My working assumption is that American business and political elites are two weeks behind in their attempts to address the virus crisis. The steps they are taking now were necessary two weeks ago. And the steps that are needed now will not be taken for another two weeks.
So you can look at the news about events being canceled, telework being encouraged, and so on, and say that this is all for the good. But it would have been better to have taken these steps before, say, the Biogen conference.
So ask yourself, what are the steps that we will wish we had taken two weeks from now? Perhaps more self-quarantining by people who do not think they have been exposed.
“Arguably Wrong” who is a smart, serious guy with a couple of decades of experience in projecting medical crises models three strategies here:
https://www.unz.com/isteve/arguably-wrong-ballparks-3-different-strageties/
Going all out NOW seems to be vastly better than half-assing it later.
I disagree with ArguablyWrong’s assessment and I am more inclined to side with Kling, but with a more targeted Self-Isolation approach based on vulnerability, exposure, and symptoms. I have no medical crises modelling credentials and rely on nothing more than what I call “engineering judgement”.
The infection curve is indeed a Bell Curve like in the “flatten the curve” meme, perhaps skewed, but a Guassian Curve nonetheless with undetermined standard deviation and peak. Staying below the Health System capacity is the crucial goal right now.
The Wuhan approach was terrible, not the worst, but terrible. You should not be thinking about Trump/politicians and headline-making decrees. The U.S. never had the systems nor processes in place to mimic the approaches long taken by the nation-states impacted by SARS (China, Taiwan, South Korea, Singapore, Canada). The U.S. must rely on a decentralized approach starting with the individual, family, neighborhood, and community.
Self-Monitor. Self-Isolate. Self-Track. Don’t Panic. Use a pulse oximeter (if you can) if you are experiencing significant difficulty breathing (SpO2 should be above 90% and below 80% is critical) to judge when to seek medical attention.
Flatten the Curve is the correct approach. “Going all out NOW” is exactly what Kling is advocating. Trump going all out NOW will cause greater harm, just like Wuhan.
Everyone should Self-Monitor and assume that every new flu-like symptom is COVID-19 and act rationally and responsibly.
I’m wondering if dry, northern climate people have evolved social norms to reduce the spread of such viruses, e.g. taciturn; socially distant; introverted; taboos on physical contact; etc.
I don’t think so. The Canadian tracking seems to indicate that the spread is very mundane; Spit and Space. The distance a cough droplet travels is what counts.
No. This is wrong.
The curve isn’t a Gaussian; there is no closed form for it, you just have to run the differential equations. I have done explicit estimation of the costs of different approaches: about $14 trillion for an uncontrolled epidemic, about $7 trillion for the “flatten the curve” approach where the main goal is to avoid stressing the healthcare system, and about $3 trillion for the “nuke the curve” approach where the goal is to drive down incidence as soon as possible, then run contact tracing/quarantine.
Note: this is assuming that the “nuke the curve” approach involves shutting down ~90% of the total economy for about 2 months. It’s still cheaper.
Oh brother, we are talking Fermi Estimates here and a fixed size population. The curve is not exponential, it is limited by the population size and infection rate has to eventually slow; something Gaussian-like if not exactly Gaussian at the edges.
Your confidence in your explicit estimates is troubling. Your model is based on an assumption about the efficacy of specific coercive interventions in the aggregate and then projecting these impacts on a large economy. I have much more faith in Kling’s simple human interaction model and it can help plug the gap until sufficient testing capacity comes on line.
Do you believe you could have modelled the difference between the outcomes in Taiwan vs South Korea? I should stop clicking through links.
For 2.5 million Americans to die by late 2021, probably everyone would have to get it and then a large fraction would have to get it again in short order. The general mortality rate will almost certainly be significantly below 1%; the mainstream estimates for the fraction of cases that get recorded tend to be only about 10-20%.
Respirators, respirators, respirators.
How about “millions of noninvasive ventilators for home use”.
The intubation invasive ventilators in ICUs have presented a huge bottleneck in other countries in response to a massive outbreak of severe respiratory problems.
Ideally, you want tons of them everywhere, decentralized, available for particularly vulnerable people to use for the duration of hospital saturation and triage necessity. There are lots of CPAP machines out there already, which aren’t ideal, but better than nothing.
