PSA: learning from the example of Europe (COVID-19)
(Sorry, this isn't about Michigan or sports, but I think it needs to be said.)
Yes, what we are experiencing with these massive shutdowns of public events is unprecedented in our lifetimes. No, it's not - at all - an overreaction.
If you think otherwise, read about Italy.
Italy was the first European country to get the coronavirus and initially, took a rather blasé attitude to it. There were no local restrictions and limited testing. One local politician urged people in Milan not to panic and popularized a MilanoNeverStops hashtag. (He now has the coronavirus.)
According to the latest numbers, Italy has 17,660 confirmed cases of coronavirus, which has led to 1,266 deaths. 250 people have died from it in the last 24 hours.
This article is a grim assessment of the situation there.
Now consider this: three days ago, TIME published this article on Italy, noting that it had had "463 deaths and at least 9,172 people infected. So in three days, the number of confirmed cases has doubled and deaths has more than doubled. The Italian mortality rate is a massive 7.2% of all cases, nearly double the global average of 3.7%.
Why is this happening in Italy, a wealthy country with a very respectable health system? Simple: Once you have too many critically sick people for the number of beds (or ventilators, respirators, etc.) in your hospitals . . . a lot of people die. If you have two patients on the verge of death but only one tube, what are you supposed to do?
Now consider this: the United States has fewer hospital beds per capita than Italy! Our tipping point, where we have to go into triage mode and simply let some patients die, is lower than theirs is. That's sobering.
What about other European countries?
France got the virus not long after Italy and it has been speculated that they will be the next European country to crack. In the viral Medium article that everyone saw, written just three days ago, France had the most coronavirus cases of any beyond the top four (China, Italy, Iran, South Korea) - by a fairly significant margin.
France has gotten many more cases since then, and now has had 79 deaths. The situation is becoming increasingly worrisome, although it has a fairly study health system that boasts twice as many hospital beds per capita (6.0 per capita) as Italy (3.2).
The French government has faced some scrutiny for its coronavirus response but by last weekend it was figuring things out. The Women's Day march in Paris was cancelled, and the PSG soccer club was forced to play in front of an empty stadium in its key Champions' League match. Despite the recent increase, France (3,661 cases) now has the fourth-most confirmed cases in Europe. While Germany (3,675) is basically in a statistical tie, there is also...
Spain. They're suddenly in the second position in Europe in both cases and deaths. How'd that happen? Well, last weekend, when Paris was cracking down on big gatherings, Madrid permitted 120,000 people to march on Women's Day - and 60,000 to attend a soccer match - and 9,000 to attend a political rally.
Now Spain, with 20 million fewer people than France, has significantly more cases (5,232) and deaths (133). And they have fewer hospital beds per capita (2.97) than Italy. They may be in real trouble now. They've nearly mirrored Italy's curve to date.
France and Spain both gained a lot of cases/deaths, but France flattened its curve through social distancing. Spain did not, even though it already had less wiggle room, due to having half the hospital beds per capita. Now Spain is finally shutting things down and it should flatten its own curve, but is it too late?
We have 2.77 hospital beds per capita, fewer than any of these countries. That means our potential day of reckoning, where we're forced to give up on patients for lack of space, could come sooner than it did for Italy.
Don't do what people in Italy and Spain did. Practice social distancing. Don't go to the library, the gym, the movie theater, any place that attracts a lot of people. . . it sucks, but it's worth the sacrifice for right now. This isn't just about you, it's about everyone's health.
(P.S. I left out Germany, because they started vigorously testing as soon as Italy showed weakness. They've identified lots of cases early on and have only had 11 deaths. And with 8.0 hospital beds per capita, their curve can go awhile longer.)
March 13th, 2020 at 10:50 PM ^
Yawn......
If you're gonna yawn, please do it at least six feet away from me and everyone else.
Better yet, do everything at least six feet away from me and everyone else. Thanks.
Constructive. If you don't agree that this is something to take seriously, at least do us the courtesy of explaining why. Also, stay away from me and my family.
