This is misguided. The capacity of the healthcare system in rural areas will be even easier to overwhelm.

I think, actually, this statement is misguided, for a couple reasons. Its very likely that people are underestimating the average city's "hospital beds per capita" metric; frankly, a ton of people live in the average city (duh). Are there enough beds in many of America's tier-2 (say, Austin) and tier-3 (say, Cleveland) cities to cover all of the population?

By comparison, outside of cities, the spread will be far, far slower than within. Yes, healthcare is worse, but there's an order of magnitude fewer cases. People travel less. They go to the store once every two weeks, not every 4 days, even when there isn't a quarantine. They don't visit the new hipster restaurant down the street. They don't live twenty feet away from their neighbors.

NYC has 25% of all of the United State's cases, despite having ~2% of the US's population. This is the same story that is playing out in every state. Let's take Indiana as an example, being that they're having a relatively moderate outbreak with mostly rural areas surrounding a top 15 US city by population: Indianapolis has 41% of the state's cases, despite representing ~12% of the state's population.

This shouldn't be a surprise; diseases spread faster in cities. But, what you're asserting is that, eventually, rural areas will see the same spread that cities are. This feels misguided. That isn't to say that some, or even most, rural hospitals wont be "running hot" for a really long time, and that the virus wont spread and these areas, but its simply unlikely that the situation will ever be as bad as in major cities.

Confirmed cases depend on testing. What’s the testing capacity in Indianapolis vs rural areas?

There’s also a time lag. I think it hit New York first because of all the travel connections.

But why would rural areas be immune? People do still meet each other. They do go to church.

Tellingly, flu death rates tend to be higher in rural areas:

https://www.washingtonpost.com/nation/2020/03/19/rural-areas...

Yep everyone in rural places blindly goes to church no matter every Sunday (eye roll).

Legal action has had to been taken already to prevent gatherings at churches.

https://www.foxnews.com/us/louisiana-pastor-who-defied-coron...

Many US states do not currently have restrictions on churches. I was replying to the point that people in rural areas are spread out. My point was that some activities, like church, bring people together into an enclosed space.

My position is based on the unpredictability of exponential phenomena and the fact that the healthcare system in rural areas has been in the process of being hollowed out for quite some time. The incubation period of COVID-19 (estimated median 6 days last I checked?), coupled with the fact that most people who carry it are asymptomatic means that it's only a matter of time before it hits rural areas whose capacity is like, what? 0.5 ICU beds per county? If you need a ventilator out there you're gonna fucking die.

The majority of COVID-19 patients who need a ventilator are going to die regardless of whether they actually get a ventilator or not. Hopefully that will change as more effective treatments are developed, but that's the current reality. By all means let's do whatever it takes to deploy more ventilators, but they're not a panacea.

I've been curious on this. Do you have numbers for people that have been put on them?

New York has 1,600 ICU beds; there are a bunch of counties in rural America that have zero. The CFR in these counties if the virus gets out of hand will be appalling.

Of course it's misguided. Which country handled this crisis worse than US? Misguided is an understatement.

Maybe Brazil?

> "We're all going to die one day"[0]

> “I’m sorry, some people will die, they will die, that’s life,” Bolsonaro said in a television interview on Friday night. “You can’t stop a car factory because of traffic deaths.”[1]

> Bolsonaro has compared the new coronavirus to a "little flu," condemned the reaction to it as "hysteria," and said Brazilians' immune systems are so strong they can swim in raw sewage and "don't catch a thing."[2]

> He has called the virus a “measly cold.” “Some will die” from it, he said, because “such is life.” [3]

> ..more than 20 members of Bolsonaro’s U.S. delegation have tested positive for the coronavirus. Bolsonaro ignored his own health ministry’s advice to self-isolate for a couple of weeks and to discourage large gatherings. He made a defiant show of shaking hands and taking selfies at a rally that attracted hundreds of his supporters. [4]

[0] https://www.marketwatch.com/story/brazils-bolsonaro-downplay...

[1] https://www.nytimes.com/reuters/2020/03/27/world/americas/27...

[2] https://www.afp.com/en/news/15/bolsonaro-takes-down-virus-sh...

