction with friends. Many people will lose touch forever. If people now suddenly have less friends, they are less likely to network and find new friends, that will cause damage to society. It will also become harder to make new friends because of all the restaurants, bars, and gathering places that will likely go out of business forever.

          The longer the shutdown of everything happens, the more difficult it would be to end it. At the most extreme long term 4 weeks “28 days” would be absolute max a shutdown should be allowed to occur. This would only be to gather some time to make plans. It might be best though not to have this 4 weeks right now, and instead wait a month, because almost no one has coronavirus right now. Overall, i’m not in favor of a shutdown at all.

          The real approach to this problem, would be to for the 55+ and those at risk because of medical conditions, but especially 70’s and up crowd to self isolate, for those with jobs “of these groups” they could receive a fixed stipend to allow them to temporarily leave their jobs “if they leave job”.

          If this were a virus that didn’t discriminate on age, the ideal approach would be vastly different.

    • Javert Chip says:

      My wild-assed guess:

      They did it with very authoritarian governments within highly homogenous voting populations.

      Singapore population: 5M
      S Korea population: 51M

    • Say It Aint So says:

      Population of 5.5 million….and islands…easier than landlocked states and cities..

    • ReelPolytick says:

      South Korea is a monoethnic state whose people have high national pride, like Japan. When they need to save their nation, they all get on board, with vigor. Add the people’s high work ethic, discipline and a slightly authoritarian state yet with a free press and you have a country ready for war yet not consumed by paranoia, as is their neighbor to the north. It’s a winning formula. That’s my couple of pennies’ worth.

    • IdahoPotato says:

      I have 2 reports from India, from last week, of people travelling back from Europe to New Delhi via Indira Gandhi international airport.

      Both underwent thermal imaging at the airport. The bags were offloaded by airport staff from the conveyor belts and people picked them up without jostling and getting close to each other.

      One of them got a visit three days later at home from Airport Authority staff who wanted to let her know that she and her bags arrived at the terminal around the same time as a flight from Italy whose passengers somehow were not tested (they had just started testing that day) and she was to isolate herself and contact healthcare authorities if she showed any symptoms. They gave her some contact numbers.

      As for people arriving in the U.S., it is a complete farce how this is being handled. I read the Twitter feed of a vice.com journalist who flew in after covering the ourtbreak in Lombardy last week and walked through Immigration at JFK without a single question asked.

      You can get tested quickly if you are a baseball player, apparently, but if you are a firefighter in Kirkland, Washington who has had contact with potentially many cases, despite pleas from your Union, you can’t.

  5. Iamafan says:

    Chances are (unless you are a medical professional) you will now hear about an ECMO machine.

    https://medlineplus.gov/ency/article/007234.htm

    You can add that to oxygen tanks and a respirator.

    When my mother’s cancer went to her lungs, I got to live with this stuff for about a month till her lungs gave up. My brother-in-law is a confident Harvard trained physician and director of that hospital so we got special treatment. They tried, but the result was the result. She passed away. For the family, it was agonizing seeing your Mom hopelessly in pain.

    Now, I can imagine that with hundreds of patients unable to breathe.

    I really hope we have enough beds, room, equipment and medical staff.
    Pray for the best. Prepare for the worst.

    • Unamused says:

      I’m sorry, IM. I’ve been there too. I don’t want to talk about it.


      Come away, O human child!
      To the waters and the wild
      With a faery, hand in hand,
      For the world’s more full of weeping than you can understand.

    • Wisdom Seeker says:

      The way to ensure we have enough beds, equipment and staff is to get serious about stopping people from casually infecting one another. We have far more control over the rate of infection than the supply of care.

      • Xabier says:

        This is the problem here in the UK: they are deliberately NOT trying to control or modify the rate of infection.

        In the light of this, it’s rather a good thing that one of the large public parks in London has been designated for a tented mass-morgue….

    • KYnativeNotDeplorable52 says:

      How many people are needed to run/maintain the ECMO? My mother died in early January (of an unrelated illness) but was on a non-ECMO respirator for four days. I noted at the time that it required two people — an RN to oversee my mom while the specialist periodically adjusted the respirator — and this was in a Trauma level 1 public hospital that was swamped (so not a for-profit hospital trying to squeeze as much $$ as possible).

      • Cas127 says:

        Basically, an ECMO is oxygenating and circulating your blood, bypassing your own lungs (theoretically giving them a chance to “rest” – a ventilator makes use of your own lungs, but assists them).

        So you can see why the ECMO is considered a more delicate (and therefore scarce) piece of machinery that requires a higher level of expertise to monitor/operate.

        I don’t think widespread ECMO use will be employed if there are not even enough ventilators.

        These issues matter because it appears that ARDS/cytokine storm in the lungs is actually what kills a small Pct of C19 infected people…it is just that apparently there are going to be a shit-ton of C19 infections and that the causal chain from C19 infection to higher-than-flu ARDS outcomes is well established.

        Presumably it is because hospitals are apparently telling us that they are seeing supranormal ARDS presentations among patients tested positive for C19 (but ARDS can be caused by multiple other diseases (or even be idiopathic))

  6. Javert Chip says:

    Wolf

    There is a very interesting on-target mathematical discussion of difficulty/techniques modeling the Wuhan virus experience at.

    It uses current data from China, Korean and US data to produce some pretty eye-popping graphs & predictions. Using dry mathematics to model a complex & dynamic system has its risks and depends on “good” data; this might be worth a look.

    The link uses a mathematical technique called “Gompertz curves”, which has been found to have applicability in medicine & population analysis. It’s highly useful in commercial environments (where I bumped into it) for things like cell-phone market take-up & saturation.

    • Unamused says:

      Using dry mathematics to model a complex & dynamic system has its risks and depends on “good” data; this might be worth a look.

      There isn’t enough good data on the US to do that by a long shot, not even enough to get started. We came. We saw. We shrugged and walked away.

      • Daedalus says:

        First, you are correct about our paucity of data. This is a HUGE defect in our understanding that is not being addressed. Not only has nobody reached out to me to be part of a ‘random sample’, but I can’t even get a test unless I ‘exhibit symptoms’ This is really stupid, but shows the level of intelligence prevalent in out ‘ruling class’.

        Secondly, I love your “Veni Vidi WTF?” bit.

        Thirdly, I’m not so sure using a logarithmic scale is all that appropriate. The logarithmic increase in any infection only happens during the time when the supply of new ‘hosts’ is infinite. Therefore, when the infective agent begins to encounter those who have been previously infected, the ‘logarithmic’ increase will naturally deviate from a straight line. Thus, a ‘flattening’ on a log scale is inevitable, but not because anything ‘effective’ is being done. I’m thinking a log scale actually masks the situation (thus bolstering ‘confidence’) and shields people from the reality of the problem.

        • NoEasyDay says:

          @Daedalus-

          > The logarithmic increase in any infection only happens
          > during the time when the supply of new ‘hosts’ is infinite.

          Exponential increase?

        • Cas127 says:

          “Therefore, when the infective agent begins to encounter those who have been previously infected, the ‘logarithmic’ increase will naturally deviate from a straight line. ”

          That is a good pt – sort of incremental herd immunity…call it “hurdle resistance”…the virus has an increasingly difficult time finding a host, so the spread slows down.

          Of course, there can be nightmare scenarios where immunity is not permanent, therefore herd immunity gets lost.

          Are there real world diseases where immunity once gained, is lost…for the exact same virus?

        • CreditGB says:

          Any math formula or model, applied to incomplete data, —-especially incomplete on one side of the formula—— (which is exactly what we currently have) results in absolute garbage results.

          Tossing around mortality rates calculated on a known number of deaths, divided by a completely unknown number of actual cases, is blatantly irresponsible.

        • Javert Chip says:

          Daedalus

          Appreciate your comments.

          One minor explanation: The Gompertz curve is “S” shaped – it is not logarithmic. Gompertz has been used for hundreds of years to successfully model resource-constrained non-linear population growth. More recently, the technique is used to model other “constrained” growth rates (examples: number of infected humans or number of cell phones).

          All modeling techniques requires sufficient & accurate data for meaningful curve-fitting. China & S Korea have sufficient data (and the link I provided makes interesting predictions), but as of yet, the USA does not.

          Obviously, Gompertz curves can’t model something from nothing. When the inflection point in the new infection curve (AKA: 1st derivative of total infection growth curve goes negative) changes from increasingly-faster to slower growth, that’s the time Gompertz curve-fitting can be a valuable forecast tool.