BTW, didn't neg so as not to pile on, but you deserve it.
I echo Daleppard's yawn (and if I must I will keep my 6ft away from you). Contrary to the post, I think what we are seeing is a GROSS over-reaction. We are effectively cratering our economy out of raw fear. I accept reasonable pre-cautions, such as extreme limiting of access to nursing home facilities (my mother is in one and fits the bill of high risk). But the complete shut down of schools/sports businesses is unnecessary. For all the epidemiologists modeling things below, when comparing Italy to almost anyplace else there are several factors that need to be added in. First, it is just about the oldest population in the western world, a full12 years average older than the US. Also for the past year they have a massive traffic flow to and from china (reference silk road initiative) which pre-loaded their population for the outbreak. I take the outbreak seriously, but this is no the first Corona virus, and it won't be the last. Are we setting ourselves up for a yearly economic shutdown when the latest bug emerges? Given that 105 days into the cycle, China is re-opening everything in the Wuhan province (first confirmed case around Dec 1,2019) and their total death toll of about 4K at present, I would expect we are looking at a similar death toll. Not to get Stalinistic on the statistics, but given that the Swine flu killed 20K in 2008-09, and the "normal" flu kills 20-50K americans every year, I just can't get behind the panic.
OK, given the lack of any immunity or vaccine, it's EXTREMEMLY conservative to expect only 100M Americans will contract this virus in the next 12-15 months. (less than 1/3 of the pop.) I'd personaly place an over under on half the pouplation contracting this desease at a date of 11/1/2020, and that's accounting for the Qtine/social distancing and hoping that the summer will lower the contraction rate. I'd guess 1/3 of the population by 7/1, conservatively.
the LOWEST reasonable mortality rate (accounting for the cruise ship which was a closed/isolated system, the under testing everywhere, etc. and the availability of beds being better in the US) seems to be 0.5%. At least, that's the lowest I've seen estimated anywhere and it's using fancy math (more than basic 1st year stats & calculus)
100,000,000 * 0.005 = 500,000 AMERCANS DEAD in about 1-1.5 years.
Even if these round estimates are too extreme by a factor of 10, this will be a very bad flu in terms of deaths.
Not to mention, if 0.5% die, what is a reasonable hospitalization rate? 1% of all cases? IDK and this is a BIG question that needs answering via mass testing that would have helped inform our response. I'll let you go a head and think about 1 MILLION additional hospitalizations in this country in the next year.
STOP comparing this to the flu. I made the same mistake back in Jan. This will be "only the flu" if there was already a herd/developed immunity in the population (there is not), a vaccine (there is not), and if the MOST CONSERVATIVE death rates for COVID-19 are overestimated by a factor of 10.
March 19th, 2020 at 10:02 PM ^
The hospitalization rate is currently 19%. That's bad.
March 22nd, 2020 at 12:33 PM ^
So.....500,000 dead in 18 months.......I am taking the under.......want to make it interesting? I'll offer up that flu deaths exceed Wuhan Flu deaths this year. As much as you are sick of folks comparing it to the flu, you still fail to address the fact 'regular flu' has an existing vaccine shot, yet folks die of it in numbers that dwarf the flu, and the additional horror that flu doesn't appear to discriminate regarding age, as Wuhan clearly does. We, in turn, are sick of the hysteria and purposeful cratering of an economy, while always taking the worse case scenarios. This is a numbers game, and a big picture analysis is advisable. Yes, people are dying, and that's unfortunate, even horrific to those close to the deceased. Given that it appears a substantial, and I'll borrow your shtick and capitalize SUBSTANTIAL number of those deceased were compromised or near death with or without the virus, makes me reasonably suspicious that it is the plague you imagine (IMAGINE) it to be. All that said, I apologize for jumping in on this discussion on a site meant for stuff we truly enjoy, Michigan athletics. This kind of dialogue belongs on twitter, where we can rant uninformed and demonize the opposing view at will..........
