The article becomes much less edgy if you know what the authorities are actually saying. For example, the American CDC, in USA Today[1]:
"Dr. Nancy Messonnier, director of the CDC's National Center for Immunization and Respiratory Diseases, told reporters Friday that U.S. health officials are preparing for the coronavirus to become a pandemic."
"'We’re not seeing community spread here in the United States, yet, but it’s very possible, even likely, that it may eventually happen,” she said. “Our goal continues to be slowing the introduction of the virus into the U.S. This buys us more time to prepare communities for more cases and possibly sustained spread.'"
Sooooo... today's edgy "the media and authorities are keeping us in the dark" blog post got scooped two days ago by the CDC and USA Today.
As many public health experts and virologists are now pointing out (and as I am sure many at CDC have long realized), there's no way to know if there's community spread without actually testing for it. Current testing capacity is severely limited - which is baffling really, given that Korea is running like 6000 tests/ days now. Part of it is a logistical / technical screw-up:
For example, if you're a doctor with a case of atypical pneumonia, there's no way to actually test a patient for it unless there's clear China (possibly Hubei!) travel history. And that could take 3-7 days. However, consider the Canadian ER doctor who a few days ago decided to ask for a test for a woman who had traveled back from Iran recently - turned out she had it, and it revealed to us unexpected, but very real vectors of transmission.
These technical issues have to be solved, otherwise there's no way to distinguish this from regular seasonal flu cases and pneumonias, until - like in Wuhan - the atypical cases bubble up. At that point, it's really too late to do much containment.
Following a few comments from experts in the field and looking at some of the data being presented, it's fairly obvious this pandemic case was reasonably high. There are of course lots of unknowns models used can't account for but that's no reason to discard the potential risk entirely.
Keep in mind, many of these decisions to avoid "pandemic" talk try to take most holistic views in regards to public safety/health. There is a lot of consideration regarding deaths cause by panic actions which are often estimated/modeled as well and if panic related deaths and side effects are higher than a current actual threat, it's often viewed that the best course of action is to suppress panic until warranted.
So lack of pandemic talk doesn't inherently mean there is a legitimate reason not to panic, just that you're being given limited information. At the same time you shouldn't assume experts, the media, etc. are somehow mass conspiring against your health/safety. Assessments are probably reasonable to follow.
The best course of action is to also take a holistic look at situations independent of these groups and make your own rational assessment of risks and impact.
If you don't already have some non-perishable food supplies, you should have completely irrespective of this specific recent viral outbreak--its basic preparedness for emergencies.
Some basic preparedness (I'm not talking bunkers and 2 year food cache craziness) are warranted in general for unpredictable disaster cases so these situations are good reminders for people to check their pantry for food, etc. just in case something awful was to happen, those supplies can help significantly.
Since I hadn't lived thru anything that threatened my society, I never believed in stocking up on non-perishables.
However, the fact that I'm living thru a potential pandemic convinces me that we as a race aren't nearly as resilient as our modern amenities and high QoL suggest.
The fatality rate is on par with the flu, except in older patients (over 60) where it is currently higher.
Ironic that you should bring up flu vaccination...despite the risk of death from flu being the average person’s greater concern (by far), we
still have to beg people to get vaccinated, and the rates are low.
I’d wager that most of the folks fear-mongering about covid-19 on this thread haven’t had a flu shot this year.
This is absolutely false. You’re comparing the coronavirus fatality rate for young and healthy people to the overall flu fatality rate. Try comparing the fatality rate of 20-40 year olds only between each virus and then get back to us on how they’re comparable.
Also, I’m kind of horrified at how indifferent you are across many comments to the prospect of tens of millions of elderly and sick people dying. Just because you’re young and healthy, no one should be very concerned about this?
So using your most optimistic number of 0.4%, that’s a fatality rate 20x as high.
And again, you have many comments downplaying the significance of this virus based on your own assessment that it kills young and healthy people at acceptably low rates. What about the billions of people who are older, sick, or have the misfortune of being born in a country without access to decent medical care? Pretty easy to calmly assess relative risks to other people, especially if you get them wrong by a factor of 2000%.
I am concerned about other people. It has no bearing on my advice to you, which is that unless you are old or sick, you should stop posting misinformation to HN, and go breathe into a bag in a dim room.
Maybe play some relaxing music and light a candle. (Be careful, though: you’re many hundreds of times more likely to start a fire with the candle than die from covid!)
Yes, but we have vaccines for the flu, and as far as I can tell this is far more contagious. Even with a lower mortality rate, the death toll could be much higher.
If things do start getting bad, I expect it might happen rather suddenly.
It’s much, much deadlier and more likely to put you in the hospital than the flu, though. The trite comparisons to the flu are honestly irresponsible at this point. There’s a reason public health officials all over the world are taking this very seriously.
It is not. You are making up “facts” and need to stop.
This virus disproportionately kills old and sick people. Aside from the fact that over 80% of cases are mild, the death rate in patients under 60 is well under 1%:
Even these are based mostly on statistics from Wuhan, where a “confirmed infection” has to be severe to begin with; these rates are going to be overestimates of the real rates.
Nothing you’ve said remotely contradicts what I said. Feel free to provide actual evidence that my facts are incorrect.
Why shouldn’t we care about a virus that mainly kills old and sick people? Especially when that alone can overwhelm our medical infrastructure.
Additionally, even a 0.5% mortality rate for young and otherwise healthy people is much higher than the flu, and serious cause for concern. I’ll take a 0.5% chance of dying over 2% any day, but I still will take a lot of actions if I can to avoid a 1/100 chance that my daughter has to grow up without one of her parents.
As long as we’re talking about facts and misinformation, let’s talk about your assertion that mortality rates are going to be lower than Wuhan. They may be, but it’s way too early to say. We don’t yet have reliable data on how many mild cases are missed in the official figures, how the remaining unrecovered patients will fare, or how many deaths have been caused by the virus but are not attributed to it in official figures.
Look, I get that you’re scared and lashing out at people who are saying you have reason to be, but you’re not going to make any difference here. This is a serious global issue, which is why every country with significant infections is going to incredible lengths to try and contain it. I’d suggest you stop trying to police people on the internet who aren’t meeting your personal standards for reacting to this and instead do some prep to keep you and your loved ones safe and secure.
I provided a link to “actual evidence” in the post. Read it instead of posting rumor and opinion as fact.
Nobody said you “shouldn’t worry” about a virus that kills old people. But if you’re not old or sick, you should worry about it less than other things. Like getting the flu.
”I get that you’re scared and lashing out”
What manner of gaslighting is this? I am absolutely not scared, and I am trying to spread accurate information, in order to counter fear-mongering posts like your own.
See, there you go again. You’re suggesting that someone young and healthy should be more concerned about the flu, which is absolutely ridiculous and not supported by any data. The only “evidence” you posted is that the elderly and sick are most at risk, which no one was disputing, and which does not support your position that the flu is more dangerous to young and healthy people than this virus.
It does not have a 3-4% fatality rate. You are either getting bad information, or you are making things up.
The latest numbers from the WHO and the CCDC are an average case fatality rate of 2.3%. This is highly likely to be an overestimate, and the deaths are skewed heavily to the old and infirm.
From the most recent CCDC report [1] those under 40, case fatality was 0.2%. Under 50, 0.4%; under 60, 1.3%.
For those with no pre-existing illnesses, case fatality was 0.9%, across all age groups.
Note the fatality rate is deaths divided by current infected. But the people dying are those that contracted the disease 4-5 days ago (folks don't die the instant they get sick). So the death rate on folks ultimately reaches nearly double the reported rate?
The case fatality rate is the number of deaths divided by confirmed infections. This is what is being reported.
Infection Fatality Ratio changes the denominator to a model for the currently infected population. This is a smaller number, because the denominator is much larger.
There is no mortality metric being reported by reputable sources that is multiples higher than the CFR, as you suggest.
Or, look at the timeline for infection vs eventual fatalities. As I said, draw your own conclusions from the reported data by Johns Hopkins (do they pass the filter for 'reputable'?).
The most useful number I know is, survival chances. How many in 100 stand to be alive say 2 months later. The numbers seem worse than 98, by a good margin. At least worldwide.
Your accusations of fear-mongering are ill-founded and un-productive.
I'm of course completely factually correct that there is no vaccine for COVID-19 (although there is a SARS vaccine that may help). Which, even if it is only as deadly as the flu, is still a huge issue. I have immune-compromised family members, so I get the flu vaccine. I have no such luxury in this case.
The fact that the symptoms are mild for most people only makes it more of a danger, because people are less likely to self-quarantine if they only have cold-like symptoms.
All the confirmed cases in the U.S. are currently under quarantine. However, the CDC does fully expect that the disease will spread free here in the states.
Northern Italian states have closed all public schools, universities, and public events.
The virus is not “far more contagious” than the flu. It’s about as contagious as the flu, and maybe slightly more deadly, primarily to older/sick people.
You’re panicking, you don’t understand what you’re reading, and
(assuming that you aren’t just trying to spread fear) you should stop posting on this subject.
> At the same time you shouldn't assume experts, the media, etc. are somehow mass conspiring against your health/safety. Assessments are probably reasonable to follow.
True, but it's also not their job to work for my personal benefit. Mine is. Their job is to do the greatest good for the greatest number, but what is good for the most people is not always good for me. My job is to keep myself and my family safe, and I don't trust bureaucrats enough to make the call that I have to lose out for the "greater good".
All that aside, at least according to China, the mortality rates aren't all that high (a few percent). We'll see what happens elsewhere, but I don't think there's reason to panic yet.
We don't actually know mortality. By the numbers, 2,470 deaths, 23,419 recoveries, and 53,105 undecided cases.
10% of all settled cases resulted in death. That is far higher than the 3% of Spanish Flu and reasonably close to SARS. Median time to death is around 12 days which is similar to time to recovery meaning the 10% seems likely to be an accurate metric.
The most interesting part is the ages of cases. Last I checked, there were ZERO deaths of children 9 and under. Mortality rates hover at around 0.2 to 0.3% until over 50.
The really big unknown for me is the weird SARS antibody Antibody-dependent enhancement (ADE) effect. Basically, if the antibody levels get too low and reinfection occurs, the disease becomes much more lethal than if no antibodies are present at all. This effect is now known to be the reason mortality rates for a second case of Dengue fever are so high. In SARS, the disease disappeared before reinfection was an issue. In the case of a pandemic, a second, more lethal wave could be disastrous (if this is also possible with COVID-19). This could also complicate naive vaccines that don't account for possible secondary, enhanced infections.
> By the numbers, 2,470 deaths, 23,419 recoveries, and 53,105 undecided cases. 10% of all settled cases resulted in death.
The mistakenly low estimates of mortality rate are likely due to use of the wrong denominator. As Worldometer [1] explains correctly in their summary of Ghani et al. [2]:
> Once an epidemic has ended, it is calculated with the formula: deaths / cases. But while an epidemic is still ongoing, as it is the case with the current novel coronavirus outbreak, this formula is at the very least “naïve” and can be “misleading if, at the time of analysis, the outcome is unknown for a non negligible proportion of patients.”