          Of course external variables (like how successful a nation manages & flattens the infection rate) obviously impact model accuracy.

      • Iamafan says:

        Don’t forget we social distanced, too.

        Any so-called failed leader can tell us to do that. Snub thy neighbor.

      • Javert Chip says:

        Unamused

        I was expecting much better ad hominems from such a superior thinker.

      • Unamused says:

        Let’s make a deal, Chip. Stop lying about me and I’ll stop telling the truth about you.

    • JRB says:

      Interesting would like to see this gompertz curve for Italy, since so far US response seems much more akin to Italian response rather than China or S Korea.

      In Philly yesterday parks and streets were packed as normal for a beautiful early Spring day. Supermarket shelves only noticeable dif.

    • Petunia says:

      I was an Applied Math major. The problem with modeling complex systems is you can’t. They can adapt well to small changes and maybe to many small changes. The breaking point of a complex system is usually abrupt. It may adapt until it breaks, or it could just break.

      • Your comment may demonstrate why Fed does not use Complex systems. They would rather bend than break. Unfortunately when financial innovation uses these advanced systems, the Fed’s models lose relevance. The Fed experiment since 2009 has only worked while they control the environment in which they run the experiment, by reducing the size and number of components. (hence the moonwalk on traditional benchmarks, like employment, fiscal policy and the dollar) They keep the banks running, everything else is beyond their purview. USG is throwing 50B to the people, and 150B a day at the banks. Fed created the 1%, will they rescue them from themselves?? In order for a ‘socialist’ candidate to get a fair shake, and the people to have a chance to reclaim a place in the financial experiment, we need to delist the current WH occupant, while the Deep State acolytes like Powell, try to save a system which is clearly broken.
        https://dailyreckoning.com/why-the-fed-cant-get-it-right/

      • Javert Chip says:

        Petunia

        We are about to skate over the edge of my knowledge of statistics, but systems can be grouped as:

        o Random, which can be modeled (Las Vegas casinos do this quite well)

        o Chaotic, most of which cannot be modeled accurately due to measurement errors in initial conditions (which can quickly get us into a messy discussion of quantum mechanics not allowing perfect measurements)

  7. GotCollateral says:

    My mother runs a bunch of FQHC’s in Ohio… the biggest issue she is facing is supplies… she’ll have to close down in 14 days if things don’t change… she was supplied by the province just above wuhan for a bunch of stuff.

    Listening to her talk about the crazy store runs in the US now for toilet paper makes me glad to have moved somewhere where its still made in the country. Then again, maybe people will be able to use BBB “IG” corporate bonds. I hear 3.5% BA 2059 trading 85% of par feels like a little bit of heaven between the cheeks.

  8. Charles Reese says:

    Hi,
    Infrequent poster here. I am a retired scientist and I have a good grasp of math. I just want to say if you are over 65 with a ‘condition’ or just over 70 you need to go to the grocery store and get at least a months food. If you don’t have cooking facilities get ready to eat canned food and buy a camp stove and fuel for it. Go home or some other place where you can be alone. Your very best chance to stay alive is self quarantine. You will doing yourself a big favor and the medical system a great service as well. Each week you self quarantine you will see plenty in the news to stiffen your resolve.

    I am 78 with diabetes and I have been self quarantined for three weeks because I see how this is going to go. The math is clear, just extend Wolf’s graph out 30 days and see where we will be. This isn’t politics, you can’t spin your way out of it.

    • Wisdom Seeker says:

      Exactly this. Thanks Charles!

    • Daedalus says:

      Charles,

      We all must die. The only questions are ‘how’ and ‘when’. I’m 77, with a persistent asthma and (lately) odd headaches. I’ll do what I can to persist. I’m planting the seeds for next year’s food supply. But I realize that this virus might be my destiny.

      Of course, I’m a bit irritated that our national ability to deal with an almost certain event like this virus has been eroded in order to produce the immediate ‘bottom line’ corporate surplus. That, however, is the system our society tolerates.

      Once, the English discovered that they wanted to fight a war in South Africa against the Germans. They discovered, however, that they had a dearth of disease-free cannon fodder. Thus, they instituted ‘socialist medicine’. Now, they have forgotten, and our rulers are too stupid to learn.

      I actually love having Trump as President. On a daily basis he teaches that the relationship between wealth and intelligence is at best flat.

      • Cas127 says:

        “an almost certain event like this virus”

        In all fairness, is that actually true?

        If these were actually frequent events, the structure of healthcare would have evolved differently – not only in the US but around the world (I suspect that Italy’s socialized Healthcare system – decently ranked on paper, yet with no greater surplus of ventilators than the US, etc – is going to come under a lot of scrutiny post C19 and a lot of real world structural shortcomings/deception may be exposed).

        Also, there are literally thousands of ways to die…building in peak, surge capacity for all of them (even just the infective ones) is economically unrealistic.

        The US is already spending 20pct of GDP on Healthcare – not including the standard issue insurance company villains.

        And yet the ventilator bottleneck.

        How about forensically finding out where some of the already spent trillions have been misdirected? And that process does not require a wholesale alteration of the payment system *in advance*

        Obamacare could not get functional websites up (with 5 yr lead times!) that only handled the insurance component – let alone infinitely more complex/time driven medical issues. It took additional *years* to get these sites functional.

        That is/has been/always will be a job for regulatory/congressional oversight.

        But those sainted political processes (controlled by both parties at various times) have been captured and corrupted for decades – as with education, the system really isn’t run for the benefit of the claimed beneficiaries – it is designed and operated in practice to benefit the providers…who kick back a cut to the politicians.

    • Ed C says:

      Here, here. In addition to that I will get a short haircut on Monday and be prepared to hunker down. I am 70 and reasonably fit. I will lament discontinuing going to the fitness place I exercise at.

    • Xabier says:

      That’s just what I have advised my elderly mother, as I feel this is more perilous for her than when the Germans were bombing her in the Blitz.

      I’ve stocked her up for months, and she has strict ‘confined to base’ orders.

      And good luck to you,too, sir.

    • polecat says:

      Mr. Reese,
      All good advice .. but, with the caveat that if people are forced by circumstance to use ‘camp’ stoves, they should ONLY use them Outdoors .. due to the danger of carbon monoxide poisoning in enclosed spaces. People inadvertently die by doing so. Otherwise, spot-on advice !

  9. Pilgrim says:

    That’s key, isolate infected people … which is tough if tests don’t detect during non-symptom incubation period. Young hosts may be just fine with it, but catastrophic for weak imune system. Cinchona might have benefits for this.

    • Wisdom Seeker says:

      If you can’t tell who’s infected and who isn’t, you have to split people up into small groups (family units, for instance) and minimize the interactions between them, until any hidden infections run their course within those groups.

      • Cas127 says:

        WS,

        Even with stocking up, people are still going to need to food shop/get prescriptions.

        So I think there are finite limits to absolute isolation.

        What can be done, should be done – but self-quarantine will never be perfect.

        There probably are steps (staggered scheduling of rqd shopping by alphabetized groups, or better yet perhaps, by age groups, etc.) that could be implemented and publicized pretty quickly.

        During the days of gas shortages, simple systems were designed to spread demand out over time – within reason, the same can be done with rqd shopping.

        It will slow down spread/”squash the curve” and therefore hopefully keep us on the right side of medical/hospital bottlenecks.

        • Wisdom Seeker says:

          Cas, absolutely. Delivery services can help out here as well; much better to have a few delivery squads inside the store (or warehouse) and not hundreds of hungry contagious shoppers.

          Delivery teams could also add value by also disinfecting the packaging surfaces if requested.

        • Cas127 says:

          The most simple system of age segregated quarantine shopping might be be the creation of “Senior Shopping Day(s)” where only customers above age X, are allowed in the store (quick ID flash). WS’ in-store solutions could then be employed.

          Disruptive to an extent, but at least an organized disruption.

          After a couple weeks, if that – people are going to have to shop.

          My sense is that online delivery systems are probably too embryonic to handle the full weight of unsegregated quarantine shopping – I’ve seen many, many, many out of stock indicators at Walmart.com, etc.

          (Anybody find a well stocked online service?)

          Another simple solution might be to temporarily restrict online shopping to those over age X or with health problems (again IDs or prescriptions are a simple way to verify). That would remove the crushing demand from online order delivery.

          Again, this could be limited to certain days.

  10. c smith says:

    ” The faster we move, the shorter the shutdowns need to be, and the less economic damage overall.”

    Seems to me this is backwards. By definition, the “flatten the curve” graph means the outbreak is actually EXTENDED in time. IOW, the total caseload is the same, just spread further to the right on the X-axis (time).

