Five stages of denial
[Before starting this silly post, let me say that I’m seeing some positive signs in data from many countries; the curves seem to be starting to bend. Yay!]
Five Stages of Denial:
Stage one:
I feel for those poor Chinese suffering from the terrible coronavirus. Glad we don’t have it.
Stage two:
You say the problem is becoming worse here than in East Asia? That can’t possibly be true. Those East Asian countries must be faking the data. The West is superior.
Stage three:
OK, maybe the East Asian data is accurate, but we are much freer than the East Asian countries. That’s why we are getting hit harder. Freedom has a price.
Stage four:
You say it’s now gotten so bad in the West that many of us now have tighter restrictions that some of the East Asian countries? OK, but the Chinese are to blame for all of this. They delayed reporting the severity of the epidemic for several weeks.
Stage five:
OK, you say that an extra few weeks would have made no difference, as the West spent nearly 2 months twiddling its thumbs once we found out? And you say that our governments also lied to us? Well then the Chinese are to blame because they are a barbaric race that eats wild animals, and that’s what created the disease in the first place, just as Africans created AIDS and Europeans explorers brought smallpox to the New World.
And BTW, you are an apologist for Communist China because you are forcing me to confront the fact that the West might not be as superior as I had assumed.
I guess it was inevitable that this crisis would push people toward “us vs. them” thinking, but it is still quite worrisome. Even within the US, you have states trying to keep out residents of other states. And that prejudice is directed against our fellow Americans; just imagine how Americans feel about foreigners right now.
Unfortunately, things are no better in China, where Westerners are now widely viewed as a disease-ridden menace that needs to be kept out of their country. Let’s hope that sanity prevails in the long run. Looking back at history, I think it’s fair to say that a global rise in hypernationalism generally doesn’t end well.
PS. Here’s the pro-communist WSJ explaining how China successfully controlled the coronavirus.
PPS. Here’s an excellent NYT article on how the Wuhan government covered up the problem. It’s the best account I’ve seen.
And LOL:
Trump spent weeks downplaying the coronavirus — but now thinks keeping US deaths under 100,000 would be ‘a very good job’
To quote Former President Bush: “Brownie, you’re doing a heck of a job”.
Tags:
30. March 2020 at 10:11
Here are my stages:
1. January. Daily deaths mount in China. Poor China, looks bad.
2. January 25th. NYC officials: Isn’t Chinese New Year in New York wonderful. Don’t stay home and be racist!
2. January 31. Trump shuts down flights from China. Probably late, but the Speaker of The House calls him a racist.
3. February 17. China has completely shut down? Did you see the videos? Surreal.
4. February 23. Weird fatalism emanating from Western governments for days. Clearly, the virus is gonna break out and we’re all just kind of watching. Italy has 3 deaths at this point.
5. March 4. DeBlasio with theater recommendations. Get out there people! AOC chastises racists for not eating at Chinese restaurants.
6. March 12. US starts shutting down. Except for St. Patty’s day in NYC.
7. March 28. Worldwide global daily deaths peak (maybe.)
30. March 2020 at 10:16
Actually 4 isn’t really true. Countries like Norway and Germany were already rolling up their sleeves to handle the onslaught by late February. Definitely the US and UK were most cavalier. Trump was as much a part of the problem as anyone, but he had lots of company.
30. March 2020 at 10:47
Sure hyper-nationalism is bad – but is this not just a nature adjusted swing away from hyper-globalisation.
The sentiments people have come from somewhere (not saying they are good unconditionally) but they are certainly from some evolutionary place.
Global supply chains and no local manufacturing of medical equipment or medicine and input chemicals might be more efficient but its not as resilient necessarily.
There’s no shame in questioning unconditional free trade.
30. March 2020 at 11:12
I like the innumerate POV. A few weeks ago things were growing very exponentially (GFs > 1.5) and people were like, there are only a few hundred cases… it’s a nothing burger. Now things are doing better (GFs between 1.05 and 1.25) and people think the sky is falling…
[Note there are also those that are so utterly clueless they send college students back to their dorms right as we are starting to make progress. These are the same that lead the charge to nationalism. They should always and everywhere be ignored. It’s not even worth engaging them in conversation.]
30. March 2020 at 11:17
“Unfortunately, things are no better in China, where Westerners are now widely viewed as a disease-ridden menace that needs to be kept out of their country.”
Commonly referred to half of Chinese history.
