Read the whole thing, but this passage in particular is just chilling.

"5/ Patients above 65 or younger with comorbidities are not even assessed by ITU, I am not saying not tubed, I’m saying not assessed and no ITU staff attends when they arrest. Staff are working as much as they can but they are starting to get sick and are emotionally overwhelmed."

[1] https://oecdregionalwellbeing.org/ITC4.html

[2] https://www.youtube.com/watch?v=s85xG9Ol3Po

https://youtu.be/Kas0tIxDvrg

I would certainly like to see the example of a country able to learn from the mistakes of others.

EDIT: I realize that this response is easier to do for SAP than for the average company since we are all working in front of computers anyway the entire time, with only 1-2% of tasks tied to physical objects (paper forms, server hardware etc.).

So yes, just business as usual.

I'm close to Hamburg. We've had two or three confirmed cases in the county. Patients are quarantined at home and stable. Schools have been temporarily closed, but reopened now. The administration is taking it very serious and people are stocking up on everything, including cake.

Countries have to overreact to the circumstances that they are confronted with because in a week the situation will be much worse if they don't. The only options are to overreact when everything seems fine or to overreact when the hospitals are full past capacity.

The choices here are to overreact before the virus gets past the border; overreact when the first cases appear; overreact when the first cluster is identified or overreact when people who can't breath are being turned away from hospitals. We have yet to see what happens past that point because so far everyone has instituted a quarantine then. Germany is at the clusters developing stage.

In line with what you are saying, a problem, is that the proper reaction, if works, looks like an overreaction later. So, politically, there is an incentive to do nothing.

Feel happy now about the ad-hominem?

https://www.cnbc.com/2020/03/11/up-to-150-million-americans-...

The WHO reports "Globally, about 3.4% of reported COVID-19 cases have died".

If 50% the population gets infected, and if it's not 3.4% but "just" 3% mortality rate, that's already 1 million dead.

And according to some experts, even 70% infection rate is predicted.

Second, this 3.4% percentage of deceased patients, is at the early stages, with fewer patients and preventive measures (so that most patients that needed hospital treatment got it).

A 10% or more of patients of COVID-19 will need hospital treatment and ICU. As the number of patients rise, there wont be as many ICU units (and doctors are getting infected themselves at an alarming rate).

In Italy with ~ 7000 cases, "hospitals are scrambling to increase the number of beds available in intensive care units. Some have closed entire wards to dedicate them to severe coronavirus cases. Others have transformed operating rooms into intensive care units. Doctors are working grueling shifts to cover for colleagues who fall ill".

Let's put it this way, they have 9,172 cases and 463 deaths.

Now imagine with 100,000 or 1,000,000 cases -- still very far from the predicted 70%.

But ok, the source is your own calculations. Thanks for confirming.

That's not how epidemics work when they are contained quickly.

Europe has done a bad job at this.

Epidemics in the past have killed many times as many as the percentages above.

First, using the total population as a basis is just wrong. Some will certainly be immune to a certain degree while others are simply lucky.

Even very aggressive pandemics, hitting totally ill-prepared societies didn't infect every single person. Not even the black death managed to do so. So why do you think COVID-19 would end up doing that?

And using the 3.4% is another issue. Because you have the Wuhan rate, which is much higher than the rate eslewhere. And this thing is a moving target because testing was rather limted earlier. South Korea seems to be the best source to get mortalitiy rates due to their aggressive testing.

south korea is an outlier and most of their cases are not resolved, they may have a lot of false positives

time to act was weeks ago.

Or if you don't like my turkey reference, let's stay in the realm of technology. Pop quiz: who said "Only the paranoid survive?"

Nobody is suggesting people should quarantine themselves in Berlin, but avoiding crowded spaces, not touching your face and frequently washing your hands doesn't seem at all unreasonable.

EDIT: According to officials, one county in germany is considered high risk (link in German): https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus...

Risk matrix example: https://www.researchgate.net/profile/Kevin_Fleming3/publicat...

This is in NRW, however, where we have by far the most confirmed cases in Germany. Might be different in other places.

Actually Covid-19 cleaning solutions would be a temporary business to get into.

depending on how long friend is employed by this company, the resulting leal case could be rather expensive for the employer. Your friend would still have to look for another job, so...

