"So far, successful mitigaions in China/Korea have involved near-complete shutdown, very early in the epidemic, around the time of 100 confirmed cases."
From what I read, South Korea shut down almost nothing but had widespread testing available, including drive-through testing where people could sit in their car, get tested and receive the results via SMS next day. They also had the ability to very proactively search and locate people that had been potentially exposed to the virus via credit card transaction/location data.
But SK also published that location data online for all to see, something the US cannot do because HIPPA. People would make fun of those with the virus, such as one man who was tracked to a hotel associated with prostitution.
How is it possible that SK has performed such an extensive testing, while other developped country state they don't have the technical ability to do more than a few thousands tests a week.. Did SK developp its own technics and device for testing ??
South Korea had no mandatory shutdown, but according to Suki Kim nearly the entire city of Daegu voluntarily self-quarantined shortly after Patient 31 was confirmed positive. (Source: https://www.newyorker.com/news/news-desk/how-south-korea-los... plus personal communication)
SK has also instituted widespread work from home, closed schools, and people voluntarily wear masks and cancel events. Daegu was a ghost town for at least 2 weeks after patient 31 was detected, because each citizen decided to minimize activity.
As Italian I can confirm you guys should hurry and close everything down sooner. I would however prefer the title said “don’t be like the Italian government” instead of just “Italy”.
Not everybody here is behaving like a moron, luckily.
For people who are curious what living in China feels like now (video uploaded Mar 14th), from a Japanese director living in Nanjing, China:
https://www.youtube.com/watch?v=YfsdJGj3-jM
Things are getting back to normal, with tons of precautions.
Wow they pretty much thought of and solved every case where human contact could be possible. The elevator transportation in particular is pretty clever. Those Chinese cities are incredibly mobile. I can't even imagine how long it would take any US city to get to that point if ever.
Not to downplay the importance of containment efforts I think there is something uniquely bad about Italy's mortality rates and something really good that the Germans are doing.
Based on the Johns Hopkins CSSE data for March 13
On March 13 Germany had 3675 confirmed cases and only 7 deaths.
Adjusted for respective populations Italy was at this stage 9 days before with 3089 confirmed cases, by which time it has already seen 107 deaths.
This projects 21x COVID19 mortality rate for Italy over Germany - what gives ?
Italy's outbreak is concentrated in Lombardy so maybe weighing for the population of that area rather than the entire country is more appropriate which means Germany is currently 16 rather than 9 days behind Italy but with mortality in Italy still being 13 times higher than Germany.
Possible explanations:
Italy's 3089 confirmed cases 9 days before are selected for severity - only people who arrived with acute symptoms were tested, whereas Germany's 3675 are the results of more proactive testing and are dominated by mild or non-symptomatic cases that would have passed undetected in Italy.
Italy squandered some of its hospital capacity on first-diagnosed-first-hospitalized basis regardless of severity and began triage too late wheres Germany does better job prioritizing hospital vs home treatment from the start.
9 days before Lombardy's hospitals were already over capacity with 3089 confirmed cases while Germany's still aren't today.
Germany has 2.5x the hospital beds per population than Italy, let's assume this holds for ICU beds as well.
If capacity is the sole/dominant factor in this and we say that 9 days before Italy was already over capacity with 3089 cases than Germany will have reached a similar over-capacity at around 10k confirmed cases in a few days and then its mortality rate will begin to climb.
To be honest, at the start of this epidemic it wasn't that clear how dangerous the virus was or how easily it would spread. First it happened to Wuhan and we all thought that it wouldn't happen to us, then it happened in Italy and we still thought that we would be fine.
Thinking that it won't happen to you won't make it go away unfortunately, your country isn't special, if no drastic measures are being taken like full quarantine this will happen to you too.
My country is in full lockdown and still a lot of people don't see the gravity of the situation. People dismissing it as less dangerous than influenza are misinformed.
This pretty much describes the approach Japan is taking. We’re special, it doesn’t apply to us, it won’t happen here. Deeply ignorant approach. I’ve got a family - including a mother-in-law with a pre-existing lung condition - to worry about.
How do you measure "less dangerous than influenza"? Honestly I think it is likely in some jurisdictions to be in the final analysis less dangerous (raw population wide deaths over the season) than influenza. But I think it's worth being cautious (and am contributing and setting an example by self-isolating), because there's a small but worrisome chance it's way worse than influenza.
Why is this important? Because if knowledge authorities go around talking about severity with scary talking points, and in the end, it doesn't turn out to be so, then we wind up in a "boy who cried wolf" situation next time.
