The best data we have at this point is from China. They have 81,000 confirmed cases to date, most of them happened over an 8 week period. Obviously not all cases of the virus were confirmed but people were hospitalized and tested aggressively.
Even if only 10% of the cases in China were confirmed (and 10% is a low guess at the percentage that might need to go to the hospital with serious symptoms, and thus be confirmed), that means under a million cases in a population of 1.4 billion.
California's population is 35x smaller than China's but Newsom is predicting California will have over 25x more cases.
Sure you can argue that China is lying about their cases (WHO disagrees). Or that they are authoritarian superhumans with a superior response. Or whatever. But this discrepancy is just too big to make sense. I don't think CA will have 25 million cases in 8 weeks.
I think he is trying to scare people into staying home. Staying home is still a good idea, because the health care system will collapse at a lot fewer than 25M cases in 8 weeks. But I think it's fearmongering.
Take deaths, multiply by 400 and that's how many cases you have. This comes from the assumption of 1% mortality and 3 weeks to die.
So CA has ~8000. A doubling time is ~5 days. 8 weeks ~= 11 doublings. So 8000 * 2048 = 16M. Not too far off for a ballpark. Obviously, the exponential starts to breakdown somewhere... but where?
I don't think it's fear mongering. It's getting the public to understand the back of the envelope worst case... which is really bad. People NEED to panic... to get them to hunker down and take this seriously. The sooner than happens, the sooner we get it under control.
I had to yell at my inlaws to stop taking the train to work and going to the gym. They are 70 and have pre-existing conditions. This action will force them to take it seriously.
I don't see where 400 comes from.
If we assume that people who died today now are 1% of those who got it 20 days ago, then that is a factor of 100. Project that forward through 4 doublings for the fact that we have about 20 days of doubling every 5 days and we get to a factor of 1600. You can complicate the toy model in a number of ways, but I can't get it as low as 400.
Anyways it is worth pointing out that the curve of reported cases will continue rising for a couple of weeks as people both get symptoms then get sick enough to come to the attention of hospitals. And if the measures work, it won't be obvious from death rates for about 4 weeks. And at that point the critical question is whether we managed to slow the rise, or create an exponential decline.
My bet is that we are only going to get a slow in the rise. Hopefully enough for us to get ahead of the need for emergency treatments.
Look at the curves for every where else on the planet, the US will be the same, take it seriously
Except this is extrapolating ahead to assume no changes to treatment available. As time progresses, we find better, more effective ways to prevent death from COVID-19.
But even our dutch government is claiming it's 4 days standing in front of a chart where it's obviously 2 days.
After you reach the limit it's hard to count because people stop going to the hospital that can't take them in anyway. At that point you should just consider any increase in deaths compared to the normal the result of Corona. Wether it's a cancer treatment that got postponed because of Corona or Corona itself.
People count bodies much more reliably in pandemics. I don’t trust our confirmed case telemetry data much, but I do trust the fatality data. Unfortunately it’s about a two to four week lagging indicator. But the fatality rates also currently show this to be spreading much, much faster than it ever spread in Wuhan.
Wuhan is what happens when the curve is flattened. Not what happens when you don’t.
The issue here is every death is attributed to COVID-19 if the virus is present even if the actual reason is some other underlying health condition. Given that most victims are elderly and had serious pre-existing conditions this leads to massive mortality rate over-estimation.
You also cannot reliably compare EU/US data with Chinese: initially most deaths and cases of pneumonia in China were attributed to other illnesses. Secondly, Chinese government is notorious for flat-out lying in their official stats.
That what you claim provably doesn't happen. Even old people simply don't die that fast otherwise, and we also have the data of the people who can't breath and have to be admitted to the hospitals: there were never that many cases before, happening that fast:
https://en.wikipedia.org/wiki/File:Is_COVID-19_like_a_flu%3F...
(the numbers were compared by the Italian National Biotechnology Association, each bar is one week of time)
Scroll down to "Daily New Cases in the United States". No real need to extrapolate data from other countries. New cases are doubling every 2-3 days.
So that 400 multiplier gives the number of cases as of 3 weeks prior to the death count used in the calculation?
This is the situation with tested cases now. You can assume that there is no nation on earthq where the number of tested cases is an accurate representation of what is really going on. Deaths are far more accurate but lag behind ehat is going on by two weeks. And two weeks is a long time with something that grows exponentially.
The bad thing about this is, that this logic is flipped on it's head at times: my girlfriend had all the symptoms just like 6 of her alumni — not a single of them could get tested. And while they where still in bed their university proudly issued a press statement stating they have zero cases of Corona. Yeah — if you are not testing you will have zero confirmed cases, that is the way it is.