It's hard to take you seriously, but I will say one thing: no one will be able to say what the death toll would have been without these unprecedented measures. You may still (sadly) be proven wrong. If you are, I hope you learn to trust public health experts over wherever it is that you're getting your information now.
Only took 11 months...
March 19th, 2020 at 10:13 PM ^
I can respect this; at least you give a rationale for your stance. However, you're missing many fundamental points. Please listen to the public health experts who know what they're talking about (of which I am not one) and consider the following:
1. There is ample evidence that there are (and were early on) infectious asymptomatic carriers of SARS-CoV-2. The current infectiousness estimates (R0) peg it as worse than 2009 H1N1 ("swine flu") and on par with 1918 H1N1 ("spanish flu"). It's been a while since this pandemic could be contained by what you're calling reasonable precautions.
2. "Pre-loading" isn't really a thing. Once you lose contain, it's likely to start exponential growth if you don't take drastic measures (and might still do so even if you do). Maybe lot of early contact with China moves you along the beginning part of the curve more quickly, but that's about it. We're now at the point of trying to stretch it out and buy time, not stop it.
3. Yes, Italians are, on average, older than Americans. They also smoke more. On the other hand, they have a longer life expectancy and lower rates of obesity, asthma, diabetes, and COPD. So it's not at all as clear cut as you think.
4. This strain is not going away, China will undoubtedly have more coronavirus deaths. They are where they are today, though, *because* they shut down schools and businesses in the affected area.
5. We are always more prepared for the yearly seasonal flu and we were more prepared for 2009 H1N1 than we are for SARS-CoV-2, even now. This is also a more impactful disease, so don't use those as comparison points.
6. We don't yet know whether recovered people gain long term immunity.
7. Like influenza, this is an RNA virus and is therefore expected to have a relatively high rate of mutation. This can be problematic for drug and vaccine development and could result in a worse strain appearing.
8. If we don't act, the economic impact of a repeat of 1918 would be much worse and take much longer to pull out of. Not to mention, you know, millions dead.
It's true that most people who get COVID-19 will survive and not require hospitalization. That doesn't mean it's not a public health emergency. I take no glee in this; I'd love to be proven wrong and have the death toll be 4K without taking any drastic measures. Nothing points in that direction. Please take it seriously, don't yawn.
March 19th, 2020 at 10:53 PM ^
40 percent of the deaths in Italy are people between 20-49. You're just spouting ignorance.
I still love and agree with your point, but just want to provide an adjustment to your numbers. 24% of the cases are from people 20-49, compared to ~40% for 70+. Percentage of deaths are substantially higher for 70+ at 87% vs <1% for 49 and under.
“A study in JAMA this week found that almost 40 per cent of infections and 87 per cent of deaths in the country have been in patients over 70 years old”
JAMA Link:
China is re-opening everything in the Wuhan province
Hope you saved the receipt for your medical degree.
March 13th, 2020 at 10:51 PM ^
Damn, I went to the gym both today and yesterday. However, washed hands before and after, had a towel with me and wiped equipment down.
I understand the USA cases will rise due to having more test available. What measure to we need to monitor to determine when it’s safe to be large crowds etc ?
i must admit that i didn’t give the virus any thought last week. Maybe I was being wishful that it wasn’t anything, but now, my tune has changed.
I’ll work out at home tomorrow and limit public places.
The metrics to watch would be:
1) Reduction over time in "# of people newly exposed to the virus on a given day."
2) Total % of the population that has been exposed to the virus.
The problem is those metrics are hard to directly measure. You are really relying on epidemioligical mathematical models to estimate them.
One note: we have had multiple state (IN and OH) directors of health who have made public comments that 1%+ of their state's population has the virus. I'm not sure they were supposed to say that (nobody Federal has said this), but they're likely referencing some CDC models.
If that 1% number is right, that would mean the National current # of "confirmed cases" is THREE orders of magnitude lower than the actual number of cases. Which actually might not be a bad thing.
