Coronavirus: The Hammer and the Dance





When all of this is over, this man should earn a Nobel Prize for his writing.

It also has a tendency to directly go for the lungs and result in pneumonia, fibrosis (scarring), and permanently reduced lung capacity. For some, recovery does not necessarily mean back to 100%, and that is also not always limited to the elderly or cases with the most severe symptoms. I've seen some sad medical reports of healthy people in their 20s and 30s having no prior symptoms suddenly collapse, CT scans then discovering the extent of the damage done. There's also the problem that the immune system itself can be a killer when the infection is in the lungs (cytokine storms). Modern medicine can treat that, but not if hospitals are overwhelmed.

This can be a very nasty virus.

Watsisname wrote:

Source of the post This can be a very nasty virus.

"Can" is also an important word. If treated, mortality does seem fairly low, and I wouldn't be surprised if it approaches that of flu when all the numbers are in.  If the healthcare system is overwhelmed, however, there can be little doubt now that it becomes a very dangerous virus for some.  So flattening the curve is the key, but we must also be careful how that is done.  The vulnerable and people in healthcare must be protected, and at the same time business must continue with the least disruption possible.

midtskogen wrote:

Source of the post "Can" is also an important word. If treated, mortality does seem fairly low, and I wouldn't be surprised if it approaches that of flu when all the numbers are in.  If the healthcare system is overwhelmed, however, there can be little doubt now that it becomes a very dangerous virus for some.

Exactly, and I think that is one of the most important messages. The virus does not have some intrinsic transmission coefficient or mortality rate. Both depend on how we respond to it. Its potential to cause widespread death and suffering is extremely high if everyone did nothing. But humans are intelligent. Many are changing their behaviors rather than doing nothing, and that helps mitigate the risk.

How much action is too much? Previously we've been taught to flatten the curve (reducing R to something closer to but still greater than 1, so the virus still spreads but not so quickly), and I too thought it was the most reasonable thing to do. It is intuitive that going so far as reversing the curve would only cause unnecessarily greater economic damage. 

But after reading The Hammer and the Dance article, and thinking about it... I found the arguments for a shorter term but more aggressive solution very persuasive. Even if the author is not an expert in epidemiology or economics, I agree with him. I think flattening the curve was the right starting point, as it was easier to enact and have the public adjust while also putting us in the right direction of slowing the virus down. Then the idea of the hammer is "let's act further now, and go through a rough few weeks instead of a rough few months, which will then make the following year much easier." In fact the WHO is also now recommending suppression rather than just mitigation. If enacted carefully, it appears it can reduce the cost in both lives and economies, limit the opportunities for the virus to evolve new strains, and buy us more time and capacity to better manage the virus in the long term until vaccines are ready.

midtskogen wrote:

Watsisname wrote:

Source of the post This can be a very nasty virus.

"Can" is also an important word. If treated, mortality does seem fairly low, and I wouldn't be surprised if it approaches that of flu when all the numbers are in.  If the healthcare system is overwhelmed, however, there can be little doubt now that it becomes a very dangerous virus for some.  So flattening the curve is the key, but we must also be careful how that is done.  The vulnerable and people in healthcare must be protected, and at the same time business must continue with the least disruption possible.

This is an extremely serious situation here, and thats why whole states are being shut down.  We're going to be out of hospital beds and ventilators in 2 weeks.  Also, as researchers have shown, just because the majority of people dont die, doesn't mean it wont cause serious damage.  Research has shown that even younger patients have gotten lung damage from this virus, akin to years of heavy smoking.  I've also seen research that shows that it's causing CNS (Central Nervous System) damage.  This is far far worse than the flu and just looking at mortality numbers isn't enough.
Business and economy must take a back seat to saving people.

Watsisname wrote:

midtskogen wrote:

Source of the post "Can" is also an important word. If treated, mortality does seem fairly low, and I wouldn't be surprised if it approaches that of flu when all the numbers are in.  If the healthcare system is overwhelmed, however, there can be little doubt now that it becomes a very dangerous virus for some.

Exactly, and I think that is one of the most important messages. The virus does not have some intrinsic transmission coefficient or mortality rate. Both depend on how we respond to it. Its potential to cause widespread death and suffering is extremely high if everyone did nothing. But humans are intelligent. Many are changing their behaviors rather than doing nothing, and that helps mitigate the risk.