The dangerous thing here isn't the current number of cases, but the insecurity about it. If you have a huge number of people starting to get ill today your hospitals will fall apart in two weeks time. Doctors will have to send people home to die, like in Italy visitora can no longer be handled, people no lomger be burried — this is not a joke.
It's true though that they aren't using the highest rate they could (the 20% per day we got before social distancing). I hope that closing the schools helps... and the ICUs don't overflow immediately.
But information on testing numbers is also lagging and incomplete. The CDC was doing over 5k tests per day a week ago when the number of new cases was around 500 per day. And the number of tests were exponentially increasing too. Does anyone have any better info about how much we have ramped up testing since then? It's a big country, and there's huge "publication bias" in the media where stories about a location or person running into testing issues get the attention and stories where things are working do not. I really don't trust anyone's ability to assess the situation at the resolution of 24 hours and make anything like an accurate prediction. I would like to see them just do full-on statistical sampling by testing people at random in different cities.
With California at 1060, then I can only imagine where the final number will land. And New York has 5712 infected, and yet, they still haven’t shut down the state.
====
Now, the following is likely incorrect, but this may give an general idea of the magnitude. But doing a basic extrapolation, China had a 160x multiplier, from the initial lockdown point, to get to 80,000 infected.
If we use that, then at this point, California might register about 169,000 infected. And New York, if they lock down now, might register 914,000 infected.
Sobering numbers indeed..
But these numbers are highly dependent on population density, mass transportation patterns, and social congregation scenarios. Wuhan has high speed trains, but California has Southwest planes. Car travel and ride sharing usage might be similar. So it’s unlikely the numbers are similar to compute.
At some point, the medical system will fail, and everyone will just give up, and we are now left to our own fate.
By Jan 25th, China declared a Level 1 Health Emergency in 30 out of 31 provinces, and began locking down other provinces.
On Jan 26th, China cancelled all inter-province bus service.
On Jan 30th, China closed the highways between provinces.
Also, all of this nicely coincided with the lunar new year holiday, when the vast majority of the country is already on holiday for 2 weeks, and not going to work, or school.
It's not really comparable.
People were literally dragged away by police/medical personnel in door to door temperature testing. Like physically picked up kicking and screaming and bundled into waiting vans. And at the time hospitals were so overloaded sick people were sat in corridors with the dead on the floor beside them covered by sheets. I think most people are pretty oblivious to what draconian means. I know I was!
The documentary was Danish and called De advarede om corona-krisen - og forsvandt for those interested.
The other thing to note is that a bunch of the people that recorded the footage are now missing which is terrifying in itself.
The UK and South Korea reported their first cases on the first day; SK has slowed new cases to a trickle and the UK is facing mass infection.
"It stopped in China, so we don't need to do anything."
It stopped in China precisely because they did something. Diseases don't magically stop themselves. This is on the level of thinking your dirty dishes wash themselves, because your roommate grudgingly does them.
No, but they usually stop, when the immune system is done fighting them, either successfully or not. And pandemies usually stop, when enough people build up immunity, or failed doing so. Or when the disease is so deadly it kills quicker than it can spread. Which is here not at all the case.
So even if nobody would be doing anything, this disease would eventually go away.
It is "only" a question of how many casualties it will take. And we are discussing the cost/benefit of the measures to society as a whole. Shutting everything down has real costs, too.
And since the majority has no or very mild symptons ... it is not really likely to go extinct
2. This white paper may explain Newsom’s numbers.
https://www.imperial.ac.uk/media/imperial-college/medicine/s...
The growth is exponential and not linear which throws off most people. Surprisingly, even though the paper’s R0 is on the conservative side (2.2-2.4) and so is their case fatality rate. However, their simulations still predict 2.2 million deaths in the US if there’s no gov intervention for social distancing
Sadly https://www.theguardian.com/world/2020/mar/18/top-uk-covid-1... says that the lead author of the study has COVID and likely was infectious while he attended a press conference on COVID.
No.
Our response in the west is just terrible because of all the political nonsense, the fact that scientists don't influence our countries, and most people are just too stupid or too spoiled to listen. Look at our countries, have you seen the kids partying in Miami? The people still protesting in France? How about everyone still going out for dinner?
Don't go blaming other countries' good performance for our crappy one.
Edit: on that note, other countries have been testing people on entry for months on entry. Russia has been testing people on entry. The Philippines tests everyone on the public transportation.
