Thanks Andrew, that seems to be one of the most sensible articles about how Covid-19 should be handled that I have seen. — Janus

Indeed. Glad you've found it useful!

Putting all I've read together, including Andrew M's excellent article, unless extreme measures are taken, the US is going to hit half a million cases by about the middle of next month. Probably 250,000 identified and 250,000 downstream. — Baden

By my calculation, at the current trend of doubling every 2.5 days (case data here), the identified US cases would hit half a million by the end of this month. And 50 million by the middle of next month.

Any thoughts on why our math differs here? Perhaps you have a longer doubling period? Anyone else want to check the numbers?

The case growth has remained exponential despite the applied measures to date, as shown in the logarithmic graph here. Note that the same NYT article suggests we may need to wait up to two weeks to see if the most recent measures have their desired effect. But if ineffective, in two weeks the identified cases would be 1.2 million. With an estimated 5% requiring ICU beds (based on China data), the US would need 60k ICU beds, but the total number of ICU beds in the US is only 50-100k (which also need to serve non-coronavirus patients).

So in two weeks, if current measures don't work, doctors will need to start deciding who to save and who to let die, as Italy is doing now. In my view, this makes the case for nationwide lockdown now, as there's no time to wait and see if current measures are effective.

That's sad to hear, especially that fathers don't participate. And it's true what you say about the effects of an economic depression on people. I remember vividly when my country had a big recession in the 1990's an economist working in the Central Bank told us students plainly and directly: "The unemployed don't revolt. It won't happen. Unemployment is seen as a personal stigma." He was right, they didn't revolt. For example those 50 000 construction workers here that were pushed out permanently were out from the workforce forever. Likely after 25 years many of them are just "pensioners". That's how it goes.

Hopefully in the end everything goes well with this pandemic. And there's reason to believe so. Even if Covid-19 is a killer like the H1N1 virus of the Spanish Flu, the precautions already taken DO have an effect. Let's not forget that the Spanish Flu got it's name from Spain only because the country didn't have cencorship, which obviously made the pandemic worse. Or those hundreds of thousands of soldiers coming back home from the epidemic area of the battlefields.

That China has had so few deaths tells really that modern medicine and drastic measures work. I still believe that likely we don't get to the numbers of fatalities of the 1968/69 Hong Kong-flu pandemic which killed 1 million around the World. But the economic recession is real, unfortunately.

France and Germany are both approaching about the same number of cases per capita as Italy had when their health system started to break down. Both countries seem to be better prepared and holding up well so far. But the measures only slowly take effect, and even if they are fully effective, it'll probably take two weeks to reach the peak.

I have heard unconfirmed reports that despite the situation in Italy, Quarantine still isn't strictly observed there by everyone. People are still meeting in Cafes and the like. Boggles the mind.

The US is about to overtake Italy in new cases. Hunker down and don't take any chances. :pray: — Baden

It shows that 0% of the US cases are serious.

Any thoughts on why our math differs here? Perhaps you have a longer doubling period? Anyone else want to check the numbers? — Andrew M

Do you take into account the effect of "social distancing" and the lock downs?

You see for a logarithmic scale to continue, you would need to have people mingle as they did few weeks ago. Or put it another way. Why are there less new infections than before in China. Surely there would have to be tens if not hundreds of thousands dead by now. So is the Chinese authorities just covering up everything? Do you think that is possible in our time?

I have heard unconfirmed reports that despite the situation in Italy, Quarantine still isn't strictly observed there by everyone. People are still meeting in Cafes and the like. Boggles the mind. — Echarmion

Italians are Italians.

Chinese Red Cross Vice President Sun Shuopeng warned Italians that they were risking lives by not adhering to the novel coronavirus lockdown. He made the comments after visiting Milan in the hardest-hit region of Italy, which has recorded 41,035 cases and 3,405 deaths. “Here in Milan, the hardest-hit area by COVID-19, the lockdown measures are very lax,” the veteran of the Wuhan epidemic fight said Thursday. “I can see public transport is still running, people are still moving around, having gatherings in hotels and they are not wearing masks.” Sun warned that the resistance to the lockdown will prove deadly. “I don’t know what people here are thinking. We really have to stop our usual economic activities and our usual human interactions. We have to stay at home and make every effort to save lives. It is worth putting every cost we have into saving lives.”