[3] https://www.nytimes.com/2020/04/01/world/americas/brazil-bol...

[4] https://www.theatlantic.com/politics/archive/2020/03/bolsona...

If I use the words that I think are appropriate for the obstinate middlebrow skepticism of HN in the face of an uncontrolled pandemic, I get flagged :^)

Our death rate per capita is substantially lower than China and Italy for example.

Y'all need to understand what an exponential function looks like.

Y’all need to not compare absolute case numbers on an exponential curve between countries with vastly different populations.

I find it odd that people are comparing "worst" by number of cases and not accounting population. The US has 320mn people while Italy has 60.5, Spain has 46.8, and Germany has 83.8. These are the countries with the most cases and by population the US is doing the best out of all of them and Spain the worst. If we look at deaths, Germany is only slightly better than the US but Spain and Italy are each much higher.

The US sure has a lot of problems, but that doesn't mean everything we do is the worst.

The US spread is a few weeks behind the other countries. People are projecting based on incubation time and mitigation response what will happen. The US growth rate is on track to make everyone else look peachy keen.

I doubt there is any definitively proven date of the start of the spread. It very well could have started sooner than claims.

Every one except SK Israel and perhaps Germany.

Blue collar Americans in the cities are within a couple of weeks to telling everyone to shove it. These are people who had less than a $1000 dollars extra in their bank accounts. They have been out of a job for one paycheck already.

Credit card companies are slashing credit lines. Postal service is failing to deliver mail in some locations. Unemployment numbers/systems work as well as Healthcare.gov did upon launch.

We are one to two weeks away from massive civil unrest when thousands of people have no money to pay for food.

It is somewhat amazing to me that politicians don't seem to understand this. The solution is so simple: give people money directly, give money directly to businesses with the promise that they will not fire anyone, and do it yesterday.

Perhaps I'm simply misreading the situation and am in a bad mood, but it seems that whenever we see a government program rolled out, politicians seem more interested in preventing fraud, misuse, and politically sensitive spending than they are in seeing the program actually succeed / solve it's stated problem. This results in layers of complexity, regulations, and bullshit that impede the program from functioning efficiently. I would rather a cash transfer program have a 25% fraudulent claim rate and a 90% legitimate claim success rate than a 2% fraudulent claim rate and a 50% legitimate claim success rate. Politicians seem to want the latter. Further, there were arguments during the negotiations about the 2 trillion dollar bail out about abortions and oil subsidies ffs. These guys need to get their heads out of their asses and join us in the real world.

They actually are doing both of those points. Everyone's heard of the $1200 checks to individuals, but they also created the Paycheck Protection Program[1] which advertises itself as a small business loan program but "will forgive loans if all employees are kept on the payroll for eight weeks and the money is used for payroll, rent, mortgage interest, or utilities." In other words, if you run a small business, Uncle Sam will cover your payroll for 2 months if you don't fire anyone.

It's the "do it yesterday" part that they're having trouble with. Major banks are saying that the government isn't forthcoming with the details they need to actually implement the lending program, so they've had to delay its launch.

[1] https://www.sba.gov/funding-programs/loans/coronavirus-relie...

[2] https://www.forbes.com/sites/brianthompson1/2020/04/03/no-sm...

There has never been a single program administered by the SBA that was not comically broken.

There are two possibilities:

1. This program is going to continue the great tradition of government epic failures of providing help to small businesses

2. This time around it works and small businesses get an immediate ( in a commercial sense of the word ) help in record time.

One won't need to be a genius to figure out the implication of 2. Personally, I think it would be 1.

> The solution is so simple: give people money directly, give money directly to businesses with the promise that they will not fire anyone, and do it yesterday.

The CARES act did do this, and it did it yesterday.

Passed != Implemented

> It is somewhat amazing to me that politicians don't seem to understand this.

Since we are now awaiting implementation, politicians are no longer in the picture. They understood what needed to be done, and did their jobs. It is now up to the bureaucrats.

This isn't an accurate picture of the US Federal government.

Now that congress has passed the law, it's up to the EXECUTIVE BRANCH of the government to make it happen. There's a politician at the head of that - POTUS.

People wanted an outsider in the White House, someone who would "shake things up", and this is the consequence. This is what it means.

