For weeks, the coronavirus news has been paralyzingly bad, Steve Sailer reminds us, but there might be light at the end of the tunnel — at least if we take action:
It now is conceivable that an aggressive response in America could not merely “slow the spread” and “flatten the curve” of this exponentially growing outbreak, but crush it altogether. America’s aim should not be moderation of the epidemic, but its eradication.
Our goal should be not just to lose more slowly and gracefully, but to win.
The most sophisticated idea back in February was that the best we could hope for was to spread out the incidence of infection over enough months to avoid the apocalyptic scenario in which America’s medical system is overwhelmed and exhausted doctors must make triage decisions between treating COVID-19 victims and, say, heart attack victims.
University of Washington biologist Carl T. Bergstrom developed this useful hypothetical graph below (which he specifies is “freely available for any use under the CC-BY-2.0 license”) to get across the idea of how slowing the spread can lessen the chances that your loved one will be turned away by the hospital.
In Bergstrom’s graph, the horizontal axis is time and the vertical axis is the number of cases at any one point. Under uncontrolled transmission (the graph’s red curve) of the new coronavirus in the United States, it’s almost inevitable that our approximately 95,000 intensive care unit (ICU) beds would be filled, followed by the rest of the hospital beds in the country. Hospitals in northern Italy may be approaching this dire situation now.
If we can flatten the curve enough to follow the blue curve, the total number of cases wouldn’t be all that much different than under the unconstrained red curve, with both curves relying upon herd immunity to eventually reduce new cases to zero; but the total number of deaths from the pandemic under the slower trajectory will be much less because there would always be almost enough hospital capacity for everyone.
But slowing the spread, while a valid idea, is still a depressing goal, especially because the economic costs of the kind of social shutdowns imposed in China, and now in Italy, are no doubt enormous. The hope of flattening the curve reminds me of the dreary sports cliché that goes back at least to O.J. Simpson in 1968, “You can’t stop O.J., you can only hope to contain him.”
So, fighting a long, drawn-out war of attrition with COVID-19 has yet to galvanize the public or its leadership. Lots of Americans seem at present to be thinking: “Eh, just let it run amok and let’s get it over with.” But they don’t yet realize how awful the peak would be when the health care system overloads.
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Via heroic shutdown measures (basically, confining most of the population of this huge city to their apartments), the Chinese cut the R0 in Wuhan by more than an order of magnitude down to 0.32. New infections fell by almost 95%.
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In other words, the effort it takes to flatten the curve is almost as great as it takes to win outright.
No longer should the goal be a well-played defeat. As Cochran sums up by quoting Douglas MacArthur:
There is no substitute for victory.
Having lived through SARS and MERS and Swine Flu and others, I am not panicking.
I also lived through 87 and 2008, so the 2020 market collapse strikes me as stupid.. There is not a single person in the financial sector who has the slightest clue as to how markets work. Every single person involved in the markets is a charlatan, including people like Bufffet and Dimon, the Goldman Sachs criminals and the Fox Business frauds. Every one of them should be dragged out into the streets and purged.
Three years from now all the scares will be over, and stinking whores like Bartiromo, the Money Honey, will go on spewing their lies.
This country really needs vigilantes.
Flattening the curve should make coronavirus more manageable in the healthcare environment, but according to the graph the area under both curves looks about the same. This would indicate the same number of infections. The ‘pandemic’ would be low and slow over an extended period instead of over quickly.
Yes exactly. Absent a working vaccine (and for a virus this is hard),this is likely the best that can be done.
We see this every year with the plain old seasonal flu. We never keep it out or eliminate it, merely mitigate its worst effects. We encourage the vaccination of those most at risk, and healthcare workers, and usually the vaccine is mostly effective, but the flu still comes through sickening most and killing some. This will be no different.
By delaying the inevitable, we mitigate the catastrophic effects like crashing our medical system. The same number of people ultimately get sick, and those likely to die still die, but we reduce the second order effects.
I don’t trust any information coming from China.
If we slow it down enough, herd immunity will strangle it to death. Social distancing looks like the way to do that. And it will boost the widespread adoption of telepresence.
My company just announced mandatory telecommuting. I’m always angling for remote work; it’s just a shame it took a global pandemic and thousands of deaths to achieve my goal.