Any thoughts on why our math differs here? Perhaps you have a longer doubling period? Anyone else want to check the numbers?
— Andrew M
Do you take into account the effect of "social distancing" and the lock downs? — ssu

I'm extrapolating purely from the reported US case numbers in the table here. Yes, there are lots of unknowns, including cases missed due to inadequate testing, and the effects of the the NY and CA lockdowns. I discuss those where I use the term "measures".

You see for a logarithmic scale to continue, you would need to have people mingle as they did few weeks ago. Or put it another way. Why are there less new infections than before in China. Surely there would have to be tens if not hundreds of thousands dead by now. So is the Chinese authorities just covering up everything? Do you think that is possible in our time? — ssu

No, China's measures were effective.

The comparison with the US situation is that China's measures were stronger, made earlier in their epidemic and severely enforced. They shut down Wuhan when their identified case count was only 400 in a day whereas there were 5000 new identified cases in the US yesterday. China shut down 15 further cities the following day.

It shows that 0% of the US cases are serious. — Hanover

That 0% hides an exponential growth curve. Those case and death numbers are doubling every 2-3 days.

I'm extrapolating purely from the reported US case numbers in the table here. — Andrew M

And that is a great looking logarithmic scale growth to extrapolate from.

But notice that the information itself has an effect here. When you get greater numbers, you get greater panic and more drastic measures. That will have an effect on the forecast and the extrapolation may need what in economics and statistic is called a Dummy variable.

For example, now New York City has 43+ deaths from corona virus. What do you think the effect would be if it would be in few weeks it would be 400 or 4 000? I figure the amount wouldn't be quite high when the lockdown and the curfew will be enforce by police and the national guard, which will stop people walking in the street.

It's not clear to me what your point is. If it's that somebody should have done things differently, I dont see a lot of value in that kind of 20-20 hindsight. People always do the best they can with what they know. People make mistakes. Move on. — frank

This is just insane. There's so many things wrong with this I don't know where to start. It seems that reality has caught up to the "I'm a contrarian for style" attitude towards reasoned discourse.

First, this sentence "people always do the best they can with what they know" only makes even any descriptive sense if you assume people are doing their best according to the same ethical scale, which is obviously not true. The serial killer might be doing his best and the police trying to catch him might be doing his best too, but the detective is unlikely to reason "well, he's doing his best with the information he has about how to kill people and get away with it, but people make mistakes, time to move on". It is obviously the ethical difference of what "doing one's best is" which creates the conflicting situation for the detective.

I have made it quite clear in my analysis that there is an ethical difference with Western leadership in this situation, that they wanted to protect the stock market over people's lives. We can go into the evidence for this if you really want to be that cool a contrarian. I have a lot of time on my hands ... but something tells me you may not have time to go into it in the weeks to come.

So, even if I admitted the premise that "everyone's doing their best with the information they have" in a sort of kindergarten playground view of politics where as long as a politician is just as reasonable as the stupidest member of their base, we should empathize with their hurt feelings for being called out on starting a war based on "intelligence fixed around the policy", or giving trillions of dollars to their corporate friends, or passing or defending existing laws making corruption legal -- even if I admitted that premise, if such people have an incompatible ethic to mine, if their goal is to create a crony system to line their pockets, then it's an even greater problem for me if they indeed are "doing their best".

But of course the premise isn't true. Criminal negligence exists as a crime precisely because people don't "always do their best with the information they have". Are you really defending the position that criminal negligence has never occurred? People have always done their best and perceived victims and the justice system should always just "move on" in such situation?

What's worse than throwing down some truisms, that aren't even really good truisms, is the implication of your argument that people should therefore not be held responsibility for mistakes and everyone should move on.

The whole premise of democracy is to get better management in place, not continuously excuse bad management, so, if they are "just mistakes" clearly they're pretty big mistakes and the argument could be made that maybe a first or second grade level of learning ability and critical thinking should be aimed for.

This is not a joke, I'm pretty sure I could explain exponential growth to a precocious first grader or your average second grader (at least in countries with evenly funded, high standards, public education), as they know basic addition and multiplication, and so explain why the disease will propagate really quickly, hurt a lot of people if nothing's done, why containment is important early on, and the basis of social distancing so doctors can help everyone. These are all really simple concepts and all that's needed to understand to make good decisions.

The idea decisions couldn't have been better really is premised on the idea that leadership shouldn't be expected to have an analysis more sophisticated than a kindergarten child. Either, literally the case with Trump who a first and second grader would be able to tell is not making any sense, or then in a sort of plausible deniability "no one saw this coming" sort of way to indeed cover for mistakes (but not the mistake of trying to save people's lives but just not having information about that, the mistake of thinking inaction would be good for the stock market and being disastrously wrong so, now that that's clear, pretending to be an idiot sounds better than explaining what information was known when, and why inaction was chosen over action).