The POTUS can and should be making this implement faster.

> Now that congress has passed the law, it's up to the EXECUTIVE BRANCH of the government to make it happen. There's a politician at the head of that - POTUS.

This is implemented through the agencies of the Executive branch, the operations for which are almost entirely run by bureaucrats. When Trump entered office, he didn't just fire all of the bureaucrats at the Department of Labor, he just replaced its head.

The folks that work on the day-to-day operations of processing unemployment insurance claims, or maintaining/improving the systems remain largely unchanged. Their employment is a function of the budget and funding, which is determined by Congress, and then assented by the POTUS.

In the case of CARES, the Senate unanimously passed it, and POTUS quickly signed it into law. He is not going to micro-manage its implementation. It's now up to the bureaucrats.

If you don't want this unrest, start giving people food. The solution is obvious, and is only unpalatable to idealogues.

There's no centralized system to do this. Everything relies on thousands of little trading businesses. Those businesses are now closed. It will take at best a couple of months to get a different system in place.

If that system gets rolled out, the US as the country is over because it is an admission that the US is not capable of maintaining it's existing economic system.

All the groceries are currently open. All the farms are currently working, minus migrant labourers, because we would rather have crops rot in the field, than let them into the country. All the truckers are currently hauling.

The only part of the distribution system that isn't working very well because of the shutdown is the part that distributes dollars.

Any service disruptions right now are not due to the shutdown - they are due to the actual effects of the virus. Look at the MTA. Half of its employees are sick, and the other half have called in sick. Train service has been reduced, and passengers are now packed like sardines in a can on the trains that are still running. Look at the supply chain disruptions - they aren't caused by people being stopped from coming in to work - they are because people can't, or are afraid to come into work.

As well they should be, given the state of healthcare in this country. Who is going to pay for their care if they are one of the 20% that need hospitalization after catching it?

Yes, the issue is becoming dollars. There are programs in place that seek to do this. Specifically "food stamps" -> the latest bill funds these a lot more.

But due to years of people handwringing over abuse, and "economists" encouraging thrift, the process to get food stamps isn't speedy, it's state-by-state, and now it's overwhelmed.

Due to the general anthemia among the GOP for welfare type programs, different states are going to see different levels of urgency with boosting the food stamp programs. It's much the same as how some GOP led states refused the medicaid expansion that was part of the ACA.

Hopefully this will reveal new information to voters of those states as they slowly starve and as they realize that certain other states are doing better - what's the difference? Competent governance. You can't buy it, but you can vote for it.

> All the groceries are currently open.

That's a talking point.

Chinatown grocery stores are mostly closed in both Manhattan and Queens. Patels is closed everywhere.

Edit: Downvotes don't protect from reality

https://www.patelbros.com/coronavirus

Enough grocery stores are still open, and grocery delivery services are doing roaring business. We're not remotely (yet?) at risk of people starving from inability to obtain food.

Non-gigantic grocery stores are going to start closing because contrary to the official positions logistics is broken. Smaller grocery stores have very small margins and operate on COD basis. A friend of mine owns one. His distributors raised prices between 10-50% across the board and removed all the incentives. He does not have enough money to stock up at the new price points so he is slowing the buys, cleaning out inventory and is going to close unless the social distancing goes away by the end of the month. Anecdotally, other small supermarket operators are thinking about doing the same.

Effective grocery store prices are 2x - all of the sales have been removed. Eggs in Queens went from $1.69/dozen to $7.99 a dozen.

$1200 tax credit for 2020 ( this is what it actually is ) is nothing for people who live and support high cost areas which are the people who allow for the white collar jobs to exist.

Are those logistics broken because the government shut the logistics operators down, or because people running them have fallen ill, or are afraid of falling ill?

Every state with shutdown orders considers logistics essential services. Nobody but the virus is preventing the people working in them from going to work.

I'll repeat it: Nobody working in food production and distribution is forbidden from going to work.

If prices are rising, it has nothing to do with the shutdown, and everything to do with the fact that there's a global pandemic... Which will be made worse if lift the shutdown orders.

Are you planning on ordering these people back to work at gunpoint, to lower the price of eggs? Or are you going to instead, consider extending a short-term loan, so that the grocer can absorb the price hike? The number of hens laying eggs hasn't changed over the past four weeks.