As the parent calls out, a better estimate of mortality rate for an ongoing epidemic is deaths / settled cases where settled cases is the sum of deaths and recoveries.
I'm seeing current numbers show 41,490 active and 45,112 resolved. Between your numbers and mine, the number of deaths increased by 507 and the number of recoveries increased by 21,693. This means the fatality rate for this set of resolutions is still lower, 2.2%. This trend is fairly pronounced downward as the WHO report on the matter calls out, we've learned a lot about the disease and are identifying a lot of totally asymptomatic cases [1]
Uh, they don't calculate the mortality rate of the virus by guessing how many people would have died in 1900's care. The mortality rate is that high because that's the percentage of people currently dying.
Mortality rates are easy to compare - they are numbers that take healthcare and disease intensity into account because they are statistics from observation.
If anything, the numbers suggest that had the covid-19 struck in 1918, the mortality rate would have been higher.
...in 1918. When we didn’t have things like antibiotics or mechanical ventilators (or even a solid grasp on germ theory).
Non-adjusted comparisons to medical outcomes in 1918 are useless.
(pre-empting the criticism: antibiotics absolutely matter for a viral outbreak like this. Many people who die from respiratory illness actually die from secondary bacterial pneumonia.)
The observed mortality rate already accounts for advances in medicine that are actively being used, no? Mortality rates are easy to compare: x% died back then and y% die now. Those numbers take into account the various characteristics of the disease and health care.
People aren't saying this acts like the 1918 disease so it should have the same mortality rate. People are saying the observed mortality rate is the same. That's in spite of medical advances.
You’re making a lot of assumptions. Sure, if the reported death rate is correct (it isn’t; it’s going to end up much lower), and the medical system in Wuhan is up to first-world standards (it isn’t; they’ve had to scramble to build halfway adequate infrastructure for the population), and the distribution of victims is the same as the 1918 flu (it isn’t; this virus kills mainly old, sick people), then sure, you can just compare mortality rates.
But since none of those things are true, you can’t. It’s not like these parameters are fixed; they’re dramatically affected by the time and context in which they’re measured.
They're hardly useless, and if the current virus is killing the same percentage of people as the 1918 flu despite all of our medical advances, that's a strong indicator the current virus is significantly more potent, which makes the blithe assertion that "the mortality rates aren't all that high" even more dubious.
"We’re not seeing community spread here in the United States"
The US is barely doing any testing, so if there was community spread of COVID-19 in the US right now, there's a good chance they wouldn't even know about it.
My understanding is that until very recently they wouldn’t do the test unless you had been to Hubei, so there would be no community spread by definition.
I think part of the article's point was that communications to the overall public is kind of lack luster. One of the key bits of the article is that we need to get the individual citizen mentally and physically ready, and that involves helping articulate (ahead of time) what the types of actions and behaviors may become necessary. What does living through a pandemic actually entail? What are the actions to take now, and what actions will I have to take?
Communities aren't just made of public health organizations and hospitals and emergency workers, they're made of individual citizens and their families and friends. Communities should be made prepared from both the top down, and from the bottom up.
Before you propagate this information and take action, read this post about the psychology of fear mongering, and ask yourself if you identify with it.
1. Do you tend to mistrust authority?
2. Do you feel powerless to control the course of your life?
3. Do you feel like you have special information and insight the rest of us do not?
4. Do you feel comfort when thinking about the end of the world because once it happens, you will be prepared and validated?
This seems to just be a set of general steps for the dominant culture to downplay dissenters or individuals for whom the system isn't working. It doesn't tell you anything about if the system is actually working or not, or if those individuals are right or wrong. Anyone who disagrees with the system will probably go through similar feelings (maybe not point 4).
You could put yourself in the position of someone who grew up poor and disillusioned as part of a visible minority in a US city, or a Hong Kong protestor, or almost any other anti-hedgemony protestor and they'd check the first three boxes. Are they wrong or is the system wrong? Nothing in this list helps determine that.
I think you misascribe the intent here; in medicine, symptoms and circumstances are correlative (and must be interpreted in a manner consistent with that). For example, chest pain correlates with heart attacks but many other causes exist as well and not everyone will display the same symptoms.
The list above is merely a set of correlations. It may be useful to consider, but must be interpreted appropriately in a given context.
It would allow a count to ten style consideration of personal bias to better frame the news. Down side is if you check #4 it's unlikely you can be reasoned back to reality.
I think you see point 3 come through in the discussions talking about privilege and lived experience.
It's a natural step after point 1 or 2 where the dominant group rebuts with "well it works for me, so it should work for you", and the minority group provides their theories as to what results in them having a different outcome.
This is hilarious. Isn't 2012 the underlying model they use for everything today?
Fearmongering is the go-to default for absolutely every issue the media covers. Then during an actual literal pandemic they take a short break from every other the-world-is-ending story to give us the "don't fearmonger" lecture.
If you ever find yourself split in doubt between your own sanity and that of the media's, please for the love of God assume they're insane first.
1. There isn't a single media (often, when your tribe is against another, you view the opposition as monolithic rather than a spectrum composed of different viewpoints)
2. And they're not insane, editors and social media algorithms are rational and reacting to reader incentives (but it is "insane" to mistake media sources for a rational human, because most media is about covering extreme events[1])
> There isn't a single media (often, when your tribe is against another, you view the opposition as monolithic rather than a spectrum composed of different viewpoints)
The overwhelming majority of the media that people consume in the U.S. is created by the same handful of companies, which each have roughly the same rules about what kinds of stories you're allowed or not allowed to publish. Having worked at one, I can assure you that you're not just allowed to publish whatever you want as long as it conforms to basic journalistic standards or whatever.
Great point. Would you argue the media landscape is the way it is due to incentives these select organizations face or the monopolistic nature of these companies?
Separately, you note the high concentration of media creation, but don't speak to the even higher concentration of media distribution (e.g., social media), which likely has its own influence on what is created.
> Would you argue the media landscape is the way it is due to incentives these select organizations face or the monopolistic nature of these companies?
It's been 10+ years since I've read chapter 1 of Manufacturing Consent, but IIRC the basic argument is that:
- Media companies are the way they are because they're funded by advertising.
- Media companies have an oligopoly because they are allowed to fund themselves via advertising, and advertising has monopolies of scale.
> you note the high concentration of media creation, but don't speak to the even higher concentration of media distribution, which likely has its own influence on what is created.
That's a good point. The fact that media companies own less of their own distribution is probably the biggest thing that's changed since Manufacturing Consent was originally published, so now institutional incentives need to be considered across two different dimensions.
> Having worked at one, I can assure you that you're not just allowed to publish whatever you want as long as it conforms to basic journalistic standards or whatever.
Should this be surprising? A newspaper isn’t a blog for a bunch of journalists, it’s an organization that makes a collective effort to speak with a single authoritative voice.
That’s a far cry from all newspapers sharing an institutional perspective, though.
It depends on what "diverse" means to you. I would say that Scientific American isn't the same as a partisan news channel.
But to the degree that an ad driven model and social media is the primary way news distribution happens, media incentives are monolithic for media organizations.
On a discursive note, if you are interested in media incentives, "All the News That's Fit to Sell" is a great book that goes into media incentives in previous eras. When the economies of scale for printing presses went up, media naturally became more centrist and less alarmist because a single paper had to appeal to a larger audience. It gives you a sense for the power of incentives in dictating what media is created/distributed.
You must be living in an alternate dystopic 2020 media landscape where the problem is something else besides radical fragmentation of markets, instantaneous elevation of social media anecdotes to national coverage, and widespread agreement to disagree about matters of fact.
The one thing we can’t criticize our media for is a lack of diversity.
Regardless of the other three points, it is generally rational to mistrust authority because many authorities have repeatedly failed in the past to protect lives during emergency scenarios.
Conspiracy theorists tend to mistake incompetence for malice; or partial incompetence for total incompetence. Hurricane Katrina doesn’t invalidate health and building codes; education; law enforcement and EPA, FAA, and SEC regulations. Decisions made are both bad and good, but it’s irrational to think the decision makers are generally untrustworthy.
One of the most glaring flaws of the conspiracy theorists is that they assume authority are bad for bad sake, like they're some mindless evil that does bad thing for .. no apparent reason. Even though the priorities of authority might not be aligned with that of the people, it is still a set of rational priorities, for personal gain etc. Too many conspiracy theorist make no sense because the act they suspect authority do does not make any sense for anybody.
It is perfectly rational to distrust decision makers, it makes no difference whether the intent is malicious or it is just incompetence. The end result is the same.
I trust them to be malicious enough to hide their incompetence.
I am working with some, not in a high risk domain at all and I worry the same kind of people work in high risk domains (sometimes they work in both, next election they might move to another minister).
Sure, but what’s your point? Decisions _should_ be based on past information. You don’t expect politicians to be clairvoyant do you?
There’s no doubt that politics, especially US politics and government, are pretty screwed up, but it doesn’t automatically follow that anarchy is better.
Some of it works and some of it doesn’t. That’s the point I’m trying to make.
I think you have a point because this fear also creates incentives for scammers to profit from it.
There is a difference in how people "act" on the collective level (administrative bodies and bureaucracies, even companies) and how we respond on the individual level (employees, bread-winners, family members).
There is no serious / open conversation about this inside companies right now - some places I know even discourage you and slap you with the fear-monger label, while hoping it will just blow over. Especially in Tech where we could just send people home right away and work remotely hardly anyone does this (if it hasn't already been policy).
> Decisions _should_ be based on past information.
Related term of art for programmers is underhanded code. Always make your undermining of security and insertion of backdoors to appear to be a simple coding error: http://underhanded-c.org/
If one is responsible for ensuring security, they won't be very effective unless they realize malicious actors masquerading as the incompetent exist and are active.
If I am working on security critical software I don't try to determine the intent of anyone at all, everyone is assumed malicious and their code/actions reviewed as such.
My question was in a more general sense, do you assume that all mistakes are done on purpose to conceal some sort of plot?
> everyone is assumed malicious and their code/actions reviewed as such.
Yes we are in agreement.
> in a more general sense, do you assume that all mistakes are done on purpose to conceal some sort of plot?
Obviously not and no one is claiming that. The extremes of never assuming malice and never assuming incompetence are ... extremes.
Always starting with a presumption of innocence is said to be a useful premise for a criminal justice system. And always starting with a presumption of malice is a useful premise for security oversight. Not just code but other things like Secret Service details and plane boarding. It's assumed that boxcutter is for hijacking, so you have to give it up. It's presumed that bottle of water is some sort of chemical to be used in making a bomb, so you have to give it up. It's presumed that baby is a secret bomb, so the baby is going to be scanned and inspected. An unrecognized wellwisher rapidly approaching the President on stage at an event is presumed to be an assassin and will be tackled. A car of lost people looking for a wedding location which is approaching a US security checkpoint in Iraq or Afghanistan without slowing down will be machine gunned. A suspicious man, under the influence, who is staggering along down the center of the road in Baltimore who does not follow orders to stop and get on the ground and who instead reaches into his pocket for his id, cell phone, or breath mints, will be shot dead. Malice is the default assumption in a wide variety of security contexts.