Interesting.
I always took from that that the flatter curve might also at least incrementally reduce the number of overall cases and the number of those who die simply by reducing the number of infected spreading it around at any one time and the pressure on the hospitals caring for those sick in danger of dying.
Not much, perhaps, but some.
But otherwise, yes, reducing the second order effects is the main benefit and not trivial. Everybody who needs medical care for something else entirely will be grateful.
Graham,
You also reduce the overall death rate from the virus combined with other things. If you slow the rate of hospital admissions for the virus, you leave room for the treatment of everything else that might kill an untreated person. If the pressure on the system requires war condition like triage, other people who don’t even have the virus get triaged out of their bed/elective surgery/doctor’s attention and so on, and die of whatever they suffer from that isn’t the virus.
“but there might be light at the end of the tunnel — at least if we take action”
I think regardless of what humans do, the illness will just run it’s course as illnesses always have.
I think the biggest problem with this crap today is that people forget what the past was like, even within their own lifetimes.
’57 Asian flu epidemic? Hong Kong flu epidemic, in ’68? Ring any bells? Go take a look at the damage those did, especially to younger generations, and everyone is freaking out about something that is only lethal enough to kill those with really compromised immune systems and advanced age? WTF? What. The. Actual. F**k.
The insanity of it all is that this is nowhere near as dangerous as something like a widespread Ebola epidemic would be, and people are flat-out freaking themselves out over it all. Whole thing is nuts, just nuts.
Consider the following.
This plague starts off like pneumonia. (Have you ever had pneumonia?) Then it’s between ten and one hundred times deadlier than the flu. That’s pretty bad.
There’s something I’m much more concerned about.
Imagine how much it would suck if this plague takes 10-20% off the top of your effective lung capacity. Permanently.
It’s going to happen to many tens of millions of people in this country alone.
It could happen to you.
You won’t be laughing then.
Kirk,
You have hit it on the head. We HAVE forgotten. much like the anti-vax movement, who panic about possible side effects because they have forgotten about just how many people died in the past from lack of vaccination, we have forgotten the bigger pandemics of the past…
Nobody under 55 will be able to remember the ’57 flu. Back then we also got most of our news from newspapers, not 24 hour TV news and the internet.
Look at the Great Toilet Paper Panic, which apparently started in Japan, (which is weird given their fancy computerized toilet/bidet things), and spread to Australia. I am convinced the North American part of the Great Toilet Paper Panic happened because news stories of Australians fighting over T.P. went viral, and planted the idea over here.
There is also the general “pussification” of western society, viz the anti-vax people, and the anti-GMO people, and the general health panics over things like Bisphenol A in plastic water bottles. We have not HAD to panic over disease epidemics for so long, that we worry about trivialities like pesticide residue instead. Then suddenly, we run into a real honest-to-god epidemic and panic.
I remember my mother rather matter of factly describing the pretty much annual polio outbreaks when she was a kid. Nobody of a younger generation has a direct memory of anything comparable.
Been thinking about all that this weekend.
I was born in 1970 so my life experience is closer to that of the millennials than that of my parents in some ways. They were born in 1940 in the UK. Most that the youngers have been vaccinated against, so was I. I might even still have gotten smallpox since it hadn’t officially been eradicated yet though it was certainly not in North America any longer. I had measles, mumps, rubella, pertussis and who recalls what else. tetanus, maybe. Some may not be good anymore-tracking isn’t great and most of us don’t keep up to date on that. But still. The only thing I know we didn’t get shots for then that they do now is chicken pox. We all just caught that. Thank goodness after 50 I can get a shingles vaccine. Counting the days. My dad had that. It blows.
I’m sure I had regular flu a few times as a kid. Colds a million times. I was spared but there were, as I think still are, meningitis scares in the schools from time to time. But that’s about it.
The last few flu variants like SARS, MERS, H1N1, and H2?? struck me as noteworthy, mainly because I don’t recall any novel coronas or unusually bad flus from the 80s to the 2000s.
So all in all, a very safe time. So compared with even those last 4, this one already seems more infectious and more deadly, at least until we get a handle on total number of case. By comparison, SARS in North America can already be called a damp squib compared with COVID19.
