Why we're in "suppression" mode in the US, for SARS-CoV-2

We missed the initial “containment” phase, so now we’re in “suppression,” trying to make sure everyone in the country is in contact with as few other people as possible. Jeremy Young on Twitter lays out the standard epidemiological reasoning, plugging in the estimates for infection and mortality rates, to show why this is necessary. And we really need to get this under control before things go back to normal, or we run a sizable risk of spreading it all over again.

Continued on ThreadReader:

The Imperial College team plugged infection and death rates from China/Korea/Italy into epidemic modeling software and ran a simulation: what happens if the US does absolutely nothing -- if we treat COVID-19 like the flu, go about our business, and let the virus take its course? 

Here's what would happen: 80% of Americans would get the disease. 0.9% of them would die. Between 4 and 8 percent of all Americans over the age of 70 would die. 2.2 million Americans would die from the virus itself. 

It gets worse. People with severe COVID-19 need to be put on ventilators. 50% of those on ventilators still die, but the other 50% live. But in an unmitigated epidemic, the need for ventilators would be 30 times the number available in the US. Nearly 100% of these patients die. 

So the actual death toll from the virus would be closer to 4 million Americans -- in a span of 3 months. 8-15% of all Americans over 70 would die. 

How many is 4 million people? It's more Americans than have died all at once from anything, ever. It's the population of Los Angeles. It's 4 times the number of Americans who died in the Civil War...on both sides combined. It's two-thirds as many people as died in the Holocaust. 

Americans make up 4.4% of the world's population. If we extrapolate these numbers to the rest of the world (warning: MOE is high here), this gives us 90 million deaths globally from COVID-19, in 3-6 months. 15 Holocausts. 1.5 times as many people as died in all of World War II. 

Now, of course countries won't stand by and do nothing. So the Imperial College team ran the numbers again, this time assuming a "mitigation" strategy: all symptomatic cases in the US in isolation. Families of those cases quarantined. All Americans over 70 social distancing. 

This mitigation strategy is what you've seen a lot of people talking about when they say we should "flatten the curve": try to slow the spread of the disease to the people most likely to die from it, to avoid overwhelming hospitals. 

And it does flatten the curve -- but not nearly enough. The death rate from the disease is cut in half, but it still kills 1.1 million Americans all by itself. The peak need for ventilators falls by two-thirds, but it still exceeds the number of ventilators in the US by 8 times. 

That leaves the actual death toll in the US at right around 2 million deaths. The population of Houston. Two Civil Wars. One-third of the Holocaust. Globally, 45 million people die: 7.5 Holocausts, 3/4 of World War II. That's what happens if we rely on mitigation & common sense. 

Finally, the Imperial College team ran the numbers again, assuming a "suppression" strategy: isolate symptomatic cases, quarantine their family members, social distancing for the whole population, all public gatherings/most workplaces shut down, schools and universities close. 

Suppression works! The death rate in the US peaks 3 weeks from now at a few thousand deaths, then goes down. We hit but don't exceed the number of available ventilators. The nightmarish death tolls from the rest of the study disappear. 

But here's the catch: if we EVER relax suppression before a vaccine is administered to the entire population, COVID-19 comes right back and kills millions of Americans in a few months, the same as before. 

After the 1st suppression period ends in July, we could probably lift restrictions for a month, followed by 2 more months of suppression, in a repeating pattern without triggering an outbreak or overwhelming the ventilator supply. Staggering breaks by city could do a bit better. 

But we simply cannot EVER allow the virus to spread throughout the entire population in the way other viruses do, because it is just too deadly. If lots of people we know end up getting COVID-19, it means millions of Americans are dying. It simply can't be allowed to happen. 

How quickly will a vaccine be here? Last week three separate research teams announced they had developed vaccines. Yesterday, one of them (with FDA approval) injected its vaccine into a live person, without waiting for animal testing. That's an extreme measure, but necessary. 

Now, though, they have to monitor the test subject for 14 months to make sure the vaccine is safe. This part can't be rushed: if you're going to inoculate all humans, you have to make absolutely sure the vaccine itself won't kill them. It probably won't, but you have to be sure. 

Assuming the vaccine is safe and effective, it will still take several months to produce enough to inoculate the global population. For this reason, the Imperial College team estimated it will be about 18 months until the vaccine is available. 