This is just a general comment about all of these (really quite nice) data visualizations: they're based on confirmed cases.
Given the many issues with the limited availability of testing this of real concern as it makes it much harder to judge the accuracy of "X days behind", etc.
Also this is very different per nation. E.g. Germany has labs in most university clinics and a tight network of private commercial labs, which are nearly all able to test for COVID-19, while the situation in Italy regarding tests was much much worse, so they didn't see it comming at all.
So how can one really compare the numbers between nations when their testing capabilitied are so different?
The ground truth is certainly deaths - if you know the mortality rate if the virus you can infer from the number of deaths how many people had been infected at some point in the past.
Of course it would be much better to have an idea how many people are infected now, so you can base your decisions on it..
The dangerous thing about viruses is that they grow in a logistic curve and the first part of that curve is exponential. So things can grow out of proportion literally overnight, like they did in Italy.
The general response to this would be that the amount of testing can shift the prognosis by couple of days. Is New York 14 days behind Italy, or 10 days, or 20 days? Doesn't matter if no action is taken, and the best results will be achieved by taking action immediately.
Forecasting Germany as if it were Italy isn't entirely fair, given that Germany has only had 9 deaths with 5000 confirmed cases while Italy had close to 200 deaths by the time they managed to confirm 5000 cases.
As far as I can tell the situation does seems to be developing at the same rate, but going by the confirmed deaths I'd place Germany about 2 weeks behind Italy, not a mere 7 days. Which for exponential growth matters a lot.
Edit: Also note that forecasting countries as if they were South Korea has the opposite problem as the fatality rate of South Korea has remained low compared to other countries (though not as low as Germany's and those of Scandinavia).
Right now the official explanation is that we're quite good with testing and isolating cases so far, which would mean that the confirmed count right now is much closer to the actual count than in Italy (or the US).
On Twitter the opinion seems mostly to be that the death cause is doctored.
I'm kinda hoping for the first, right now, because the projections aren't pretty (even if we're a bit further behind Italy). We only now started shutting down schools, and most events and even that is spotty as every state does its own thing and sometimes even every city.
Mortality rate is very dependant on age and health. The initial infection in Italy was in an hospital and so the initial propagation was in older population and in the medical staff which have a lot of contact with old people and people with bad health.
On the other side, people in Germany who gets the virus were very often young people travelling to Italy and they contaminate their young and healthy German friends when they come back in Germany.
This is probably enough to explain the initial difference in mortality.
People presuming that there’s a difference in viral behavior between countries and that’s why some countries, in these early days, are showing statistical differences.
But this is folly. There is no evidence that some “peoples” fare better and that some countries have “better” health systems. Evidence out of Seattle indicates that the illness rate and death rate from China are showing up here as well.
Don’t kid yourself that your area will be less hit and that’s why you can keep on living a normal life.
>Forecasting Germany as if it were Italy isn't entirely fair, given that Germany has only had 9 deaths with 5000 confirmed cases while Italy had close to 200 deaths by the time they managed to confirm 5000 cases.
I think it's fair, Italy's population just happens oldest in Europe and more likely to suffer fatalities.
I submitted this as a new story but it's worth repeating here: here in Seattle, we're already Italy [0]. The hospitals are having to provision ECMO machines based on demographic prognosis, and the respirators are probably only a couple days behind. Presumably this will be the situation in every major American city 2 weeks from now.
"Scott Mintzer
Brain
@scott_mintzer
UPDATE: I have been contacted by a couple of people who say that this thread doesn’t not entirely paint an accurate picture of the whole Seattle area situation.
I do not want to delete and leave no trail, but anyone there other info should by all means report what’s going on."
I went to pick up an to-go order yesterday and was surprised to find the local mall parking lot still full (U village) and people sitting in restaurants, with no care for keeping distance from each other. Ditto for the grocery store.
I guess people still aren’t taking it seriously, even though Seattle schools and libraries are closed for a month+.
Is there a source to corroborate? A guy with historical tweets corroborating he works in a hospital in Seattle says he just finishes his shift and this is BS
Wow not giving ECMO to BMI 25+ is really something.
I am fairly skinny and it wouldn't take much for me to reach 25.
They should consider revising the cutoff especially since Chinese people can be of thinner frames. 25 may be slightly overweight for them but normal for others.