Here's somthing for which I couldn't lock down a number - those "flatteen the curve" graphs - what is the actual time scale on the independent axis? My best guess was 50-100 days, but that was admittedly a bit of a WAG
From the Spanish flu chart that probably influenced the modern "flatten he curve graph" we've seen:
So you we're right with your thinking, that chart is 105 days long.
Yeah, those graphs all just illustrate the concept. It's hard to know the numbers on the x-axis.
That said, I've been playing around with the math.
The below is definitely a "1st-order" model and the CDC models would be considerably more sophisticated. But if we assume the 1% #s shared by the Indiana and Ohio directors, here's my math:
(1) It would be reasonable to assume that the first Ohioian got infected on 15-January (the date of the first confirmed American case).
(2) If we mathematically assume that the number of cases on day x+1 = (number of cases on day X) * (a constant) ---- e.g., exponential growth ---- we get to 117,000 cases (1% of Ohio) on March 12th via a constant of 1.2272.
(3) That also means the number of cases in Ohio on March 5th would be 27,911.
(4) I chose March 5th because that is at the high end of the "4-7 day incubation period." ALL of those 27,911 cases should have showed symptoms by today, March 12th.
(5) As of March 12th, Ohio only has 6 confirmed cases. Not a large number of the (theoretical) 27,911 cases were critical enough that a test was done. I know there are issues with test shortages - and that has an influence on the "6" number. But even if you make that 6 a 600, it's only 2.5% of the (theoretical) 27,911 actual cases.
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So that is from the start to March 12th. Going forward from there:
(1) If that 1.2272 exponent stayed constant, we'd get to the point of 1MM new daily infections by 30-March and a total of 12.9MM infections (100%+ of Ohioans!) by 4-April. Exponential growth is quick, of course.
(2) However, that 1.2272 exponent won't stay constant. 2 things can and will reduce it. (A) Social Distancing, less interaction. (B) As more and more of the public has already been exposed to the virus, community immunity builds. Slight mutations are possible and such, but I'm considerably unlikely to contract again once I've initially been exposed.
(3) I assumed that Social Distancing will bring that 1.2272 down to 1.1704 (25% reduction). I also brought in assumptions as regards community immunity building.
(4) Running those numbers, we would expect 23K "first contractions" in Ohio today. That goes up to 498K "first contractions" in Ohio on 11-April, which is (admittedly kind of scary) a 22x increase vs. today. On 11-April, 6.57MM Ohioians have been exposed, 56% of the population. But at that point, the "# of first contractions per day" metric starts to go down. By 5-May, we are where we are today (23K). By 4-July, that metric is 0 new cases per day.
(5) Of course, this is all super-sensitive on the number in the exponent. Make that number 1.1136 (50% reduction due to Social Distancing), and our peak daily figure is 332K on 24-April. Make that number 1.0568 (75% reduction), and our peak daily figure is 166K, but that's not until early June.
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Again, I'm not claiming any high level of sophistication here. But that's how I'm directionally thinking about where we are on the x-axis. The math is highly dependent on the correctness of the OH and IN officials' 1 % numbers too, of course (I tend to think they are right). I'd share my Excel sheet here if I could attach documents, but I don't think I can.
(all those #s are for Ohio, but I think the percentages would go for any state).
March 14th, 2020 at 10:37 PM ^
Your post reminded me of this article I just read, which I thought others might be interested in:
March 14th, 2020 at 11:43 PM ^
Thanks for the link - I had not seen that. That's a wonderful article, and the visuals presented are suburb. That's good journalism.
What strikes me - every time I run those simulations, the "slope of the brown area" --- which is mathematically equivalent to "number of new people being exposed on a given day" --- has a HIGHER maximum value in the quarantine situation than the moderate distancing situation.
And that's important, because "number of new people being exposed on a given day" will be roughly proportional to number of people who need hospitalization because of this (at that time).
