All reductions in (non-essential) travel are good in a pandemic. That doesn't mean it's sufficient, but it's something positive.
I think we would all like to see stronger social distancing rules domestically (in the US), but here the US has a problem as it granted the President broad discretionary powers to suspend international travel but not domestic gatherings, which can't be banned via executive order and even if congress were to pass a law banning such gatherings, there would be first amendment implications as well as federalism issues.
It's not easy to pass a law giving the President this type of power and I suspect many in congress already rue passing the laws that gave the president power to suspend international travel. That's one of the prices of living in a federal government with separation of powers and a bill of rights guaranteeing right to assembly rather than in a place like China.
For example, the CDC has issued social distancing guidelines but they are only guidelines not laws: Santa Clara county has said "no thank you we'll follow our own guidelines" instead, when the CDC asked to ban meetings of more than 250 but Santa Clara banned meetings of more than 1000, and just refused to change their target to the CDC recommendation.
So the US simply lacks the tools that would allow the President to go on the air and announce "I'm declaring that the MLB season needs to be delayed and Disneyland must close." He can try to exert pressure, or rather have the CDC exert pressure, but these types of declarations are not going to happen in America.
Long term, I think some mechanism to mandate more social isolation is going to be needed.
For example when travelling from California to Arizona, there is currently no quarantine area or checkpoint, and that's fine if you want free movement, but then it's harder to say that states should run their own pandemic policy as long as there is free movement between states.
And this is a general trade off. More interconnected world => localism is less viable as a means of countering global threats.
But I'm just a cynical man. It could very well be something else and I'll be very interested to read about this emergency once it's all behind us.
Yet we can't.
That's crazy and it has to change.
Similarly in Puerto Rico after Hurricane Maria, a politically connected one-man "energy company" called Whitefish, with no experience or skills, emerged out of nowhere and was given the contracts to rebuild the entire Puerto Rican grid.
Months later nothing had happened other than he hired a few people as unskilled as himself who were just dorking around down there, while people died.
So they fired that guy and hired another company called Cobra, with the same terrible terms, and the same ineffective response. Eventually it was found out that Cobra people had paid massive bribes to officials to ensure the deal.
https://www.nytimes.com/2019/09/10/us/puerto-rico-fema-arres...
The whole story of Whitefish being unqualified is just corrupt politics. Subcontracting is a legitimate way to get the work done.
China, South Korea, Taiwan, Singapore and Hong King all slowed the curve, and have rules governing their whole country.
At any rate, no, a town that has 50 people per square mile should not be forced to respond in the same way as some city with 50,000 people per square mile. In the meantime, the people of Fargo have all the relevant information and their local officials can make calls as needed to suit their demands.
The NBA just suspended their season "until further notice".
All travel is essential to somebody. All restrictions on movement also have a cost, and any analysis that only looks at the benefits of something without looking at the costs cannot hope to be correct.
But we can consider the downsides and decide that we want to restrict travel.
I don't actually need to go visit my rellies. I want to, but I don't have to. On the other hand, if I go on a voluntary trip, I probably have to return home because I can't really afford a hotel indefinitely into the future.
So it's obvious to me that there is some distinction between necessary and nice to have.
I genuinely have been underwhelmed by the reaction to this disease through much of the world. It is necessary in a constitutional democracy to react sometimes to maintain the trust of the voters - or they might say "A democracy is fine when things are going well, but when the chips are down we need a strong leader who can make the decisions we need". Saying "those entertainment business can't open during this outbreak", "keep your tables at least a metre apart" and "don't travel" are reasonable reactions in this circumstance. And we need democratic leaders so that they can know when it's gone on for too long and they have to accept we can't stop it - something a "strong leader" can't tell.
I travelled to starbucks today. I’d hardly consider that essential.
I assume the U.S. government will be pumping money directly into the hands of small businesses and employees.
But OPs point stands -- unless you're working from home and never going out to eat / get groceries / not go crazy from cabin fever you have to travel somewhere
Restricting routine trips to just home-to-work, work-to-home, and large-scale resupply missions is still acceptable at the moment. Make use of your local grocery's picker service with delivery to the parking lot, if you can.
Consider switching your dining-out trips to ordering via phone, fax, or electronic ordering system, and doing drive-through, carry-out, or parking-lot pickup. Pay electronically, in advance, instead of handling cash at the point-of-sale terminal. If you get cabin fever, and need to socialize, do it through screens.
It is essential for Starbucks to serve customers in order for them to stay in business. You don't have to stop going. But you can put in your order via website or app; walk into the retail location only when it's ready; pick it up without speaking to, breathing on, or touching anyone; and then leave immediately. It is possible to minimize the duration and intensity of contact, without eliminating it entirely.