That way you have energy to deal with with what you've got. I'm in an emergency room now preparing for a 12 hour shift. Wish me luck. — frank

I wish your patients luck. As for you personally, you'll get what you deserve in this situation.

Even Trump supporters may be able to see this obvious logic considering the time frame is so short; many are impressively immune, updating their beliefs Trump is not to blame for anything in real time, but we will see if this applies to all members of the flock. — boethius

What obvious logic? I agree that Trumps initial response was bad PR, he went all out to claim the problem was under control while it was not. However, I do not see a problem with the actions he took. He quickly (much more quickly than e.g. European countries) introduced travel restrictions, and appointed a Corona Tsar to coordinate further actions. What exactly should he have done that he did not?
I feel the strong smell of TDS here again.... orangeman bad, no matter what.

What obvious logic? I agree that Trumps initial response was bad PR, he went all out to claim the problem was under control while it was not. However, I do not see a problem with the actions he took. He quickly (much more quickly than e.g. European countries) introduced travel restrictions, and appointed a Corona Tsar to coordinate further actions. What exactly should he have done that he did not?

I feel the strong smell of TDS here again.... orangeman bad, no matter what. — Nobeernolife

I'm just going to appreciate this beautiful exercise in mental gymnastics, let it stand a bit as a refined and advanced example of the double-think talent, and then completely demolish it.

I'm just going to appreciate this beautiful exercise in mental gymnastics, let it stand a bit as a refined and advanced example of the double-think talent, and then completely demolish it. — boethius

So in other words you can not give a concrete example of what Trump should have done that he did not. Figures.

That 0% hides an exponential growth curve. Those case and death numbers are doubling every 2-3 days. — Andrew M

So the 0% is bad?

So in other words you can not give a concrete example of what Trump should have done that he did not. Figures. — Nobeernolife

Did you even read to the end of the sentence?

Why would saying I'll do something later imply I am unable to do it?

I can't go into this now, because the layers of denial are so thick that it will take more work to fully explain every reasoning mistake you are committed to.

But to give one simple example, so you don't live in some illusion in the meantime that I'm delaying because "I can't deliver", Trump could have seen that relying on a single test process was a large risk; that "diversification" is a key risk reduction strategy.

Mitigating actions of a test failure would have been:

1. Had one or two parallel test-kids developed by other companies to increase the odds one is successful at scaling quickly in the critical first outbreak phase (where all reductions in infection rates have the highest return on investment; Tump's a business mad so surely understands that concept).
2. Negotiate to fly-in some tests short term (maybe in exchange) if testing is delayed, perhaps in exchange for money as well as promise to fly back even more tests when things are sorted out in the US. Because, you know, he's the president and can phone up other leaders and "make a deal".
3. Invest and re-organize in scaling tests as quickly as possible once the problems were solved.

Sure, it was also bad PR to claim the "Anybody that needs a test gets a test; they're there, they have the tests, and the tests are beautiful" and "The tests are all perfect, like the letter was perfect, the transcription was perfect, right? [...] This was not as perfect as that, but pretty good.", but it was also terrible decision in the real world of managing the test situation.

As the "doctor" I criticize above points out, it's difficult to make decisions without good information, so anyone managing this crisis at a first or second grade critical thinking level would have been very focused on the tests and making sure they happen quickly.

You're so bitter. Maybe you should read more Boethius.

So the 0% is bad? — Hanover

It's like starting a fire in your house. In the beginning it's just a candle and the fire is "contained" so nothing to worry about, then the candle falls over due to making a half-asked effort to put the candle correctly in the candle holder. The fire starts to spread, but at first it's only "0%", if rounding to 1 digit, of the house, not to mention the county or the state or the entire world (most of the world's ocean anyways, immune to wood-based fires!).

Then the fire grows, consumes the house, jumps to the woods, causes a massive forest fire that is some meaningful percent of the state, burns down whole towns ... but because people aren't flying this fire all over the world, it's stilled contained to it's geographic area due to the physical dynamics of how fires spread, it doesn't become a significant percent globally ... so I guess this analogy doesn't lead to something you would actually consider a problem.