This could easily be an issue of colloquial interpretation barriers, but there is a significant difference between healthy skepticism and a mistrust driven by assuming the other party is always acting in bad faith.
Like I said, this could be a simple misunderstanding of concepts, but there is a percentage of the population who have drifted from a healthy skepticism into paranoidTown where they assume good faith people/humanity are out to get them. This mistrust is causing many of them to fail to apply basic logic in their decision making.
Hopefully your post was advocating for what I would call a healthy skepticism.
Not just that, they're always acting in bad faith and most of time even against their own interest! To cause harm to _$you_ specifically because $you're so important.
> there is a percentage of the population who have drifted from a healthy skepticism into paranoidTown where they assume good faith people/humanity are out to get them
And how big is that percentage? I’m starting to believe, sincerely, that views like the one you expressed are more paranoid and driven by fear-mongering than the views described in your comment. I call these people flat eartherers, e.g. those who believe there are many flat earthers all over the place who are a problem.
And yet 99% of the time, the authorities do a great job of running everything here in the west. The 1% of the time they fail, it proves the conspiracy theorists and fear mongers’ point.
> You never heard about the lead poisoning that didn't happen.. but you'll hear about Flint Michigan.
Not a great example for this point. Cynically, you heard about Flint because journalists rode the hype train for views and clicks, either failing to do research on other communities or failing to promote those stories to the level of hype required to break into the mainstream. They were close to notifying the public of a widespread public infrastructure and health issue, but for whatever reason fell short and became fodder for anti-"fear-mongering" attitudes.
> . . . The Michigan city doesn't even rank among the most dangerous lead hotspots in America . . .
> In all, Reuters found nearly 3,000 areas with recently recorded lead poisoning rates at least double those in Flint during the peak of that city's contamination crisis. And more than 1,100 of these communities had a rate of elevated blood tests at least four times higher.
> . . .
> Like Flint, many of these localities are plagued by legacy lead: crumbling paint, plumbing, or industrial waste left behind. Unlike Flint, many have received little attention or funding to combat poisoning.
Since you're mostly counting hurricanes, here's a list of all category 4+ hurricanes that hit the US, although most were not that strength when they actually made landfall:
* Hurricane Isabel (5, 2003)
* Hurricane Charley (4, 2004)
* Hurricane Ivan (5, 2004)
* Hurricane Dennis (4, 2005)
* Hurricane Katrina (5, 2005)
* Hurricane Rita (5, 2005)
* Hurricane Wilma (5, 2005)
* Hurricane Ike (4, 2008)
* Hurricane Matthew (5, 2014)
* Hurricane Harvey (4, 2017)
* Hurricane Irma (5, 2017)
* Hurricane Maria (5, 2017)
* Hurricane Florence (4, 2018)
* Hurricane Michael (5, 2018)
* Hurricane Dorian (5, 2019)
That's 15 hurricanes. Of these, Katrina and Maria were the only ones where the response was considered botched. That's only 13%.
And how many of them required anything but the standard response from authorities? I can't think of any aside from Katrina and Maria. But it's when an atypical response is warranted that authorities ability to respond is tested. Based on that metric, the track record is poor.
There's also the concern of incentives. The authorities are incentivized to treat every emergency as requiring nothing over and above the standard response, because statistically this is correct. And so you would not expect the authorities to be able to recognize, or be honest about when an unfolding emergency requires an atypical response.
> And how many of them required anything but the standard response from authorities?
What do you mean by "standard response"? It seems to me that you have a working definition that is less an objective standard and more a subjective, circular definition of "anything that didn't fail."
Take Hurricane Harvey for example. The rain Houston received was record-breaking: ~30" in the course of a day or so, when the previous monthly record was 19". Does that require merely the "standard response"?
What I mean by the "standard response" are actions that are just some variation of: mobilize national guard, provide emergency shelter, distribute emergency rations of food, provide mobile health care, etc, and usually to some reasonably localized geographic location. Basically the sort of responses where simply modeling your response after the previous similar disaster is sufficient. The problem with Katrina and Maria was precisely that the playbook from prior disasters was inadequate either due to the type or scale of problems faced.
> Basically the sort of responses where simply modeling your response after the previous similar disaster is sufficient. The problem with Katrina and Maria was precisely that the playbook from prior disasters was inadequate either due to the type or scale of problems faced.
The Gulf of Mexico is no stranger to hurricanes, and Katrina and Maria don't even top out the strongest hurricanes on the list (that honor goes to Wilma). Hell, Katrina is only the third strongest hurricane of 2005. That's why the response was so heavily criticized: Katrina was essentially the hurricane that New Orleans' levees were designed for, a repeat of Hurricane Betsy a few days shy of 40 years earlier. Even the levee failures should have been scenarios that had been planned for in terms of disaster response.
> The potential public health threat posed by COVID-19 is high, both globally and to the United States. The fact that this disease has caused illness, including illness resulting in death, and sustained person-to-person spread is concerning. These factors meet two of the criteria of a pandemic. It’s unclear how the situation will unfold, but risk is dependent on exposure. At this time, some people will have an increased risk of infection, for example healthcare workers caring for patients with COVID-19 and other close contacts of persons with COVID-19. For the general American public, who are unlikely to be exposed to this virus, the immediate health risk from COVID-19 is considered low at this time.
From "Coronavirus Disease 2019 (COVID-19) Situation Summary"
> This is an emerging, rapidly evolving situation and CDC will provide updated information as it becomes available, in addition to updated guidance.
I don't see how that relates at all. The parent is talking about how we perceive information and especially information that comes from authoritative sources.
That doctor had first-hand experience of what was happening and the authorities getting in his way when he tried to get the word out. He was never in a position where he had to decide between going with the consensus or follow a fringe theory, but rather whether to follow the obviously incorrect official version instead of what he could see with his own two eyes.
Have you ever heard The expression "the exception that proves the rule"? Do you understand the meaning of the expression? It means that the rule is so good that exceptions to it are so rare that they seem significant. The prototypical examples are plane crashes.
What do you think the chances are that I haven't heard about that? What do you think makes this an exception?
There is a lot of politics happening around this theme. Can you trust the numbers put out by the authorities? Yes, within a margin of error due to unreported cases.
The article is not at all in the fearmongering category. It appears to me quite level headed and simply acknowledges that we are past the point of containment, something that seems born out by the facts.
To continue to deny that there is a pandemic will do a lot more harm than to accept that as a fact and act accordingly.
Do you realize it's completely irrational to debate unknown unknowns? Any certainty comes from bias. So you think the doctor is the tip of the iceberg but you absolutely can't know how big the iceberg is. I think the doctor isn't and honestly I can't know that either. What I do have going for me is the biased perspective that on balance the world is being run adequately and if all of these subversive things were true that couldn't be the case. But I readily admit that that's circular and to the extent that it's not it's completely apriori.
My point is, in case that isn't clear: the people on the front lines of this outbreak are telling a different story than the one that you seem to favor and that up to some point (right up until it became untenable) was still held by the Chinese authorities. So I'm a little skeptical about numbers and stories coming in from Chinese official channels taking them as a baseline with the mental note that things might be much worse.
The data points that we have from outside of China: Iran, the cruise ships, South Korea and several other regions where the virus has established a relatively strong foothold should give anybody pause at this point, any comparisons with the flu are pointless and noise.
Whether or not we are calling a pandemic is semantics, in all but name it is here today.
The doctor was the tip of the iceberg, he is no longer. But there are other people in charge of the messaging for other countries and it seems as though the dreaded pandemic word is now also used by the CDC and similar organizations, internally and with qualifiers ('preparing for a pandemic') it is more a matter of time when they will feel comfortable in using it publicly.
My two cents in this great discussion. The climate change emergency and the biodiversity collapse with no corrective measure taken whilee the stakes are so high for our survival seem to be proof that the world is NOT run adequately.
If you think the entire government has your specific best interests at heart, isn't that a sign of schizophrenia? That sounds not much different than people who think that songs on the radio or TV shows were created for them specifically.
> 3. Do you feel like you have special information and insight the rest of us do not?
Most people are following this story very little or not at all, so if you're even remotely paying attention then you have special information and insight that the vast majority of people do not.
8 dead on 43 cases suggests severe under-reporting of the number of people infected. That in turn suggests that testing is inadequate which may cause the disease to spread further than necessary. The fact that infected Iranians have turned up in Lebanon and Canada is further proof that the number of infections is likely higher than reported.
If we take the 2-3% mortality reported elsewhere as the base than the 8 people confirmed dead would suggest at least 300-400 infections, or about 8 times higher than officially reported by the Iranian authorities.
Latin America and Africa have the temperature going for them but especially Africa has a ton of back-and-forth with China so you can expect there are or will be cases there.
Indonesia is an interesting case especially geographically. Maybe there is some data on how well they did during previous pandemics?
The premise of this article is that we should essentially press the “panic button” now, to get people through the shock of preparing for a pandemic while we know it’s safe to do so.
> Suggesting things people can do to prepare for a possible hard time to come doesn’t just get them better prepared logistically. It also helps get them better prepared emotionally. It helps get them through the Oh My God (OMG) moment everyone needs to have, and needs to get through, preferably without being accused of hysteria.
> It is better to get through this OMG moment now rather than later.
The preparedness tips in the article are generic enough, but worth skimming. Basically:
- Get extra prescription medicine now if you might need it
- A couple months of non-perishable food storage is a good idea
- Practice band washing and avoid touching your face.
- Cross train employees at work to minimize the impact of absences.
> - Get extra prescription medicine now if you might need it
I hate this advice. It's not "wrong," in the sense that technically it would be a good thing to do, but it's also so wrong that it transcends categories of right and wrong.
Your refill schedule will not allow you to get extra prescription meds early. And if it did, your insurance wouldn't pay for it - which means paying sticker price, which means ... well, depends on the med, right? I used to take an antacid that had a sticker price of about 800/mo.
For almost anyone, "stock up on an extra month of prescription meds" isn't a thing. It's just not a choice. For it to /be/ a thing, someone actually needs to write a law stating something like "once per calendar year, a physician can write an extra parallel prescription for a supply of medications not exceeding three months, and insurers must pay for it," or somesuch.
Until that happens, I don't even know what to /do/ with that kind of "advice."
> Until that happens, I don't even know what to /do/ with that kind of "advice."
My wife asked once, and was told that 3 month supply prescriptions are common for people that use mail order pharmacies, and was happy to write one. Insurance covered it too, since the refill schedule was every 3 months -- it comes out to the same cost in the end.
Again, that depends on the med. Your monthly allergy prescription? Sure! Your oxy Rx? No way. My spouse and I are on some meds (not oxy) that they absolutely would not refill for 3 months at a time. My other meds do come in 3 month prescriptions from a mail order pharmacy.