Still, it may turn out not to be as bad as we fear and that’ll be good. I won’t decide until later which measures I thought right or wrong. Though personally I could do with less panic but earlier action. My country is still weak on points of entry control as of this weekend.
I’m of the view that even a layered defence starts outside the perimeter, hits a hard line at the perimeter, and then builds from there.
Similarly, the right of Canadians to enter or exit their country freely is in our Charter, & frankly is an old right recognized from the terrible pre-1982 Darkness. But plague control is right up there with war and rebellion as Core State Functions overriding quite a lot, for me.
I’d hate to be stranded overseas, I admit. Though it’d depend on the country somewhat.
Meant to add that I am really struck to be nearing 50 and this is my first, albeit tiny and perhaps overdone, glimpse into the world my parents knew when young.
Not just those flu pandemics like Asian or HK, or even polio. My dad, pretty sure, had Scarlet Fever as a boy in wartime Scotland.
Graham, you have lived through similar epidemics–You just don’t realize it because you weren’t scared to death about them the way they’ve done this one.
AIDS? The H1N1 flu? Ring any bells…?
This whole thing is taking on a lot of the markers for an information operation designed to instill panic and irrational action in the populace. Most of it stems from piss-poor work by the CDC, which has for years been focused on bureaucratic make-work outside its real function. Look at what they did with that Gates Institute survey that was running in Seattle–The doctors running that wanted to survey for coronavirus, but were shut down because… Why, again?
We should already have the infrastructure and everything else in place to be running surveys of the population to see what diseases are actually out there every year, looking at the actual data, and not just the stuff that gets into the medical system once it’s gotten to the point that patients are dying from it. It’s similar to that problem where the psychologists keep looking at the mentally ill for an idea of what is going on in the heads of mentally functional people–You look at the sick end of the scale, and you’re going to find your results skewed horribly. Same-same with epidemiology.
I’m pretty damn sure that the virus behind COVID-19 has been here in the US for months, probably back to around January. Locally, we’ve had this really nasty cold/flu going around that mimics the symptoms for what was going around in Wuhan, and I’m going to offer up the thought that the reported disease rate is going to go exponential right alongside the rate of testing for it. It’s here already, has been, and hasn’t been particularly lethal up until it hit the vulnerable populations like that nursing home in Seattle. End of the day, what the post-mortem is going to be is that we talked ourselves into this crap more than the disease put us here. I think that three-four years from now, the consensus is going to be that we overreacted, and that the side-effects outside the disease process probably killed more people than the disease itself did.
On the other hand, maybe the cleaner air over China and Italy will save more lives…? Who knows.
Point remains–This isn’t even that big a deal, from what I think the actual numbers are. The lethality looks horrible, right now, because it’s being compared not to the actual real-world number of infected, but to the number of tested and confirmed cases. What about all the people who didn’t get sick enough to justify the expensive test…? Who knows how many are in that cohort, which is going to tremendously affect the calculations.
We badly need to get out into the general population and do survey testing to see what is actually in their systems. Right now, we’re doing the epidemiological equivalent of fighting all our battles at night, at the junction of four mapsheets, and by Braille. We don’t know what we don’t know–If the COVID-19 virus is already out here, and endemic in the population, of course it’s going to look terrible when we test only those that develop really bad symptoms and die from it. Without knowing the other half of the numbers, namely “who gets it and doesn’t get really sick”, we honestly don’t know sh*t about what’s going on with this thing.
They come back and do antigen testing in the next couple of years, I wouldn’t be a bit surprised to find out that 90% of us had it, and never developed major symptoms from it.
Kirk,
I skipped over AIDS but that’s an interesting example for me.
There is this cultural memory out there, pushed by certain circles, that there was ignorance about AIDS, too little government action or information or education, etc., and that’s why so many PEOPLE DIED {!!!}
Funny thing- I was a hetero, sexually extremely inactive teenager in the mid-80s, with essentially no chance at all of getting it unless I needed a blood transfusion, and I was still, to use the vernacular of my then time and place, scared shitless of AIDS. It’s one thing to note that anybody could get it from various sexual practices, quite another to fail to note, over and over again, that it was far and away less likely for heteros, even less for monogamous heteros, and so on. I was of course actually aware that I was least likely of all as an inactive non-combatant to ever be exposed to it, but still I was terrified of sex. If that was the aim, it worked. So why so many gay men weren’t getting the word or felt under-informed, I can’t say. I remember them as years of fear. I exaggerate a bit, not like I was thinking about it all day, but when compared to how the era is remembered, I was aware of AIDS and then some.