Quarantines of mass amounts of the population are not going to help, what needs to be done is isolate those most at risk from the general population

Absolute containment is highly unlikely, but delay can help a ton.

Edited: Just found the article (Malling Skole i Østjylland)

https://www.dr.dk/nyheder/indland/skole-sender-klasse-i-kara...

https://ourworldindata.org/coronavirus

All measures we take optimize for that. Vaccination increase the amount of immune people, quarantine pulls the inflection point forward and slows the spreading. Protecting the most at risk population further reduces the risk of spreading. And so on. So yes, the early phases are exponential. But the later phases are not. So modelling this thing exponentially against the max. number people on earth is just wrong.

Italy was slow, and is already a nightmare.

Italy was slower than that.

[1] https://foreignpolicy.com/2020/03/09/italy-covid19-coronavir...

To be fair, that is true of 95% of humanity.

These politicians are representative of their voters, as democracy should be.

Isn't it that they make decisions on behalf of the voters and should take the best professional advice on their behalf?

So far we have never come up with a working political system that banishes this stuff. It's a game theory problem.

I don’t have any well-thought-out solutions, but I am tickled by the idea of frequently anarchically randomising the way power gets donated from the people to the government.

The idea is that every citizen would be involved in one, maybe two laws in their entire lifetime, therefore giving them the sense that this is the one time they can contribute to politics in a meaningful way. Also their names are tied to that particular law forever, meaning that fear of social pressure could be more effective than for a politician who votes for 1000s of things in their political career.

I'm by no means an expert, but to me the problem seems to be lack of proactive social distancing; and lack of proactive testing of everyone with symptoms.

Current guidelines seems statistically sound, it's just that we have little mitigation for the few that do slip through.

"The researchers found very high levels of virus emitted from the throat of patients from the earliest point in their illness —when people are generally still going about their daily routines"

https://www.statnews.com/2020/03/09/people-shed-high-levels-...

The stories abound of a hospital visit with a magical bill that appears months later with some unpaid sum that's in the 4 digits. Everyone knows someone who this happened to - I happened to know a couple who received a 5-digit bill for a baby who died many many months later. Now, as a rational person you're not going to go to an ER willy nilly, and sometimes an ER is what you get pointed to by smaller medical centers.

The U.S. medical model doesn't work - for the group. It works - for the individual. I had superb eye surgery recently from a top world center and it was fully paid. But the viruses don't care if one of us can afford care, and the other can't, because the virus views us as a singular organism, and now we're all at risk. Which is exactly how the health system should begin viewing us.

I'm particularly miffed about this because it seems to have spread to our shores and convinced a bunch of people that the reason the UK has lower numbers than Italy is because they're not testing people, to the point they're literally unable to believe that Italy has only tested twice as many patients for the coronavirus as the UK.

"In a series of 51 patients with chest CT and RT-PCR assay performed within 3 days, the sensitivity of CT for COVID-19 infection was 98% compared to RT-PCR sensitivity of 71% (p<.001)."

https://pubs.rsna.org/doi/10.1148/radiol.2020200432

https://www.youtube.com/watch?v=xhYJS80MgYA

Little trick to know (with some good approximation) the doubling time of some low-percentage growing system: count it linearly up to 10% and then multiply by 7 (which is roughly the doubling time for 10% growth). Example: 2% => 5*7=35 years to double.

If something grows by 2% per day, vs 2.1% per day, after a year the second one is >20x bigger.

  >>> 1.02**365
  1377.4082919660768
  >>> 1.021**365
  1969.6808462403098
  >>>

Apparently I don't understand exponential growth either cause I assumed a 5% difference scales linearly (as in the difference between 20% vs 21% growth rates for a given period should be the same as between 2% and 2.1%).

Silly me.

Any call for drastic measures, even when drastic measures seem like common sense to some people, need to explain why the measures should be implemented and under what circumstances they should be lifted.

They're lifted after most of the population has already been infected and the disease has run its course (as in China).

> Now long would you maintain that quarantine?

I'd suggest start with 2 weeks, and reassess after 10 days. I note that in TFA Italy's administration extended this (initially) out to the 3rd of April, which seems like a reasonable timeframe.

