There are presently several differing models of national response to the COVID-19 outbreak. Let’s consider some of them.
China
Presently, the only “success story” in dealing with the COVID-19 outbreak is China. China’s number of new cases and present reported cases of COVID-19 are declining, people are recovering from it, and fewer who have it are dying.
In late December trains entering or leaving Wuhan were cancelled. On January 23 Wuhan and other cities in Hubei Province were “locked down”, i.e. neither people nor information was allowed to leave. By January 29 all cities in Hubei Province had been quarantined.
In my opinion these lockdowns and quarantines were not particularly effective since by January 29 every mainland Chinese province had one or more cases of the virus diagnosed.
To the best of my ability to determine the Chinese have been treating COVID-19 patients with some combination of modern and traditional Chinese medicine.
Frankly, I don’t believe the information we are receiving from the Chinese authorities at all. I don’t believe their case reports, recovery reports, or death reports. That’s a problem because none of the other countries’ approaches have been an unalloyed success.
South Korea
The approach taken by South Korea has been somewhat different. It has not engaged in the lockdowns of the Chinese response but has relied instead on an aggressive testing regime.
That has reduced the number of new cases but it has not, unfortunately, reduced the number of new cases to zero. Recently, there has been an uptick in the number of new cases. Whether that will result in a new wave remains to be seen.
The apparently lengthy recovery period remains a substantial complication. As long as those who are infected don’t recover and more people become infected, you don’t have the downward-sloping curve that the experts seem to be relying on.
It should be noted that at least 20% of all diagnosed South Korean cases derive from a single cluster.
Japan
Japan’s approach has been similar to South Korea’s but to my eye appears to have relied more closely on identifying and isolating clusters of infections.
Its infection rate has remained quite low (7 per million population) but given that there has been a recent uptick in diagnosed cases that may just mean that Japan is lagging behind other countries.
Conclusion
I am at a loss to explain Italy’s situation. IMO either Italy’s R, for unexplained reasons, is a lot higher than anywhere else, or the virus began to spread in Italy a lot earlier than they think it did. I simply don’t think that the numbers add up otherwise.
What that means for the U. S. I have no idea. If there are many, many more cases than we presently know about, that means that the virulence of the virus is actually lower than we presently think it is—closer to that the seasonal flu. More testing might allow us to identify clusters faster and more reliably. Then what?
Talking with our ID people they seem pretty convinced that Italy did not take the disease seriously at first. They also think that while S Korea was testing like crazy they had a lot of very successful self quarantining.
Steve
That one cluster related to a religious organization in South Korea accounted for 60+% of cases.
Given the majority of transmission is now believed to happen from asymptomatic or mild-symptomatic carriers, South Korea was “fortunate†with that one cluster in figuring out who to test.
Sadly, I doubt that we can rely on a lucky break or all of the occurrences of COVID-19 in the U. S. deriving from a single cluster. In theory we could test 330 million people. In practice we can’t. There will always be a certain level of non-compliance and, if we aren’t willing to deport people who are here illegally, I don’t see how we will be willing to test everybody forcibly.
As Guarneri suggested in the comments of another post, we need to concentrate resources where they’re most needed. However much we might wish that will be decided by experts that’s not what will happen. It will be decided politically.
I share your (everyones) distrust of Chinese numbers. If we stipulate, though, that they are somewhat directional and believe things have peaked then it will be due to an iron fisted quarantine approach. We can’t or won’t do that. Its irrelevant.
The SKorea experience seems to be an analog to what I’m talking about. A smaller, definable cluster that can be managed rather than trying to manage an entire country’s population. Japan may be following a similar cluster management strategy.
And then we have Italy. (Which we seem to be watching to take our cues.) Whether by national culture, carelessness, population age or whatever, they found themselves with everyman carriers infecting the vulnerable. It has had predictable results. Basically the current US approach.
“However much we might wish that will be decided by experts that’s not what will happen. It will be decided politically.”
Two weeks ago Nancy Pelosi and other horrid people of her ilk announced that Trump’s measured response was “too little, too late.” Media pounced. I had a sinking feeling. Then the politically motivated claim of “science deniers” came into vogue. The die was cast.
The issue became political – hysterical do anything and everything!! Let the medical science community determine everything. What did you think their response would be? Protect and save everyone of course.
No one thought like a manager. Reduce the problem by a factor of 10. Something I can actually manage. The only counter to what I’m saying here would be if the underlying assumption that the vulnerable group is concentrated is false; its more broadly distributed. I’ve seen reports of quite a few cases among the younger, but only 1 death. That occurs with any flu.
One concluding thought in this rant. If I was Trump I would have told all the news agencies “send your science and health reporters, leave the political reporters at home, I won’t call on them.” The media coverage has been despicable.
Would the Chinese authorities tell us if their outbreak had not peaked? I think they might lie, confident in their ability to manage the fallout of that lie after the fact.
I’m sure you are correct. The general point still pertains. They bludgeoned their population into quarantine. There must be horror stories. That option is simply not available in most western societies, especially the US. Our approach is fundamentally structurally flawed.
In the words of those towering deep thinkers, The Beastie Boys. You have to fight, for your right, to party!!!!
Let me put it this way. If Illinois’s governor sends out an order to “shelter in place” I will personally start a petition to impeach him. Online of course.
Read an article on Quillette on this and in the comments section someone suggested that the area in Italy was mafia controlled rag industry with many illegal Chinese workers. People donate unused clothing to goodwill, Salvation Army, and what doesn’t sell is baled and sold by the ton. Here in the US much of the bulk clothing is shipped to the Dominican and Haiti for profit. From Italy, I don’t know where. Point being, if true, illegal Chinese workers may have brought virus to Italy sooner than they think.