Here is what a country does when it is serious about this (Taiwan in this case):
Such predictions are weaselling, though. “Up to 1.6 million” is a “prediction” that essentially cannot be wrong, and is equivalent to saying “I’ve no idea, aside from limiting it to a number that would represent absolute catastrophe.” It reminds me of those signs you see in front of hew housing developments that say “Units from the 700s.” That means there is one property, probably a garden shed, that will be priced at $799,999, and all the rest will be way more.
Over here in Seattle, our schools are closed, the area’s major employers of desk workers have all gone to either mandatory or strongly encouraged work-from-home, downtown is dead during the day, gatherings of more than 250 people are banned, gatherings of fewer than 250 people are only allowed if you practice social distancing of six feet[sup]*[/sup], and of course, all sporting events are cancelled. I’m personally basically not leaving home at this point, except for walks in the park and trips to the grocery store. Restaurants, clubs, bar, music venues, theatres - they’re all getting just flat-out murdered.
So, uh, are we doing enough? Obviously, I’d love to see much, much more widespread testing, but even in that absence, is it reasonable to expect a decline in new cases towards the end of the month? Or at least getting off the exponential rocket? Or do we have to do more?
[sup]*[/sup]Gatherings of exactly 250 people are totally fine. 
It’s not enough until you start testing, and here’s why.
If you rely on social distancing for an arbitrary period of time, then there’s a good chance that arbitrary period of time may lead to an apparent decline that leads some to conclude the worst is behind us. However, the virus is still alive in someone, somewhere, and it’s still very contagious. How long do we enforce school closures, teleworking, disruptions to the economy before we let people go back to life as usual? Over time, people are going to insist that they go back to life as it was before, and yet unless we test, we will have very fuzzy ideas about the scope of the epidemic. The danger is that we go back too early and the virus ramps up yet again. We’d very likely go through another cycle of closures and disruptions to the economy, but even worse, we’d end up having a lot less faith in any future governmental response, and it’s critical that people have institutions that are credible and reliable. They will simply ignore them in the future if they can be trusted to give them accurate assessments, and that would make any future pandemic that much more dangerous.
It’s all about the testing and giving sick people immediate, comprehensive, competent, and affordable healthcare - full stop. It’s even more important than social distancing and travel bans, but in reality those bans are about as useful as a TSA agent taking away your half-empty water bottle in an attempt to stop a terrorist incident. They make us feel better, but that’s about it.
Hopefully testing will be expanded now that commercial labs like LabCorp and Quest are offering COVID-19 assays. Unfortunately, samples still need to be collected at a doctor’s office or medical center, since personnel at the lab service stations aren’t authorized to do the swabs (and probably don’t have the necessary PPE).
Not only do samples not need to be collected at a doctor’s office I would say this is the last place we need contagious people grouping together.
I just came from a doctor’s office and it was empty when I walked in. When I walked out it looked like a Dawn of the Dead sequel. It was a waiting room full of elderly people on oxygen. One person with any kind of flu would have killed the lot of them.
And I’m no spring chicken. I’ve only had a serious bought with the flu twice and it was a miserable experience. I don’t know if it was S Korea that came up with the idea but it was a damn good one. We’ve already got 7 states doing it and it should be a national thing shortly.
You missed my point, so I’ll rephrase: it appears that LabCorp, Quest, et al. have a stated policy that their phlebotomists/draw station personnel WILL NOT collect nasopharyngeal or oropharyngeal swabs for COVID19 testing; those samples will need to be collected elsewhere and then sent to LabCorp/Quest for testing.
So unless you have one of those local drive-thru testing operations available, or you keep a supply of calcium alginate swabs and viral transport media at home and know how to properly swab yourself, you’re still going to have to go to a medical facility of some kind to have your sample collected.
The germ theory of disease, proving that illnesses were frequently caught from other individuals (rather than the previous miasma theory) was one of the saddest of scientific discoveries.
The melancholy germ theory tells us that social distancing saves lives. I predict (with no more than mild confidence!) that, a decade or so from now, when really good histories of COVID-19 are written, they’ll argue that lives were saved, by the current, unsustainable, social distancing. But most of the lives saved will be of people who might have died from infectious diseases other than COVID-19.
I wouldn’t be surprised if one result of the current panic is more attention paid to infection control generally. Your post is a perfect example.
Taiwan saw what was happening in China and was reacting to it in December.
In part because of the European ban, Americans flooded home and today in O’Hare throngs of people were lined up for bag pickup and customs for six or more hours, packed in like sardines. Great place to, I dunno, pick up a virus.
At the approximate 30% daily rate of increase, we’d have around 150K confirmed cases in the US by the end of March. People here are going to start getting really squeamish as those numbers rise.