There are also many Chinese accounts of thousands of bodies just being cremated without being tested. to be fair, Italy is now supposedly experiencing the same thing now due to hospitals being overwhelmed.
Since this is a disease with the highest mortality for the older age groups, Italy was always going to have a higher mortality rate.
[1] https://www.sciencedirect.com/science/article/pii/S120197121...
The lockdown is every word that true to its literal meaning during that period of time. People are not allowed to leave their own apartment. It is more like national level home arrest than volunteered quarantine.
All policies are enforced through each individual district, roughly equals to each apartment complex, that entering or leaving the complex requires its own passes. Let alone make a mask a requirement for everyone, without which you would put arrested in public.
I don't think any other countries can implement such a strict lockdown really. In California's case, I think the spread will no doubt slow down, but it is not going to be enough to burn out the virus. In the meantime, we need an effective treatment to be deploy to really battle this.
Can't believe this timeline is getting so intense this quickly in 2020, this is history making by everyday...
> People are not allowed to leave their own apartment
that's literally what's happening right now in Italy (and I think other European countries). It is not voluntary quarantine; although the level of enforcement is not at the level of China, you can get arrested if you are found outside without a good reason.
The Chinese meanwhile crack the whip -- and people listen, mostly 'cuz they know the government will back up their words harshly.
I believe he was making a point over what would happen without any mitigation. China put in place very aggressive mitigation efforts to keep its numbers from exploding out of control.
There's also a lot of monitoring and risk mitigation in place, so they should be able to catch inevitable slipups (eg medical staff treating remaining patients) pretty early.
Vietnam is also doing a mandatory 14-day quarantine at designated sites (hotels, military bases) for those arriving from ASEAN countries, the US, and Europe. There is no reported community spread yet, and all the cases are from people flying into the country and infecting a few individuals. The policy was only enacted a few days ago, but I really hope life here can return to normal if we start to catch all the cases before they leave quarantine. Additionally if we can test everyone before letting them leave quarantine.
81k is what China got after instituting lockdown as soon as they saw 400 new cases in one day.
The world was shocked when they started to build the new hospitals that the numbers didn’t seem to justify. Maybe the numbers were right and they understood what they were in for, which would be a real feather in their hat for their country’s model.
Only those parts of the world who don't understand exponential growth.
You should brush up.
The US flu death in 2018-2019 is estimated to be 34k. [1] China's flu death in the same year is 144. [2]
China's population is 4x to that of US. While the numbers cannot be compared directly, the difference in magnitude says at least something about its counting methodology, if not straight out lying
If I am to extrapolate, the corona virus death in china is at least two magnitude under reported
Have you considered that those countries just simply have had a better response to mobilize than the western countries?
They literally welded doors shut on apartment buildings. They are not superhuman. They just have a different take when it comes to individual rights.
There is no reason to assume the growth rate will taper off in country x like it did in China if country x does not take similar, or equivalent measures.
Yet next door mostly democratic Taiwan started acting on 31st December, and no one’s talking about them because they have prepared well and avoided an outbreak. Most other countries haven’t done so well...
Everything I have read states they closed off certain doors to ensure that you couldn't get in / out of the building without getting a health screen.
They built 2000 isolation hospital bed capacity in something like 6 days.
The estimate Newsom presented is credible.
The bigger difference is that California’s cases were more broadly diffused across the population than China’s at the same numbers (in part because it didn't originate from a single point in CA but had multiple points of introduction, and in part probably because of differences in lifestyle and social interaction patterns.)
I think that you discount this option too quickly. Have you been to China before?
At least in the most dense regions of China that I observed, the state definitely at least seemed to have the ability to enforce some form of effective mandatory social isolation. Even in rural areas, the government seemed to be able to project authority using tech.
Sure, their squat toilets are a mess but I don’t think that really reflects the technological capabilities of the state.
There are urrently around 675 cases in California according to the CDPH (https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization...). So this trend would lead to 6 million cases in 8 weeks. The governor probably assumes there are 4 times more cases than detected. So 6M × 4 = 24 million.
But those that get sick get very very sick. And this will put much pressure on health care.
The fear is real. Take a look at the footage of Chinese hospitals and doctors.
Without lockdown the numbers will go up in 8 weeks.
Unless the numbers are crap, then it makes total sense.
But the WHO disagrees, ah well, then I guess we should stop using our thinking machines.
It really didn't "grow unchecked for months".
>using our thinking machines.
OK. You first, then.
Here's the timeline.
Nov 17 - First known case of coronavirus
https://www.livescience.com/first-case-coronavirus-found.htm...