March 15th, 2020 at 10:37 AM ^
FWIW (not much I'm sure), Here's my model. Based on simple logistic growth (no immunity or qtine/distancing, no recovery accounted for in this model)
http://www.math.stonybrook.edu/~julia/MAT132F16/LogisticHandOut.pdf. see pg 6 for the basics of logistic growth.
f(t)=c/(1+ae^(-kt)). = # of confirmed cases (obvsly different than actual contracted cases)
I'm using population numbers for the USA
(c = 350 = total pop in millions)
https://ourworldindata.org/coronavirus for USA: 3/10/2020 had f=.000472 cases in millions (my t=0), 3/14 had f(4)=0.001678 cases in millions
a=741,500 ish = c/f(0) - 1
Solving this initial value gets me a k=0.3171 (reciprocal days) and a peak in the contraction rate at t= 43 days from 3/10 --- puts us at April 22-24ish when half the population of the US would have contracted the disease.
Consider 3% of the confirmed cases requiring hospitalization that's .03*175million = 10.5 million potential hospitalizations between now and 4/23 or so if nothing was done.
This is all spurious of course as this is an incredibly unsophisticaed back of the envelope estimate with assumptions (as mentioned) that are too simplified at best. AND IT ASSUMES DOING NOTHING TO PREVENT CONTRACTION. AND is only accounting for 2 data points of confirmed cases on 3/10 amd 3/14 which is before any inflection point due to isolation/distancing.
That is a good first-order model, good post. It's definitely a logistic curve (which looks like an exponential curve - at the beginning). The functional form is correct.
Some thoughts:
(1) You're using "confirmed cases." I still think "actual cases" is the way to model the future, acknowledging that there is an estimate involved in calculating "actual cases."
(2) The IN and OH Health Directors said last Thursday that "1% of residents already have the virus." There have been other Health Directors who have now said the same thing, and they've cited CDC models as their source. It is apparently, in reading further, a rule-of-thumb in the industry that you're at the 1% level once "community spread" has become a thing. And there has been a good deal of "community spread" in the USA of late.
(3) So the 2 data points I'd be inclined to put in your model would be "1% of residents" on March 11th, and "2% of residents" on March 15th. The latter is a bit of a guess, but community spread has still occurred in recent days and social distancing hasn't taken hold completely.
(4) Putting those #s in the model get, 50% of the population is infected by day 27 (7-April) in the absence of doing anything.
roger all that. so, the basic Q of the timescale for the peak in the "flattening curves" is about 30-40 days in the absence of preventative measures. Probably good that our area closed schools until 4/20. Will be anxiously waiting any data that indicates the inflection point has occured- back in late Jan/Feb when we modelled the data out of China with my students, we had already seen reported cases deviating from the pure exponential growth that they were modelling. Inflection points are key!
Absolutely on the inflection points! A reduction in "new cases per day."
China, if one believes their numbers (and I do tend to), hit that point around February 13th.
South Korea hit that point around March 3rd.
Singapore and Taiwan have been pretty steady state.
Everyone else is still to the left of the inflection point. I think Italy's inflection point remains about 11 days away. We'll be sometime in the first half of April, I think.
A long way to go ..................
March 13th, 2020 at 11:26 PM ^
In case it isn't obvious to everybody else, that's number of hospital beds per 1000 people that jmblue is quoting.
I was wondering if each German citizen truly needed eight hospital beds.
March 23rd, 2020 at 11:21 AM ^
But not everybody will need hospitalization.
Many people have had little more than cold or flu like symptoms which were treated at home.
95% of those currently infected are classified as mild.
Also, for those who are following the number, please remember that the total number (353,000 as of March 23rd) INCLUDES those who have died (15,000+) and those who have recovered (more than 100,000). So actual current cases which are being tracked are closer to 238,000.
This data is not meant to make light of anything, but to put full perspective on things.
OP, all that European stuff is fine, but as a good American what I really need to know is which team I should blame when things go haywire in the U.S. Blue team or Red team? Faux News / MSPMS? Rush / Maddow? I want to be ready to post on social media. Please advise. Thanks!
March 14th, 2020 at 10:37 AM ^
You can always blame the Russians.
Don't go to the library, the gym, the movie theater,...