You keep repeating talking points from TV.

> I'll repeat it: Nobody working in food production and distribution is forbidden from going to work.

That is not the message that is being repeated on TV and on the news. The message is "stay home. if you are close to people you are going to be infected and die. stay home". The message is not "Stay home unless you work in list in blah blah blah. Also, unless you have comorbidity such as diabetes, heart disease, compromised lunges you are going to be fine". If you keep repeating that people are going to die, people are going to believe you even though the number of people who are going to die that do not have comorbidity factors have a very low risk. That's how you destroy logistic.

Right now Amazon, objectively a logistics company, has an equivalent of the ground hold on all non-essentials. I cannot get a frying pan delivered until April 24th.

> I'll repeat it: Nobody working in food production and distribution is forbidden from going to work.

We are at 10% of seasonal flu death numbers heading head first into a wall.

> You keep repeating talking points from TV.

This is a very weird line of argumentation. Do you think there is some media-wide conspiracy in favor of containment? To what end?

These "talking points" are also what the epidemiologists and politicians are saying. Just because you are in the minority that doesn't agree with it doesn't make you right and everyone else wrong.

> Right now Amazon, objectively a logistics company, has an equivalent of the ground hold on all non-essentials. I cannot get a frying pan delivered until April 24th.

Amazon is having a hold because demand for everything is up, because people are trying to avoid going outside to shop... And because their employees are concerned about their personal safety. No government agency has stepped in to shut down an Amazon warehouse. If you lift the shutdowns, you will actually increase their concerns about personal safety.

> If you keep repeating that people are going to die, people are going to believe you even though the number of people who are going to die that do not have comorbidity factors have a very low risk.

Those people have relatives who are at risk, or may not be interested in rolling the dice on ending up in the hospital. This virus has a much higher hospitalization rate than the flu. Are you ready to pay for all their medical bills? Has socialized medicine finally found its moment to arrive on the shores of the United States? Or, alternatively, are you personally ready to take a job lifting boxes in a warehouse for $15/hour with no medical benefits? One that you commute to in a subway car that's packed shoulder-to-shoulder with sick people?

The MTA is unable to operate the NYC subway, because they have so many sick employees. Do you think a Krelminesque order to stop broadcasting bad news on the telly is going to defy reality, and get the subway running at full capacity, again?

> We are at 10% of seasonal flu death numbers heading head first into a wall.

Italy has, over the span of 4 weeks, hit 300% of their regular seasonal flu deaths, and 50% of the hospitalizations, despite a lockdown but this apparently does not stop people on the internet from drawing false equivalences to the flu.

Do you have a better plan for dealing with a virus that sends more people to the hospital in 4 weeks, than the flu does in half a year? How many hospitalizations and deaths do you think they would have hit if cases continued to double every three days?

> Amazon is having a hold because demand for everything is up, because people are trying to avoid going outside to shop... And because their employees are concerned about their personal safety.

You cannot have it both ways - either employees are concerned for their safety and logistics therefore is affected or they are not and logistics is not affected.

> The MTA is unable to operate the NYC subway, because they have so many sick employees. Do you think a Krelminesque order to stop broadcasting bad news on the telly is going to defy reality, and get the subway running at full capacity, again?

MTA decided to cut the service on NYC subway because it projected a drop of demand. It is an organization has been been mismanaged for decades. I find it very difficult to believe that it would suddenly be making marginally optimal decisions in "the stay at home" environment.

> Italy has, over the span of 4 weeks, hit 300% of their regular seasonal flu deaths, and 50% of the hospitalizations, despite a lockdown but this apparently does not stop people on the internet from drawing false equivalences to the flu.

The vast majority of hospitalizations and deaths come from comorbidity.

> Do you have a better plan for dealing with a virus that sends more people to the hospital in 4 weeks, than the flu does in half a year? How many hospitalizations and deaths do you think they would have hit if cases continued to double every three days?

Order a stay at home for at risk population and population with comorbidity. Lift it from anyone else. Eat 10-15% hit to the economy rather than a total devastation. The mass poverty creating economic hit is going to destroy the medical system much faster than COVID-19.