I am just thankful all these opinions are coming out now instead of festering in the darkness for years or decades. Since everyone is thinking them in private, let’s have a public discussion! This is the West, after all.
30. March 2020 at 11:25
I don’t see the point of your rather arbitrary statements. Should we send a thank you note to the CCP?
Thank you so much for this deadly virus? Keep eating bats and armadillos, the CCP is such a great party, your system is so superior, basically it is our fault, sorry for bringing the virus to China.
Nobody can tell me how it is the fault of the Western countries though, but just assume the usual, somehow in the end it is of course our fault.
And Brian got a point. If Trump had closed the borders earlier and consistently, the US would have been spared. So that’s your point? That Trump wasn’t crazy Trumpian enough? That sounds a little weird coming from you but okay, it is noted.
30. March 2020 at 11:56
@BD – good summary by Brian D, but note, merely closing borders earlier without testing would not have worked: 2/1/20 : (WaPo on the Trump bar on non-US citizens from CHina): “Shortly after the White House announced the new restrictions and said there were six confirmed U.S. cases, a seventh case was confirmed in Santa Clara County, Calif.” – so the virus was already here, and note Trump did not ban US citizens, and testing was delayed. Not enough was done by Trump.
@C. List: “I don’t see the point of your rather arbitrary statements. Should we send a thank you note to the CCP?” – wow, what an ungrateful Nazi you are. Reminds me of a short story where the Japanese putative ally to the Nazis was disgusted at such disloyal allies, and hated them. Truth is, and good for us, the Nazis superiority complex kept them from working closely with their allies. Among other things, they failed to integrate their Romanian allies so during Operation Uranus at Stalingrad the Nazis got their butts handed to them when their Romanian allies caved, which the Soviets wisely targeted (there’s no ‘fair fighting’ in war, the USSR did their homework and found the weakest link).
Excellent post by Sumner and I would add a final stage: when Americans learn the SARS-CoV-2 virus was developed in America (U. of NC – Chapel Hill) and perfected in Wuhan (refer to my previous post), and, this is sad, demand war rather than, as India recently said, merely that China obey more strictly the international rules against bioweapons (which the Nazis did not follow either).
30. March 2020 at 12:08
Brian, You said:
“Trump was as much a part of the problem as anyone, but he had lots of company.”
Exactly my view.
Christian, You said:
“I don’t see the point of your rather arbitrary statements. Should we send a thank you note to the CCP?”
Yeah, you’ve always had trouble understanding “the point”, haven’t you?
30. March 2020 at 12:53
Scott,
why don’t you tell me what the point is? Express your thesis in one sentence, it can’t be that hard. Or do you think that the thoughts you expressed in this post are so profound that this is not possible? And why this reference to 5 stages? The 5 stages don’t make much sense, and the reference makes no sense at all.
Who found out what and when? That’s not what happened, or did the WHO or anyone else say, be careful, something really really big is coming, you have to prepare for it as if World War II was coming. Nope, I don’t think so.
If your only point is that the world is now sinking into hypernationalism and butchering each other, that is neither profound nor realistic. It’s not gonna happen.
But some countries will from now on consider whether they should really continue on the current course, that large parts of essential products are produced mainly in China, and that in times of crises one has to listen to smart aleck ex-liberarians saying: “Oh gosh, it can’t be that hard to produce hundreds of millions mask here from scratch in a month.”
@Brian
Thanks, Brian. But the highest infection authority in Germany maintained until early March that the risk for Germany was “minimal”. Not to mention that thousands of Germans and Norwegians were partying in Austria as if there was no tomorrow and then spread the virus over half of Europe.
30. March 2020 at 16:06
I think Christian List owes Dr. Sumner an apology or he gets banned. He’s clearly a troll who adds no value to any discussion (unlike me). Nazi-lover? Probable check. Rude? Check. Uses foul language? Check. Falsely claims to be a doctor? Check, and arguably against the law as well. Has reading comprehension problems? Check. Adds nothing to the comments except confusion? Check. I do envy his ability to indent quotes with those cool “|” marks however. But as a skilled programmer (C#) I won’t take five minutes to learn how he does it, that’s a waste of time. Kind of like List’s listless life. Germ-many. LOL.
30. March 2020 at 17:09
Scott (or anybody) answer me this.