As an Italian living in one of the red areas I feel it's pretty hard to do better than Italy in the west if you are hit first
South Korea had Seegen almost single handedly testing the population, China is not a standard of what a liberal democracy can do
We did everything we could, I've been staying home for 3 weeks as of now, but we couldn't predict the virus spreading from the hospitals of small cities hitting hard on the elderly population
80% of the deaths are >75, 98% are >65, the avreage age of the deceased is 79.4 years old but if we look only at women their average age was 84.2 years (South Korea life expectancy is 82 years) and we counted every death as a coronavirus related death if the patient tested positive, but most of them died for pre-existing conditions, while other countries are not counting them if other conditions where already present (and I imagine old people at the hospital are there because they are already ill)
So I must say that despite our own indiscipline, bad luck was a very strong factor in what happened
BTW Spain is already looking worse than us at their same day
Italy last is a special case - not that everyone else doesn’t need to take exceptional action. To be sure social distancing, closures of places of congregation is in order, and safety practices like washing hands often are necessary. But Italy is a special case...
- Italian leather manufacturing is by and large run by Chinese ownership today.
- Many of the employees in these shops are from China as they will work for much less.
- Italian population skews very old - a very vulnerable population.
- Italian culture has close families that meet near daily, have generational family living together, and populations are proximal.
- The wide Chinese population in north Italy went back and forth to infected areas of China during the Chinese New Year.
- When they came back there were many “patient 0’s” in the region.
- Because of this, numerous exponential functions were set off at the same time.
- Because of the closeness of Italian culture the virus had the necessary engine to propagate.
It’s not Italy’s fault. They got a perfect storm here. They are managing the best they can.
That's trivially disproved by simply taking JHU daily data of Italy and other countries, and plotting it as date x log(cases). You can see that most Western countries follow the exact same path.
> Because of this, numerous exponential functions were set off at the same time.
This doesn't make much difference, other than complicating contact tracing, etc. Italy doesn't appear to be too different from other countries based on the data so far.
How are California and Washington "behind" Italy, when both states had infections reported before Italy? Sorry, trying to understand the methodology here.
Or are you just basing this off of raw case counts?
China had people dying in the streets, but we're now at the point where the quarantine has had effect, so it's successful mitigation. They also initially quarantined only the area of the initial outbreak (Wuhan), and only later expanded lockdown measures to most of the country (covering 800 million people at the peak, IIRC). And of course the quarantine leaked enough that the infection spread to the entire world.
But sure, thank you CPC, a model response from a model government.
> And of course the quarantine leaked enough that the infection spread to the entire world.
It spread prior to the quarantine being put in place.
> at this point it's run its course, so it's successful mitigation
Only ~80,000 people out of 11,000,000 in Wuhan were infected. For a disease this contageous, that we don't have herd immunity for, that's hardly 'run its course'.
To be honest I don't really want to criticize China here, but rather the slipshod way in which countries are being compared. Wuhan has been in lockdown for almost two months now. Italy's national quarantine is only a week old. The number of detected active infections is delayed with respect to the actual number of infections, so it takes time for the effects of a quarantine to be visible in the data. What is the point of taking two countries at different points in the curve and presenting one as a shining success story and the other as the worst-case scenario?
Korea will have to remain on alert, forever, as their population has no established immunity. A vaciine may never come - there is no influenza vaccine (it mutates every season).
Plus, there are grim, yet economic, benefits if the sickest and most elderly die from Coronavirus, in the form of long-term savings on pensions and healthcare. This should be taken into account in strategic national planning.
The UK approach seems the most sensible - keep the economy and society functioning, and recommend that the most vulnerable practice self-isolation. Better to isolate those who are not participating in the productive economy (ie. the sick and elderly) than the entirety of the population.
[+] [-] raspasov|6 years ago|reply
From what I read, South Korea shut down almost nothing but had widespread testing available, including drive-through testing where people could sit in their car, get tested and receive the results via SMS next day. They also had the ability to very proactively search and locate people that had been potentially exposed to the virus via credit card transaction/location data.
[+] [-] Nightshaxx|6 years ago|reply
[+] [-] bsaul|6 years ago|reply
[+] [-] benkuhn|6 years ago|reply
[+] [-] endogui|6 years ago|reply
[+] [-] cma|6 years ago|reply
[+] [-] gcatalfamo|6 years ago|reply
Not everybody here is behaving like a moron, luckily.
[+] [-] theseadroid|6 years ago|reply
Things are getting back to normal, with tons of precautions.