However, for the sake of argument, imagine people do fly the fire all over the world, well now there's a global problem, very expensive, all started from a mismanaged candle. If you want a "natural" trigger, just replace the candle with a lightening strike in a field and the town fire department saying "well, it's not a whole percent of the world yet, so we will wait to act".

The most cost-effective time to stop the fire is before it's out of control. Once it becomes out of control, "not everyone will die" isn't really relevant to people and governments dealing with the fire.

I wish your patients luck. As for you personally, you'll get what you deserve in this situation. — boethius

I have no idea who you are but remaining humble is my suggestion for a start on how to deal on an interpersonal level with others.

What I quoted above is a direct attack on a fellow thinker who also happens to be on the front line of this war so either say something positive to another member or say nothing at all.

What a small person to attack someone trying to help others, pathetic.

AND as far as doing the best we can with what we have and what we know IS the best many of us can do.

Just back off the personal attacks and we might just get somewhere POSITIVE.

And Frank, my every energy is with you and you wife to help keep YOU safe.

Good energies surround you from me :pray:

Mitigating actions of a test failure would have been:

1. Had one or two parallel test-kids developed by other companies to increase the odds one is successful at scaling quickly in the critical first outbreak phase (where all reductions in infection rates have the highest return on investment; Tump's a business mad so surely understands that concept).
2. Negotiate to fly-in some tests short term (maybe in exchange) if testing is delayed, perhaps in exchange for money as well as promise to fly back even more tests when things are sorted out in the US. Because, you know, he's the president and can phone up other leaders and "make a deal".
3. Invest and re-organize in scaling tests as quickly as possible once the problems were solved. — boethius

I understand all of this is being done.
I fail to see what he could have done differently in concrete terms, He reacted quickly, and as I pointed out, quicker than other European countries (although not as quick as Taiwan and Singapore, I give you that. But those places, being Chinese, arguably had a lot better insight of what is going on in the PRC).

I have no idea who you are but remaining humble is my suggestion for a start on how to deal on an interpersonal level with others. — ArguingWAristotleTiff

It's not an attack. It's a prediction. I predict you can't avoid the consequences of an overloaded medical system if you are a medical professional. It's essentially a mathematical certainty at this point.

I'm extrapolating purely from the reported US case numbers in the table here.
— Andrew M
And that is a great looking logarithmic scale growth to extrapolate from.

But notice that the information itself has an effect here. When you get greater numbers, you get greater panic and more drastic measures. That will have an effect on the forecast and the extrapolation may need what in economics and statistic is called a Dummy variable.

For example, now New York City has 43+ deaths from corona virus. What do you think the effect would be if it would be in few weeks it would be 400 or 4 000? I figure the amount wouldn't be quite high when the lockdown and the curfew will be enforce by police and the national guard, which will stop people walking in the street. — ssu

Yes, I would expect those things to have an effect. But as we've seen elsewhere, those effects may not register in the figures for up to 2 weeks (some of those who got the virus the day before the lockdown may not be tested for up to two weeks). And the success of the lockdown depends on how well it is enforced in practice (see the Milan example quoted above), as well as the specifics of the lockdown. Another factor is that testing may still be inadequate so the base numbers themselves may be much higher right now.

As it happens I was in New York City until last weekend (and in LA a few days ago), so I've seen firsthand how long it takes for social distancing and other measures to properly take hold. Problems may surface with the lockdowns as well.

Then there's the potential effect of overwhelmed hospitals and health workers. The available ICU beds and health workers are critical factors.

So whether we see 400 or 4000 or more in a few weeks would seem to depend crucially on whether the needed measures are made soon enough.

(Got to go now but will follow up tomorrow.)

It's not an attack. It's a prediction. I predict you can't avoid the consequences of an overloaded medical system if you are a medical professional. It's essentially a mathematical certainty at this point. — boethius

You can state what you believe to be fact without personal attacks. Saying you get what you deserve was stated in a personal way to Frank.
Own it and apologize or own it and not apologize. Either way it's a reflection on you.

I understand all of this is being done.

I fail to see what he could have done differently in concrete terms, He reacted quickly, and as I pointed out, quicker than other European countries (although not as quick as Taiwan and Singapore, I give you that. — Nobeernolife

You provide the counter examples to your own argument. That's not a good debate tactic.

South Korea is also a great example of what competence looks like.

The problem grows exponentially in the outbreak phase. Every doubling time matters a whole lot; indeed doubles the problem. Doing the things that should have been done, only later, is not at all the same thing as doing them on time. This will take some math to explain (and any leader we expect to be running at an above kindergarten thinking level would be able to understand), so I will fully develop it in my full response to your previous comment.