    • Wisdom Seeker says:

      @ C Smith, that’s a good question, but I think if you can cut the infection rate and keep the caseload down, then you buy time for the test-and-trace method to sequester more of the infected, and you can bring down the tail of the curve faster too. The “fastest and most painful” approach would be to pretend the virus doesn’t exist, just have everyone go about business as usual, get sick and either live-or-die. But most countries aren’t going to even try that. Once you go for “flatten the curve”, I think it’s always the case that flatter-and-lower is better.

      Sadly, in a few more months we’ll have a lot of different examples to compare-and-contrast.

    • Daedalus says:

      Congress is out for the weekend. Every three days doubles the number of people that will die.

      • Wisdom Seeker says:

        One thing to keep in mind here is that public health response is primarily a county and/or state responsibility, not federally controlled. Each state is shutting down on its own timetable, with harder-hit counties leading where they must. Congress really doesn’t have that much to do with “bending the curve”, though we will need them to coordinate federal support for all the damaging side-effects of the shutdown.

        • Unamused says:

          One thing to keep in mind here is that public health response is primarily a county and/or state responsibility, not federally controlled.

          A claim flatly contradicted by the very existence of the CDC, FDA, and NIH. Also note that CDC and FDA very much control the approval, development, and distribution of test kits and bungled it badly due to political interference for ideological purposes.

          It sure lets Fearless Leader off the hook though, doesn’t it? The buck never stops there. His rallies did get canceled though, poor guy. No one suffers more than he.

        • Cas127 says:

          Una,

          So centralized solutions are not always and everywhere an absolute and unalloyed good?

          And government entities are not in practice always run selflessly, at any level?

          Or that ongoing oversight of grand government programs is often not a priority at all, lacking as it does the political PR value of loudly trumpeted *upfront* promises – untested by any actual operation.

        • Happy1 says:

          Yes, although the “bully pulpit” of the Presidency should have been used in this way, as FDR did for the Depression, but Trump is incapable of seeing anything but his own personal benefit and had to be dragged kicking and screaming to address this.

          But the response in the US is local and state and NOT federal, the FDA largely was an obstruction here to testing, and the CDC botched the intitial round of testing.

      • Eferg says:

        A bit of a sarcastic contrarian view, but it might be better that congress extend its recess indefinitely. If they reconvene there will be two major activities: throwing accusations at each other and printing/borrowing more money to throw “pork” at favored groups or causes – all of which would be in the name of the virus, but 95% unrelated to it. Any benefit to managing the virus situation will be accidental.

        I do not think that a “committee” of 535 politicians is going to fix anything.

        • VintageVNvet says:

          Couldn’t agree more Eferg: “Clean House,,, Senate too.”
          So far as I can see and figure today, the puppets posing as politicians who are supposed to be the public servants of We the People per our constitution, are in fact, only the servants of the rich and powerful known as the oligarchy, and their own personal aggrandizement/pockets.
          To be sure, there are exceptions, and always have been, but today is, according to many metrics I have read, the worst situation since the 1920 era that was so tragic that it led to the, so far, worst depression in USA history, and then directly into WW2.
          Perhaps Wolf can do some of his very educational analyses and graphs to show this??

    • Happy1 says:

      The reason this is key is because ICU capacity is the key to survival in this pandemic. If the curve is too steep, the ICUs fill and people die (see Wuhan, and now Lombardy, soon to arrive in Spain).

  11. WES says:

    A few days ago my wife read a comment from a Japanese doctor that seems to make some sense (I have not read the report myself, so just hear say).

    If you think you have caught the coronavirus, one test you can perform at home to see if you are or about to have trouble breathing, is to try and hold your breath for 10 seconds.

    If you can do so without difficulty, then the coronavirus has not yet infected your lungs.

    However, if you cannot hold your breath for 10 seconds without difficulty, then you need to seek medical attention!

    How true or useful this advice is, I simply do not know. Only a medical person would know.

  12. David Calder says:

    I looked for a possible connection as to why King County, WA., really the wealthy side of Lake Washington, and Westchester County, NY would have in common, both recognized as the two hot spots in the US, and it is their wealth. Test kits were available for those folks but working class Everett, WA had none so sick people were sent home with fevers of 101and able to answer yes to two or more questions that define COVID.

    Charles Reece is right. Do what he recommended but realize the canned goods you just bought may have sneezed on by a sick store clerk so wash them before opening.

    We are leaderless and alone in this fight..

    • Iamafan says:

      I live near New Rochelle, Westchester county, NY.
      The very rich are not exactly in New Roc but in neighboring towns.
      So this is hurting a lot of poorer people who really can’t afford to get sick.

      • David Calder says:

        But are the poor getting tested?.. Blue collar Everett, WA was sending home the sick untested while the eastside of Lake Washington, Kirkland and environs was..

        • Happy1 says:

          I can tell you that in CO, testing isn’t occurring for anyone that isn’t sick enough for hospital admission.

  13. Jeff Relf says:

    Real viruses are trivial;
    unknown viruses are apocalyptic.

    Starting with the Hong Kong riots…
    People lose their job and go insane.
    People go insane and lose their job.

    Hence these pain relievers:
    – Heroin, Religion.
    – Negative interest rates.
    – Negative risk premiums.

    • Daedalus says:

      Good post, Jeff….. Like your list of ‘pain relievers’ and the implication of their equivalence.

  14. Javert Chip says:

    Except he has explicitly said he did not use paid sick leave.

    Putting words into other people’s mouths is is stunning, not to mention dangerous.

  15. Iamafan says:

    I think the article should concentrate on how the USA screwed up in testing for the coronavirus early maybe because of “not made here” politics.
    The timeline is rather clear. China released the genetic data Jan 10-11.
    Germany developed tests immediately. So Korea used it own test by Seegene. US CDC screws up their own test.
    Meanwhile, there’s a video out there of German Qiagen detection machines just waiting for FDA approval for weeks.
    We deserve to know the truth.

    • Universal healthcare fan says:

      The difference between the US and South Korea, Germany and even China is that the US does NOT have universal healthcare and South Korea, Germany and China do. This should be a wake up call for the US to adopt universal healthcare and to hell with the profits at all cost HMOs.

      • backwardsevolution says:

        Canada has universal healthcare, and yet we still have planes flying in from China many times a day, plus Iran and Italy. God only knows how many of these people are carrying the virus. And it’s the same in the U.K.

        I think most of the Western countries (the ones with central banks) have pretty much followed the same play book: the economic health of the country matters more than the physical health of the citizens.

        They haven’t been testing (even in countries with universal healthcare) because they don’t want you knowing the real numbers. If you knew, and the numbers were significant, you’d have been screaming for the closing of the borders, shutting down economic activity – OR – if the numbers were insignificant, you’d realize the trillions handed out by the Federal Reserve were unnecessary.

        And when tests were given, there were too many false negatives (the tests were given too early in the infection to register positive), so what’s the point?

        The best advice was given above – hunker down and isolate yourself until it blows over.

      • Paulo says:

        Uni,

        As a Canadian I wish to actually come to the defense of the US system in a few ways that both our systems share.

        1) Neither countries have enough Hospital beds or ICU spaces. In the USA it is to maximize profits. In Canada it is to control costs and the dampen the ire of the anti-tax people. Our hospital bed availability per 1,000 population is almost the exact same number. The bed availability in Italy is 2.5X more.

        2) We are both trying to flatten the ‘curve’.

        Having said that the medical care Canadians receive does have better outcomes for 1/2 the cost, at least measured by availability and longevity.

        We also have adequate testing, and free of charge, obviously. My province of BC has tested more people than the usa, with1% of the population. We should have drive-thru testing stations by the end of next week.

        Our information is given out 2X per day by our Health Officers. The politicians stand behind them and keep their mouths shut. Policy is based on what science dictates.

      • Happy1 says:

        Italy has universal healthcare, shall we emulate their response as well?

      • BioChamp says:

        China does not have a universal healthcare system. Care is financed by a combination of personal cash payments for services and various forms of health insurance. The costs are far more reasonable than the US system, though.

    • Wisdom Seeker says:

      Iamafan, I share your concern about the test situation, but every day I see progress on that front and I know people have solved it. They have drive-thru testing in my community now. We missed a chance to contain this.

      But at this point I’m much less worried about assigning blame and fixing that system. I’m extremely worried that thousands to millions of people will die needlessly because people won’t stop spreading the disease. Put the focus there first, and then we can rework the CDC’s pandemic test kit system.