You’ve stressed the need numeracy. I just watched the morning news on Asahi TV. They’re complaining about how bad a job the Japanese government is doing. That the Japanese government’s criteria for testing people is way to strict and that not enough people are being tested. In contrast Germany has much looser criteria and is testing lots of people and doing a much better job. Ok so presumably if the criteria for testing is much stricter in Japan then rate of positive test results will be much higher in Japan, because they’ve already pre-screened for contact with a known carrier, cough, high fever persisting for several days, etc. Makes sense. So I checked the numbers.
Japan 6.4%
Germany 7.6%
How can Japan have a lower positive test rate.
So what about other countries. Singapore and South Korea have done massive testing and in fact they have very low positive test rates.
Singapore 1.4%
South Korea 2.4%
So presumably that has had some positive impact on outcomes like lower per capita deaths per million (pretty hard to fudge death numbers in democratic countries)….
South Korea 3.0
Singapore 0.5
Japan 0.4
Despite the fact that Korea’s percentage of old people is half that of Japan, and despite the fact Singapore has only 40% the percentage of old people and a climate which by all accounts is hostile to the transmission of the virus. And despite the fact that Japan has had no mandatory shutdowns or social distancing. And despite the fact that Japan has the most jammed packed public transport in the world.
How does this make sense?
30. March 2020 at 17:25
HERES MINE
F*CK CHINA / CCP
WE ARE GOING TO KICK ALL CCP FAMILY MEMBERS OUT OF EVERY SINGLE 1ST WORLD WESTERN UMBRELLA COUNTRY.
AND ALL CCP MEMBERS IWTH ONE CHILD ARE GOING TO BE TRAPPED IN CHINA FOREVER
And I have been saying that for 3 YEARS.
Bc I know how power really works Scott and you are uncomfy with a head-on debate with me.
Once I started beating on you, you make short stupid quips.
ANYTIME you want to publicly debate and put a couple of grand on it – let me know.
We will destroy the families of anyone form CCP who ventures outside China’s Economy and Scott, there’s nothing you can do about it.
30. March 2020 at 18:37
Oh my Morgan, Pooh Bear and the boys are gonna be so sad when you get done with ’em.
30. March 2020 at 18:50
Here is the truth:
1. In China, we cannot leave our homes without a pass. And the pass is only given every three days to obtain food & water.
2. If you have a temperature over 37.3c they will take you to a makeshift hospital. There are no beds available. People are given one blanket, and told to lie on the floor. You will get water and food until you die.
3. The number of cases exceeds 1M. The govt keeps the number lower by not testing and not reporting all cases.
4. China is not Southeast Asia. Please look at a map. Our culture is NOT the same. Our government is NOT the same. Thailand, Indonesia, Singapore, and Malaysia are not ruled by an oppressive regime. Everyone in China would move to Southeast Asia if they could.
5. People who are sharing the real situation via video are being arrested.
Please educate yourself about this despotic government, before you claim how wonderful it is. Nobody here feels safe. Nobody here feels like the government is protecting them. The government is only protecting their image. That is all.
And for people reading, please do not listen to this American moron who thinks China is so wonderful and does not know difference between China and Southeast Asia. Try to live here. And then maybe you will appreciate what you have. I know your country is not perfect. No country is perfect. But you must appreciate your freedoms. Thank you.
30. March 2020 at 19:00
Morgan is the guy that played on his high school football team and thinks that means he was Lawrence Taylor.
30. March 2020 at 19:20
Boys, I took what Scott had to offer, absorbed it and have waited years for him to say something new. Even learn o sell his thing better. Even then, he hasn’t changed his sales pitch at all.
NGDPLT is great. Genius thinking.
It is the sister policy to WEEKLY WAGE SUBSIDIES (mine)
Other than that, Scott is really kind of emotional.
And he’s deeply emotional about China.
—
Again, Scott won’t get into with me, I explained very simply, the 1st world is going to BAN CCP family members.
Scott could say THAT’S GREAT! DO IT!
But he won’t, he won’t really confront it head-on. Bc he can’t without sounding like an idiot.
30. March 2020 at 19:36
This site has a truckload of narcissistic goofballs commenting LOL
30. March 2020 at 19:41
silly boys
https://www.themoneyillusion.com/morgan-warstler-wants-to-auction-the-unemployed/
30. March 2020 at 19:46
Scott, your China posts are some of the best stuff on your bad blog these days. Keep up the good work.
30. March 2020 at 19:57
Here’s an oldie but a goodie where Scott groks clearly that reasoned argument is just a sharp boned tool used to stab apes with
I stab Scott on his blog
https://www.themoneyillusion.com/more-good-news/#comment-57062
30. March 2020 at 19:58
Morgan inadvertently raises an interesting point, with his comment “silly boys.”