OK. States are banning gatherings of more than 250-500 ppl. None of these things are that. So- what SHOULD people be doing and what SHOULDN'T they be doing? Examples:
- We're going to an open air place to get ice cream, seems OK to us
- daughter wants to go bowling with friends after, we said no to that one
- Library is closing monday and we are getting some books today
- can we visit a friends house for a game night?
- Are play dates for little kids ok?
- Sleepovers? I'd probably say no to having 6-8-10+ kids for a sleepover
Overall point is, this is not a quarentine situation. No one is on federal lock down. Now if it is, let's say it and do what is necessary. Any other opinions are welcome
March 14th, 2020 at 10:43 AM ^
Sitting within 2m of any other table is a risk, even in the open air. The virus can live on surfaces for up to 3 days. So ice cream is a risk, but presumably you aren't going to stop living to avoid getting a virus that won't kill you (though it might kill your kids' grandparents, if they're still around and you follow up your regular activities with a visit to grandma). Most of the other things are quite dubious, though one trip to the library isn't going to change the overall risk you're running that much.
What we are doing is hanging out exclusively with one family who lives next door. None of us have any elderly relatives in this country, so the slightly increased risk of 4 additional people seems ok to me. But many of our acquaintances are meeting in small groups with their kids, with the membership of those small groups rotating. This is a deeply stupid idea, if you ask me. One infected kid is eventually going to get everybody, because they are all playing at being vectors instead of being careful.
I had been working on a concept, in my brain, for what is essentially shared risk groups. How high is your risk? What is your risk tolerance? Do you see old people regularly? Then you come up with similar people with similar risk profiles and tolerances, and you should be able to interact with them as long as their risk profile doesn't change. The problem is if one part of that breaks down, it doesn't work.
THESE are the kind of questions I wish the experts would answer!
- Getting take-out seems fine. I think Dr. Fauci even recommended it for people who want to get restaurant food.
- Having a small 2-4 person study group seems ok as long as everyone limits contact with outside groups too. A risk, but seems low (for now).
- Is it ok to play poker with 4-5 friends who haven't traveled or shown symptoms? Seems ok, but who knows?
- Is it ok to play ultimate frisbee with people? Seems riskier, but probably better than basketball. But I don't know!
- Is it ok to go hang out with my family at my parents' house (50s) if we keep the group small and avoid physical contact? No idea!
One thing I'm almost certain was a massive mistake was all the st. patrick's day parties I saw around Ann Arbor this weekend. Crowds of 20, 30, 40 people packed into living rooms, porches, small front yards. Drunk people hugging, holding hands, dancing closely. Plus people are going from party to party, mixing with others. You couldn't ask for a better situation to spread if you were a virus. If there was one person that was carrying the virus and they went to 2 parties and a bar, that could turn into 1,000 cases in two weeks. Yikes...
Having drinks at home with your SO and/or 1 or 2 best friends seems like it's worth the risk. Spending time with people you love is what makes life worth living. But the darty lyfe, party-hopping culture should probably be stopped entirely for a few months.
March 16th, 2020 at 12:13 AM ^
I'm not a medical professional... but I've been dealing with crisis management on this at my company for a few weeks now, so I have opinions on the internet. Here's my answers for you:
- Getting take-out seems fine. I think Dr. Fauci even recommended it for people who want to get restaurant food. - Likely okay.
- Having a small 2-4 person study group seems ok as long as everyone limits contact with outside groups too. A risk, but seems low (for now). Not ideal, wash your hands, sit apart from each other. But do you need to to do this?
- Is it ok to play poker with 4-5 friends who haven't traveled or shown symptoms? Seems ok, but who knows? Same as above.
- Is it ok to play ultimate frisbee with people? Seems riskier, but probably better than basketball. But I don't know! No, although in the open, lots of contact, sweat, fluids, etc. Definitely would not recommend.
- Is it ok to go hang out with my family at my parents' house (50s) if we keep the group small and avoid physical contact? No idea! If you are still out in the world I would not go to your parents.