[+] [-] eBombzor|6 years ago|reply
[+] [-] toxicFork|6 years ago|reply
[+] [-] seemslegit|6 years ago|reply
Based on the Johns Hopkins CSSE data for March 13
On March 13 Germany had 3675 confirmed cases and only 7 deaths. Adjusted for respective populations Italy was at this stage 9 days before with 3089 confirmed cases, by which time it has already seen 107 deaths. This projects 21x COVID19 mortality rate for Italy over Germany - what gives ?
Italy's outbreak is concentrated in Lombardy so maybe weighing for the population of that area rather than the entire country is more appropriate which means Germany is currently 16 rather than 9 days behind Italy but with mortality in Italy still being 13 times higher than Germany.
Possible explanations:
Italy's 3089 confirmed cases 9 days before are selected for severity - only people who arrived with acute symptoms were tested, whereas Germany's 3675 are the results of more proactive testing and are dominated by mild or non-symptomatic cases that would have passed undetected in Italy.
Italy squandered some of its hospital capacity on first-diagnosed-first-hospitalized basis regardless of severity and began triage too late wheres Germany does better job prioritizing hospital vs home treatment from the start.
9 days before Lombardy's hospitals were already over capacity with 3089 confirmed cases while Germany's still aren't today. Germany has 2.5x the hospital beds per population than Italy, let's assume this holds for ICU beds as well. If capacity is the sole/dominant factor in this and we say that 9 days before Italy was already over capacity with 3089 cases than Germany will have reached a similar over-capacity at around 10k confirmed cases in a few days and then its mortality rate will begin to climb.
[+] [-] jgeerts|6 years ago|reply
Thinking that it won't happen to you won't make it go away unfortunately, your country isn't special, if no drastic measures are being taken like full quarantine this will happen to you too.
My country is in full lockdown and still a lot of people don't see the gravity of the situation. People dismissing it as less dangerous than influenza are misinformed.
[+] [-] darkteflon|6 years ago|reply
[+] [-] dnautics|6 years ago|reply
Why is this important? Because if knowledge authorities go around talking about severity with scary talking points, and in the end, it doesn't turn out to be so, then we wind up in a "boy who cried wolf" situation next time.
[+] [-] michaelbuckbee|6 years ago|reply
Given the many issues with the limited availability of testing this of real concern as it makes it much harder to judge the accuracy of "X days behind", etc.
[+] [-] atoav|6 years ago|reply
So how can one really compare the numbers between nations when their testing capabilitied are so different?
The ground truth is certainly deaths - if you know the mortality rate if the virus you can infer from the number of deaths how many people had been infected at some point in the past.
Of course it would be much better to have an idea how many people are infected now, so you can base your decisions on it..
The dangerous thing about viruses is that they grow in a logistic curve and the first part of that curve is exponential. So things can grow out of proportion literally overnight, like they did in Italy.
[+] [-] TeMPOraL|6 years ago|reply
[+] [-] contravariant|6 years ago|reply
As far as I can tell the situation does seems to be developing at the same rate, but going by the confirmed deaths I'd place Germany about 2 weeks behind Italy, not a mere 7 days. Which for exponential growth matters a lot.
Edit: Also note that forecasting countries as if they were South Korea has the opposite problem as the fatality rate of South Korea has remained low compared to other countries (though not as low as Germany's and those of Scandinavia).
[+] [-] ygra|6 years ago|reply
On Twitter the opinion seems mostly to be that the death cause is doctored.
I'm kinda hoping for the first, right now, because the projections aren't pretty (even if we're a bit further behind Italy). We only now started shutting down schools, and most events and even that is spotty as every state does its own thing and sometimes even every city.
[+] [-] Rexxar|6 years ago|reply
On the other side, people in Germany who gets the virus were very often young people travelling to Italy and they contaminate their young and healthy German friends when they come back in Germany.
This is probably enough to explain the initial difference in mortality.
[+] [-] ryanobjc|6 years ago|reply
But this is folly. There is no evidence that some “peoples” fare better and that some countries have “better” health systems. Evidence out of Seattle indicates that the illness rate and death rate from China are showing up here as well.
Don’t kid yourself that your area will be less hit and that’s why you can keep on living a normal life.
[+] [-] nujabe|6 years ago|reply
I think it's fair, Italy's population just happens oldest in Europe and more likely to suffer fatalities.
[+] [-] ocholaoizoren|6 years ago|reply
[deleted]
[+] [-] Analemma_|6 years ago|reply
[0]: https://twitter.com/scott_mintzer/status/1239290389963714562
[+] [-] jacquesm|6 years ago|reply
https://twitter.com/scott_mintzer/status/1239330209247215617
"Scott Mintzer Brain @scott_mintzer UPDATE: I have been contacted by a couple of people who say that this thread doesn’t not entirely paint an accurate picture of the whole Seattle area situation.