  16. Ed C says:

    Politicizing a plague isn’t a useful exercise. Disunity isn’t helpful. You’ll get your say in November.

  17. Tom Stone says:

    I have been self Isolating for several weeks now due to being immunosuppressed (Chemo) and it looks like I’ll have to continue that for the foreseeable future.
    As to stocking up on food, many can’t afford to buy a month’s supply and still pay rent, utilities, etc.
    It’s looking bleak for the bottom 50%

    • NoEasyDay says:

      @Tom Stone-

      > As to stocking up on food, many can’t afford to buy a month’s
      > supply and still pay rent, utilities, etc.

      This is a great time to save money wasted on processed foods, wean oneself from excess salt and sugar and learn to cook.

      • Urbane says:

        Yes, sugar, and other fast carbs, are bad, but there is effectively no such thing as excessive Salt. Healthy kidneys can easily excrete a Kg of Salt per day (very hard to eat/drink), but having to recycle too little Salt is very expensive.

        See the book “The Salt Fix” which demolishes the myth that low Salt is a good idea; it’s a very bad idea, which can impair the immune system and metabolism, and ironically cause hypertension. People need between 7.5 to 15g per day, and can tolerate a lot more.

    • Wisdom Seeker says:

      I want to mention that most states are working out how to waive (or at least defer) utilities and rents and other irritating fixed costs, so people don’t go broke while they can’t work because they have to hibernate.

      I know that’s a huge concern for a lot of people but the politics on that are so obvious that something will work out. No one in their right mind wants to be the guy that evicts the working family with young kids into the middle of a pandemic. So if cash is tight, don’t pay any bills other than groceries and meds, and then ask everyone else you know what the consequences will be of them being patient with you until Congress and the state legislatures sort things out.

      • Bobber says:

        A year or two ago, an often cited statistic came out, indicating 50% of households couldn’t pay for an emergency expenditure greater than $400. I guess we’ll find out if this is an accurate statistic.

        • Wisdom Seeker says:

          @Bobber, that’s a misleading interpretation. People didn’t have $400 surplus cash lying around. But they would have ways of paying that emergency cost (because those emergencies happen all the time), typically on a credit card paid back from saving the next month. For this pandemic, there’s also 401K loans (for those with 401Ks), early IRA withdrawals (maybe Fed Gov could waive the penalty taxes temporarily), home equity loans, and then if push comes to shove you plead with family (which I believe is a bit more common in Hispanic and Asian communities). There’s a lot more resilience in the system than some people claim.

  18. IdahoPotato says:

    Please do not get on a plane anywhere in this country. Passengers at Dallas Fort-Worth Airport were herded together like cattle for 3.5 hours and made to fill questionnaires, no one was tested, and they were all sent on their respective ways.

    The pics made my toenails curl.

  19. ML says:

    I find it fascinating that at a time when boosting one’s immune system is needed people generally carry on eating and drinking the sort of food and drinks that are harmful to their immune systems.

    Here in UK the Government is advocating herd mentality where if enough of us get it somehow that will solve the problem. In other words, each of us should deliberately put our own health at risk for the good of all. Naturally, most people baulk and instead put themselves first – which in my view is best – but to carry on eating junk food, processed food, call it what you will, does them disservice.

    The most popular food for panic buyers is pasta and milk. Why adults think that milk is healthy is beyond me. As for pasta, wheat is hardly the most digestible.

    Whenever I publicly list the food and drink that in my view are unhealthy and do us no good I am told in no uncertain terms that scientists disagree etc. It may be thought weird to not drink milk and not eat pasta – and in my case, not eat chocolate, added salt, added sugars, not smoke, not drink coffee, tea, alcohol – but given the choice between weak immune system and a healthy one which when there is a pandemic around means the difference between life and death, I know which I would rather have.

    • Michael Church says:

      You are creating a list which is contradictory. Tea for example is known to have beneficial effects for cognition and the stomach. I know of no evidence that milk has a bad effect in moderation on the immune system (especially organic milk which has higher levels so good fat acids). Of course sugar and smoking are really damaging to health. Smoking damages the lungs directly, it is not really a matter of weakening the immune system. Lung tissues get damaged and for many people they end up with COPD a kind of slow death by drowning. So you are correct your list does not correspond to the scientific evidence. One thing you did not mention and possibly one of the most important to mitigate covid19 is to exercise your lungs directly (not just indirectly though exercise like running). There are many such exercises from yoga (eg breath of fire, long deep breathing and 4 stroke breathing in Kundalini). These exercise the lung tissue and strengthen the tissue just as exercising your arms strengthen the tissues of the arms.

      • VintageVNvet says:

        Good Point MC;
        however, when i first attended ‘yoga boot camp’ in the Sierra, they taught us to run through the very very isolated hills doing various deep breathing ”pranayamas” as best we could, including using the footfalls to measure our long breathing.
        most of us could do only two or three footfalls per breath to start; many of us could do 8 or more after a month or so of that exercise, (as well as extensive lessons in various other components of classical yoga.)
        one metric was very clear,,, my chest expanded over 2 inches within a year of that beginning (without an accompanying expansion of waist — that took about 30 years, LOL,) so I had to get my suits at BB in the ”college” section once again

    • Urbane says:

      It should be obvious that a bad diet is the primary cause of metabolic disease and what allows infection to gain purchase more easily; genetics less so.

      Hunter gathers preferred the rest of animal carcasses over lean meat, because of higher nutrient content, despite “Paleo Diet” dogma. Obviously vegans and vegetarians are foolish malnourished cultists, because some nutrients are only available in usable forms from diary or animal carcasses.

      All seeds, beans and nuts, probably Coffee and Cocoa bean too, need soaking/rinsed in cold water for several hours, or fermented, to significantly reduce anti-nutrient content; it is ‘time-saving’ idiocy/greed when this is not done, including the idiocy of Yeast risen (most) bread from non-soaked grain seed flour, rather than Sour Dough (fermented) bread. All grain flour older than about 3 days old probably contains rancid germ oil, especialy the deception called Wholemeal flour.

      Generally the less industrially processed food is, the better, to prevent heat damage and avoid harmful additives like sugars, soy, expeller-press seed oils, and various nasty synthetic chemicals. All pasterised foods are heat damaged, so must be avoided e.g. all dairy from pasterised milk! All food containing light sensitive nutrients, including Olive Oil, Avocado Oil, Nut oils etc., should be in UV filtering or opaque containers. Sugars of all kinds should be limited/avoided, especially any sugar which is not absorbed as Glucose.

      Better to eat more traditional foods, like pastured unpasterised Butter or Cheese (e.g. some French products) for vitamin K2 MK-4 and good fats, decent quality Cod Liver oil capsules or animal Liver for vitamin A and D3, freshly cooked meat, including organ meats, rendered animal fats and fermented foods, limit/stop starch consumption if eating enough fat, and trust your taste buds on how much salt you actually need, which can be a lot more than authorities advise!

      • Paulo says:

        Maybe a more bearable existence to heed the words of the late Robert Shaw?

        Romer Treece : I just stay home and I drink rum.

        • polecat says:

          Ha !

          I tend to go with J .M. Greer’s advice, and shun any and all ‘macro neurotic’ diet regimes. Everyone has different needs.
          ‘;]

    • Unamused says:

      In other words, each of us should deliberately put our own health at risk for the good of all.

      “All of this was indispensably necessary,” replied the one-eyed doctor; “for private misfortunes are public benefits; so that the more private misfortunes there are the greater is the general good.”

      Taken to it’s logical conclusion, then, everything will be perfect once everyone is well and truly fucked.

      We’re keeping the gates locked. Go away.

    • mtnwoman says:

      Agree.
      Now is the time for totally unprocessed food if possible, healthy fats, adequate protein, low sugar/etoh.

      LOTS of herbs: garlic, red onion, capers, leeks, rosemary, thyme, cinnamon, clove,, fruit and eat a lot of the stuff you don’t usually eat like the web that holds the pomegrante seeds, the inner peel of the grapefruit and oranges..

      And at least 7 hours of sleep/night. 5 hours drops your NK cells by 70% (these are the front line asassins to virus and bacteria. Sunlight (vit D). Moderate exercise.

  20. Rob says:

    Australia has closed its borders with any incoming people having to self isolate from midnight Sunday.

  21. John says:

    Wisdom seeker
    Thanks for the thoughts. It’s my understanding in NJ. One has to have a fever to be tested. I assume that’s everywhere else.