Sure, It really depends on the potential for abuse and the doctor's decision. There are a lot of critical medications that aren't likely to be abused. If you check with your doctor they may very well write you the prescriptions you need if you ask and explain why.
I imagine such medications must be very important to take as prescribed, but the only other option I can think of is one day out of every two/three/four weeks, take less of it so that you can save it and slowly stockpile it.
It's an ADHD medication, so there's no health risk associated with not taking it, they're just really strict about the amount given out at once because they don't want people getting a 90 day supply and selling it. Sometimes I won't take it on weekends to keep some extra just in case I might not be able to get a prescription filled on time due to no doctor appointments being available, or the pharmacies being out of stock for a few days.
Nothing. To be more clear about the potential for abuse, it's an ADHD medication, so they don't want you selling it to other people to abuse. It's not physically addictive, so you can only really get hooked on the benefits, there aren't any withdrawals or anything if you don't take it.
Your refill schedule will not allow you to get extra prescription meds early.
I hate your advice, seriously. You can't speak for every person and every prescription. You are talking people out of taking action when you are outright wrong for some, if not most, situations. Literally yesterday just got an extra 30-day subscription for a handful of prescriptions. Not for coronavirus, but because we are planning to be visiting family in Europe next month. Fingers crossed that travel won't be disrupted.
If you are on a critical medication, talk to your doctor and insurance company. You can probably work it out.
How? I once went to three different urgent care clinics and two different emergency rooms begging for an Augmentin prescription. I felt a stabbing pain in my gut hours after eating bacon for the first time in 10 years, and I had strong reason to believe Augmentin was the solution. They all refused to prescribe me Augmentin. I even tried bribing a few doctors with two thousand dollars in cash. They all said no. They all insisted I needed a CT scan before they’d do anything else. I finally obtained Augmentin by finding a discord server full of Mexicans who I paid to mail me some Augmentin they simply ordered over the counter there. After a month of extreme pain, I felt fine again 24 hours after taking the Augmentin.
Ask the doctor to write your prescription for three months. Call up insurance company and get a "vacation" flag/whatever which will pay for three months. (Source: I used to do this)
Just because not everyone will be able to do it for every medication does not mean that it is not good advice for those who can act on it. It keeps healthy people from needlessly exposing themselves to higher risk of illness by standing in long pharmacy lines with potentially sick people, and it makes lines shorter for sick people who need to go to the pharmacy.
You don't need a doctor to write a prescription for you to go out and buy a sofa. A pharmacy cannot by law let you refill a 30 day prescription less than about 30 days after the last time you refilled it for many medications, so you can't use your existing prescription to go stock up either.
Pharmacies seem to cheerfully dispense larger quantities even if it's not indicated on the prescription.
> But increasingly, the psychiatric association has heard from members that smaller quantities specified on prescriptions are being ignored, particularly by CVS, according to Dr. Schwartz, the group’s president.
> CVS has created a system where doctors can register and request that 90-day supplies not be dispensed to their patients. But doctors report that the registry has not solved the problem, Dr. Schwartz said. In a statement, CVS said it continued to “refine and enhance” the program.
> Dr. Charles Denby, a psychiatrist in Rhode Island, became so concerned by the practice that he started stamping prescriptions, “AT MONTHLY INTERVALS ONLY.” Despite those explicit instructions, Dr. Denby said, he received faxes from CVS saying his patients had asked for — and been given — 90-day supplies.
> Dr. Denby, who retired in December, said it was a “baldfaced lie” that the patients had asked for the medication, providing statements from patients saying as much.
I think there is a real need to understand how much of a vector our phone screens are. People touch their phones, wash their hands, and then touch their phones again.
Are you conflating the overuse of antibacterial soaps (risky, likely harmful), with cleaning surfaces that people touch (helpful, mandated in hospitals)?
I'm not talking about keeping children inside instead of letting them play in the dirt. I'm talking about people accidentally exposing themselves to a thin fecal veneer on their phones because of usage patterns.
Isn't this true for anything that you regularly touch but don't regularly wash? Like your wallet, your keys, your headphones, your car steeringwheel and on and on.
Good point. I go caseless so I just spray both sides of my phone with an alcohol-based solvent and wipe with kimwipes (the same way I clean my glasses).
But I certainly haven’t been conditioned to do this as often as I wash my hands.
The specific advice for food storage is "weeks" not couple months - the couple months is directed at prescription meds. The different timelines allocated is likely due to the relative feasibility, the risk of running out, and the ease of resupply.
Advising people to store food en masses is quite irresponsible. We have had rice, noodle, pasta, bleach and toilet paper shortages for around a month in Hong Kong caused by panic buying triggered by a rumour that there would be a supply disruption. We also went weeks where all of the fresh food was being bought out and frozen.
This point of view is reasonable only if food disruption is actually very unlikely. If there were food supply disruption in Hong Kong, having a great deal of nonperishable and frozen food on hand would be a good idea for most residents, wouldn't it? The fact that rumors were enough to generate shortages for a month in itself confirms a certain degree of insecurity...
That's just how densely populated islands function. If you're a doomsday prepper on a densely populated island, your first step should probably be to move somewhere that's not a densely populated island.
Doomsday prepping on the "densely populated island" requires a great deal more wealth than it does elsewhere (also, offshore speedboats and firearms!), but one needn't be a doomsday prepper to react to credible rumors of upcoming food shortages.
The insecurity was just caused by people literally filling their trolleys with rice as soon as the store opened every day. The government keeps a huge buffer supply which can be released in the event of genuine emergency.
Why didn't the government use some of the buffer to smooth out this apparently artificial demand spike? That is what every other nation on earth uses its agricultural surplus to do.
Assuming the pandemic will happen, people will buy in bulk and cause shortages anyway. So we are better off getting people to buy food sooner rather than later. This gives more time for stores to replenish stocks.
It's responsible to have built up the food supply over long periods of no shortage. Unfortunately the people who have that foresight are often called paranoid.
Sounds like the people who thought there would be a supply disruption were right, and the people who didn't see it coming are blaming the people who did see it coming.
No, sounds like there wasn't any "supply disruption", rather a "demand excess" from people who thought there might be one. Those are different things.
Bill Gates could cause a potato shortage if he started buying up all the potatoes in America. But that wouldn't be a supply disruption if farmers are still growing potatoes at the usual rate.
We can argue about the exact definition of the word "supply", but the bottom line is that when the suppliers are no longer capable of providing goods to stores, it's kind of pedantic to say "it's not a supply disruption!".
Okay but if Bill Gates says "there's gonna be a potato shortage!" and then causes it by buying up all the potatoes, it's a bit backwards to say "wow that Bill Gates is so smart, however did he predict the future potato shortage while those stupid poor people couldn't?"
There was no supply disruption, in fact the supply increased. The shops just couldn't keep up with huge numbers of people buying more than they needed because they knew that panic buying was taking place.
I didn't see the article making the case for "pressing the panic button". It made a case for having an open dialogue in places of power, to educate the public, and it provides a great number of practical tips on how to do so.
> Over-alarming risk messages are far more forgivable than over-reassuring ones.
The risk of panic is that if there ends up no need to panic, then folks won't listen later when there is a need to panic.
I see this all the time with fire alarm tests. No one takes them seriously -- when a real fire comes they will not take the necessary steps to evacuate fast enough.
This is one case where it's worth overreacting to. Biological epidemics are the only thing that has had the capacity to kill >50 million people in a year. In my risk classification hierarchy I put pandemics above nuclear war and wayyyy above terrorism. Yet we've spent trillions on the war on terror the past 20 years while there's no coordinated plan in the U.S. for this yet. If there's even a 2% chance of this going pandemic in the U.S. we should be allocating at least a billion with apolitical expert driven policy implementations to prevent spread.
My jaw dropped when I read that the State Dept allowed infected Americans to fly with uninfected persons to the U.S. from Japan against the express recommendations of the CDC. This is what we're dealing with and I'm not optimistic.
The plans the US already has for a flu pandemic should mostly carry over, no? COVID is probably worse than the seasonal flu, but it's not outside the reasonable range of what a flu pandemic could do.
> COVID is probably worse than the seasonal flu, but it's not outside the reasonable range of what a flu pandemic could do.
I think the issue is that we don't know yet how bad COVID-19 is. China is hiding stuff and it's not clear what is going on over there. There are also some uncomfortable, if true, things about it: like asymptomatic transmission for 2 weeks and ability to survive on surfaces for 5 days on certain conditions.
> it's not outside the reasonable range of what a flu pandemic could do.
By about 3-4 orders of magnitude, it is. The flu tends to kill about 60K people annually and most of those are old or very young or already had a compromised immune system. This is with the figures known so far and before there is a vaccine around 2-3%. If left unchecked it would overwhelm available health care capacity pretty quickly.
The Chinese mis-handled this. But it would be a mistake to think that the west is super prepared for something like this compared to China. ICU capacity is limited, test capacity is limited. Our advantages are mostly in more transparent messaging and wealth. Those two will have a big impact on the economic and health care aspects but it may not be enough to drop this down to the level of yet another flu.
A flu pandemic, in official terminology, is a different and more severe thing than the seasonal flu. The government regularly plans for such outbreaks and isn't afraid to spend a billion dollars when needed; for example, about 5 years ago they preemptively struck against bird flu by obliterating poultry farms at government expense. (And that one didn't even affect humans!)
I don't think you're getting your numbers from an accurate source either. The flu kills a lot more than 6k people by every estimate I've seen.
Normally, yes, but the seasonal flu is excluded from the definition so we don't have to say that there's an annual recurring pandemic. When agencies talk about flu pandemic preparations, they're referring to an outbreak so severe that it no longer counts as just the seasonal flu.
Right. But COVID-19 isn't influenza related so all these flu comparisons are moot as far as I'm concerned. The mortality appears for now - with all the figures that I've seen - to be much higher.
If this thing keeps going like it has for the last couple of weeks then it will make the last H1N1 pandemic look like a walk in the park. The final count on that was 100's of thousands dead in 199 different countries. And it didn't take off nearly as fast as this.
But new pathogens always look much worse than they are because we haven't got testing sorted out yet. We test the very serious cases, we don't test the mild cases.
Yes, that's a good point. Especially valid because there is a very real limit on the number of test kits available. That's also a risk in case of asymptomatic spreading.
> This is with the figures known so far and before there is a vaccine around 2-3%.
There's still a lot of uncertainty around the fatality rate here. For cases outside China, the fatality rate so far is about .2%, compared to about .1% for seasonal influenza. By contrast, in Hubei the reported fatality rate is around 4-5%. (Numbers are as of last week so might be slightly outdated now).
My guess is that the 2-3% estimate is too high. In Hubei there is probably a reporting bias towards counting the more sick cases -- mild or asymptomatic COVID cases are probably being reported less often.