That’s probably the last time I felt like that, and with poor to no reason. Now I have somewhat better reason.
AIDS was and remains hard to catch. Starting from my current lifestyle, I’d likely really have to work at it to put myself in harm’s way. Who has the energy?
Respiratory diseases are less hard to catch. Plus I’m older now and I’ve had some minor troubles in that area. SO I’m a bit more worried than I was about AIDS and with much better reason.
Now, when we look at past respiratory epidemics, there are some caveats that might apply here and I certainly think you might prove to be right on this. I’m just not as confident.
One side is- at this stage SARS had moved around the world more slowly, so far as work at the time or since showed, IIRC it had many fewer total cases worldwide or in the US or Canada, the death rate among those I don’t recall. H1N1 similar.
SO I genuinely don’t know- are we seeing over panic and overreaction, maybe. But it sure sounds like there are more cases, spreading faster, with more deaths [agreed, that rate may fall] than in SARS, MERS, or H1N1. At least as far as affecting Europe and North America.
Whether it will prove to surpass the Asian and Hong Kong flus, I dunno. I don’t even know how those played out without looking it up.
Perhaps this will indeed prove worse than SARS but not as bad as those older cases.
The only thing I can stress again to that is that we’ve grown out of awareness of those realities. None of the stuff since 1970s seems to have reached the level of actual threat posed here- AIDS harder to catch and fewer exposed, Ebola hard to catch unless already epidemic or one is at the epicentre, past respiratory panics amounted to less than COVID has already managed.
I guess I’ll wait and see. I have official directives to follow, at any rate.
One thing that still strikes me- I was as I said born after the HK flu of the 60s. I don’t remember any big flu or respiratory panics again until SARS, then H1N1, H2xx, MERS, now COVID all in 15 years. It’s as though species interaction and flu regeneration is accelerating, whether or not getting more lethal.
Well. I ramble. I had had my first bronchitis and to date only pneumonia in late 2002, just before SARS. I was still less concerned about SARS than I am about COVID. I genuinely don’t know whether that’s rational or not.
I totally agree with you on the limits of our arsenal. I tend to the view that plague control is up there with war and rebellion as a Tier 1 state function, justifying spending, effort, and if necessary rights curtailment. If it was understood to be a responsibility by governments as limited as those of classical Greece or Rome, then I don’t consider it an offense against limited government. DOesn’t mean I endorse all the tier 2-3 stuff that might be helpful like single-payer, yet there are folks who would support the latter and not the former. Funny world.
Your ideas for more systematic testing sound like the path forward. We may get it, though probably from the wrong side of the aisle and as part of a package I don’t buy. So it goes.
FOr your amusement, recently the Globe and Mail’s John Ibbitson posted a column on how the Government of Canada’s response to COVID has been a “lesson in leadership”. The contrast with Trump was naturally made explicit.
I don’t like the latter’s hamfisted public comms, nor think he has struck the right measure between confidence boosting and supporting or taking immediate action, but it has had it’s pros.
Our government’s slip is starting to show, and Ibbitson’s column has not aged well.
In particular, border control and airport screening and travel restrictions have been a complete balls up and probably still are. The PM is in self isolation because his wife traveled to London well after they should have started cutting back on fluff travel.
Our medical officers are not doing badly- they are MDs and pretty good communicators. I’m not sure they will prove to have done it all right. But the political level has been praising itself too much.
AIDS was always political. Always.
First point was that the people who got it were a vocal minority, and that the best means of prevention was behavioral modification–Quit having unprotected sex with random strangers, and quit having anal sex. Do that, and your odds of getting it outside of some random blood transfusion were infinitesimal.
But, the gays did not want to modify their behavior, and being perverse exhibitionists, decided that their little medical issue was Very Important. So, they did two things: One, made massive propaganda to the effect that the normies didn’t care, and weren’t doing enough about what was basically a gay-only problem, and they refused to cooperate or even allow traditional medical countermeasures for epidemic disease–Such as quarantine, tracking, and all the rest.