  22. Michael Engel says:

    1) The Wuhan virus sent the Nasdaq to the canvas : NDX
    backup on Oct 2018 high.
    2) SPX a higher low, doing few push ups.
    3) The DOW a lower low, like Cuba JFK WWIII 1962 low, that sent the DOW from 524.55 to 1,000.11 in x4 years.
    4) IWM is the only index that shook hands with Trump gap, the Oct/ Nov 2016 gap and visited the Dec 2015/ Jan 2016 gap, pumping muscles in the gym for the last x6 years, since Oct 2014.
    5) WTI is high energy screaming on the peloton since Mar 2015.

  23. raxadian says:

    News from Argentina:

    We have ONE International airport, while everyone in the USA in Europe was PANICKING about Cow Videos (Coronavirus actually) we did NOTHING until we had at least a person infected around here.

    Worse, this week, you know with FREAKING ITALY IN THE QUARANTINE CLOSET we STILL AREN’T TESTING EVERYONE THAT COMES FROM COUNTRIES WITH CASES OF CORONAVIRUS!

    But I am sure everything will be fine… eventually.

  24. Michael Engel says:

    1) Comrades, get a heart attack, or cancer and pump up US GDP.
    2) Anarchists, start a restaurants recession with :
    Douglas Graham : 80/10/10.
    3) Grad med school for $ 35 from :
    Andreas Moritz : Timeless Secrets of Health & Rejuvenation.
    4) Don’t kill yourself becoming extreme.
    5) Learn the about the cause, not the symptoms.

  25. Michael Engel says:

    1) China export a global and deadly recession. The Wuhan virus killed 50 people.
    2) US crime rate will be falling. Less bar fights. The murder rate, rape & robbery will plummeted.
    3) The Wuhan virus will save the depressed from sticking a gun to their head.
    4) Neither a gov, the Fed have the power to control a deadly virus.
    5) The most powerful people at the top are not immune.
    6) When u have a steak dinner with wine u pay the bill, but bacteria
    will feast on your meal.

    • paul easton says:

      And the Phage will feed on them. The Phage is the highest thing that God ever made.

  26. JM says:

    My first question is a little provocative because if the British government was right?
    Last year there were 650,000 flu deaths in the world and 35,000 deaths in Italy, now in Italy the first European country affected there are about 1500 deaths, then these figures could give reason to the British government that this pandemic is declared for a another reason also to hide the catastrophic world economic situation, reading these figures a serious question arises ?

    • Jdog says:

      The contagion factor of the regular flu is about .01% The contagion factor of this flu is 3.5%. This flu is basically SARS with elements of AIDS that attack the immune system. Without extreme measures this virus has the potential to be every bit as deadly as the Spanish Flu of 1918 which killed 50+million people at a time when world population figures were much lower than today. In addition, the early strains of a virus are often much milder and less deadly than the mutated versions that follow. The fatalities in the first year of the Spanish flu were relatively low, it was the second year that the majority of the fatalities took place after the virus had mutated to a more lethal strain.

      • mtnwoman says:

        Yes,
        T cells play a critical role in antiviral immunity.
        COVID 19 exhausts T cells

        T cell counts are reduced significantly in COVID-19 patients, and the surviving T cells appear functionally exhausted.

        https://www.medrxiv.org/content/10.1101/2020.02.18.20024364v1

      • JM says:

        You are right about the greater danger of Covid-19 but to make a comparison with the Spanish flu of 1918 is not possible because most of the deaths were caused by malnutrition and the First World War was the main cause and also our health system and now much more efficient as well as medical research to find a vaccine quickly. Currently if I could choose I would go to live in England because I don’t think the British government is not a stupid choice to leave the epidemic to run its course trying to save the sick as much as possible without sending the economy to collective suicide, close all activities for months means this.
        The UK’s contacts with Japan to learn how to do the health emergency is already indicative that Japan seems to be at the forefront of the policy of not blocking the economy.
        https://japantoday.com/category/politics/update1-abe-johnson-agree-to-cooperate-over-coronavirus-response

  27. unit472 says:

    I’m going to go on again about the Diamond Princess cruise ship as this is the only complete coronavirus case with a precise timeline and outcome.

    January 20- Ship leaves Yokohama with 2500 passengers ( half over 70) and 1200 crew.
    January 23- 80 year old Hong Kong man shows signs of Wuhan flu
    January 25- Man disembarks in Hong Kong for medical treatment
    January 27-28- Port call at Danang, Vietnam
    January 30- Disembarked passenger confirmed as Covid-19 case
    February 1- Port call in Okinawa- 13 passengers AND crew leave ship and fly home! Apparently after Okinawa sightseeing visit something changed aboard. Passengers confined to their cabins sometime between February 1 and 3rd?
    February 3- Emergency return to Yokohama
    February 4- Ship quarantined in Yokohama
    Today from Worldometer- 696 cases, 7 deaths, 233 cases still active, 15 critical.

    While cruise ships have had norovirus outbreaks before, one might suspect a major operator like Princess has pretty good sanitation procedures in place to stop these outbreaks yet in two weeks the Wuhan flu was able to run rampant.

    Once in quarantine passengers and crew were medically examined daily. Those exhibiting symptoms were tested for Covid-19 and if positive hospitalized. It doesn’t get any better than this in terms of medical care. No self reporting or calling your doctor. Daily examinations and testing with immediate treatment in good uncrowded hospitals with fresh doctors and nurses. Despite over half of the 2500 passengers being 70 or older we get a mortality rate of about 1%. Again, as good as its going to get absent some new treatment.

    My conclusions. Social Distancing is the only available option but as the Diamond Princess shows once the virus is present about 20% of the population will become infected. Had Diamond Princess locked the passengers in their cabins on January 30th when the sick passenger who disembarked in Hong Kong illness was confirmed it would only have stopped passenger/crew interaction by a day or two. The 1200 crew would still have to interact and we might consider this 1/3 of the shiI’m going to go on again about the Diamond Princess cruise ship as this is the only complete coronavirus case with a precise timeline and outcome.

    January 20- Ship leaves Yokohama with 2500 passengers ( half over 70) and 1200 crew.
    January 23- 80 year old Hong Kong man shows signs of Wuhan flu
    January 25- Man disembarks in Hong Kong for medical treatment
    January 27-28- Port call at Danang, Vietnam
    January 30- Disembarked passenger confirmed as Covid-19 case
    February 1- Port call in Okinawa- 13 passengers AND crew leave ship and fly home! Apparently after Okinawa sightseeing visit something changed aboard. Passengers confined to their cabins sometime between February 1 and 3rd?
    February 3- Emergency return to Yokohama
    February 4- Ship quarantined in Yokohama
    Today from Worldometer- 696 cases, 7 deaths, 233 cases still active, 15 critical.

    While cruise ships have had norovirus outbreaks before, one might suspect a major operator like Princess has pretty good sanitation procedures in place to stop these outbreaks yet in two weeks the Wuhan flu was able to run rampant.

    Once in quarantine passengers and crew were medically examined daily. Those exhibiting symptoms were tested for Covid-19 and if positive hospitalized. It doesn’t get any better than this in terms of medical care. No self reporting or calling your doctor. Daily examinations and testing with immediate treatment in good uncrowded hospitals with fresh doctors and nurses. Despite over half of the 2500 passengers being 70 or older we get a mortality rate of about 1%. Again, as good as its going to get absent some new treatment.

    My conclusions. Social Distancing is the only available option but as the Diamond Princess shows once the virus is present about 20% of the population will become infected. Had Diamond Princess locked the passengers in their cabins on January 30th when the sick passenger who disembarked in Hong Kong illness was confirmed it would only have stopped passenger/crew interaction by a day or two. The 1200 crew would still have to interact and we might consider this 1/3 of the ships population the bare minimum of a national population that will also be unable to ‘social distance’ themselves under any circumstances because their work is essential to keep a society functioning.

    • Cas127 says:

      Unit,

      This is an interesting point, the cruise ship did operate as a sort of “closed environment” experiment with many more known factors/timelines than is normally the case.

      One major difference though – the “closed environment” kept the same population recirculating among the same population (until room confinement at least) which makes me wonder if they ended up marinating in a pool of infection/re-infection.

      There are aspects of the Spanish Flu response (very large, apparently pretty open hospital wards) that make me wonder if “pool marination”/locus of infection maybe made things worse (amplification of severity due to perpetual re-infection, etc.).

      Perhaps one of the medically trained people on the board could address these issues.

      • unit472 says:

        A cruise ship is not much different than a big hotel or office building save cruise ships have big open air decks and suites with balconies.