Typically not. But that's not how this stuff works. It is bell curves all the way. So your old, very young and vulnerable people will make up the bulk of those that die but there will be plenty of regular people in the prime of their life that will die as well.
That was an anomaly in many other ways too. Keep in mind that a good chunk of the world was still recovering from WWI. Being exposed to some other disease earlier in life can give a similar effect to vaccination.
This is one of the reasons why HIV spread was not as bad as it could have been in Western Europe where exposure to a disease still gave some benefits many centuries later:
Yes. Old and very young people are typically more susceptible, but 29 year olds can die from even the seasonal flu, and the potential that young people can be atypically susceptible to a pandemic is well-known.
Health care professionals will tend to be vaccinated against flu, so they are less likely to get it, so you'd be looking at a very small population which is why you don't see more deaths.
If we widen this slightly to healthy but unvaccinated 29 year olds we do start to see deaths from flu.
I think mutually assured destruction works well enough to prevent all out nuclear war between multiple nuclear armed states. Riskiest scenario there is a nuclear state attacking a non-nuclear state that cannot retaliate in kind.
With a pandemic there's no one to negotiate with to come to an armistice.
The way outlets such as The New York Post deal with this is absolutely irresponsible. They keep on re-posting total garbage that has been debunked multiple times and Google isn't helping by linking to it.
The lack of testing and testing capacity in the US is deeply alarming. They’ve only run 500 tests so far and criteria still require the patient to have recently traveled from Hubei! By comparison South Korea is running thousands of tests per day, which is why it is picking up so many cases. Absolutely unforgivable complacency and lack of transparency from CDC.
There is almost certainly community spreading in the US that is going undetected.
Once local cases finally start getting reported and tested in the US, there will be panic and a lot of the same irrational hoarding behavior and shortages observed elsewhere. It would be better if the CDC mentally prepared and educated the public for what is to come. Normalcy bias is very real, and people here are still culturally not ready for this reality..
“Reminder: As of today (Feb 23), the US remains extremely limited in #COVID19 testing. Only 3 of ~100 public health labs have @CDC test kits working and CDC is not sharing what went wrong with the kits. How to know if COVID19 is spreading here if we are not looking for it.”
“Now >10 days since CDC recalled kits w still no explanation for failure. Failure to share what went wrong hinders progress by all labs nationwide. Expeditious sharing of information is a must during epidemics. We say this to China and CDC should practice as well.”
“Without more information, public health labs & well resourced hospital labs setting up CDC published assay in-house are held at complete standstill, unable to prepare for what will inevitably be concern for local transmission.”
“Without rapid diagnostics ready to go, healthcare infrastructure may become rapidly inundated, even if cases turn out all negative - an abundance of caution will require quarantines until test rules out a case. Any backlog can quickly hamper hospitals.”
“Additionally, recommendations for testing continue to tie in to recent travel to China or some contact. With cases in at least 28 countries, and local transmission increasing, testing and surveillance nationally must move forward”
“We cannot know if there is coronavirus here in US if we are not testing. We must get the US up to speed for diagnostics and we need expeditious information sharing from @CDC to the lab testing community here and abroad.”
Do you have a source for this analysis? Or for the numbers?
Generally, the CDC is quite good at their jobs. If you think they’re shrugging their shoulders right now and being lazy or complacent about something, you’ve probably misunderstood part of the story.
It’s virtually tradition for Internet comment sections to fill with overconfident armchair experts who claim to know better than the professionals as well as the general public in these cases of outbreak. The arguments usually hinge on one or two “gotcha” statistics that they think are evidence of a larger problem. IMO, it’s not helpful. Let’s focus on actionable tips like this article instead of armchair criticisms of professionals based on unsourced information.
Sentinel testing of ILIs (influenza like illnesses testing negative for the flu) in major metros was to have begun at least a week ago. But now delayed for some unknown period of time due to reagent failure on the PCR test kits.
For further context, BC in Canada has alone managed to run more tests than the entire US as currently reported. We have 60x the population and more travelers from the source region in the key Dec/Jan time frame. If we wait till the severe ARDS cases show up like in Iran and Italy it’s already out in the community and causes unnecessary panic.
As the person in charge of viral testing at Brigham and Women’s / Harvard med just tweeted today:
“ Reminder: As of today (Feb 23), the US remains extremely limited in #COVID19 testing. Only 3 of ~100 public health labs have @CDC test kits working and CDC is not sharing what went wrong with the kits. How to know if COVID19 is spreading here if we are not looking for it.”
“ Now >10 days since CDC recalled kits w still no explanation for failure. Failure to share what went wrong hinders progress by all labs nationwide. Expeditious sharing of information is a must during epidemics. We say this to China and CDC should practice as well.”
“As someone responsible for overseeing virology diagnostics at our hospital @harvardmed @BrighamWomens - the need for clarity and quick turnaround is paramount to keep the hospital running smoothly in event of local transmission. So far, process from CDC leaves much to be desired”
Probably unlikely, given the understandable emphasis in the medical community on gold-standard diagnostic methods. But if one of these companies can collaborate with the CDC to get their hands on a large number of patient samples for validation, the FDA for quick approval, and a reliable manufacturing partner for scale-up, the possibility exists.
(Edit: spelling and added required collaborators to the list)
Your thesis here is that all the layers of the public health system would just shrug their shoulders in the event of an unexplained cluster of sick people. It's unrealistic.
No, their thesis is "There is almost certainly community spreading in the US that is going undetected," which is based on observations that the US is doing less testing despite having much greater populations and higher incidence of risk factors. Do you contest that statement and its supporting arguments?
They don't detect the disease by going around testing people at random, they test suspected cases (typically people sick enough to make contact with the health system, with symptoms of the thing being tested for).
For testing capacity to matter, there would need to be known clusters of suspected cases...if you have known clusters of an unknown disease, "undetected spreading" isn't exactly the situation you are in.
I apologize about the rhetorical framing of my other comment, I wasn't trying to put words in their mouth, I was pointing out a predicate that they did not address.
> There is almost certainly community spreading in the US that is going undetected.
So basically you are making unsubstantiated claims so then you can be "correct" in your assertion there will be massively stupid group think actions afterwards.
There is always massively stupid group think. That's how this works.
That 'might' is probably safely replace with 'are'. No country - even the richest - is prepared to deal with this many ICU cases. For instance in the UK (which has a very good healthcare system) there are about 6k ICU beds on a population of ~65 million.
And then there is the risk of having ICU personnel become infected themselves. This is not a trivial challenge.
In this case, I guess we have to just trust the people that go through the most competitive and intellectually demanding decade of school and professional training on the planet. They have the benefit of being on the front lines themselves, with the lives of themselves and their coworkers at risk.
edit: if it helps avoid distractions, let me say it is obviously not a "benefit" and medical professionals are underappreciated heroes. They deal with infections disease every day, sometimes far more dangerous than covid-19. For them, the danger and planning isn't hypothetical like it is for a vast majority of the commenters here. I trust the medical community to plan for this appropriately more that I trust any other group of professionals.
That's not a benefit. And given that these people will try to do their jobs even when under=equipped and understaffed they are paid too little to begin with.
Perhaps that's why there's no point declaring a pandemic.
If you do, some prepare, some panic, the panicking ones clog the ICU and the virus spreads like wildfire, the ICU can't keep up.
If you don't, nobody prepares, everybody's sprung upon and taken by surprise, the stampedes oversubscribe ICU capacity in much the same way as above.
At the end of the day I think the two variables all of this boils down to are infrastructure capacity limits and individual survival rates - and that no relevant models exist that can readily catalyze this specific set of circumstances with confidence. IIUC, what models do exist are not precise/disambiguating enough. So it all comes down to unresolvable clique interpretation. Officials can't work with that. :(
The difference is that we can recognize that containment has failed and start planning accordingly. I don't think any rational authority is at this point still arguing that this will be contained to within the borders of those countries now affected. So you might as well accept that we do indeed have a pandemic on our hands, which will have substantial economic impact but need not have a substantial toll in terms of lives lost.
Waiting with that declaration is the same as what the authorities in Wuhan did initially: they hoped it would blow over. But viruses do not care about our politics. And if we do not take relatively drastic measures to stop community spreading then the impact will be much higher, both economic and in terms of lives.
The response so far seems to have concentrated on containment. That has - you could argue this - failed. The next logical step is to declare a pandemic, according to the CDC there are now cases in 32 countries with confirmed community spreading in about half of those.
Note that a pandemic is only related to the geographical spreading in combination with the risk factors (highly contagious, relatively high mortality rate).
Anyway, this thread will be obsolete before the week is out, I would be highly surprised if WHO/CDC will not do this in the next couple of days. The only way they can avoid doing it is if the number of cases and the number of countries affected will go down.
"On the advice of the Emergency Committee, the WHO Director-General, declared the COVID-19 outbreak a public health emergency of international concern (PHEIC)."
So scaling of ICU is already possible to a degree. In most hospitals in case of a major accident (eg terror isn’t attack with many injured) theatres are used as ICUs and all non emergency surgery is stopped. I suspect this will happen in these cases. The main issue is going to be sufficient nursing staffing (ICU requires 1:1 nurse:patient ratio usually).
That trick doesn't work when you're talking about infectious diseases. You need to isolate your patients from each other to avoid re-infection and you need to stop rotating your ICU personnel between units or they themselves will become vectors for infection to people who would otherwise recover or may be mis-diagnosed.
Please stop threating the virus as if we would all die.
The things you have in the article should be the things you should do anyway:
-No touching your face, is something you should stop anyway, as the flu will also kill you if you have bad luck and it is the same problem
-Having certain things prepared in case there is a local emergency is a good idea anyway, but the recommandation at least in austria is about 10-14 days, so I hope most of the people already have that.
-Supply chains won't break down because of such a virus, just as it didn't because of the swineflu and other things.
-If supply chains break down, we have more than the coronavirus to worry about.
No, we won't all die. But the impact will be substantial if the infections are not brought under control.
Just like not everybody dies from many other diseases such as the flu. The difference here is that it also hits hard on otherwise healthy people and that healthcare workers are very much exposed to infection. If that front line does not hold it can get worse rapidly.
Western countries with good medicine and infrastructure in place stand a chance of riding this out with just (possibly substantial) economic impact. Poor countries are in for a rough ride. Check out what is happening in Iran right now (which your linked video conveniently leaves out, possibly because it does not fit their narrative).
Mortality rates around 2-5% for a pandemic are nothing to sneeze at, infection rates in close proximity are very high making it hard to care for those that are showing symptoms and put high density population centers at serious risk.
No, but you can try to slow down the rate of infection to avoid overloading the healthcare system.
> You can try to fasttrack vaccinies, but you can't really stop a virus with such a transmission way from spreading.
Agreed.
> That is a problem but it is nothing new.
It certainly isn't anything new. But if the past is a guide here than the impact can be substantial.
> Every few years we will have new diseases and unfortunately they will spread and kill people.
We do. But most of those do not have this combined potential of spreading a-symptomatic; long incubation time and relatively high mortality. That makes this one more serious than for instance SARS and MERS, the impact of which was already substantial.