It seems to me that building an improvised NIV as a DIY project wouldn’t be too difficult or expensive, though it’s probably illegal, who knows and, honestly, who cares.
It would be really easy and cheap without raising the oxygen level, and the parts are in plentiful supply. If one wanted to add a capability to raise oxygen levels via onsite generation, that’s not too hard or expensive either, but I don’t know whether there would a bottleneck on the membranes or sieves or, if one was really playing MacGyver, electrolysis anodes. You were all paying close attention during high school chemistry class, right?
As a percent of population, the US is now where Italy was on 2/25 and Germany was in early March. Italy and Germany were both behind at those points as well. I don’t dispute that. But as a percent of population, we still have had fewer cases than them. We are still at risk of them exploding upward in the next two weeks.
Well, first you have to let the career civil servant regulators fail at their “master” plan developed though hours of committee meetings. Then you assign people who know how to fight, whether it be new commanding officer in the field for a war or new medical professionals in a pandemic. The FDA’s plans and rules quickly became part of the problem. The CDC using threat of government violence to prevent private and university labs from developing tests AND then failing in their own centralized effort was the problem. But you don’t know which bureaucrats to fire until they fail to rise to the occasion and cling to their TPS reports.
We are always behind in the beginning because the best people to fight the war are usually not the ones who do best in the “peacetime” bureaucracy.
The US currently has a 5.6 case/million pop. Orders of magnitude less than China, Italy, Iran, UK, France, Sweden, Switzerland, South Korea. But close to the 5.5 for Japan.
I’m confused. You correctly start by describing a failure then you conclude with a comparison based on the output of that failure.
As a bureaucrat, I think the broader point of “We have reached a stage of civilizational and institutional degeneration such that failures like this are now both inevitable and unavoidable and we are literally going to bureaucratize ourselves to death” is worth seriously considering.
Here’s an anecdote. There is some good evidence that higher temperatures and humidity help prevent transmission of the virus. That makes sense given the typical seasonality of these kinds of colds, and also recent studies that show that dry air in hospitals spreads infections, while humid aid helps a lot.
So, in a big building with over a thousand people, a certain bureaucrat tried to write a memo with reference to those studies with the suggestion to raise the temperature and humidity, which, if this thing goes into the summer, might even save a buck or two on cooling expenses and “climate change yadda yadda”.
Dead in the water. Not because anyone says “no”, merely typical bureaucratic-refuseniking being so 2015, but because now we’re gotten to a point at which responsibility and authority are so dispersed in such an obscured and ill-defined manner that no one even knows how to say “yes” to such a thing unless the OMB or OPM or GSA directors themselves insist upon it, which is how we roll in 2020.
At this point the President himself probably has to tell people to do it, or they won’t do it. The joke about Brezhnev-like sclerosis is only getting at the surface of how Soviet the attitudes are becoming, and in this case, the nomenklatura don’t know how to do anything unless Stalin himself tells them how high to jump.
My issue is using the relatively low value of “5.6 case/million pop” as truth immediately after describing the bureaucratic peacetime failure that produced that chronic underestimate.
I LOVE the “peacetime bureaucracy” meme. No disagreement there.
I must admit, I’ve blinded myself with the comfortable thought that it is all a long way away from Alabama, and will be handled by competent authorities before it gets here. We’ve bought a few cans of soup and liptons rice, but anything more strenuous sounded too much like being a Prepper.
But this link penetrated my fog – it has the kind of charts this audience should love (20 million views). This disease is infectious for a week before you get symptoms, and the spreadsheet says there will already be thousands of cases walking around your small town before the first confirmation – after which it is almost too late.
https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca
FWIW, Alabama just now declared a state of emergency and will close schools starting on March 18th, which in my opinion will be too late.
I do not understand the purpose for self isolation. You hole-up in your house for two weeks and don’t get sick. That proves you are clean of the disease. So you go back out into the world and encounter people who may be carrying, and run the risk of becoming infected yourself. What did the self isolation resolve?
Theoretically, if everybody isolated themselves for two weeks and the infection resolved in the currently infected people then the virus would disappear. In fact not everybody will be isolated, but the spread of the virus would be slowed, allowing time for tests to be manufactured and reduce the chance of health system overloaded.