        Passengers do mingle together on cruise ships because the nightclubs, casinos, bars and restaurants are all on board but that make them a lot like the big Las Vegas hotel casinos which, BTW, are still open. Still in the case of the Diamond Princess they did not learn that a coronavirus infection had taken place until January 30 and passengers were confined to their rooms no later than February 3rd though it might have been as early as February 1st. Still 20% became infected!

        Expect something similar to occur in Las Vegas!

    • Wisdom Seeker says:

      There are now several other cruise ship outbreaks which could also be informative. I expect a few Ph.D. theses will be writing on this topic eventually.

      P.S. To be snarky, perhaps Princess Cruises should re-brand as “Corona Cruises”? Unless other cruise lines also had outbreaks but were less transparent about them, what was it about Princess that made them so susceptible?

      • Cas127 says:

        WS,

        The same cruise ships tend to repeatedly service the same regions of the globe, with only seasonal (or annual) migrations across regions. My sense is that Princess may have simply had bad luck of the draw region wise, initially.

  28. paul easton says:

    When you think about it you have to admit that we have long been it a situation that is dynamically similar to the pandemic, but vastly more serious. I refer of course to climate change. But due to the slower time scale, combined with the frog-in-the-pot effect, we have been unable to respond to it.

    For the pandemic we face a fatality rate of at most a few percent, and the prospect of a quick recovery. If climate change continues to follow its natural course we can expect a very long term reduction of the carrying capacity of the earth, a fatality rate of at least 90%, and a global collapse of the money economy.

    Climate change is old news by now, but we haven’t done anything significant about it yet. As with the pandemic, time is of the essence if we hope to bend the curve. I hope there might still be time for a significant response, and that the rise of the pandemic will help us think about it.

    • unit472 says:

      Once people get a taste of economic disaster ( and they are getting the initial dose right now) the last thing on their minds will be mitigating a putative climate change! It will be get me a job so I can eat and have a place to live.

  29. doug says:

    Public places getting empty. The only places full of people around here are craft breweries. Younger folks mostly.

    I have nothing to add other than ‘thanks and good luck’ to all.

    • Bobber says:

      I’m near the outbreak in Seattle, and I was driving around yesterday (Saturday). The traffic was about 50% of normal on the roads and in restaurants. The grocery store parking lots were doing better, maybe 60-80% of normal capacity. There is no formal quarantine in Seattle yet, but people are taking some precautions.

      I still find it odd that many states are allowing large gatherings up to 200 or 300 people. Why? Those big meetings aren’t productive anyway. Do it on a webcast.

      The best thing for business is to shut down the virus as soon as possible, through whatever means necessary. It will be painful for profits, but profits will be devastated and credit issues will appear if this lasts for a long time.

  30. Michael Engel says:

    1) Brick & mortar is dead. Brick & mortar empty shelves.
    They are sold out. Retail extended hours. Pharmacies inside, exhausted their inventory.
    2) SPX inside backbone #2.
    3) SPX osc above below resistance line, the upper line, for a while. It might plunge to #1, or takeoff in a sling shot, like a launched rocket above backbone #2 for several years.
    4) Wash your hands, buy vitamine B, C, D, E..and red wine to prolong life,
    Chocolate boost moral during a crisis.
    5) Chocolate will bend your back forwards.
    6) Steaks, wine, a delicious chocolate cake and a cup of coffee, will change the acidity in your blood.
    7) To restore PH the body extract calcium from the bones and the jaws.
    8) Chocolate bend and dentists business is to drill in your teeth.
    9) When bacteria have a painful party deep inside the mechanical jaw, when chocolate or wine is dripping through the bones porosity, dentists will kill the nerves, charge to fix the symptoms, but not the cause.
    10) Toxicity can travel to the glens, or up to the brain,
    dimming eyes lenses, causing vertigo, headaches, killing brain cells…
    11) Dumped toxic material cause black stains on the forehead.

    • paul easton says:

      WTF is SPX?

      • Iamafan says:

        Trust me. red wine is better than SPX.I

      • VintageVNvet says:

        May mean this??
        SPX:IND
        S&P 500 Index

        never had been a big fan of that index/market, until i started reading this site, which, as mentioned in another comment on this thread, is the only one i have seen where Wolf not only approaches finance (at least somewhat) scientifically, with real data and good graphs, but he also moderates it most of the time to enforce some manners, etc., based on his published rules
        there are a ton of what certainly appear to me to be well informed smart folks commenting on here, some of whom apparently think everyone knows every abbreviation they know, no matter how obscure, though in fairness to my attempt at humour, most such short cuts are common in finance/stock and other markets, etc.

  31. Iamafan says:

    Suddenly everyone is an expert. Notice how financial market commenters have become epidemiologists. When I took my statistical analysis classes (grad level) at Rennselaer Poly, a few of my classmates were researchers paid by Pfizer or similar companies; all of them super humble. Together we would discuss how we would design experiments Box, Hunter, and Hunter style. Few went on to help write papers. Even fewer became professors. Today, it’s run wild. Who to believe? There’s an explosion of what Taleb would call Flaneurs.

    • Unamused says:

      Suddenly everyone is an expert.

      An ‘ex’ is a has-been. A ‘spurt’ is a drip under pressure.

      At least the oil industry got bailed out again. The expert-in-chief does have his priorities, after all.

  32. Jdog says:

    It amazes me that people still expect governments to work in the public good. The fact is your government is owned by corporate interests. Politicians live or die by the campaign contributions (bribes) given to them by corporations. These huge campaign contributions are the tools by which corporations buy politicians. In this crisis, like in all other situations, corporations will use lobbyists to dictate to government which course of action is in the corporate best interest, and the politicians will obey, because their political survival depends on it. Every politician, on both sides of the isle, sell their very souls to the corporations, and that is the system we have. So do not expect the government to put the interest of the people above the interests of the corporate world because that is simply an unrealistic expectation given the reality of the situation. The government could have done more to limit infection and death in this crisis, but that would have hurt the corporate bottom line and that is not what the corporations who run our country want….

    • paul easton says:

      The sad thing is that the bribes are minuscule compared to the profits. Our politicians are a glut on the market. They need a trade union, to set some basic standards.

  33. c1ue says:

    I don’t disagree with the general premise of the article, but the author has several important points not well defined:
    1) There will be thousands dead no matter what happens. The only questions are how many thousands and how fast.
    2) Italy is the 6th oldest population in the world – age is the single most important factor in nCOV mortality
    3) Italy also has the fewest hospital beds per 1,000 population of the Western European countries – somewhat less than the US. Another major factor. Remember – this isn’t about health care system quality – it is about health care system capacity. We’re not talking about gender changes or plastic surgery…
    4) The US has experienced 5% loss in hospital beds from 2005 to 2017. Richer areas have gained 10% beds vs. 20% population gain; poorer/rural areas more than made up for the difference. Thank you for-profit health care.
    5) Exponential curves – particularly in the beginning before testing – are even less useful than extrapolating stock markets on straight lines.
    6) Medically, 4 days is the minimum incubation time for nCOV – so doubling can’t be shorter than that. In reality, doubling should be at least 7 days and as long as 4 weeks.
    7) Mortality exists at all levels except 10 and under. But it is low. The problem is that after age, risk factors include smoking, obesity, hypertension. Americans are fat…
    8) What’s the deal with toilet paper? Unlike Australia and Japan where bullshit articles were popularized featuring masks made of toilet paper – why are Americans stocking up? I was in the grocery store Friday – the TP aisle was almost empty and the checkout lines were literally historic: 20-30 people long with every 2nd person buying 3 packs of 12-roll toilet paper. Friends in Russia are joking that Americans are scared shitless by nCOV…
    9) the biggest problem is I don’t think people have really thought this out. nCOV isn’t going away – the lockdowns will slow down the spread which is good. However, what happens to the economy with no one travelling, no sports, no concerts, restaurants hit, tourism dead? The US economy is enormously dependent on consumption – nCOV lockdowns are the single best way to hurt consumption.
    So let’s say the lockdowns work. nCOV is still going to be out there – and the growth curves are just going to start again after the lockdowns stop.
    I’m not saying not to do them – but I am asking what the end-game is when a vaccine is 12-18 months away, minimum. Repeating cycles of lockdowns?
    China has instituted draconian measures to identify exposed people and quarantine; Europeans are generally societally aware/responsible enough to self-regulate, but the US will never be able to execute these type of measures either by force or by individual initiative. \
    I can see China and most of Europe coming back to some semblense of normal in a few months – I am not hopeful of the same thing in the US.