Again take my answers for what it's worth. But I've been working on this for a few weeks now and am pretty conservative on this. I'm not seeing my mid-60's parents. I told them not to grocery shop, I will use Shipt or get groceries for them. I'm not going out with friends, or to restaurants. We're not having people over to our house.
We NEED to hit the pause button. The sooner people recognize this, and just don't do much for 30 days, the sooner this gets better.
Keep in mind that you might not be impacted, but as a society we can be even if you only have mild symptoms and can go about your day. That's how this is getting spread.
March 14th, 2020 at 10:39 AM ^
I expect the US to do better than Europe once it becomes as serious about this as Europe is. One thing you only learn about other countries by living there is how their hygiene standards differ. Where I live in Europe, people don't cover their coughs. They use a single Kleenex over and over again and don't wash their hands after wiping their nose with it, even if they are about to touch all of the food you are buying while they check you out at a grocery store, and even if they are about to make you a sandwich with their bare hands. They really do not know how to use gloves in food service. They touch their faces regularly without thinking about it, even while making food for people. Many of them never wash their hands after using the toilet. Some places it's worse; e.g., in a nearby country, adults openly pick their noses. But nobody who grew up here even notices any of that.
Yesterday, on the last day that cafes and restaurants were allowed to be open here, I was talking to the owner of a cafe about what they were going to do when they had to shut down. At the end of the conversation, I watched him cough into his hand, and then use that hand to set out a tray for somebody's coffee, which he then put his entire hand down on top of.
None of that shit will happen in the US, so the contagion should spread less in the US. However, no European government at this point, aside from the UK, has been as committed to denying that coronavirus is a serious problem as the US government has been. Fortunately it looks like the US has now woken up to the problem. Now that the US is actually trying, I expect the superior hygiene and food safety standards there to make a big difference. But they waited far too long to start trying. Hopefully the negligence kills only thousands of people rather than orders of magnitude more.
good point. The “everything is disposable” lifestyle that the US uses is actually a good thing here.
March 18th, 2020 at 11:32 AM ^
I think you are grossly overestimating the hygiene levels of the average American.
March 14th, 2020 at 11:06 AM ^
Re: Hospital Beds vs ICU Beds
From investment provider research memo:
Meanwhile, a 2013 study by the Department of Health and Human Services determined that the US has the most Intensive Care Unit beds per capita of any country at 20-32 per 100,000 people. This is far higher than China where there are only 2.8-4.6, demonstrating why they needed to build hospitals overnight. Likewise, the US far outdoes countries with socialized medical systems like Canada (13.5), Sweden (5.8-8.7), or the UK (3.5-7.4). This means the US is better suited to deal with the healthcare capacity issues that could arise with a Pandemic than virtually any other country in the world.
My understanding is that given the rise of outpatient procedures, overall bed count has fallen. Our ICU bed is still near tops globally.
Welcoming input from anybody with knowledge/input on this...
March 14th, 2020 at 12:10 PM ^
First: Excellent avatar name. You need a picture. I think this would do the job:
I think this is the 2013 study of interest:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551445/
It's referenced in the discussion here:
https://www.niskanencenter.org/is-u-s-health-care-well-equipped-for-the-coronavirus/
I'll leave judgments of the Niskanen Center ( https://en.wikipedia.org/wiki/Niskanen_Center ) to the gallery.
Thanks for the cites. Much better response about why we are better prepared than many others who insist it is so have provided.
March 16th, 2020 at 11:59 AM ^
Good stuff all around. Pic updated too. Be well out there!
https://www.statista.com/chart/21105/number-of-critical-care-beds-per-100000-inhabitants/
US has 34.7 to Italy’s 12.5.
Thanks for making me look. I’ve been hopeful there was a fact based reason to believe we should be in better shape than Italy.
March 16th, 2020 at 12:22 PM ^
This is consistent with other second-hand info I've seen. Definitions vary significantly across countries. An inpatient rehab bed and a vent-capable ICU bed are wildly different capabilities, at least in this context. Also, it's easier (though not easy) to 'create' med/surg beds than ICU beds.