> The flu does that yearly.
If you want to compare what is happening now to the seasonal flu then you are probably not equipped to evaluate the risks. The flu predominantly affects those that are already weakened and it tends to kill people who would have been dead soon anyway. This virus is nothing like that.
> Will it mean the end of the world or have a high impact on countries that have a robust healtcare system? No
It won't mean the end of the world but it likely will have high impact on countries with robust healthcare systems because (1) the economies of those countries depend on everybody being free to move around and interact with each other, something which anti-spreading measures will affect and (2) even the most wealthy countries with robust healthcare systems have limited healthcare capacity, typically on the order of 1 ICU bed per 10000 people. Assuming you can staff them.
Supply chains have already started to break down in at least a few sectors. China, Japan, India and Korea are where lots of stuff is made, including electronic components and drugs and drug components. China at least slowed shipping way down over the last month.
I think the WHO not declaring a pandemic is mostly wishful thinking on their part, the longer they wait the bigger the impact to the system. There are now 30 countries with known infections, a large number with likely undetected cases due to lack of local infrastructure. Impact to the economy and general panic are on the one side of the scale, there is still only a very small chance that they will be able to contain this.
Well. Infection rate is going down already. Death rate is starting to slow down. Death rate was never higher than a common flu. Healing rate is increasing drastically, many heal without medical needs.
So, should we really talk about a pandemic? A flu pandemic?
Or has the virus changed in the last few days and I've missed it?
Infection rate in China is going down and the way they keep changing their criteria makes it hard to find continuity in the numbers. Elsewhere it is still rising.
That caused the jump. But those cases were there all along, just not reported. Now they have - again - changed the criteria and made them more stringent resulting in an apparent drop in the number of cases.
To those commenting about infection rate going down:
Do you take into account that China relaxed the requirements for diagnosing a case many days ago, and then made them strict again a couple of days ago? That's one sucky move that makes thing seem like they're slowing down. Or so you just look at graph and think everything is fine? Or is everything actually improving even taking the reporting changes into account?
It's well documented in various day to day coverage feeds. The one I'm thinking about is CNN. I'm pretty sure its public information disseminated by China.
Recommendations for what individuals can do are buried but very practical:
* Try to get a few extra months’ worth of prescription meds, if possible.
* Think through now how we will take care of sick family members while trying not to get infected.
Cross-train key staff at work so one person’s absence won’t derail our organization’s ability to function.
* Practice touching our faces less. So how about a face-counter app like the step-counters so many of us use?
* Replace handshakes with elbow-bumps (the “Ebola handshake”).
* Start building harm-reduction habits like pushing elevator buttons with a knuckle instead of a fingertip.
With few exceptions, you should be able to ask your MD for a 90 day supply with 3 refills (enough for 3 months immediately, with refills for the rest of the year).
But the exceptions are the things you really don’t want to be running out of. Which is extremely unfortunate and silly given that those who want to source these things illicitly will do so and those who follow the rules will suffer.
Not sure what you're referring to. I'm thinking of medications like injectables, which may not have a sufficient shelf life to permit getting the full set of supplies all at once. But most of the medications which are life-threatening if withheld (e.g., antiplatelet medications after a stent) can be obtained in bulk with a normal prescription.
I was thinking of Adderall specifically but in the case of Benzodiazepines, withdrawals can be fatal and they’re controlled substances so presumably ineligible for the 3 months prescription.
Yes, I agree; while benzodiazepines are not generally considered life-saving medications, they can be life-threatening (like alcohol) if high tolerance is developed and cessation is abrupt.
We will see. The graphs of numbers of confirmed infected all seem to be bending down, but of course there's the possibility of biases like unreleased numbers and incomplete testing. I guess we will know in a few weeks which direction it is going to go.
That being said, with death being so rare among the young, I don't see why most people should panic more than they do about flu season. Obviously it is a serious concern, but I think on the extremes there is a bit more alarmism than is warranted. Of course, those same sensational articles are going to be the ones that get upvoted on social media sites like this one. I remember when the avian influenza scare was on how many end of the world articles there were. Not that it wasn't a pressing concern but it seems like these types of situations capture the public's imagination and fears a little more than is justified by the facts on the ground.
Also keep in mind that this message is coming from a "risk communication expert" who probably gets more exposure and therefore more business the more extreme their predictions are. Are they actually privy to any information or knowledge the other experts aren't aware of? Do they have any skin in the game at all when they make this prediction? Consider the source is all I'm saying.
> That being said, with death being so rare among the young, I don't see why most people should panic more than they do about flu season.
This is my thoughts why Covid-19 is much more dangerous than seasonal flu: first it is much more virulent, and hard to detect, many of the infections in Korea were due to one 61 years old woman alone. Secondly the mortality rate is higher too, estimated at 2-3%, with the serious cases at around 10% (please correct me if I am wrong). Those two above combined means if left unchecked, Covid-19 can easily overload our medical system, as what is happening in Wuhan*. So I will most likely won't perish or suffer any long term health problems from Covid-19, but our society as a whole might be devastated if we can't contain it. There is no need to succumb to irrational fear (like what's happening some countries), but we should all be prepared.
Actually I am worried about Iran, the embargo from America means their medical system are lacking all essentials. That's why they have so many deaths, second only yo China.
The mortality rate for hospitalized flu patients in the US is about 10%. Mortality rates of categories like "serious cases" depend on a bunch of arbitrary and unverifiable assumptions, so I don't think this proves the coronavirus is bad or isn't bad, but 10% isn't as high of a number as I think you're intuitively expecting.
> Secondly the mortality rate is higher too, estimated at 2-3%, with the serious cases at around 10% (please correct me if I am wrong).
I don't think we actually know that for sure. The flu mortality rates that get tossed around are the overall mortality rates, but for COVID-19 as far as I know we only know the mortality rates among those who have tested positive. Especially in a situation like what's going on, this is going to be a heavily biased sample.
Fwiw I'm not advocating idleness or putting our heads in the sand. I think taking extreme measures to prevent the spread of this disease and eradicate it is smart. I am just hoping people can keep things in perspective.
Fair enough, there is still a good amount of uncertainty. But even so with the data available 2-3% seems realistic taking into account that some under-reporting will also be happening because people die that were never tested in the first place. The testing capacity of the countries where the virus has now solidly established itself is maxed out.
This is spot on and a pretty realistic way to look at what is happening. What goes for Iran goes for large swaths of Africa, Latin America and Asia as well.
> The graphs of numbers of confirmed infected all seem to be bending down
Those numbers are dominated by the reports from China. If you look at just the cases outside China, then those are still on an exponential curve with a doubling time of about 6 days.
I take these as examples of how quickly things can go wrong if they go wrong.
People seem to overconfidently brush this off as isolated incidents because religion is stupid and we're not all in a cruise ship. It could also serve as an example of how bad things can get if one person goes unidentified and happens to go to a crowded place. Like a teacher, or clerk, or waiter.
Just this past week a coworker returned from Beijing, and there was nothing in place at Frankfurt airport. No questions, no flyer asking you to wash your hands frequently, no phone number you're supposed to call if you feel sick... It's left to the common sense of the individual, which I don't trust everyone to have.
If you remove all the people that died you end up with zero fatalities!
The problem with those clusters is that in close proximity the virus spreads very fast. There are quite a few communities where people are living together about as close to each other as if they were on a cruise ship. Hong Kong comes to mind.
Rural communities where people are less likely to have intensive contact and shared resources are less at risk to begin with. You don't remove those either to get 'more interesting curves'.
Death and rate of serious (ECMO/intubation) is much higher than the flu and this is much more contagious. Most of the reason we're seeing a bend in the numbers is also due to extraordinary measures being taken to slow it down.
It's hard to tell what's alarmist with quarantine and shutdown of schools/businessess coming down so hard on the affected areas. People aren't used to that sort of thing.
The right steps are being taken in general. If this does continue to spread, which seems likely, people will need to exercise calm and patience.
Yep. Thunderf00t did a video on the power of net infectivity rate as dominating the outbreak irrespective of mortality rate.
Infection can be most basically modeled by an ordinary diff eq. And what happens is when everyone knows about it, the infectivity drops off a cliff and the illness reaches a carrying capacity rather quickly and dies out with good sanitation and quarantines. It could be Ebola-deadly and it still dies out because the transmission rate drops to almost 0.
Because of self-preservation and global news, a modern pandemic would only work if it were like Hepatitis C and norovirus: very long incubation period and airborne.
>with death being so rare among the young, I don't see why most people should panic more than they do about flu season
Perhaps I'm misinterpreting your tone, but I'm not so cavalier about performing solo heavy-duty, months-long care of parents & grandparents and the possible loss of company senior execs/mentors and coworkers over 30.
Perhaps you are. See my other comments on the subject e.g. here: https://news.ycombinator.com/item?id=22397271. I also think you are exaggerating the risks when you say "coworkers over thirty", considering death rates at thirty are still well below one percent of those ill enough to go to the hospital and get tested. That sort of language is exactly what I was reacting against in my comment.
The big population centers in poor countries are the ones to watch, especially where there have been wars and where there is very little infrastructure. Iran, Iraq, Syria, most of Africa, the poorer parts of Asia and Latin America, though countries with higher temperatures seem to be so far mostly spared. But those with lower temps will be the hardest hit if this is not contained, and likely that is a passed station already, containment has failed so now we need to brace for impact.
Sure. And we should be concerned for them. But I sense that many people are scared for their own lives and those of their children, which I feel is not really warranted. Maybe I'm generalizing my personal experience of my own mental state and who I've talked to, but that is what I've been exposed to. And of course the items discussed in the rest of my comment should modulate people's fears as well.
I don't think anyone would dispute that. Certainly I did not intend to do so with my comment. I personally have a stock of about thirty days of non-perishable biscuit that can be used to supply calories in an emergency, and a forty gallon canister that could be filled with potable water ahead of a disaster. It's not enough to live on independent of civilization for more than a few weeks, but if more than that is needed we are probably screwed anyway.
At the risk of going full doomsday mode (and besides stockpiling on food and masks) - lets say pandemic happens and some useful meds/vitamins do go out of stock - is there any advice what those are i.e. what kind of meds/vitamins would be practical to buy right now to help fight/slow COVID-19/infection in the future?
No, just food and meds for fever. I'm actually concerned there will be a shortage of food just because everybody is stocking up at a sudden panic, not necessarily because we actually end up with a huge pandemic (which might or might not happen at a later point in time). So for the first time in my life I'm thinking about actually doing this.
I don't think anything is known to help in treating/curing right now, I'd guess most of the relevant medicine is just to treat the symptoms while you ride it out. Stuff like fever reducers (ibuprofen) or something to relieve the respiratory symptoms (dayquil/nose spray).
when stocking up on meds, I would certainly include antibiotics (need prescription in my country). just as water and food do not fight coronavirus, antibiotics is simply a BFG one needs to have around against simpler infections when hospitals are overloaded and supply systems halt.