It is better to be in contact with your regular friends, acquaintances, and business associates--that are all the same people every day--than to have a lot of transient contacts with complete strangers. It is slower to traverse a social network one connection at a time than to hit a lot of random, unconnected people all at once with a brodcast.
Not at all.
Isn't there an obvious compelling state interest?
I don't know how strong that actually is. Over the past few years, we've seen some Trump work the courts pretty consistently. Even if his administration is doing something explicitly unconstitutional, running something all the way to the Supreme Court can take 6 to 18 months, during which time the unconstitutional order would stand (if not stayed early on).
Their point is that there's absolutely no effect of banning travel between two areas with similar prevalence, based on rather simple logic.
Take two bags with mostly white and a similar number of red balls in them. Then, twenty times, grab one hand from each bag and empty it in the other. What's the expected change in number of red balls?
Multiple cities with hundreds of thousands of people in both the US and Europe are infection free right now. Extending that for even a few weeks is very useful.
By your model, some reductions in travel ought to have a negative effect. Is that a fair corollary?
Limiting all Schengen traffic is an extreme example, but it's not obvious that some level of restriction would necessarily produce a significant bottleneck effect (given that citizens are exempt).
By your last analogy, the red balls would have paint rubbed off them in the exchanges.
When the concentrations in the US get higher it will start to make sense to constrain travel more over there. Right now the chances a domestic flight contains an infected individual is quite low, but that won’t always be the case.
Bear in mind the virus cannot be stopped, or contained at this point. All we can do is slow it down while also limiting the harm our countermeasures cause.
Saying the virus cannot be stopped seems defeatist. China seems to have managed it locally, albeit with some very aggressive measures.
That's what you're proposing, if you don't realize it. If you get the growth rate below 1, you can wipe out the disease, instead of merely delaying it.
But this is clearly false because population density is another important factor for contact between people.
There is a lot more leadership across government (federal, state, local), private industry, and independent individuals could be doing to proactively reduce transference and even stomp out significant portions of infection is followed through. My point is that our cultural trends surrounding all of these (governments, work, personal action) are almost all running counter to what we need to be doing.
We need strong government leadership at all levels pushing support out where possible, be it resources, accurate non-politically influenced/dictated information, etc. Businesses can be more proactively supporting work from home more where feasible, extend sick leave or create sick leave options to reduce pressures to work, provide some security/continued employment for those who need it (especially demographics at high risk). People can avoid attending work when sick, reduce/limit public exposure (be it out shopping, attending an event, etc.), practice frequent hand washing, limit exposing themselves to at risk populations, etc.
Economically it's a disaster (as the markets are also anticipating) but it's going to be one way or another. It seems to me that you're better off to take a well calculated hit that can bounce back to a healthy workforce that doesn't strain existing healthcare infrastructure than trying to pretend nothing is going on, minimal fallout will occur, and play-it-by ear.
I'm considering the USA fully seeded at this point.
Even if you think you have it, there's still not enough test kits available yet - even if you're swabbed it can be days for a result(Saying this from west michigan).
It matches this article on restrictive testing.
https://www.theatlantic.com/health/archive/2020/03/coronavir...
Long distance travel and exposure to those who have been (e.g. hugging your wife got off a plane from Spain 2 days ago) is still a top predictor for exposure.
Which is exactly why everyone with those symptoms needs to be tested. One of the most important things we need to do right now is detect the people who got the virus through community transmission.
> Long distance travel and exposure to those who have been (e.g. hugging your wife got off a plane from Spain 2 days ago) is still a top predictor for exposure.
I'd say that testing those people should be lower priority, since an assumption they're infected is more likely to be accurate, so they can take preventative measures without needing a test.
This. I'm in my twenties so it's very possible for me to get COVID and only experience cold like symptoms (or less!). I'm sorry to everyone, but I won't self-quarantine myself for 14 days just because I have a stuffy nose (it's likely a cold right?). I'm fortunate enough to have the ability to take time off/work remote - but what if it's a cold this week and COVID in two weeks? I can't take a month off.
I'm from West Michigan - ATM there's very little testing available, and I'd only be tested if I had recently traveled. But we're past the point where recently traveling is such a big indicator - we're seeing plenty of community transmission for me to believe it's very likely everywhere already, and any lack of cases is because of a lack of testing.
Overpay for an extreme case rather than adapt your system around it.
Now, I have other complaints about our system and how it is unsustainable, but this is a poor argument as to why.
To be clear I'm not saying more infections are a good thing, simply that if there are a lot more cases that already exist, knowing they exist and having more accurate data that shows us COVID19 is less harmful than currently perceived/projected would be good for everyone.
The president did claim that some criticisms about his handling of the situation were a "new hoax" in the same way he has labeled previous unfounded criticism and accusations as hoaxes.
Huh?