That and the fact Taiwan, China, and South Korea (e.g.) have gotten their numbers under control (flattened the curve) means the US is going to find a way to do the same thing. How it does it is anybody’s guess. We don’t have a very authoritarian structure, and that makes what China did considerably more difficult here.
I’m betting there’s no way the US lets the numbers climb much into the 100K’s without imposing very strict measures. There’s also no way the (esp. the right-leaning) US gov’t is going to stand around watching China returning people to work and resuming factory operations while we’re stuck with snowballing disease spread and a progressively worsening economy. And there’s the associated likelihood that if this administration makes us “look bad” relative to China, their head’s on a block in the upcoming election.
We’ll probably get stuff mandated uniformly at the federal level soon. Stuff like mandatory closing of schools and universities, prohibitions on public gatherings beyond a certain size, partial community lockdowns, the designation of quarantine centers a/o some kind of home quarantine tracking, and much more aggressive disease testing and contact tracing (the JAMA link on Taiwan just above has even more specifics). It will probably the same in nations worldwide (though Boris Johnson is apparently toying with the idea of letting the virus run through the British population–to build immunity!?).
Those approaches are what the WHO has been pointing to all along (in its “controllable through public health measures” line), and nations failing to do so adequately quickly is mostly (iirc) what triggered the pandemic declaration–to try to wake people and governments up.
The hits just keep on coming, eh?
Another ‘on-the-fly’ decision with the ramifications clearly not thought out in advance.
The hits just keep on coming, eh?
Another ‘on-the-fly’ decision with the ramifications clearly not thought out in advance.
Or people who might have died from a fall, or a car accident, or drinking themselves to death. The fact that they might have died from something else is unimportant.
There are other considerations than just the fatality rate. Tens of thousands of people requiring extended hospitalizations is going to put extreme financial pressure on individual households and medical providers. It’s also very likely that many survivors who are sick enough to require hospitalization - many of whom are not old but in their 30s, 40s, and 50s - may sustain permanent lung injury. Again, there’s absolutely no immunity to this disease. There will be tens or even hundreds of thousands of exposure in the next 1-3 months. Even a fraction of this would be a significant number of people whose lives are significantly and permanently altered in some way as a result of infection.
Are you saying the current measures being taken by state governments and businesses in the states are generally worthless in dealing with this?
Wait, we know there “absolutely no immunity”? When did we determine this? I’m not finding anything but question marks.
And SOMETHING will be done financially for individuals and businesses. This is an election year, after all. I have no idea what it’ll be or if it’ll be “enough” for everyone, but with this much pressure on the system, I don’t think doing nothing and letting this much financial failure go on is an option.
I read somewhere (sorry, no cite) that this POTUS claims to react, not plan. Something triggers him; he says, “Do it!”; nobody asks, “What then?”
That’s the positive view. Assuming we’re not run by a moron surrounded by morons, somebody may engage in nefarious planning. How many Americans solvent enough to be working, visiting, or vacationing outside the country are supporters of the orange terror? What, they’re mostly disloyal? Let them infect each other. What, they take the COVID home and infect their elders unto death? That’ll teach-em!
Hard to say. But negative worth is starting to seem more plausible.
Some states are banning restaurants from having sit-down service. So lots of us will be lining up in front of, and behind, strangers to order and pick up food, rather than being moderately isolated from others, outside our family, by sitting at a table.
Do I know for sure that the restaurant rules will make the epidemic worse? No. I have no evidence one way or the other.
Then there is the closure of schools and day cares, even those used by low income, sometimes undocumented workers, who need to work to eat and will be crowding their kids into novel surroundings where the novel virus may flourish. Or may not flourish. Again, I have to evidence one way or the other.
So why do I say negative worth is more plausible? I’m not a doctor, but I do read medical history from time to time. It has taught me that when people make medical decisions without carefully gathered, double-checked, evidence, they are usually wrong. That’s what is happening.
P.S. The U.S. federal government may be worse than state and local. Read:
Lots of us will be staying home and cooking. And lots of us will be ordering GrubHub or getting fast food from drive-through windows.
Medical history is also full of stories of cases where the government refused to do anything because they didn’t take a threat seriously, and the damage that caused. They crammed troops onto ships in 1918, they put the handle back on the Broad Street pump because they thought John Snow was crazy. You’re right–it’s really hard to say what the right thing to do is, because we don’t have anything like enough information. But the speed of contagion here is very, very scary and it seems an abundance of caution is called for.
Look, I have friends who will be bankrupted by this–people losing their small businesses, people who work as musicians and roadies. I teach in a poor school district, and I know there will be kids hungry, kids unsupervised. I know their education will take a hit. I have lots of doubts, lots of concerns–but I am not at all convinced we’d be better off giving this a few more days or weeks to play out before we do anything radical.
What do you think they should be doing?