During those 18 months, things are going to be very difficult and very scary. Our economy and society will be disrupted in profound ways. And if suppression actually works, it will feel like we're doing all this for nothing, because infection and death rates will remain low. 

It's easy to get people to come together in common sacrifice in the middle of a war. It's very hard to get them to do so in a pandemic that looks invisible precisely because suppression methods are working. But that's exactly what we're going to have to do.

Source: https://twitter.com/jeremycyoung/status/12...

Leaders set the pace when responding to crises...

Instead of informing the public about the spread and danger of the coronavirus, Trump spent months downplaying its significance, spread, and severity. That matters. The executive branch takes cues from what he says and tweets, to try to implement his vision, especially given how often he publicly belittle and fires people who disagree with him. It’s no surprise that there were serious delays in responding to this crisis. This video of Trump waving off concern, time after time, is damning:

Source: https://twitter.com/therecount/status/1240...

"If we want everybody to stay home during a coronavirus crisis, we need deep change to make that possible"

Because we have a weak social safety net, most people in this country can’t simply take off the two weeks necessary to stop this virus in its tracks. We need guaranteed housing, and universal paid sick and family leave.

Rossana Rodriguez, Carlos Ramirez-Rosa, Byron Sigcho Lopez, Daniel La Spata and Jeanette Taylor in an op-ed in the Chicago Sun-Times:

The COVID-19 crisis makes it impossible to ignore what has always been true: 

Our collective health and safety as a city and a society depends on the health and safety of the most vulnerable among us. 

As a result of rampant inequality and a nearly non-existent safety net, the United States appears to be on the brink of an especially devastating virus outbreak. Thus far, the primary response has been to urge individuals to change their behavior, in ways that are often impossible for working-class people in Chicago and nationwide.

Stay home if you’re sick, though Chicago requires that companies provide employees with just five paid sick days, while the virus can incubate for up to 14 days. Stock up on supplies, though nearly 40 percent of all Americans don’t have enough in the bank to cover a $400 emergency. Practice social distancing, though an estimated 86,000 Chicagoans are living on the streets, in crowded shelters or doubled-up with relatives. 

We applaud Gov. J.B. Pritzker’s decisions this week to close schools, bars and eat-in dining at restaurants. But unless we take action to guarantee healthcare, housing and income security for everybody, the virus is likely to continue to spread as it has, further stressing our already gutted public health system. 

If we want everyone to stay home, we need universal social benefits that leave no one out…

Source: https://chicago.suntimes.com/2020/3/16/211...

"The Coronavirus Called America’s Bluff"

This article is the fairest explanation I’ve read on why the US is in its current mess—testing so few people, taking extreme measures to quarantine ourselves.

Trump’s cult of loyalty is the most immediate cause of the problem, but that’s only a result of the corruption that has grown for decades as the rich have gotten richer and bent the system in their favor. We need to revolutionize the way we govern ourselves, democratizing decision-making at every level.

Anne Applebaum, in the Atlantic:

…We don’t know all the details yet, but one element of the situation cannot be denied: The president himself did not want the disease talked of too widely, did not want knowledge of it to spread, and, above all, did not want the numbers of those infected to appear too high. He said so himself, while explaining why he didn’t want a cruise ship full of infected Americans to dock in California. “I like the numbers being where they are,” he said. “I don’t need to have the numbers double because of one ship that wasn’t our fault.”

Donald Trump, just like the officials in Wuhan, was concerned about the numbers—the optics of how a pandemic looks. And everybody around him knew it. There are some indications that Alex Azar, the former pharmaceutical-industry executive and lobbyist who heads the Department of Health and Human Services, was not keen on telling the president things he did not want to hear…

Once again: Nobody threatened Azar. But fear of offending the president may have led him to hesitate to push for aggressive testing nevertheless.

Without the threats and violence of the Chinese system, in other words, we have the same results: scientists not allowed to do their job; public-health officials not pushing for aggressive testing; preparedness delayed, all because too many people feared that it might damage the political prospects of the leader…

…

All of this happens on top of all the other familiar pathologies: the profound polarization; the merger of politics and entertainment; the loss of faith in democratic institutions; the blind eyes turned to corruption, white-collar crime, and money laundering; the growth of inequality; the conversion of social media and a part of the news media into for-profit vectors of disinformation. These are all part of the deep background to this crisis too.