How much action is too much? Previously we've been taught to flatten the curve (reducing R to something closer to but still greater than 1, so the virus still spreads but not so quickly), and I too thought it was the most reasonable thing to do. It is intuitive that going so far as reversing the curve would only cause unnecessarily greater economic damage. 

But after reading The Hammer and the Dance article, and thinking about it... I found the arguments for a shorter term but more aggressive solution very persuasive. Even if the author is not an expert in epidemiology or economics, I agree with him. I think flattening the curve was the right starting point, as it was easier to enact and have the public adjust while also putting us in the right direction of slowing the virus down. Then the idea of the hammer is "let's act further now, and go through a rough few weeks instead of a rough few months, which will then make the following year much easier." In fact the WHO is also now recommending suppression rather than just mitigation. If enacted carefully, it appears it can reduce the cost in both lives and economies, limit the opportunities for the virus to evolve new strains, and buy us more time and capacity to better manage the virus in the long term until vaccines are ready.

The economy doesn't matter at this point.  The actions taken might seem too aggressive but that's precisely what makes them the right actions- we are behind the curve right now (talking about curves) because the amount of people we think are sick is actually an underestimation.  That's why you need to be so aggressive right now.

Watsisname wrote:

It also has a tendency to directly go for the lungs and result in pneumonia, fibrosis (scarring), and permanently reduced lung capacity. For some, recovery does not necessarily mean back to 100%, and that is also not always limited to the elderly or cases with the most severe symptoms. I've seen some sad medical reports of healthy people in their 20s and 30s having no prior symptoms suddenly collapse, CT scans then discovering the extent of the damage done. There's also the problem that the immune system itself can be a killer when the infection is in the lungs (cytokine storms). Modern medicine can treat that, but not if hospitals are overwhelmed.

This can be a very nasty virus.

People should get the vaccine for pneumonia...I saw that recommendation also.  Also saw some emerging researching showing how the virus impacts the CNS.  40% of the people hospitalized are under 50 and 70% of the fatalities in Italy occurred in males.
People may be "smart" but they are also selfish, and I think that matters more.  Did you see all those crowded beaches?  Ridiculous.

AlmaDely wrote:

“It had only killed 41 people” isn't a good metric. A virus that’s infected, say, 500,000 people and killed 41 is quite a different thing from a virus that’s infected 42 people and killed 41.

The mortality rate of this virus is 41 in 4,000 cases, or about 1%. Doesn’t sound like a lot, right?

By way of comparison, the mortality rate of influenza A is 0.1%, hepatitis A is 0.3%, anthrax is 0.6%, smallpox is 3.0%, and Lassa fever is 1.1%.

So we’re talking about a virus with comparable mortality to smallpox and Lassa fever, that’s easily transmitted (it has an R0 of somewhere between 1.4 and 2.5, meaning each infected person can be expected to transmit it to 2–4 others). By way of comparison, the R0 of influenza is 1.4 to 1.6, and Ebola is 1.5 to 2.0.

It’s as lethal as smallpox and spreads as fast as or faster than Ebola.

It's 10x more deadly than the flu and spreads twice as fast.  But mortality isn't the whole story because it can cause permanent lung and CNS damage even among those who recover.

A-L-E-X wrote:

Source of the post The economy doesn't matter at this point.

Remember that there is a percentage of the population that is alive thanks to a well economically developed society, and we can't allow that to change.  We need to be pragmatic.  We want to avoid triage in healthcare, and trade that for temporary triage in the economy but we do triage. Food and goods still need to be distributed and that part of the economy can't stop.  Infrastructure needs to be maintained.  For the most part things need to go on, but in a more "undercover" way.

A good interactive map with models for each state in the US, showing the cases over time and expected number of deaths based on current trajectory and under adapting different levels of social distancing or lockdowns.

https://covidactnow.org/

We're already seeing in the data that the social distancing and shutdowns enacted early in Washington and California have had a measurable effect in slowing the spread of the virus.  These two states currently double their number of cases every 3.5-4.5 days, versus doubling every 1.5 to 2.5 days elsewhere (New York, New Jersey, Florida):



To put those doubling times into perspective, it means for example that if two states now have 1,000 cases, but one doubles every 4.4 days while the other doubles every 1.4 days, then after 10 days, the former would have 4,800 cases, while the latter would have 141,000.

But as the above site demonstrates, the social distancing is still not enough. It lowers and delays the peak of infections, but still leads to a tremendous overwhelming of ICU capacity and a tremendous number of deaths. More and more states are therefore beginning to apply more extreme levels of lockdown.