That 0% hides an exponential growth curve. Those case and death numbers are doubling every 2-3 days.
— Andrew M

So the 0% is bad? — Hanover

Only if people think that there's nothing to see there. What percentage do you think it should be before taking action?

You can state what you believe to be fact without personal attacks. Saying you get what you deserve was stated in a personal way to Frank. — ArguingWAristotleTiff

It's not a personal attack. It's a personal prediction, but I have strong arguments for why the prediction will come true.

If my prediction is untrue, then can come back and say "nope, didn't encounter any unusual difficulties due to corona virus; I was completely right to downplay the threat, whatever small mistakes the administration made in failing to contain or prepare seriously in February didn't really have much impact on how things played, we should move on from those small details, can verify myself all doctors who were super concerned and crying wolf feel silly now".

It's only a "meany attack" if my analysis is right in which case a medical professional that downplays my analysis will suffer the consequences personally.

Ignoring a danger and then suffering the consequences of that danger is a textbook definition of "getting what you deserve". As someone with some sort of medical authority, could have had much higher impact on helping to prepare himself and his colleagues as well as shape public opinion.

certainly assumes he's done the best he can with the information I've provided here and, more importantly, medical professionals around the world. Again, if that premise is wrong, and he could have done better with the information he's had access to, he'll get what he deserves in not doing his best for himself and his patients.

So, my conclusion follows from my premise. What matters is the premise.

In terms of the medical system, political leadership and society as a whole, excusing all the mistakes that have been made, means keeping people who are not acting in the public interest or not competent (or both) exactly where they are, not learning anything and so inviting the same mistakes next time or for some other crisis (which could be tomorrow).

I have read your response and I will leave your words to justify your intention.
It was uncalled for and unappreciated.

I dont have any authority. I'm a respiratory therapist who used to sell medical equipment and now is back in the clinical setting.


Thanks! It's strangely quiet right now (with rumbling in the distance) :grimace:

Yes, I would expect those things to have an effect. But as we've seen elsewhere, those effects may not register in the figures for up to 2 weeks — Andrew M

This is true, but there is also the crucial moment measured in days just when the pandemic got rolling on. When it started in Italy, Europe or the West hadn't got the pandemic hysteria. Now when it has truly started in the US, the population takes action.

And just how successful that "social distancing"? If we take into consideration that China has roughly about 24 more times people than Italy, then it wouldn't be that China has less deaths. Yet month ago when the epidemic started in Italy and when there were only a handful of deaths the actions were taken only regionally. The CNN journalist one month ago were reporting from a Venice quite full with tourists going around.

South Korea is also a great example of what competence looks like. — boethius

Would be even greater if there wouldn't have been patient 31. This tells just how much things are prone to the butterfly effect:

In South Korea, where the virus first appeared on Jan. 20, public officials said the situation was largely under control for the first several weeks, as the first 30 infected people adhered to strict containment strategies.

But patient 31 changed everything. “The situation here was not really serious until mid-February,” said Hwang Seung-sik, a spatio-temporal epidemiologist at Seoul National University, in an interview with Al-Jazeera. “It began to get very serious starting with patient 31.”

Patient 31 traveled extensively through South Korea, even after doctors had suggested she isolate herself due to a high likelihood that she had been infected. The Korean Center for Disease Control found that she ultimately had contact with approximately 1,160 people. There are now more than 7,800 confirmed cases in South Korea, and more than 60 people have died.

Actually now 8799 cases and 102 deaths and counting.

I dont have any authority. I'm a respiratory therapist who used to sell medical equipment and now is back in the clinical setting. — frank

This is still more medical authority compared to someone who knows nothing about medicine.

Of course you believe you did the best you could with the information you had, as you believe that about everyone it seems. I am predicting you will see in this crisis why such an assumption is erroneous.

If we assume people above us in authority are "doing the best they can" then there's no reason to challenge them, nor mitigate bad decisions that we see happening.

Even if you don't perceive you have any authority at all to persuade about respiratory illness or the consequences of running out of respiratory equipment, sharing correct analysis with colleagues who do have "authority", as you would consider it, could have better informed them if they were otherwise busy resulting in the best decisions according to your social theory, as well as informing your close circles and social media circles, doing your part to fight misinformation that the crisis can be downplayed (of course, assuming my analysis is largely correct; if the crisis is overblown, then there are no lessons to learn).