Source: https://www.theatlantic.com/ideas/archive/...

Denmark's a good example of how to handle potential job losses in a crisis

Denmark is one of the most democratic countries in the world, so it’s no surprise they’re handling the coronavirus crisis reasonably well. Because workers are nearly equal to owners, even though their economy is still market-oriented, they have figured out a way to mitigate the looming job losses:

Continued on Thread Reader:

The deal covers companies who'd have to lay off at least 30% of staff, or 50 staff or more. 

In return, companies commit to not lay off any staff for economic reason while they're receiving state compensation. 

Incredibly what can be done when the political will is there 

…

Covering 75% of wages for a period may seem like a bad deal for the state. It isn't: Lost jobs = lost tax income and increased benifits payments. This is a better way to lose that money, as it helps avoid a downturn in econ. activity and fallout from nonpayments of rents,mortages 

The condition of the deal is a strong trade union movement. But as usual, the Danish model is weaker when it comes to protecting the self-employed, people on zero-hour contracts, etc.. Many have already lost their jobs - what will be done for them remains to be seen. 

Also, the deal is short-term, lasting until June 9th. 
Some employers who expect a longer-term recession already say they won't take the deal, prefer sacking over paying 25% of salaries. 

So longer term questions remain. Would the state keeping employment going for longer if necessary? What about jobs that are actively harmful to the environment - so-called #batshitjobs - will they be sustained or will the crisis be used for a just green transition? 

While most countries dither and delay, Denmark has moved swiftly to help workers impacted by the economic fallout from coronavirus – securing a deal between unions and employers to protect wages and prevent layoffs.

tribunemag.co.uk/2020/03/denmarks-answer-to-the-coronavirus-recession

☝️ my piece on Denmark's answer to the Coronavirus recession…

Source: https://twitter.com/buerubner/status/12391...

Please practice "social distancing" and good hygiene

It is really hard to fathom just how bad it would be if everyone in the US was infected with the new coronavirus. Very few here have much experience with other highly infectious and/or lethal outbreaks, so it’s hard to understand the risk to society as a whole. This tweet gives us an idea of what would happen if everyone was infected, and the current ~3% death rate holds:

If you’re not older or already have health issues, you may feel like a very low chance of getting infected is worth going out or being around a lot of other seemingly health people. But spread that small chance across a large population, and the numbers start to add up. YOU may not die or suffer long term harm, but others will. Do the wise, ethical thing, and stay home and practice as good hygiene as much as possible.

"The Coronavirus Shows It is Time to Remove the For-Profit Infection from U.S. Health Care"

Healthcare is a human right. Yet in our system, 60,000 people die every year because they can’t afford it. Everyone should be guaranteed access to quality medicine and care, both because it’s the morally right thing to do, and because every person’s health affects everyone else’s, both directly (as during outbreaks of infectious diseases like the current coronavirus), and indirectly (as their ability to contribute to society is impaired). What’s stopping us are the entrenched interests, which drains an enormous amount of resources—money, time, etc.—from the rest of us, which could be put to better use. Detailed studies from think tanks ranging the political spectrum all show that singlepayer Medicare for All would save us a massive amount of money over time. We must demand it, now.

Fran Quiqley, addressing the horror and stupidity of our system at Common Dreams:

Last week, I listened as several Indiana workers in the hospitality industry gathered in southeastern Indiana to talk about their health. A cook in her 60s shared how she had gone months without her asthma inhalers because she couldn’t afford them. During that period, she was taken to the hospital by ambulance twice. A restaurant server talked about not being able to pay for tests her doctor recommended for potentially cancerous breast tissue. Another has seven prescriptions. She tearfully described her perpetual calculation about which to fill, because she can’t come close to affording them all.

Each story was greeted by sad, knowing nods. Several workers spoke about skipping doctor visits, reluctant to add to the stack of unpaid medical bills already piling up on their kitchen tables. 

Beyond their inability to get the care they need, they all had another thing in common: They all had health insurance.