> ... In most countries ... ordinary citizens have not been asked to prepare. Instead, they have been led to expect that their governments will keep the virus from their doors.
This will be a painful but necessary shift. Realizing there's no way to stop the spread of coronavirus from "over there" to "over here," the best move individuals and groups can take is to forego large gatherings:
> ... the switch to measures like canceling mass events designed to keep us from infecting each other.
How long this will take is anybody's guess. But any organization still planning a conference of more than a few dozen people should really stop and consider the wisdom of that plan at this point.
Fear-mongering aside, the article basically says "have some masks and be prepared for supply disruptions of critical things (medicine in particular)" which seems like generally a good idea? Maybe that's just the Boy Scout "be prepared" in me, but that feels like a low cost way to insulate yourself from the unexpected (pandemic or otherwise).
Sounds like the word "Pandemic" is getting the "AI" treatment: A lot of people have heard of it in the movies, the movies make it seem like if this word applies to your situation is an end of times scenario and people should be panicking and worrying.
I don't think that's what the CDC and others want to get across. Much like (most) AI researchers and partitioners trying to downplay the fear mongering.
As a species we really seem to love Existential crises.
When things are uncertain, $VIX volatility index is a good bet. Maybe look into the most popular sellers/manufacturers of those surgical face masks, I'm sure those guys are making a killing right now.
PSA: spreading FUD and panic isn't helping anyone. The common flu is a "pandemic" every year, so should we freak out and buy 1000 kg of wheat while inconsistently not having any means of food production? Don't act out of fear; act out of reason, honesty and proportionality.
Does it though? COVID-19 may actually have a much lower fatality rate as we are only getting reports of people that get symptoms, maybe that's only 10% of infections, maybe even less.
The common flu has a total case fatality rate of ~<10% to 0.1% that of 2019-nCoV, based on still-evolving data.
A key point of actions to date has been an attempt to prevent 2019-nCoV from achieving pandemic status, so that it doesn't recur on an annual basis.
If sufficiently widespread, and affecting a quarter to half the globe's population, we're looking at tens of millions of deaths. Contrast 12,000 - 61,000 deaths in the US from influenza (https://www.cdc.gov/flu/about/burden/index.html), and 291,000 - 641,000 worldwide (https://www.beckershospitalreview.com/quality/cdc-global-ann...). That's with effective vaccines and antivirual treatments, neither of which exist presently for 2019-nCoV.
Preventing this coronavirus from becoming "just another flu" would be a Very Good Thing.
The WHO knows this and the pandamic button is also a early signal, they don’t press it when is “too late”. They have protocol and procedures after they declare it, and doing it too early will probably mess it up and cause confusion. This guy is living in his own world.
Earlier in the week I went to large university library. There were at least 5 people there severely coughing. Everyone else was sitting around like it was perfectly natural, no masks, no attempts at containment or isolation.
Yes, we're in cold and flu season, so it could be just ordinary cold and flu (which is bad enough, as the flu kills lots of people as is, so spreading it is irresponsible at best), but the US is hardly doing any testing, so for all we know it could also be COVID-19.
The amount of complacency around the US right now is stunning. People are just burying their heads in the sand and acting like it couldn't happen to them, relying on the media or government to tell them when to take it seriously, and both the mainstream media and the government flat failing to get people to prepare or take any measures to slow down the spread of this disease apart from telling them to wash their hands.
The numbers coming out of China are not reliable, but given the numbers we do have (including non-China cases) it seems COVID-19 (aka SARS2) is far worse than the regular flu (for which at least we have a vaccine, though not nearly enough people take it).
We should be doing everything we can to slow the spread of this disease, to buy some time for medicine to study it and come up with treatments, but instead outside of countries that are already obviously seriously affected people are acting like it doesn't exist.
That kind of complacency provides the perfect breeding ground for this disease.
For those of you who want to keep a closer watch on what's going on, see:
People panic over everything imaginable. The only defense is logic. (which unfortunately is only a slow and long term defense)
At this point I feel I am more likely to win the lottery and get struck my lightning twice before I get this virus. And even then, what is the death rate for healthy adults?
It's amazing how easily people freak out these days.
For healthy adults death from a pandemic is rare, but in a true pandemic large parts of society are expected to stop working.
If you are only interested in your own well being (which is fairly uncommon, do you not have family or friends?) Then make sure you have stocks of food, water and small bills.
At this point, yes. But that's not the way to look at this. The way to look at this is what will happen over the next couple of weeks/months and to what degree we can avoid community spreading once the virus achieves a foothold, which - sorry - at this point is mostly a matter of time.
Containment can be done early on and if done effectively can get you back into your 'no need to worry' mode. But once containment has failed you are in different territory and will have to play a much more complex game with more substantial impact.
So your present day chances of contracting this in the next 24 hours are looking pretty good but your chances of contracting this in the next couple of months are substantially better than winning the lottery or getting struck by lightning even once. Unless you live the life of a hermit.
A vaccine would be quite handy, but we do not have one - yet , though that race is on - and even if we had it you still need to make it in quantity to be effective. A virus doesn't particularly care about whether you are able to think logically or not. It cares about contact between people and not killing its host too quickly. That way it improves its chances of spreading its genetic code.
There is a lot I can do for my family and friends about helping them not be _irrationally_ afraid.
Eliminating irrational fear is valuable. Spreading undue panic is reprehensible.
What are the numbers? What is the risk equation? If we avoid these, then we are not speaking from knowledge but simply guessing and editorializing. Which tends towards panic, not rationality.
Eliminating irrational fear is very valuable. But there is also something to be said for being rationally afraid: to try to put boundaries on how scary this thing really is and what the likely impact will be.
Undue panic is 'we are all going to die, the end is neigh' kind of bs.
But a measured response could easily be that it would be better to reduce travel if you do not really have to, avoid concentrations of people and so on.
The numbers that we know so far are impressive enough that I believe those measures are warranted. 1-2% mortality, aerosolized infection confirmed, tactile infection confirmed, reasonably long incubation time, tests appear unreliable, virus now present in 25+ countries, with serious outbreaks in several of those. This is no longer in 'common flu' territory, nor is it in 'black plague' territory. Let's hope it stays that way and can be pushed back into the bottle again or that a vaccine is developed fast enough and produced in quantity enough that the bulk effects can be reduced.
> One horrible effect of this continued “stop the pandemic” daydream masquerading as a policy goal: It is driving counter-productive and outrage-inducing measures by many countries against travelers from other countries, even their own citizens back from other countries. But possibly more horrible: The messaging is driving resources toward “stopping,” and away from the main potential benefit of containment – slowing the spread of the pandemic and thereby buying a little more time to prepare for what’s coming.
I don't get this part of the article at all. What's exactly counter-productive about not allowing civilian travellers from affected provinces? That seems like the best method to slow the spread to me. The longer we can keep it away from anybody, the better, because the more time we have to come up with a vaccine or alternative ways to combat the disease.
It's definitely possible that covid-19 will eventually reach all parts of the globe, but we should try everything possible to not let it reach those parts before we have come up with a vaccine.
The time that border closures would have stopped the spread is past. Those measures are useless now, 25+ countries have the virus within their borders now (and likely, many more without knowing it) so it will spread within those communities unless measure to stop that spreading will be taken.
This sucks but if you live in a wealthy country you will likely survive this, it may still impact you economically.
Closing borders might not stop the spread, but it certainly slows it down if there is a major population of sick people in one country, but in the other country the population of sick people is smaller. The numbers of detected and undetected cases are different, but definitely not uncorrelated.
The less people have the disease, the more you can focus onto containment measures. If you detect one case in a country of 30 million, you can test everyone who had contact with that person and maybe even their entire street. However, if there are 10 000 cases in that same country, you suddenly have a problem.
Even if you assume constant spreading rates with an exponential model of patient number increase, where after a period P, the number of cases doubles, then with 10 case, after P you have 20 cases. If you have 100 cases because you left your border open and, say 50 000 people from the country with many cases got in, you'll have 200 cases after period P.
Closing borders is an efficient method to slow down the spread. Of course you need to accompany these cases by within-country measures like China is taking, but you can isolate them to affected regions. What's important though is that you prevent travel in any fashion as much as possible, because the virus doesn't travel by itself, it needs humans to travel for it.
Most of the time there are still ways you can cross, so instead of having known routes where you can test and treat accordingly,
you have an unknown number of people crossing the border on unknown points and spreading the virus in unknown regions.
The point of epidemiological containment is to reduce the R value such that R<1. Once this is done, eventually, inevitably, the epidemic will burn out.
Yes, more people will become infected, yes, some will die.
But the level of person-to-person transmission will have fallen below the level necessary for the epidemic to sustain itself, and it will slowly decline and fade out.
Perfect containment, 100% effective vaccines, 100% vaccination rates, (neither of which apply here: there is not yet a vaccine), 100% travel and contact curtailment, 100% sanitation, 100% filtration, are not required. Only sufficiently effective methods to reduce transmission.
Of which, strong, effective, and widespread travel restrictions within or from epidemic zones are a very sensible tool.
The virus doesn't spread because of a natural effect, but because infected people travel and take the virus with them. The speed of the spread is as fast as the fastest method of travel. If we have FTL travel, it travels faster than light. If we have airplanes, it travels as fast as them. So even if you don't watch land borders, shutting down airplane traffic to a country is highly useful: the virus cases are isolated to the border region of your country, and you can focus your attention to that part.
Usually there is already infrastructure to close down land borders for cars and similar. So why not use that infrastructure? Besides stomping out the few cases inside its own borders or preventing travel from affected regions, it's the most useful measure a country can take. After that there are only inside country prevention methods, like curfews, forbidding car usage, etc.
tldr; use "ebola" elbow bumps instead of handshakes, don't touch your face, there should be an app to count the # of times you touch your face, tell your friends not to touch their face when they touch their face. Did I mention not to touch your face?
what is happening with antivirals, why should these take years in crisis/pandemic situations? Would govts rather see mass hysteria and huge hit to economies rather than trying new vaccines?
As Hacker News is usually full of people that can provide good advice: What should I personally do to prepare? I'm living alone and have the ability to work remotely once the virus starts spreading here.
My guess is mostly stocking up on food, which I've planned to do for a long time - sounds like a good motivation to finally prepare a list and get shopping.
Should I bother with a N95 mask? I already have surgical masks that I used last year when I got a cold, but FWIU they only help protecting others when you're already sick. I can spare the money for a N95 mask even if I don't end up using it, but I'm not sure it'll actually help.
Touching your face less and using knuckles to touch buttons as well as washing your hands more often are things I'm already working on. I guess I'll start carrying hand sanitizer when leaving the house.
> As Hacker News is usually full of people that can provide good advice:
Be careful. Comment sections tend to attract overconfident armchair experts rather than professional advice. This is a forum where technology people congregate, not virologists.
You may get repeated advice about general prepper techniques, but in my experience the mainstream prepper types can be over focused on unlikely doomsday scenarios instead of more realistic extended economy-slowing scenarios.