Incarcerated people rioted ... and a churlish part of my brain suggests that's just to be expected, but each nation state can learn from, and put more effort into educating than, the earlier pioneers.

> Is there some amount of time after which the virus will go away?

We don't really know - but it sounds like a rhetorical question(?).

I know that I'd be happy with a two week lockdown - option to renew - here in AU ... especially if it reduced my chance of dying. The numbers cited in TFA are suggesting a 3% mortality rate now, and massive propagation rates and embarrassingly poor treatment / survival rates even in a first world country early on in the pandemic cycle.

> Any call for drastic measures, even when drastic measures seem like common sense to some people, need to explain why the measures should be implemented and under what circumstances they should be lifted.

I'd invert your usage of the precautionary principle and ask, given what we know so far, why the default response isn't to shut down non-essential travel and public events for a couple of weeks.

I mean, what's your acceptable ratio of dead people : inconvenienced live people?

step 1 should have been to bring military in the streets to enforce the thing, because police is both decimated by the virus and overwhelmed from the new responsibilities and cannot handle what's happening

Where I live I already have to provide my babysitter a signed letter where I certify that she comes to work here. She's from a different township (comune) and the police could fine her if caught without that document.

It's not going to stop 100% of people from moving around, but even it this reduces the spread by a few % it's already a big improvement; even reducing the daily rate from 21% to 20% can have a 20x effect on total cases over a year.

so I guess I was right since the beginning

But i askari think it will go exactly like the Spanish flu. We will have a second wave which will also kill the younger.

The people that scare the hell out of me are the gaggles of PhDs and other "very smart people" who seem to think that we shouldn't be closing schools and working from home because reasons. Our organization doesn't even have paper towels in the bathrooms (It's bad for the environment!). Actual sanitation is not a priority.

By comparing the number of Corona virus cases and deaths to the annual flu deaths he is implying that the number of deaths from Corona virus in the US is low and the risk is negligible, and while it is currently low this completely misses the point that in other countries it has proven to be extremely contagious and has a much higher mortality rate than flu. In other words, there is a significant risk if adequate steps aren't taken to reduce the risk of transmission. See: Italy, China.

You can also have non-exponential growth and still have many new cases, if people are getting over their infections faster than they're infecting new people. If a million people were currently infected and every week 500,000 new people were infected but 500,001 of the existing infected people recovered, that means the number of currently infected people declines over time, but you'd still have 500,000 new cases every week and just about everybody might eventually get infected before it dies out, even if it eventually does. (This is similar to what happens with the flu, except that it has exponential growth in winter and then below exponential growth in the other three seasons, so the actually dying out never really comes.)

To really get rid of it you want to have something like 100,000 cases last week and 75,000 cases this week and so on. But even then you might have 25,000 fewer cases this week because 50,000 people recovered but 25,000 new people got infected.

So whether it has exponential growth or not isn't really the issue. It's what the growth rate is. A small exponential growth rate isn't catastrophic -- the number of cases grows but not so fast that everybody is infected by the time they have a vaccine or other more effective countermeasures that get the growth rate back below exponential.

Most importantly, the growth rate isn't immutable. It's affected by things like people washing their hands and having effective testing and quarantines. So will things be fine? They will if people do the right things. Maybe some of them have been and some of them haven't. Maybe they'll get better at it going forward, maybe they won't. As a result there is a significant amount of uncertainty.

But panic is useless. Even if all they can do is reduce the growth rate from 150% to 130%, that still buys more time to respond. Even if everybody ultimately gets it, better that it happen over five years than five months. And if some people are doing it wrong, try to help them do better. Everybody likes to see the bad orange man look stupid on the television, but maybe this is a situation where we come out better off with everybody working together.

Which is why the growth rate is really what matters. Which isn't immutable. It goes down if people wash their hands. It goes down if sick people stay at home.

This is also why it really matters if the rate is 150% or 130%, even if both are very bad, because the higher rate is very worse. And the rate gets lower if sick people stay home, but it gets higher if idiots panic and start hoarding masks and stealing hand sanitizer which increases the rate of infection when they aren't there for other people to use.

Panic is not just useless, it's actively harmful.

Another sign that people don't get exponential growth, even if they think they do.

So no, panic never helps. Staying calm and level headed does.

