The coverage of the COVID-19 pandemic is replete with fantasies, frequently peddled as realities. There are realities. As of today at least 160,000 people worldwide have contracted COVID-19 and at least 6,000 people have died, both of which mostly in China. Those are realities. Here in the United States as of this writing those numbers are 3,324 people diagnosed with the disease of whom 63 have died. That’s 10 cases for each million population, a number that’s rising every day. Those are facts, too.
This morning on the talking heads programs Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health (NIH), asserted that the federal government is doing everything it can and everything it should to address the pandemic. That is an opinion. You would not have to search very hard to find people, both informed and un-, who hold the opposite view. That, too, is an opinion.
It is my opinion that the graph at the top of this post, which is making the rounds these days, is a fantasy or, at the very best, grossly oversimplified. My objections to the eye-catching infographic are many, the primary one being that we simply do not know whether any governmental or personal measure or group of measures would have the illustrated effect. The graphic is intended to convey the message that we can minimize the total number of deaths due to COVID-19 by constraining the rate at which new cases are diagnosed below the dashed line labelled “Health-care system capacity”. We do not know that any set of measures put in place now, on February 21, or on January 21, when the first case of COVID-19 was diagnosed in the United States, would have that effect. We just do not know.
My confidence would be higher if we had banned all foreign travel to the United States and closed our borders on December 21, 2019 but those measures would have required prescience and would undoubtedly have been condemned as a drastic overreaction. Our European cousins are condemning the recent announcement of a ban on European travel. You can imagine what their reaction would have been had that step been taken a month or two months ago. However, as soon as “community spread” began taking place, it may already have been too late to produce that outcome. Again, we just don’t know.
My second objection to that graphic is that the dashed line is depicted as flat (slope of zero). If we are prudent we should be increasing the slope of that line with all due haste. It is my understanding that is already happening by bringing trained individuals who have left the workforce for one reason or another back or by training new individuals as well as other creative ways of increasing the total size of the resource. But that doesn’t make as compelling an infographic.
My understanding is that measures being taken will not reduce the total number of cases or deaths but are intended to prevent the health care system from being overwhelmed.
As to Fauci, he lied about Robert Gallo’s theft of French research, and he misled us during the Ebola scare. He’s part of the swamp that needs draining.
We will need more staff, but I think the limiting factor will be equipment. We don’t have enough masks and they don’t fit a lot of people anyway. We need tons more PAPRs also. No idea who makes those, and they are better anyway, mostly. (Harder to work in I think.)
Fauci needs his organization working at full speed. His job is to protect and deny they did anything wrong in the past and to defend what they are currently doing.
“My confidence would be higher if we had banned all foreign travel to the United States ”
That needed to include Americans coming back. Or they needed to quarantine, though given how many stories we have of people not sticking to their quarantines we would still have had an outbreak. Think it just delays things.
Steve
Steve
Dr. Fauci’s claim was that the area under the curve in the “flattened curve” scenario was less than that in the “no intervention” scenario, i.e. fewer deaths. It should be noted that, since we have adopted travel bans first to China, then to continental Europe and most recently to the UK as well, the “no intervention” scenario has been obsolete for some time. Additionally, since many state and local governments, companies, and individuals, we’re a considerable distance from the “no intervention” scenario.
My private opinion is that we’d’ve needed to shut down international travel as well as all travel within the U. S. in January to flatten the curve enough.
Steve:
Since 3M appears to be a major manufacturer of PAPRs, I presume that my post on 3M’s actions pertains to those as well.
3M making 30% more is like pissing in the ocean if it gets bad. The numbers I have seen suggest that we have about 1-2% of the masks we would need. Also, people keep focusing on the N-95s because when they think of infections they think of people in masks. The N-95 does fit a lot of people. Its running about 25% in my group. They need PAPRs. The literature suggests a PAPR is probably better anyway of high risk procedures.
Steve
This graph is exactly the one I referred to yesterday. It’s really more of a concept. A rising capacity curve is of course a goal, but the horse has been out of the barn for decades; It’s absolute level is too low to handle the rise in the infection rate. The debate about what should be or should have been long ago is for the Monday morning quarterbacks.
The key right now is to slow the infection rate through responsible personal actions. The American people and their behavior have more ability to affect this rate and the ultimate outcome than government.
We got our first local case yesterday — Woman in her 70s from Orlando who flew here to visit relatives; her son had recently been in Switzerland and they were in a car together for two hours, and now both are hospitalized. (Think about this in terms of climate and which climate is relevant; it may have simply been transmitted in the trans-Atlantic airplane from unknown sources (maybe Switzerland, maybe not); and inside a car)
My brother returned Thursday from Netherlands/Belgium/France, and upon arrival in Atlanta wasn’t questioned.
Not particularly on topic for this post but relevant to the entire discussion. Lombardy (the part of Italy where their outbreak was first noticed) probably has the largest population of Chinese nationals in Italy.
I found this twitter-thread useful from a computational/system biologist working on infectious diseases who has spent five years in a world class ‘pandemic response modelling’ unit. Talks about what we don’t know:
https://mobile.twitter.com/BallouxFrancois/status/1238837158007447558
A very interesting thread, PD. Thank you. You may notice that it largely supports the view I’ve been taking. For example this (from the second Tweet):
and this (from the eighth)
In the worse case scenario, if the coronavirus is the “Wayne Gretzky†of viruses, both endemic and infection produces only short term immunity – “flattening the curve†would buy time to invent and produce at scale the “magic bulletâ€, (ie an effective antiviral or a vaccine).
Better pray that isn’t the situation everyone will be in.
I think we need to be prepared for the eventuality that NO effective vaccine is ever developed. That shouldn’t mean the end of everything. It would just mean that we would need to learn to live with a certain level of risk.
I’m struggling to understand the stats from China. If this really has peaked and fallen off as much as the figures show, can we infer that the measures taken there worked? Are they still implementing all of those measures, and if not, is there enough herd immunity?
And if those measures worked, how do our actions compare? I know that a lot of closings came late and in places where their not mandatory people are still congregating at restaurants and bars, but I don’t have a good understanding of when bans were instituted in the various Chinese locales to have a point of comparison.
I think we need to disregard the reports from China completely, relying only on Singapore, South Korea, Taiwan, and Japan as early indicators with Italy, France, Germany, etc. following behind.
I do believe the crisis is practically over in China.
The most trustworthy indicator in they are reopening schools — the CCP knows messing with kids safety is very dangerous, so the government must be confident to take that step.
You have to separate what the Chinese did outside of Hubei vs inside of Hubei.
Outside of Hubei, I would say the US / Europe is getting close, perhaps the only major difference is the stopping of long distance public transportation (air/rail).
Inside of Hubei — that’s a different story. Italy is at that level of lockdown. The Chinese took two more steps — they used CT scan / Chest X-Ray to do quick diagnosis (they also had problems with testing), and they forcibly quarantined people (put them in commandeered hotels) who had contact with confirmed cases.
On Bloomberg news today a doctor from Italy said they are starting to see fewer new cases, a possible hint that the lockdown imposed last week are having an affect.
On the US side, the place to look for where this goes is Washington State.