January 3 - Whistleblower Dr Li thrown in jail
"Li warned colleagues on social media in late December about a mysterious virus that would become the coronavirus epidemic and was detained by police in Wuhan on 3 January for “spreading false rumours”. He was forced to sign a police document to admit he had breached the law and had “seriously disrupted social order.”
https://www.theguardian.com/global-development/2020/feb/07/c...
Jan 18 - Annual Wuhan Lunar New Year banquet. Tens of thousands of people gathered for a potluck. (Hosted by the Mayor of Wuhan)
Jan 23 - Wuhan put on lockdown
https://www.axios.com/timeline-the-early-days-of-chinas-coro...
The research also found that if interventions in the country could have been conducted one week, two weeks, or three weeks earlier, cases could have been reduced by 66 percent, 86 percent and 95 percent respectively – significantly limiting the geographical spread of the disease
https://www.southampton.ac.uk/news/2020/03/covid-19-china.pa...
Looks like a couple months to me.
It reminds me of France:
March 15: French municipal elections (in all French cities)
March 16: General lockdown announced
Thanks for the response and links, but I basically regret this entire interaction and would rather leave the discussion here.
Just stay inside, shut up, and be glad we aren’t being overrun by witches like back in Salem. Those were terrible days.. witches everywhere! Thankfully, Quick thinking politicians got rid of them.
There will need to be back-and-forth quarantines, or targeted quarantines, or some other creative method of allowing people to live roughly normal lives after a few weeks.
The death rate among the under-70 population is a different matter. If the medical system is overloaded and working-age people start dying en masse, I imagine that would change public consciousness quickly.
There will be overlap between people who die of diseases routinely (the elderly, the immuno-compromised, and those with underlying conditions, and the unlucky) and those who die of this disease. No matter, the point still stands - if 100,000 people dying is what it takes to change people's behaviour significantly, that ought to happen every month, and it doesn't.
It's really not much of a problem, beyond the problem people have created by stockpiling too aggressively.
Might as well risk living before we die.
Think about it this way. The Ro spread factor is somewhere between 2.2 and 3.0 by most reports. People are contagious for 7 to 14 days before they know it. Therefore every infected person spreads a new case only once every 2 to 5 days on average. The problem isn't that the virus is explosively contagious per-interaction (measles is higher), it's that the incubation period is so long across so many interactions.
Cut that recognition time from that 7-14 days to 2, cut off those interactions, and that's how you get Ro below 1 to stop it. That's what South Korea did, by way of both rapid testing and contact tracing to test them too. Reports are that their rapid test gives false positives of up to 10%, but that's okay, a false positive is much less consequential than a false negative.
What jurisdictions in the Western world have the means and will to implement that remains to be seen.
Though I guess whenever you are producing enough virus to be contagious you would probably test positive at that point too.
At any rate, that's an approximation. The key point is for the average testing and isolation interval to be shorter than the average time to pass on a new case, whatever that interval actually is. If that happens, then it's stoppable.
Why? In a total lockdown situation, the positive cases might infect their close people the live with, but not really anyone else. And in a half lockdown, with still going out/shopping ... the infection rate is much slowed, if a high enough percentage of the infected isolate enough. That is all that we want, I thought.
That works if there is a relatively low number of cases, or you have enough testing capability to carpet bomb everyone with tests.
Once the number of cases gets too high, contact tracing has lost, because you have too many unknown cases in the community.
If you can’t test a large percentage of your population, you can’t detect pre-symptomatic or asymptomatic people that are spreading the virus.
There are still millions of people going about their day here in LA and nobody will stop them.
This is the most ridiculous fantasy a subset of HN users love to bring up, but there is just absolutely no chance that this happens in any meaningful way.
Many people (medical people) have experienced SARS in 2003 and they stay on alert this time. Except there are still enough people (especially the government personnel) not learning from / haven't experienced SARS.
If the current measure can eliminate the spread, I will feel lucky. But if the virus keeps spreading, I won't be surprised.
Judging by how long the shelter in place has lasted and affected curves in Asia, we should be prepared for ~2 months as a baseline. From what we're hearing from friends, life is starting to return to normalcy in Hong Kong, with no new domestic cases reported (though now they're contending with new imported cases from overseas travelers returning home). They have a really effective screening/tracking quarantine system in place where they'll give you a location tracking wristband for remote monitoring.
Our family has been affected by this since late January, and there's a big mental challenge aspect to this. Being able to walk outside (unlike in Wuhan) is really big.
It's truly unfortunate that the the country's health services bungled their initial testing and screening ramp up.