I do not want to delete and leave no trail, but anyone there other info should by all means report what’s going on."
[+] [-] turtlebits|6 years ago|reply
I guess people still aren’t taking it seriously, even though Seattle schools and libraries are closed for a month+.
[+] [-] jupp0r|6 years ago|reply
[+] [-] CraigJPerry|6 years ago|reply
https://twitter.com/lastson76/status/1239321792562343937?s=2...
[+] [-] jupiter90000|6 years ago|reply
[+] [-] rjeli|6 years ago|reply
[+] [-] Leary|6 years ago|reply
I am fairly skinny and it wouldn't take much for me to reach 25.
They should consider revising the cutoff especially since Chinese people can be of thinner frames. 25 may be slightly overweight for them but normal for others.
[+] [-] asjw|6 years ago|reply
South Korea had Seegen almost single handedly testing the population, China is not a standard of what a liberal democracy can do
We did everything we could, I've been staying home for 3 weeks as of now, but we couldn't predict the virus spreading from the hospitals of small cities hitting hard on the elderly population
80% of the deaths are >75, 98% are >65, the avreage age of the deceased is 79.4 years old but if we look only at women their average age was 84.2 years (South Korea life expectancy is 82 years) and we counted every death as a coronavirus related death if the patient tested positive, but most of them died for pre-existing conditions, while other countries are not counting them if other conditions where already present (and I imagine old people at the hospital are there because they are already ill)
So I must say that despite our own indiscipline, bad luck was a very strong factor in what happened
BTW Spain is already looking worse than us at their same day
[+] [-] BryanBigs|6 years ago|reply
[+] [-] unknown|6 years ago|reply
[deleted]
[+] [-] unknown|6 years ago|reply
[deleted]
[+] [-] nemo44x|6 years ago|reply
- Italian leather manufacturing is by and large run by Chinese ownership today.
- Many of the employees in these shops are from China as they will work for much less.
- Italian population skews very old - a very vulnerable population.
- Italian culture has close families that meet near daily, have generational family living together, and populations are proximal.
- The wide Chinese population in north Italy went back and forth to infected areas of China during the Chinese New Year.
- When they came back there were many “patient 0’s” in the region.
- Because of this, numerous exponential functions were set off at the same time.
- Because of the closeness of Italian culture the virus had the necessary engine to propagate.
It’s not Italy’s fault. They got a perfect storm here. They are managing the best they can.
[+] [-] TeMPOraL|6 years ago|reply
That's trivially disproved by simply taking JHU daily data of Italy and other countries, and plotting it as date x log(cases). You can see that most Western countries follow the exact same path.
[+] [-] mlyle|6 years ago|reply
This doesn't make much difference, other than complicating contact tracing, etc. Italy doesn't appear to be too different from other countries based on the data so far.
[+] [-] csomar|6 years ago|reply
That's like ... most of the world. The special case is the Western world and the USA.
[+] [-] scurvy|6 years ago|reply
Or are you just basing this off of raw case counts?
[+] [-] crispyporkbites|6 years ago|reply
Do we lift the quarantine? Relax it a bit? Stay in quarantine indefinitely?
What does the model look like for that? Without a full picture the initial strategy could make things worse in the long run.
[+] [-] jupp0r|6 years ago|reply
[+] [-] Camillo|6 years ago|reply
But sure, thank you CPC, a model response from a model government.
[+] [-] vkou|6 years ago|reply
It spread prior to the quarantine being put in place.
> at this point it's run its course, so it's successful mitigation
Only ~80,000 people out of 11,000,000 in Wuhan were infected. For a disease this contageous, that we don't have herd immunity for, that's hardly 'run its course'.
[+] [-] Camillo|6 years ago|reply
[+] [-] mothsonasloth|6 years ago|reply
https://discord.gg/prydRc
[+] [-] williesleg|6 years ago|reply
[deleted]
[+] [-] AncientTree|6 years ago|reply
Plus, there are grim, yet economic, benefits if the sickest and most elderly die from Coronavirus, in the form of long-term savings on pensions and healthcare. This should be taken into account in strategic national planning.
The UK approach seems the most sensible - keep the economy and society functioning, and recommend that the most vulnerable practice self-isolation. Better to isolate those who are not participating in the productive economy (ie. the sick and elderly) than the entirety of the population.