    • Wisdom Seeker says:

      @c1ue, I didn’t want to write a book, so I did have to gloss over some details in order to focus on the key points. Here’s a reply to a few of your points:

      Regarding (1), the data so far show that the total number of cases and deaths are both much lower if people actively defend against the virus rather than ignoring it. Wuhan ignored it an paid the price; Italy is following that path. Singapore and Korea reacted much faster and has held out.

      (2 and 3) – Northern Italy has world-class healthcare and was brought to its knees. Southern Italy is weaker system (as explained by other commenters above) and that would be part of why the government went with a national lockdown strategy; have to protect the south. Note also that France is reporting >50% of ICU cases in patients under age 50 (N of 300 so far), so it’s not all about age.

      Regarding capacity – if the outbreak is big enough it won’t matter if you have 1 ICU per 100,000 people, or 10 of them. The difference in mortality will be a rounding error. So the goal is to minimize the peak of the outbreak.

      (4) Yes, capacity is an issue in all nations regardless of what system they run. I believe this is more to do with the long period without a significant pandemic or other health crisis. And of course the systems have become much more efficient at things like outpatient surgery without a hospital stay. That was great for surgery patients but is proving to be terrible for pandemic care capacity.

      (5) The exponential curves I plotted are all confirmed case data from testing. It’s true we don’t know the true spread of the disease, and it may be growing more slowly than the test data indicates. One would hope the testing can outrun the disease (and South Korea may get the award for that along with Singapore, Taiwan and China). But one cannot bet millions of lives on that hypothesis and the US in particular is clearly “under-tested” to date. Love to see the growth curve roll over but when and where will it?

      (6) Doubling time can easily be faster than the incubation time if R0 is high, especially with super-spread incidents like Wuhan giant dinner, Spanish political rally and so on. This virus feasts on opportunities for mass infection.

      I’m skipping (7) and (8) and (9) – longer term or less critical issues. (I also don’t get the TP panic. But it was one of the first things I stocked up on myself so maybe it’s just a case of wanting to not be too impacted at home in a siege environment.)

      Love to have a post on your point (9) sometime … and I expect we’ll have many of them. Personally I’m watching China for clues, since they are first up to deal with that challenge. Right now they are working on how to handle the risk of imported cases from the global environment. And how to restart key enterprises while keeping risk of renewed local outbreaks to a minimum.

      • unit472 says:

        Re: capacity. Having read Govenor Cuomo’s piece asking Trump to use the Army Corp of Engineers to convert college dorms and old military bases into hospitals I have no objections but question the facilities he chooses.

        The better solution might be to ask families to take their parents out of nursing homes for a few months where they are very vulnerable ( 27 of the 40 deaths in Washington State were than one nursing home in Kirkland). To assist them a Medicare/Medicaid could provide a CNA from those nursing homes for a few hours a day. Nursing home residents without families to return to would be housed at the remaining ‘long term care facilities’ which is the proper term for nursing homes.

        The freed up nursing homes which are already equipped with the rudiments of hospitals ( hospital beds, nurse call systems, kitchens and laundry facilities, auto fire doors etc.) could be used to house less than critical covid19 patients or those in the infectious but recovering phase.

      • c1ue says:

        Thanks for your reply.
        i would note that:
        For 2) and 3) – world class health care does not equate to capacity, or am I misunderstanding you? You can have the best doctor and hospital around, but it won’t matter if there are fewer beds per 1,000 people than the country with less skilled doctors.
        4) – clearly a function of national priority and wealth. Russia, Japan, South Korea, Germany and France have very high beds/1000 numbers vs. the rest of the world. Italy, despite being an EU member, has worse than US availability.
        5) The curves aren’t reliable because there isn’t universal testing being done. Secondly, the advent of testing is very spotty in most countries. So since nobody is testing 100% of the population nor did different nations start testing at the same point – there is a huge amount of variability inherent in the data.
        Ultimately, time will tell.
        6) Agreed, R0 being high can lead to faster doubling times – but then again, is R0 going to be that high when people are driven to panic? Hand sanitizer sold out, masks being worn everywhere, self isolation, etc. It seems unlikely that early Wuhan will replicate no matter what – and let’s be fair: when exactly should Wuhan have recognized that nCOV had arrived and was a serious issue?

        In any case, what I consider important is whether nCOV has become established or not. The regular flu is established – we can’t get rid of it without doing something really radical…along the lines of lockdowns, and that might not even work.
        If nCOV is established – which we’ll know a month or two after China ends their lockdowns (I assume they have to end it sometime), then the benefit of the lockdowns now – in the absence of other measures like active increase of herd immunity – make a lot less automatic sense.

  34. Michael Engel says:

    1) My wealthy liberal friends from Salem NY.
    2) Its spring time, build the horse trailer of your dream.
    3) Visit us online for horse trailers custom design.
    4) Our vets will do coronavirus tests.
    5) We have custom made horses face masks to fit your horse sizes. Get a discount for a gross in a box.
    6) Can fit some people large heads.
    7) Check online pigs trailers special design.

  35. RD Blakeslee says:

    “The oldest and sickest get left to die, so that others have a chance to live.”

    Collectively it has to be that way in society because most of our oldest did not (for whatever reason) prepare well for life. It’s not just communicable diseases – it’s everything that can threaten one’s well-being.

    So, once again (in hope some young people may find it persuasive): Live a life designed to avoid risks imposed by the populace at large as much as is reasonable and enjoy yourself, family and friends in a private Eden of your own construction.

  36. 1) There are a lot of young people with underlying conditions who don’t know it.
    2) The virus also affects the brain.
    3) No one is certain was post recovery will be like.
    4) The Virus can reinfect. Any vaccine is going to be DNA based, and untested on human beings?
    5) Medical facilities are hubs for new infection. Ever spend the day in the ER?

    • c1ue says:

      The anecdotal stories of reinfection – in light of high false positive rates for nCOV tests – have to be taken with considerable doubt.
      There are now lab tests where rhesus monkeys infected with nCOV showed no capability for reinfection.
      The regular flu is still out there…

  37. Tony says:

    Governments are pretty much declaring martial law (Including the United States). It also seems odd that you’d completely stop the means of industry and also have massive amounts of money printing. That’s like filling up a car with gas that doesn’t have a motor. Please don’t get distracted as other bills are trying to be passed such as a anti-privacy bill from Lindsey Graham and also the airstrikes going on in Iraq. The virus should not be the news.

    • Tony says:

      I’d also like to add the massive amounts of data collection going on about this virus from how ALL YOU people are reacting. This will probably end in some sort of intrusive “patriot act” health terrorism. Were we have to give up civil liberties in order to not get a virus. Since this economic bubble…it also seems people have been living as bubbles. There will not be a cure. Our immune system is the cure just like all the other flu viruses. People will die regardless of how much toilet paper you own.

  38. Unamused says:

    The CDC is now publishing statistics on Cov-19 testing:

    cdc.gov/coronavirus/2019-ncov/cases-updates/testing-in-us.html

    The latest:

    Date CDC labs US Public Health Labs

    3/9 28 2564
    3/10 60‡ 2161‡
    3/11 0‡ 1683‡
    3/12 0‡ 429‡
    3/13 0‡ 5‡

    ‡ – incomplete

    All statistics are preliminary. There appears to be at least a five-day delay in updating the data, even from the CDCs own labs.

    It’s easy to assume there’s a lot of black market testing going on but there’s no data on it. Believe whatever you want.

    CDC 24/7: Saving Lives, Protecting People™

    • Tony says:

      well, don’t go in the swimming pool. You might get polio.

    • Tony says:

      Someone dies of heart disease every 18 seconds. Why keep posting data about this “Breaking News today….3 people have died.” and then the following day “Breaking News today, a 4th person has died!” It’s like really? Are people just that much out of touch with the reality of death and mortality rates among humans? Keep your heads on, people. Go outside and play in the sun. Stick to business as usual. Fun Fact: There will be more bankrupt people than people who actually die from this virus.

      • Unamused says:

        If you can’t measure it, you can’t manage it.

        At ease, disease. There’s fungus among us.

      • Wisdom Seeker says:

        @Tony – your attitude, if adopted globally, would lead to 70 million dead from this thing. (Business as Usual scenario is that of 7 billion people, 50% get infected since no immunity and highly infectious and insidious virus, 2% death rate per current best estimates: 70 million dead.)

        The reason why people are tracking the infections and deaths is because that’s the primary gauge of “how bad this will get” down the road. In addition, evolution has given humanity a tribal “cooperative defense” mechanism, responding to the suffering of others, and you’re watching it in action.