I’ve seen papers where they project what the experts think the course of the disease would have been, had they been allowed to do any actual counter-measures like quarantine and shut down vectors–Actual number of victims should have been about a tenth of what it actually was, but that would have meant shutting down gay bathhouses, quarantining victims, and all that other “unpleasantness” that the gay community didn’t want. And, because of that, we had everyone running scared about heterosexual AIDS, which was never a thing in most places because the disease doesn’t lend itself to heterosexual transmission. Oddly, the vagina has defenses built in for being penetrated by foreign objects, while nature has taken the position that the anus is exit-only.
AIDS should never have been a crisis. If we’d done what we should have done, which was to implement actual epidemic-prevention measures, it wouldn’t have killed anywhere as many people. But, the gays turned it all political, and made those measures impossible to use, so we got what we got. Frankly, the whole thing was a travesty, one that we never should have enabled. If I’d been running things, I’d have simply run the activists over, implemented quarantine and vector shut-down, and let the activists whine. More of them would have lived.
AIDS was really the result of horribly irresponsible and risky sexual behavior on the part of the gay community. The kind of stuff that went on the bathhouses was insane, guaranteed to create some kind of major health issue, and when you added in drugs and the rest of it all? Holy crap, what a pluperfect way to get a “gay plague”. Entirely self-inflicted wound, and they wanted the rest of society to pay for it.
I don’t have a particular animus against or interest in gay sex, but… Jeez. Have some ‘effing responsibility for what you’re doing, and don’t do stupid sh*t like have twenty or so anonymous partners in a night for anal sex in an environment that ain’t none too clean in the first place. I swear to God, I’ve spent time going through some of the public health documentation surrounding what was going on in the bathhouses during that era, and I wouldn’t keep pigs in those places, let alone have unprotected anal sex there. The venues themselves were just… Nasty. I was looking through those reports, and the only thing I could conclude from seeing where all this was taking place was that there were other, deeper, mental illness issues at play besides just the sexual deviancy. I seriously doubt I could even get an erection in that environment, it being as filthy as it was. It’d be about like going home with some gorgeous wreck you met at a bar, and finding her apartment looking like the inside of a dumpster. “Yeah, sorry, got to go…”.
Now, granted, the reason those places made it into the reports I was reading was because the health departments were shutting them down, but the fact that it took the health department coming in and doing that to put an end to vast numbers of people having sex in those venues each and every night they were open…? Yikes.
Kirk,
Absolutely right! I have a book in my library, The Fourth Horseman by Andrew Nikiforuk, all about epidemics..
On the subject of AIDS he has a lot to say. One of the interesting things to me, is a comment he made about doctors’ mystification about how “healthy young gay males” were getting this disease, when they were anything but.
Despite being around one percent of the population, they accounted for the majority of the syphilis infections, and because of promiscuous anal sex, were riddled with things like shigella, a fecal-oral illness, like cholera, usually only found in the Third World.
I think that you are right, when this is all over we will find we are over-reacting and the second order effects to society and the economy will be greater than the direct effects of the disease.
We are treating this like it is going to kill anyone, rather than just the vulnerable. If you are young and in good health, you are at very low to negligible risk, so rather than shut down the whole economy, we should be doing our utmost to protect the vulnerable (old, infirm and immune-compromised), and let the rest of us get it and develop some herd immunity.
Like I said on another newer thread, the response to the Fukushima nuclear disaster, killed far more people than the actual accident. Reportedly there were hundreds of excess deaths among evacuated old folks from care homes and hospital patients, who would not have died if they were left in place, compared to the one person who died in the actual accident (of a heart attack).
Kirk,
A concise and strong summary to which no valid objection can be raised.
All that will be forgotten and/or memory-holed if it has not been already, despite its obvious accuracy.
Paul,
I had forgotten Nikiforuk’s book but I think it was one of the best of that time, worthy of sitting on the same shelf as Plagues and Peoples for all it’s more contemporary edge and style.
That bit about how “healthy young gay males” were getting it is almost a textbook, if niche, definition of political correctness. Total inability to arrive at obvious conclusion from observation and evidence because it would offend sensibilities, including the doctors’.