> What should I personally do to prepare?
I suggest reading the linked article. This is exactly what the article is about.
Of course, I'm not going to treat anything here as the absolute truth, but I'm looking for things I might have missed.
I read the article, but other than keeping food and not touching your face etc. I didn't see much actionable advice for me. I'm not taking any prescription drugs, I don't have any family members close enough that I could treat them and handshakes are uncommon at my office.
Keeping a stock of non-perishable food is always good advice, some means of purifying water (visit your local camping store), a hand crank radio/light. That's about it.
For the rest, we are all essentially about to be victims of math, and the math on any disease with a 14 day or so symptomless incubation period, and high infectivity is uncompromising. It was always going to spread world wide, and there was really nothing anybody was going to be able to do about that.
If you had to spend 3-6 weeks homebound, literally not leaving at all, what would you need? Include the usual over-the-counter meds you might normally use in the course of a year.
Then, if the economy tanked as a result of an epidemic, for 3-5 years, what would you wish you'd bought beforehand?
That's about all you can do.
Remember, if you're homebound, you'll really want to exercise after a few days. Some way of doing that indoors is wonderful.
Face masks don't prevent highly-infectious airborne viral diseases from being caught by healthy individuals, they mainly reduce the chances of an infected person spreading it more.
This panic buying of face masks and toothpicks to press elevator buttons is hygiene theater. If you're sick, stay home. The. End.
They can. You need to buy surgical respirators instead of surgical masks. They look fairly similar. Masks prevent you spreading the disease to others. Respirators prevent you spreading the disease and others spreading it to you.
> My guess is mostly stocking up on food, which I've planned to do for a long time - sounds like a good motivation to finally prepare a list and get shopping.
If you're going to stock up on food, allow me to suggest cans of whole San Marzano tomatoes. San Marzanos (and other close relatives) tend to last really well in a can -- almost as good as fresh!
Keep some extra onions or shallots and a few celery roots in your fridge, and perhaps some Calabrian chili flakes in your pantry, and you can make delicious pasta sauces or soups from them. Also, this works just as well on a random Tuesday night as during a pandemic.
Or just slice the tomatoes and put them on a sandwich. And if there's no real crisis in your area, then you're still in luck, as you've got a good supply of tomatoes for next winter.
Probably you should pick up some beans to go with them too, from a dietary standpoint, but I'm a tomato lover, not a bean lover, so I don't know what the right type is there.
Food items should include things you can eat while/after your digestive system is wrecked, also known as the BRAT diet, bananas, rice, apple sauce and toast.
I wonder if the single most effective thing that can be done to lessen symptom severity/risk of death is to work on improve cardiovascular fitness (since the clear majority of deaths seem to be amongst people who have cardiovascular illness/weakness)? I haven't seen any advice to that affect though.
Yes it can. I think it's unrealistic to expect that some ordinary gear is going to save you when you get exposed to it. The focus should be on not getting exposed.
Unless you are doing work that involves lots of tiny particulate matter (and even if you do), I think 50 n95 masks is pretty darn excessive. Most people don't even wear them correctly.
N95's not bad, but N99 (FFP3) is what you probably want for viruses. In theory these are designed to last a "shift" (8h). The manual should explain how to use it safely.
I'm not aware of the possibility of cleaning used masks. Just because the outside is clean, it doesn't mean the filter's still good.
If you want something cleanable get a full face mask with a cartridge filter. These look like (and actually can be) a gas mask. It also clearly communicates that you're serious about this, unlike the peons with those silly normal masks.
2019-nCoV is a viral disease spread by droplets and close physical contact, possibly by contaminated fluids, including human waste (sewage). Literature I've seen suggests relatively close prolonged contact is necessary -- hours around an infected individual. There've been some "super spreaders", including apparently a woman within a South Korean church, who've infected numerous other individuals.
There is no vaccine or effective curative treatment. Medical treatment is currently limited to diagnosis, and treating symptoms.
At an epidemiological level, the outbreak will be halted when the level of transmission (R value) of the disease falls below 1: one infected individual on average infects fewer than one other additional persons. The outbreak will continue for some time after this, with occasional new cases, but the total new cases should fall.
Halting transmission means disrupting transmission vectors:
- Less person-to-person contact.
- Less high-risk contact.
- Reduced risk of exposure through contacts.
Keeping yourself and the things you touch clean is the single most effective thing you can do.
Soap and water are a low-tech effective mechanism. Wash your hands. Often.
Alcohol-based hand-sanitizers work.
Antibacterial sterilisers are not effective against 2019-nCoV, though may reduce risks of secondary / opportunistic infections.
Soap, detergent, or bleach sterilisers on high-contact surfaces should be useful. Taps, light switches, door handles, elevator buttons, toilet handles, counters, keyboards, touch devices.
Note that many modern devices disinfect poorly if at all. Many are harmed by water. Consider, e.g., keyboard covers if necessary.
Barrier protections such as gloves, masks, or eye protection may be useful if:
- You cannot avoid touching possibly-contaminated surfaces, e.g., shopping trolleys, on public transit. Discard gloves and masks after the exposure episode, dispose as hazardous waste, and wash hands after removal.
- You are or may be infected yourself, to avoid infecting others.
- You're assiting others who are or may be infected (family, friends, neighbours, etc.).
Masks and gloves should not be worn as a matter of course (e.g., around the home) so long as there's little risk of infection.
Be generally aware that an epidemic may be declared where you are, and what the implications are likely to be.
That includes several weeks of reduced transport, possibly including long-range transport. Schools and businesses may be closed. Medical services may be overextended.
Workplaces should make contingency plans for remote work or possible shutdowns, as well as assess and implement cleaning procedures.
If you have not yet had a flu shot get one now. Not because it will prevent 2019-nCoV infection, but because 1) you don't want to be getting sick with something else in an epidemic and 2) you'll reduce load on medical services and risk of nosocomial infection through healthcare services.
(I've been fighting with close family and friends on this point -- idiotically stubborn individuals are an exceedingly unfortunate and frustrating reality. The elderly, uneducated, and or mentally handicaped (Parkinsons or other conditions) may be especially resistant to sensible preventive actions.)
Consider changes to routines (e.g., work, school, socialising, religious worship, fitness or gym) in the event of a local outbreak. Preparing to minimise transmission risk will be useful. Do so for others in your household as well (partners, children, parents, housemates).
Get in touch with neighbours and have a mutual support plan in effect. Buying supplies for someone who's sick is low-risk, but will make their recovery far easier.
Overall severity for most people is low, deaths outside China have been reassuringly low. The worst places for the outbreak seem to be those with poor public infrastructures, public health, general healthcare, and institutional trust. Unfortunately, the US has been trending in the wrong direction on all these measures, but in large part remains among the more prepared countries. Countries lacking these traits, having poor communications and public health, and cold, dry conditions are most at risk. North Korea has been on my watchlist since early in the outbreak, and the lack of any case reports seems improbably accurate. Iran's outbreak may be concerning.
China's containment efforts seem generally to have been working well, with a few possible exceptions. Prison outbreaks are among the more troubling notes in recent news.
Coronavirus generally thrives in cold and dry conditions, which should become far less prevalent as Northern hemisphere spring and summer arrive. To that extent the epidemic being self-limiting is likely.
Second-order effects, including disinformation and panic, are all but certain to be the most severe disruptions anyone will personally experience. Global economic and supply-chain shocks are possible, though if handled sensible, not a tremendous risk. Money doesn't grow on trees, it's easier to come by than that: central banks can inject it at will.
One possible high-risk vector: if you live in close contact with others and have shared plumbing, poor isolation betweeen drains might be a potential vector.
In the SARS oubreak, one superspreader infected numerous other people at a Hong Kong hotel. Diarrhoea and vomiting were among the victim's symptoms, and seven other guests on the same floor fell ill. How specifically the virus spread (plumbing, ventilation, housekeeping staff) isn't clear, but as with the cases of cruise ships in the current outbreak, close quarters and susceptible populations is a bad combination.
Do not tell people to stock up on food. There is no need and this is how you create runs on supermarkets and panic. If the situation becomes severe enough for this to become a problem, this will be organised by authorities.
Keep calm, follow basic hygiene, and be ready to work from home at short notice. Maybe don't travel unless you have to.
This is not the end of the world and the risk is low. Change course only if the risk to you becomes high based on facts.
> If the situation becomes severe enough for this to become a problem, this will be organised by authorities.
Ummm... FEMA’s track record handling extremely localized emergencies doesn’t fill me with confidence at their ability to handle a nation-wide incident.
Maybe it has something to do with growing up on a farm, but I can recall snowstorms that left us without power for 5 days and the roads totally plugged for 3 or 4 days. The government didn’t help milk the cows then, and I don’t expect they will today, either.
If your Plan A for emergency situations is to sit on your ass waiting for someone to save you, then I fear to see what you are thinking you can improvise as a Plan B.
In the (very unlikely) event I am quarantined at home it will mean that my whole town is quarantined at home (if it's only me then there is no supply issue). In such case the authorities will have to enforce this and control the situation. Look what happened in Wuhan, for example.
The point of this stockpile isn't to deal with total long-term breakdown. They're not telling you to get 2 weeks supply because they think there will be no food available for 2 weeks. They're telling you to build up a supply to help ease the very supply distribution activities that you're saying will happen. The more supply buffers that exist in individual households, the more easily authorities and organize and distribute supply.
I find it interesting that China has managed to keep things organised in Wuhan and throughout the country but American commenters on HN seem to expect that in their country it would be Mad Max.
Was this response intended for a different comment? Regardless, I don't get the feeling you're overly familiar with what's going on in China or in this comment thread...
I loathe these kinds of clickbait headlines with all my being and will not give them my click under any circumstances. I can only imagine the writer twisting his/her nipples in expectation of all the extra traffic he/she will get from Hacker News.
The biggest question to me is: do you really believe there are no cases in Indonesia? Does that make sense?
Because if there are in fact dozens of people infected in Indonesia, and we don't know about it, containment is over. Based on the apparent transmissibility and incubation period, I don't see how to come back from that.
When you're a hammer, everything looks like a nail, and when you're a virus researcher, every outbreak looks like a pandemic. The facts on the ground don't match the pandemic conclusion. There were two cases in all of Santa Clara County a few weeks ago, now there is one case.
"Dr. Nancy Messonnier, director of the CDC's National Center for Immunization and Respiratory Diseases, told reporters Friday that U.S. health officials are preparing for the coronavirus to become a pandemic."
"'We’re not seeing community spread here in the United States, yet, but it’s very possible, even likely, that it may eventually happen,” she said. “Our goal continues to be slowing the introduction of the virus into the U.S. This buys us more time to prepare communities for more cases and possibly sustained spread.'"
Sooooo... today's edgy "the media and authorities are keeping us in the dark" blog post got scooped two days ago by the CDC and USA Today.
[1] https://www.usatoday.com/story/news/world/2020/02/21/coronav...