At least, they had what often passes for health insurance in the United States. Unique among other nations, we prioritize the interests of corporations making billions of dollars in health care profits over the goal of ensuring access to care. While 27 million Americans have no health insurance at all, four in ten working Americans have a high-deductible plan that forces them to pay thousands of dollars out of pocket before they get any benefit from the premiums taken out of their paychecks each week.

Reams of academic medical studies confirm what the workers in Indiana tell us: Price tag barriers to accessing health care deter people from seeking the care they need. As recently as last month, most Americans may have seen this as a problem solely for the worker who could not afford to see a doctor about her high blood pressure or diabetes. This month, we know it is a problem for everyone.

That same worker is unlikely to seek testing and treatment for the coronavirus, which means they may unknowingly spread it.

…

Source: https://www.commondreams.org/views/2020/03...

COVID-19 isn't the flu; we didn't test and quarantine when it started, so now we need to "flatten the curve"

I’ve seen several people compare COVID-19 to the flu, often accompanied with bad information, mostly downplaying the severity of this crisis, and brushing off the absolute necessity of dramatically reducing our contact with each other.

Unlike the flu, noone has resistance or immunity to any strain of COVID-19 yet, which is one reason it’s spreading very fast. It’s also several times deadlier than the flu. The flu kills about 0.1% of those it infects. The best estimates, so far, of the rate of death for COVID-19 are between 0.7% and 3.5%. The flu kills tens of thousands in the US each year, in spite of widespread resistance. Without aggressively and preemptively quarantining ourselves, COVID-19 is expected to infect half the population. Given the average rate people die from this disease, if left to infect half the US or more, over a million people could die from it in the next year. The flu is no joke. COVID-19 is even worse, and therefore needs to be taken very seriously. The faster we respond, the fewer people will be infected and die, and the better care those who are infected will get from hospitals, since there are a finite amount of resources available at any hospital.

Italy’s a worst case scenario for hospital overload, given how fast COVID-19 was allowed to spread. They didn’t contain it quickly enough, so now their health system is severely overloaded. The World Health Organization rated their health system as the second most capable in the world, yet now in many places there are more than twice the number of critically-ill people than hospital beds available. Only a fraction of those infected are receiving the care they need. Containment and quarantine procedures have been even slower here in the US, and the WHO ranks our health system as 37th. We are grossly unprepared for an Italy-level outbreak.

If we had begun testing and quarantining when we should have, we might not have to resort to so many closures, cancelations, and quarantines. As a best case example, even though it’s literally a city (meaning there are a lot of people in a relatively small amount of space), Hong Kong did everything as well as possible, so very few people have been infected so far, and their hospitals aren’t strained. As soon as the virus was announced, and it was known to have originated from a particular province in China, they began testing and quarantining everyone who had recently traveled in from Hubei province, and tried locating everyone who had come into contact with them, and quarantined them as well. The people of Hong Kong began self-quarantining immediately, too, and the Hong Kong government eventually issued strict quarantine rules. Because of that, there are still fewer than 150 confirmed cases of COVID-19 infections in the country, and infections of all communicable diseases have dropped. Very few people will die from this disease there, even though cities are one of the places most at risk for mass infection. Here, instead, the White House refused to do more than contain the spread, for weeks after a containment strategy was useful, and even refused to test and quarantine dozens of infected or likely-infected people traveling in from known infected areas, so now the infection is likely everywhere in the country, and we need to take extreme measures to contain the spread.

There are several actions we, communally, can take right now to reduce the spread of COVID-19. The most important one is simply reducing how much we’re around other people, especially large groups of people. And when we do need to go out (as most of us have to for work—at least until Congress is able to pass a bill guaranteeing paid sick leave, if not also rent relief), we should wear a mask (obtain one if you don’t have any yet), use appropriate hand sanitizer after touching things, and wash our hands very well whenever possible.

Doing these will “flatten the curve” from a sharp and large spike of infections, to a longer but smoother hill of infections, ultimately:

  • reducing the total number of people who get infected, and therefore are subject to lasting harm (there are reports of permanent lung damage), or death

  • giving hospitals a better chance to respond adequately, by having to deal with fewer patients at a time

  • giving labs more time to develop a vaccine or cure, further reducing transmission, harm, and death

We’re all in this together.