If you were on the left, then as now, any kind of recognition of any of that was presumed to mean concentration camps for gay men. We were all just drooling at the chance to do that, don’t you know. Like they put Liberace and Paul Lynde in them in previous decades.
On the response. Still torn as I was last night. Between business as usual with a bit more handwashing and social distance [at last- societal approval of my preferred way of life; Introverts are always the last minority] and concern that this is proving worse than SARS, at least for now. Again, I’m not who I was in 2003, so there’s that.
I can’t say I’d care for respiratory disease at this point, unless I had confidence of getting the weakest virus load.
Still, I am on essential services part days, so there you go. Still out on the street, being careful on mostly empty buses, took cab today. Hardly any retail or food service but has already taken every measure short of closure, and some have done that.
I figure laying up enough supplies if I have to isolate and basic precautions- wash hands a lot, assume all others have not.
That doesn’t mean second order effects won’t turn out to be worse- I already wonder about the future shape of institutions, politics and social behaviour in Canada.
My parents, 80, are following my instructions so far as I know but taking it in stride. Seen it all before.
The big problem is that we have a fair idea of the CFR, but no clue about the IFR.
CFR, if I have this right, is the “Case Fatality Rate”. i.e. people presented at a hospital or clinic sick enough to be admitted, and with the correct symptoms to get tested. Of those that test positive, we collect the death rate, which in this case seems to be about 10 times the regular flu. We can get a reasonably accurate number for this (depending on who/how much we test and how many test kits we have on hand).
On the other hand, IFR is the “Infected Fatality Rate”, i.e. the number of people that actually get/had it, compared to the number that die. We have absolutely NO IDEA WHAT THIS NUMBER IS.
There may be, (likely are), thousands of people who have already been infected and don’t know it, because they either didn’t get sick at all, or recovered from what they thought was just a mild cold or flu.
Conversely, how many old or immune-compromised people died of “the flu” or “pneumonia” over the last couple of months, actually died from the current Corona virus. Using statistics, similar to how sample poling is done, we can possibly ballpark it, but we all know how accurate poling has been of late, and math models all rely on assumptions. We all know the golden rule of assumptions (assumptions make and ass of you and me..)
We just don’t KNOW. This could turn out to be 1918 Mk.II, or just slightly worse than regular seasonal flu.
I don’t blame TPTB for over-reacting, after all, they would be crucified if it turned out to be worse, but I fear we ARE over-reacting and the second order effects will be adverse.
Like yours, my parents are elderly and my father has had a number of medical issues over the last year, and is on immune suppressing drugs, so I fear for him.
For myself, the only inconvenience so far is that I was running out of toilet paper just as the Great Toilet Paper panic hit….
I live in a long-stay hotel suite because I had to move last year due to full-building reno. Which is still going on slooooowly. I’m a last minute man, so nearly last out of there, a procrastinator and I hated that place for 16 years, so I didn’t look for a new place quickly. Plans. No follow through. Got a good rate, it’s nice if a mid-level place, can’t complain. I thought of the pros and cons but on the whole I have even less interaction with neighbours than at home, there is a cleaning staff all over the place daily, so probably safer than my dumpy, dying old apartment building had been. Better class of neighbours too. to an extent. Oven works, stove works, kitchen easier to keep clean [No amount of cleaning made me happy with my old one]. all in all, better readiness than I’d have had in my old place for the end times. Odd timing to have these events coincide.
I actually keep sanitizer at the office but earlier in this crisis, 2 weeks ago, it was sold out at three pharmacies at least and ever since. I still have some, though. SO some degree of preparation. Toilet paper no probs. Total readiness there. That will prove useful should I have to bend over and kiss my ass goodbye at any point.
I did buy some nice ruby port to keep me going this week.
Kirk,
I agree with you, at age 62, never seen anything like this reaction.
I think Dr Fauci was part of pushing the heterosexual aids epidemic that didn’t happen, as was Surgeon General at the time. Oprah stated 1 in 5 heterosexuals would contract AIDS at the time. Michael Fumento had a terrible time getting his book published and was accused of being a homophobe.
Listened to a Dr. Joel Kettner, reputable in Canada say he’s never seen anything like this reaction and sounds appalled. He said we have pandemics every year.
We have a nation full of fragile people who are suseptible to mob behavior; scare them with math they don’t understand and viola, panic.