Alarming (but not yet robustly verified) news. It appears that the strain of the virus spreading through the US might be more dangerous in younger age groups:



I'm hoping that this could be due to biases in terms of people who have the most travel and contact with others, and that more elderly may have already socially distanced themselves in the US. But we'll see how the expert review goes.

midtskogen wrote:

A-L-E-X wrote:

Source of the post The economy doesn't matter at this point.

Remember that there is a percentage of the population that is alive thanks to a well economically developed society, and we can't allow that to change.  We need to be pragmatic.  We want to avoid triage in healthcare, and trade that for temporary triage in the economy but we do triage. Food and goods still need to be distributed and that part of the economy can't stop.  Infrastructure needs to be maintained.  For the most part things need to go on, but in a more "undercover" way.

It does expose the dangers of privatizing healthcare though.  The two things I've always stated should not be privatized even in a capitalist nation are healthcare and education.  You can layer private healthcare over public healthcare for elective procedures, but everyone should have access to life saving healthcare (income should not determine longevity.)  Companies are price gouging NY for hospital beds, masks and ventilation equipment.  They are charging NY $4 per mask when it normally costs only 0.70!   As far as education is concerned, not having access to free college exacerbates income inequality.  We have both these things now in NY (and a longer life expectancy than other parts of the nation as a result.)


Over the weekend we've run into problems rolling out help to the most affected areas (NY, WA and CA).  I've heard that we are soon going to go into triage mode and have to only treat people who are in the most dire conditions, because we'll be out of hospital equipment within 10 days.  Everything is much delayed because the president is hemming and hawing about enforcing the national defense act which would enable the government to force industries to make more PPE like masks, ventilators, etc.  It is horrible here in NY now, we have 100 deaths and over 10,000 infected.  It's doubling every other day (approximately.)

They are comparing the current administration to Herbert Hoover's.  Hoover refused to act in a strong way during the start of the Great Depression.  FDR saved us by coming in and establishing strong social safety nets and stronger government control over industries.  He is still celebrated as among the 5 greatest presidents.  But right now history is repeating itself.

This is also being compared to 2008.  There was a bail out bill in Congress which got rejected because it reminded many of 2008, when corporations that were bailed out made large pay outs to their CEOs and did stock buy backs.  The general public saw very little relief back in 2008, so they are worried that is going to happen again.  A single pay out of $1200 per adult and $500 per child wont be enough.

Watsisname wrote:

Alarming (but not yet robustly verified) news. It appears that the strain of the virus spreading through the US might be more dangerous in younger age groups:



I'm hoping that this could be due to biases in terms of people who have the most travel and contact with others, and that more elderly may have already socially distanced themselves in the US. But we'll see how the expert review goes.

I've heard this too Wat.  Also the reason that NY has by far the most infected is that NY has done the most testing.  60,000 tested and 15,000 found infected in the state as a whole with 10,000 in NYC and 100 dead in the city
I saw a group of doctors on TV today talking about the importance of having a strong immune system and it being the difference between how severe a person's health is likely to deteriorate.  None of these things will prevent an infection of course but if your immune system is strong at least you stand a fighting chance- they mentioned things like Vitamins C and D, the mineral Zinc (a shortage of which was found in many of the people who died in China), antioxidants and avoiding processed food (for example that which contains high fructose corn syrup.)  I guess we should reconsider the 50 billion dollar corn subsidy we pay out to corn farmers (90% of which goes towards producing high fructose corn syrup.)  America is one of the most unhealthiest of the developed nations of the world (high rates of obesity and diabetes) because of our diet and this virus is exactly the thing which could expose it.

midtskogen wrote:

A-L-E-X wrote:

Source of the post The economy doesn't matter at this point.

Remember that there is a percentage of the population that is alive thanks to a well economically developed society, and we can't allow that to change.  We need to be pragmatic.  We want to avoid triage in healthcare, and trade that for temporary triage in the economy but we do triage. Food and goods still need to be distributed and that part of the economy can't stop.  Infrastructure needs to be maintained.  For the most part things need to go on, but in a more "undercover" way.

I agree with this however America's really bad processed diet is going to play a big part in what happens.  MSNBC had a health special last night talking about how billions of our tax dollars go towards corn farmers who are contributing towards America's obesity and diabetes epidemic by producing high fructose corn syrup.  I stopped eating processed food years ago, but I have relatives who have bad immune systems and/or diabetes and/or high blood pressure because of it- I worry about them.