He called Fox News and said on air ""So if, you know, we have thousands or hundreds of thousands of people [with COVID-19] that get better, just by, you know, sitting around and even going to work, some of them go to work, but they get better,""
His whole schtick until just about a few hours ago was that the risks were all hugely overblown.
I am also curious to know exactly which "previous unfounded criticisms" you are referring to.
Yes. Yes it is. How many times has Trump tweeted about the stock market and how it proves he is a great president? Hundreds. Literally. His NEA chair has explicitly stated "I have long believed that stock markets are the best barometer of the health, wealth and security of a nation. And today's stock market message is an unmistakable vote of confidence for the president." His entire political argument for reelection is premised on his "business acumen." His down playing of coronavirus (to what end? why?) was a blatantly partisan attempt to gamble that this whole thing would blow over rather than risk spooking the markets.
The messaging on this has been pathetic. The other day UW in Seattle announced they had a capacity to test 1,000/day. Not adequate for the nation, but for the PNW, sure.
https://www.cdc.gov/coronavirus/2019-ncov/lab/rt-pcr-detecti...
https://www.cdc.gov/coronavirus/2019-ncov/lab/rt-pcr-panel-p...
ETA: I'm having trouble locating positive control template sequences.
I am happy for S. Korea running 100,000+ tests, and embarrassed that the US has maybe run 1000s at this point. I also think that the virus is widely dispersed in the US and the best we can hope for is to keep the case load at a level manageable by our health care system. I'm pretty worried about that though.
Thankfully all of us seemed to get over it without much complication, and it doesn't seem like very many of the people we've since interacted with have come down with it. We might very well have just been lucky, though.
We are unlikely to ever find out, because we won't have a reason to give everyone antibody tests
Los Angeles → Catalina Islands → Ensenada → Los Angeles
> and were there lots of mainland Chinese people on it?
I mean, I didn't exactly go around asking people "are you from China?", but based on the number of people who sounded like they were speaking Mandarin I'd tentatively answer "yes".
> Sadly the symptoms for CoVid-19 are pretty common across a variety of diseases, so “flu-like but not flu” doesn’t necessarily point to this.
Indeed, which is why I'm still at least somewhat skeptical. Still, it's hard to rule it out, especially given the relatively-severe symptoms (not the absolute worst I've felt, but it was pretty bad).
That said, you'd be surprised what draws tourists from mainland China; Las Vegas and Reno (for example) both get plenty of Chinese tourists looking specifically to gamble, and I'd imagine the ship's onboard casino to have a similar appeal. Plus, there were plenty of other tourists from long distances, too, both from within the US (East Coast) and from Europe and Australia (from what I gathered from the people whom I did talk to). So evidently there were at least some non-Chinese tourists flying thousands of miles for it; seems reasonable that some mainland Chinese tourists might, too.
No "massive uptick" yet, but there are quite a few every week, so it could be that it's still blending in with non-COVID pneumonia cases.
Indeed. There are typically above 3000 deaths/week due to Pneumonia and 200/week due to influenza at this time of year. We had a smallish spike in mid-late January, where for 3 consecutive weeks, deaths were above trend at nearly 4000 & 400 per week.
If you assume a 1% mortality rate for COVID, and you assume all deaths are due to pneumonia, and you assume the entire late-January spike is due to COVID, that could be hiding 300,000-400,000 US cases. (To be clear, those are all questionable assumptions! The mortality rate could easily be either lower or higher, a meaningful fraction of deaths might not show as pneumonia or influenza, and it is normal for there to be a moderate spike above trend at some point in the flu season)
That doesn't mean that there were or weren't a few hundred thousand cases in that time -- it just means that some significant number of cases could easily hide in "routine-looking" spikes in the graph.
This does mean, though, that it is unlikely that everybody who got "the really bad flu" that's been going around this year actually had COVID -- but, especially if you live in a place with lots of people who travel to China regularly (like I do!), it isn't unreasonable to wonder if that "really bad flu followed by a lower-respiratory-tract infection that tested negative for influenza" you got in late January/early February wasn't really COVID.
(Remember, though, that while the rapid influenza test has a pretty low false-positive rate, it's got about a 50% false negative rate -- so testing negative shouldn't lead you to assume it isn't influenza)
Critical cases and fatal cases are way more likely to be detected for this reason -- but during the 3 weeks I was talking about, it was believed that there was no COVID in the US, except for folks evacuated from China to quarantine sites.
During that time unexplained pneumonia leading to death -- especially in an older individual -- would likely not have been thought to be COVID, and would just have gone on the books as pneumonia.
"In fact, officials would later discover through testing, the virus had already contributed to the deaths of two people, and it would go on to kill 20 more in the Seattle region over the following days." [1] https://www.nytimes.com/2020/03/10/us/coronavirus-testing-de...
Akin to how securing a network is more than setting up a firewall at the perimeter.