That said, (1) the first estimates I'm seeing are that even better-case scenarios may outstrip ICU capacity, (2) time-to-peak is 2-4 months, (3) there may be a provider pinch at peak, since providers will be exposed early...this may be as much a constraint as physical beds.
Remember the old Heinlein quote: stupidity is its own death sentence.
Don't be stupid...
March 14th, 2020 at 11:59 AM ^
Wish you were our president.
March 14th, 2020 at 12:29 PM ^
I left out Germany, because they started vigorously testing as soon as Italy showed weakness. They've identified lots of cases early on and have only had 11 deaths.
This is why I think we need as many tests as quickly as possible. In many cases, people under 60 years old may be showing such weak signs of the virus that they don't know they have it. A vast majority of positive test cases wouldn't need a hospital, but they need to know they have it so they can take extreme quarantine measures.
This should get the number of cases up, and drop the mortality rates, which should ease panic in the long run. Right now there are 25 or so confirmed cases in Michigan. It's silly to believe that there are any less than thousands of cases in the state. So right now we are looking at each other with a suspecting eye. More tests should ease that your neighbors are unknowingly spreading the virus.
The focus needs to shift from panic, and shift to
- allowing healthy people to keep the world running.
- allowing the infected to go away for a couple weeks and come back, and this is the important bit, without being bankrupt.
Italy is claiming roughly 17,660 cases out of a population of 60.48 million (0.03% of population infected). I highly doubt they would close down the country over such a small number. Their 7.2% mortality rate assuredly has a lot to do with the issues outlined in the OP. It's also extremely high because they are testing people who are showing the worst signs/symptoms. The people who have the highest chance of dying. It's likely safe to presume that ~50,000 cases in Italy have come & gone by undiagnosed.
The current number have cases in Italy that have ran their course (either ended in recovery, or death) is boasting a 46.8% death rate. That is staggeringly high. It's also inflated as hell. Probably based on those early low numbers of tests that they were giving only to people with the highest chance of testing positive. China's number was 43.2% at the start of February. Six weeks later that number is down to 4.6%.
The people under 60 in this country, that can fight this Virus at home in bed with Motrin and some Nyquil need to do so as early as possible so that they don't end up taking a hospital bed from those at risk who would end up getting triaged. But in order to do so, we need as many tests as possible to get those people off their feet and out of the streets.
Italy's mortality rate is driven in part by the age of the population (5th oldest in the world):
https://en.wikipedia.org/wiki/List_of_countries_by_median_age
and the fact that measures to slow transmission did not take place until after the virus was already widespread. Ave age of Covid 19 non-survivors in Italy is 81:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30627-9/fulltext
I think this is basically right. The draconian model of quarantining everyone will work, but the economic damage could be severe. If they shift to a model closer to South Korea of testing a lot of people, they can quarantine those people and still keep things moving economically.
Don't do what people in Italy and Spain did. Practice social distancing. Don't go to the library, the gym, the movie theater, any place that attracts a lot of people. . . it sucks, but it's worth the sacrifice for right now. This isn't just about you, it's about everyone's health.
I'm sure I'll get negged to death, but I don't care. I feel like it's inevitable that I will get it at some point in the near future. I may not go to the movies or other social activities like that, but I'm sure as hell not skipping out on going to the gym for the next God knows how long. I will be careful to wipe down equipment before and after each use and I will try my best to stay away from others. But, the gym has long been my anchor. The gym grounds me and is always a priority in my day's schedule and I'm not changing that for anyone.
I'll give you a +1.
There's a spectrum --- I think it's good we've shut down gatherings of thousands of folks. But it's not good if we shut everything down. We're a social species. And some level of risk is an inherent part of being a member of this species as well.
Go to the gym, still try to have lunch with a friend. Just as long as it's a lower-level of interaction vs. before.
The UK will be an interesting case, because their epidemiologists are talking more about "herd immunity" then "social distancing." Social distancing is still a part of their strategy, but it seems to be less so vs. any other country. And I tend to think that they're right
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