Of course there is. It's called the National Guard. It's called the US Army, Airforce, and Navy. It's called FEMA. I'm sure there are plenty of other centralized systems with tons of funding ready to do this on a moment's notice. What we don't have is leadership, with an idiot leading this country who said the pandemic is a "hoax."

The optics of the National Guard (read: men with guns) delivering food for months in the entire United States would trigger a nearly immediate break down of economic ties both internally in the US and between the US and the rest of the world

What do you think FEMA does after a hurricane?

Difference is the orders of magnitude

Where does the food come from if nobody is picking it, transporting it, processing it or selling it?

Food production and distribution has not ceased, nor is there any reason it will. Getting that food to people who cannot afford it is a different issue.

Anyone looking at this as just a New York or LA or Miami problem will learn soon enough. The cities were hit first for obvious reasons but it viruses don't self-isolate to population centers.

Honestly, my life in the suburbs hasn't been much different since this all started. It's basically been business as usual, except for things like stores not having as much food variety, fast food places being drive through only, and big box stores being less crowded. I think people in the cities will be most effected because of the large number of small shops and independent restaurants that had to close, but out in the suburbs the impact hasn't been any worse than when we get a big snow fall.

I've been thinking about this and how talking about the US as a homogenous entity is a mistake. The R0 of a big city is going to be higher than in a smaller city, suburb or the country side. For example, even before the shutdowns I could go to the grocery and count on one hand the number of people I might be within 6' of. Now it's even less. In a place like NYC, that seems impossible.

I and all the people I know are taking all the precautions, but density has to play into how fast something can spread.

And yet there have been very dense, urbanized countries that have gotten a handle on it well (such as Singapore and Hong Kong). We could do it here, but we don't have enough testing or enough masks. The density of the country is not the main driving factor behind which countries are getting hardest hit and which are not.

On the other hand, many rural communities are vastly less capable of providing the care for even a small fraction of the big cities. Many rural counties in Colorado and Idaho have the highest rate of death and are most overwhelmed in their states because they have far less capacity.

Less likely to get it vs less likely to get medical treatment.

Logically it make sense to want more rural. If you test positive go to the nearest big city for treatment.

Assuming their hospital isn't already overwhelmed.

That's true up until someone brings it to their church, a funeral, school graduation and the entire community gets it and it's like a small bomb going off. Truck drivers still go through small towns, packages still come in and out, they get food.

This is flat-out not true. People in rural areas still congregate with other people enough to cause bad epidemiological outbreaks. Past pandemics have not only hit the city and spared the countryside.

I grew up rural bet you didn’t.

I suspect rural folks are more likely to go to church, but I could be wrong.

Stereotype much?

I hope that's true because the country needs food. I don't think rural communities without any protections will be any better off though. Rural communities still gather in stores, bars, restaurants so I don't see why the spread would be any less impactful.

Because they interact less and interact less with world travellers, have less world class workers imported from around the globe. They are spread out more, take public transit less. Doesn't mean it won't spread but in a rural setting you see thousands of people less per day on average.

Shouldn't this be asterisked with a "So far"? The black plague devastated rural communities along with urban.

The Black Plague was spread by rodents. Coronavirus currently required a human carrier. I do agree about the "So Far" bit though, if precautions aren't taken, eventually someone will catch it and it'll spread.

It's already happened in a few places.

https://www.nytimes.com/2020/03/30/us/coronavirus-funeral-al...

Those will also be the locations with less preparedness. How many small towns even have ICUs?

Americans are not taking this shutdown at the moment, anyway. I live in Boston, other than that people who can work from home, work from home and restaurants/bars are close, absolutely nothing seems to have changed.

My roommate works in a random thrift shop, they're classified as "essential business" so he still shows up to work every day to read book.

I don't know why a thrift shop would be classified as "essential". Here in Minnesota they are not.

Alright well when urban Americans start talking about breaking up the country over this I don't want to hear any kvetching from the rural areas.

I have a feeling rural folk will be a-ok with that.

Until the subsidy checks run out.

My money is on the group that controls the food supply.

The people that own the food supply live far away from where it is produced.

Agree, I am saying rural America controls the food supply and is armed.