But if you want to panic, do it. But do it in private, panic itself is rather contagious as well. Maybe self-quarantine.

Here in Denmark, where we're seeing an outbreak take hold, it's the EXACT opposite.

People are going out even though they have been told to self-quarantine, even boarding planes.

A couple refused to cancel a vacation trip even though they had been asked to quarantine because their son has been diagnosed with the virus.

I really think we could use a tiny bit more panic

At this point, things are so looking so grim that there's no way to tell people not to panic without unacceptable downplaying of the gravity of the situation.

Panic is was caused the toilet paper craze.

In at least a few cases though I doubt it was not panic buying.

This should be taken seriously and people should put effort into prevention, but honestly I would prefer calling upon people's sense of civic duty rather than panic.

If that's the extent of the damage caused by panic, then we are going to be fine.

Disclaimer: I've spent quite a lot of holidays in the south, since both my parents grew up there.

Frankly, nobody knows what to do. Here we are, pondering what to do with the kids.

* The school district is open for business in spite of being the ground zero of USA outbreak. Because no kid has tested positive yet. Meanwhile, the testing scale is tiny [thousands, in a nation of 300M] and the latency is horrendous [5 days]. Most likely the virus is already endemic in the kid population.

* OK, so let's keep the kids at home, as SPS will eventually have to face the obvious and close the schools. For how long? A week? A month? Until summer? Until next year? Send them to school and pray for the best once everybody in the family eventually gets the disease?

Hard to do, when the correct thing for the administration to do is to stand back and hand decision making authority and control of resources to the bureaucracy. As long as the administration keeps interfering in the response, anything about the issue can't avoid being political.

https://www.snopes.com/fact-check/trump-fire-pandemic-team/

The executive and administrative branches together respond to a crisis like this - for example by coordinating actions, providing more funding for health services or in extremis ordering quarantine in affected areas. None of that has been done. I don't think you can effectively separate the two responses, nor do I think this outbreak is somehow Trump's fault, but he and his administration are responding remarkably badly to it.

Exactly! That is what is meant by not letting polarized politics drive the issue. We shouldn't care what 'side' is doing what, we should be focused on preventing an epidemic. Personally, IDGAF about assigning blame to any side, I'd rather that the petty bickering is dropped and effective measures are taken.

I realize the climate in the US isn't conducive to this, but assigning blame doesn't fix anything. Rather than blaming people, effective steps need to be taken. Focusing on assigning blame just puts the other side on the defensive; which is counterproductive to the kind of cooperation that will be needed to effectively respond to this crisis.

The problem is that this holds true regardless of who you consider to be "the other side."

Here in Oregon, our governor is politically on the opposite end of the spectrum from the US president. Yet the messaging from both has been nearly identical: everything is fine, carry on, wash your hands.

Making this into a political issue in either case just creates conflict, and causes the target to dig in their heels. It does very little towards a more effective response.

I can't believe I'm saying this as a libertarian but you have to put some faith into the government's action here. The public in a panic already took away all the masks healthcare providers needed to safely attend patients, diminishing the capacity to serve.

Health service ranking focuses on treatment I suppose. We need a different ranking for epidemic prevention and control.

It is possible than one hospital may be overwhelmed, but surely it cannot be representative of hospitals across Italy or even a region.

[1] for french speakers: https://www.youtube.com/watch?v=pb8Q1yr2cjo

Sadly, it is representative of hospitals across all northern Italy: https://www.ilpost.it/2020/03/08/pesenti-emergenza-ospedali-... https://www.ilpost.it/2020/03/09/coronavirus-terapia-intensi... ("Affollamento e scelte difficili")

I remember my nurse friends freaking out in 2017 because they were having trouble dealing with the extra flu cases.

"From a well respected friend and intensivist/A&E consultant who is currently in northern Italy:"

Basically, that make this twitter thread uncorborated news unless someone reached out to the Italian doctor referenced in it.

Personally I know a girl whose soon-to-be husband from zero symptoms went to being intubated in 3 days. Luckily for him there were still machines available and he's relatively young and in good shape so they have allocated it to him.

One can surely ignore these reports as they are not provided first hand by doctors. In that case it is sufficient to wait. Soon this situation will be a reality in many more regions/countries so it will be easy to experience this first hand.