YES! Restricting US<=>EU travel is just about the least useful thing we need to be doing right now.
At this point, the only rational thing to do is to try to slow the spread. The good news is that this is a very mild virus, and the vast majority of infected people will have minor symptoms. The fatality rate in Korea is currently 0.6%, and becuase of the comprehensive nature of their testing, this should be considered the upper bound on CFR.
That's the exact opposite of what the WHO said when they made the pandemic declarations:
"We cannot say this loudly enough, or clearly enough, or often enough: all countries can still change the course of this pandemic," reads a statement from Tedros Adhanom Ghebreyesus, director-general of WHO.[1]
South Korea has shown this to be correct.
[1] https://www.usatoday.com/story/news/nation/2020/03/11/corona...
But more importantly, you’re not dying and not clogging up a hospital. That’s what’s relevant to this discussion.
It will be a big problem both in Europe and in the US, because they are starting to take measures only now.
The vast majority of cases are mild, like a head cold. This is a fact, and has been reported around the world.
You’re arguing about relative hospitalization rates, but that has nothing to do with the discussion here. Mild cases aren’t clogging up ICU wards at all, because they’re quite mild.
I think you mean that this should be considered the goal upper bound on CFR. It's really the lower bound on CFR if you do everything right. If you do everything wrong, like the US is heading towards, you get overloaded health systems, critical shortages, and a 12% CFR or higher.
I think the true measure will be the year over year total mortality.
If we overload our hospitals then CFR will go towards the number of cases that require hospitalization. Which is around 20%. Italy is currently far over hospital capacity and has a CFR today of 8% and rising.
Media and government keep making this claim, yet where are the recovery numbers of people? It drags on for weeks and weeks with no end in sight, correct? And current case fatality rate in Italy is 8%, was 7% this morning, was 6% yesterday - because they do not have hospital resources for the number of serious cases they have.
Serious, critical, and dead outcomes are said to be over 20% of case. This being described as "very low, a very small number" by certain people. That is not a low number at all.
Regarding the rise in CFR: it will naturally go up as cases decline, because fatalities stem from a time when the case rate was more rapidly increasing. Korea’s case rate had been declining for several days:
https://mobile.twitter.com/AdamJKucharski/status/12297080012...
https://www.google.com/amp/s/www.nytimes.com/2020/03/05/heal...
At some point, this scary story is going to have to be adjusted to reflect reality.
Buy a stool for crying out loud, they're like $10
In comparison, Korea's response was disastrously wrong. Their "Let's test everyone" policy sent lots of people into medical limbo ("We can’t let you go because you're COVID-19 positive ... but meanwhile we have particularly nothing to do for you because you're not that ill") and got their hospitals flooded with mild cases.
Too bad money making is somehow above preventing others getting sick. People wouldnt show up to work if they didn't have to worry about their wages. I'm sorry but 3 sick days is garbage and requiring doctors notes is asine when your healthcare plan is shite. Not to mention wasting a day in a hospital. Companies can afford this stuff. It's not often and it's minimal to say the least. But God forbid a small business can't have someone for 80 hours a week at minimum wage!
This depends on how you're defining containment. Grounding aircraft may not decrease the current case count, you're right, but it may help not adding to it, or adding as much, or as fast. Because of this, it may still be worth doing.
The notion that we're going to abandon containment measures in favor of mitigation, which I've seen in many places (not in your comment though of course), is wrong. We're going to be doing both.
Now I will not attempt to speak for Europe but the US government could certainly push short public advisories and messages to adults and children through broadcast TV and even get the cooperation of streaming services as well. Short thirty to ninety second spots that give helpful non panic information.
The US President is hamstrung by both political disagreement and the law. There were articles he is loathe to declare any national emergency declaration until approached by the governors of many of the states. If he did without states approaching him and asking you can damn well guarantee there were would be Democrats out there claiming he was trying to be a Dictator and comparing him to Putin. The same article concerning the declaration also reveals all the behind the scenes work going on with Congress to get funds in place before any message is put forth so that the government as a whole looks to be cooperating as well as acting appropriately.
Based on the localized infection cases I see across the US and have been watching as well as the characteristics of the virus (life outside host/on surfaces, in air, the degree of asymptomatic transference, etc.), it's well beyond containment IMHO.
Travel isn't going to do too much to reduce infection rates alone. We need significant cultural changes to reduce infection rates, but I don't see that happening for a variety of reasons. This country isn't about proactive action and is all about reactionary action though, so we're just waiting for that reactionary threshold. Some preventative measures have been pushed but they're no where near aggressive enough at this point.
It will be interesting how this is handled in our modern cultural, current political and work culture, etc. I suspect it's going to be fairly nasty but certainly hope not. I've been advising my parents to stock up and minimize any outside interactions for awhile.