        P.S. Italy is a few days away from having COVID outstrip all other causes of death combined. It is most likely the leading cause of death nationally as of today, and it’s still growing. Nothing else on the list is doing that.

        • Tony says:

          Leading cause of death in Italy!?! really!? That is a farce. Your satire is what is feeding this. I literally have family in Italy. I spoke to my aunt the other day. You make it sound like people are dropping like flies and are being fed whatever data the media/internet is giving you. Go outside and talk to people!

        • MCH says:

          @Tony

          While I do think the media is feeding a lot of the FUD we are seeing today. I think not tracking the virus and pretending it isn’t a problem is the equivalent of sticking your head in the sand. Right now, this problem isn’t anything as bad as the Spanish flu, but no one has a clue how this bug will mutate. Whether into a harmless version or something truly bad.

          So, tracking of this virus and its evolution is absolutely critical. The problem is if you think all the media outlets are lying to you, at the end, you needn’t listen to any source of information, you have to reasonably apply logic to the situation.

          At this point 1000+ dead is quite small, you aren’t mistaken about that, but the potential for several order of magnitude of that is not out of the question. (you also have to think this is 1000+ in the span of a couple of weeks) So, it is logical to guard against that. Remember, the government does not benefit much today by having anarchy, chaos, and too much fear.

          After all, why do you think the Fed went to zero interest rate, and is likely thinking about NIRP? (Bastards)

        • c1ue says:

          I don’t know about the leading cause of death in Italy, but I saw a video where a person in Italy showed the obituary section of a local newspaper from February 9 vs. March.
          The Feb. obituaries were 1.5 pages – the March were 10.
          That seems pretty conclusive evidence that nCOV has a serious and material impact on death rates.
          The obit pictures did mostly seem to be old people as well.

  39. MCH says:

    Two sets of side comments to the virus:

    To be absolutely fair, this is a good argument for why mass surveillance with facial recognition might be a good thing. I would not be surprised if that was part of how China did containment. I’m sure there will be some who decry the death of privacy and civil liberty, and people want to continue to block this. But the fact is that technology needs to get better to enable its more effective use.

    Also, I would say that there is good reason for people to panic buy stuff, because remember, the backbone of this new economy (and the old economy too) is the trucking industry. If that part of the logistical chain starts getting infected. (likely already is) Then the store shelves are gonna break down. The fragility of that last mile (with things like Amazon Prime) can’t be understated enough.

    I don’t think the immediate problem now is with production, but more with logistics. We will see soon though.

    • Tony says:

      I completely disagree. The Patriot Act and mass surveillance is completely against the constitution. Facial recognition is VERY intrusive. Do you understand what the intention is? Just because you have nothing good to say, does that mean free speech should be banned too?

      • VintageVNvet says:

        hey, Tony,,, get over it…
        as a kid in the late 1940/early 1950 era, if, when i was walking or riding my bike home from school, I deviated in the slightest way from the current accepted behaviours, my mom, alerted by a phone call from a friendly neighbor, would be waiting at the door with a belt or other instrument of torture in her hand, and apply said torture before listening to any reason/excuse…
        later, as a driving teenager, mom would come home from her job/work on Monday and tell me exactly correctly all about what I had done the previous weekend…
        These cameras and other devices have absolutely nothing on the networks that existed before any kind of ”electronics” existed.
        OTOH, my sister and i could ride our horses, old nags that they were, all around two counties at ages 8 and 6, and IF anybody did see us, they would invite us in for a coke or something,,, and then call mom!!
        Different times to be sure, but I, for one, hope the result may be the same eventually, in spite of the Warren SCOTUS decisions we are still stuck with today.

      • MCH says:

        Tony,

        The constitution says nothing specific about mass surveillance.

        What I’ve heard from the media talking heads is always about why facial recognition is bad because it targets disproportionately “people of color” due to misidentification, what do you think is the way to solve that, by burying the technology? Give me a break, only a Luddite thinks like that. The exact way to solve that problem is to incorporate more people into those databases so that the algos become more accurate.

        I agree that there are already things that are over the limit, like how Google and Facebook monetizes our data via mass surveillance, there is a choice there as well. Turn off the internet, but that’s not exactly helping progress is it? It screws up the narrative of free speech. People don’t like Facebook having so much power? There is a choice to not use it.

        Free speech in and of itself is fine, but free speech has limits… Do you scream fire in a crowded theater and expect zero consequences? Do you like the fact that our media, “in the name of free press, and free speech” is spreading panic and fear to gin up audience numbers

        The technology is here to stay, like it, love it, you better learn to live with it. Because otherwise, you may as well find a bolt hole and stay there.

        • Tony says:

          Throughout history you can clearly see how fearmongering has been a direct result of some sort of mass surveillance against our civil liberties., e.g. War on Terror, Weapons of Mass Destruction, War on Drugs, virus outbreaks, the list goes on. I’m not a tinfoil hat sort of person, but I haven’t shopped on Amazon, I don’t use google as a search engine. There ARE choices on the consumer level. The mass surveillance that the govt imposes IS NOT a choice. You can clearly see this if you travel much. You can’t compare it to the little old lady who lived on your block in the 1940s/1950s era. Does the old lady keep a file on you and exploit you and sell that data? Apples to oranges.

    • Gandalf says:

      MCH,

      China has indeed fully engaged its entire state surveillance apparatus into fighting the corona virus

      https://www.bloomberg.com/news/articles/2020-02-24/china-uses-surveillance-state-tactics-to-fight-rapid-spread-of-coronavirus

      As the article makes clear, the underlying system comes from the Communist Party’s existing system for spying on its citizens, with vigorous contact tracing, all originally designed and intended for rooting out spies, traitors, and dissidents.

      Works fabulously for rooting out anybody with even a hint if being infected

      In addition, China’s command driven economy allowed it to rapidly ramp up manufacturing of test kits, which must be in the hundreds of millions already

      Reading about this has changed my mind about China – they may be succeeding in getting COVID-19 under control.

      The US, with its horribly disorganized and disjointed response, may be the last of the major industrial nations to emerge from this pandemic.

      If that is the case this will not be good for the USD as the world reserve currency

  40. doug says:

    I just saw this:

    https://www.reuters.com/article/health-coronavirus-fed/fed-may-announce-commercial-paper-facilities-sunday-bofa-idUSL1N2B70EB
    BAC is ‘speculating’ that fed will start buying stuff they have not bought since the good ol days of ’08…

    More and more to come?

  41. Mira says:

    Each year in the US 250,00 people have to seek care in hospitals due to pneumonia.
    Unfortunately about 50,000 die of pneumonia each year in the US.
    Mainly adults.
    Since 22 January to 15 March 2020 there have been 169,153 cases of corona-virus world wide & 6,496 deaths world wide.
    In Australia it has been said by the Federal Liberal government, that due to the corona-virus the Australian budget will be in serious deficit.
    We are more likely to believe that the corona-virus scare is a beat up to cover the fact that the current government is financially belligerent & incompetent & that the corona-virus was utilized as a deliberate cover up of that fact.

    • c1ue says:

      Sorry, but you cannot compare a new disease – just starting its population infecting journey – with a mature disease like the flu which is established in the population worldwide.

  42. SteveK9 says:

    One thing missing from the analysis in the article is the possibility that more effective treatments will be developed (I don’t mean a vaccine), and that protocols will be developed that will save more of the people seriously impacted. There are a lot of rumors flying around, but I’m sure physicians are trying out a lot of ideas. Now that China is not in an emergency, they will have more time to try different regimens and see what works. They still have plenty of patients to use in experiments (sorry if that seems callous), even though they are not in a crisis.

  43. Unamused says:

    We’ve done some checking. The despair over the lack of test kits appears to be widespread, and a couple of sources claim the effort to ramp up cov-19 testing in the US is generally expected to fizzle out. Rationing is severe. Several contacts provided no information, saying they’ve been warned not to talk about it. Indicative, but nothing definitive, but nothing positive either. It hasn’t been possible to come by any good news about the US.

    The coronavirus conference has been cancelled over coronavirus, but swearing in public has been legalised in Virginia, so there’s that.

    We have a couple of hundred packages of toilet paper in dusty plastic wrapping in one of the warehouses. I was unaware we still had them. We’ve used bidets for as long as I can remember, so functionally our supply is infinite.

  44. ObjectiveFunction says:

    I mainly lurk here, but many thanks to the author, and to Wolf, for this sober, well-informed piece. If I might suggest, please post an update soon, incorporating the additional topics covered in the comments.

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