Also, pretty much in line emergency handling. There is a reason why national emergencies are getting declared. It is the sesantional, alarmist way this stuff is reported that is driving me mad. We should all stay calm and follow guidelines. Instead people buy toilet paper (still just finny) and masks (where gets less funny pretty fast). This kind of reporting, amplified by social media, is a huge part of the problem.

We also have quite some stock of necessities at home, but that isn't any different from, say, last November or any other random months before the virus outbreak. Is it serious? Sure it is. Are we at Black Death levels? NO, and nobody says we ever will be there. I am also rather happy with the general way authorities are handling the situation. Sure, it could be improved here and there, especially at the messaging and side and by aligning policies.

Two things to note so: - When you are not old without any preconditions, your personal risk of complications is rather low. And no, I don't care about one guy being interviewed by whom ever. - Even during the Black Death panic didn't help

However official statements widely reported in the media are essentally saying similar things:

Antonio Pesenti, head of the Lombardy regional crisis response unit, told the Corriere della Sera newspaper the health system in Lombardy was "a step away from collapse" as intensive care facilities came under growing strain from the new cases.

"We’re now being forced to set up intensive care treatment in corridors, in operating theaters, in recovery rooms. We’ve emptied entire hospital sections to make space for seriously sick people," he said.

https://www.reuters.com/article/us-health-coronavirus-italy/...

https://translate.google.com/translate?sl=it&tl=en&u=https%3...

If we had the hospital capacity to deal with it, it wouldn't be so bad. But the suffering (and mortality rate) spikes pretty significantly when you run out.

If we were halfway rational we'd be rapidly scaling up medical capacity now and practicing strong social distancing now... but people are too worried it would unduly wreck the economy.

Why should we wait 20 days for things to get terrible before going to quarantines and lock down? Surely China and Italy have shown us our future.

I partly think the problem is political. If you quarantine and the virus is controlled, then it looks like you panicked over nothing, because you took this huge reaction and nothing much happened. However, if you wait till it's sufficiently bad and then you quarantine everyone will understand what you did, and later, you may get praised for your decisive leadership in a time of struggle.

What I mostly wish is that citizens could throw some sort of flag now to say "This crisis is being poorly handled. If this goes badly, let's have a review, figure out why, and correct the problem once this is settled."

Nails it. You could be so good at your job that people think your job isn’t even necessary; or you could be putting out fires caused by your incompetence all day every day and people think you’re a hero.

His base is, however, going to be disproportionately impacted by this virus.

While I don't agree with the US's lackluster response, bear in mind there's other repercussions besides "just political". The quarantines and shutdowns will almost certainly destroy a lot of people's livelihoods. From people that aren't getting paid so can't pay their bills, to small business owners that will lose their businesses because they can't pay their bills. The effects of even a 1 week shut down can expect to be massive, and impact exactly the people who are already most struggling financially.

This need not be this case. Any authorities who take action to shut down social contact now, before they turn into Italy, will be praised several months hence for being forward thinking because it will be clear what happened in every jurisdiction where they didn't shut down social contact, i.e. absolute catastrophe.

The election season is in full swing and you should have the opportunity to vote on how well you think the crisis has been handled by November.

Example: Why didn't we start testing with 100x or 1000x the number of tests? Maybe the reason is regulation on independent labs doing their own tests. Maybe there wasn't enough money banked up at the CDC such that, when a pandemic it's recognized, we can't immediately start mass producing tests.

The point is, I want it documented and explained what the failures were so that future people handling future disease outbreaks will perform better or at least not make the same mistakes. Further, a practice of exploring major mistakes would help motivate government bureaucrats to avoid making them. There should be a potential political cost to be dramatically wrong in vital scenarios.

https://www.businessinsider.com/coronavirus-testing-covid-19...

Yep. People do this with Y2K, for example. "Nothing happened, what an overreaction!"

Nothing happened because an enormous amount of work was done in advance, but people don't see that side of it as it's reasonably hidden.

Though to be fair, most of the media predicted bad outcomes were completely unrealistic and wouldn't have happened even if no effort was put into mitigation.

I think this is exactly what's happening. It's an extension of the way individuals feel -- no one wants to be seen preparing too early, because people might think they're silly.