I would guess that 99% of Scott Sumner’s readers are men.
Yet Scott intelligently addresses topics of general interest (albeit heavy on macro/monetary), and is not sexist in any way I have ever seen, and I have been a regular reader for years and years.
BTW, of the top 100 chess players in the world, 99 or 100 are men at any time.
30. March 2020 at 20:03
dtoh, I’m also puzzled by Japan’s success. And I don’t buy those who claim it’s all explained by a massive number of hidden cases, as then it would show up in the mortality data. I do understand there are a number of untested cases in Japan, as in other countries, but Japan is still a mystery to me. Bowing and masks? Washing hands?
Zhou, You said:
“Please educate yourself about this despotic government, before you claim how wonderful it is.”
Actually, I agree that the Chinese government is despotic. The fact that you believe I think it’s wonderful convinces me that you are not very perceptive. Thus I dismiss everything else you say right out of hand. Sorry, I don’t trust your judgement.
I personally know people living in China right now. I trust their opinions much more than yours.
Read this and learn something:
https://www.themoneyillusion.com/was-china-the-worst-possible-place-for-the-coronavirus-to-hit/
30. March 2020 at 20:07
Christian, You said:
“Oh gosh, it can’t be that hard to produce hundreds of millions mask here from scratch in a month.”
First intelligent thing you’ve said in a long time. You probably heard about what Taiwan did.
30. March 2020 at 20:08
Morgan,
For the record, I have always thought that plan was an interesting idea. It’s the caps, racing thoughts, and lack of humility that i find off putting. Sometimes it’s exhausting.
30. March 2020 at 20:29
Student, I’m a professional with the word. Also, I see the future
https://www.themoneyillusion.com/the-world-is-models/#comment-56902
30. March 2020 at 20:31
And then Sumner MISSING my 50% work from home claim 11 years ago
but noting I am a professional with the word
https://www.themoneyillusion.com/more-good-news/#comment-57180
30. March 2020 at 20:41
So again BOYS, nothing in me changed.
What changed is Trump drew VERY SHARP attacks on Scott’s wife’s home country.
Scott has TDS either for personal or financial reasons.
—
Look Scott is clearly the fastest hiker int he group who runs into the bear on Macro -he’s clearly Milton’s heir.
But my god, Trump SIGNPOSTED massive bets on:
1. close borders to low skilled and take unlimited high skilled
2. Make important shit in US
3. Govt is a fucking swamp of bureaucracy that may kill us
And WON ALL THREE BETS
And Scott somehow HATES HIM
Its not rational. It’s bc Scott see China under attack and instead of telling his fam to MAN UP he;s willing to fuck the USA in the keester
It’s not ENOUGH TO SAY
“Actually, I agree that the Chinese government is despotic. ”
WE ARE AT F*CKING WAR WITH CCP
And Scott’s family’s home country WILL LOSE FACE and WILL BE BROUGHT LOW BY THEIR BETTERS
And if Scott wants to win a couple of grand all he has to do is debate me
I will shake him upside down until he screams out a deeper truth that makes him a better man.
30. March 2020 at 20:52
I see the same mistakes in China as here. Not acknowledging the seriousness of the threat until it was out of control. Failures among the systems put in place to detect them, denial of the spread, lack of action until it’s to late, then blaming foreigners for it. Dodge, duck and blame. Our superiority was not demonstrated… in fact, Scott is right on this. We are doing worse than they are.
30. March 2020 at 21:02
Fear of upsetting the great leader has compounded the problem. Blinded by an ideology, many ignored the obvious signal. Take a look at Lynchburg VA for a very recent example… a microcosm of the whole thing. We too were wishing in one hand, and shitting in the other, then were shocked to see which one got filled first. Pointing fingers across the Pacific doesn’t make out shit sandwich taste any better to me.
30. March 2020 at 21:03
I’m not sure Japan is such a mystery. There are a number of variables that impact the transmission rate. When they start working in the same direction you can get exponential changes (up or down) in the transmission rate. My guess is that hygiene and the average number of people in urban households have a big impact. Masks and social greetings maybe some effect. Testing (in most cases) has little impact.
BTW – One of the reasons I think testing does not have such a big impact is that we’re only considering one side of the equation…i.e. behavior of people who test positive. They stay home and don’t spread the infection. But with testing you get a large number of negative results, people who might have stayed home out of an abundance caution because they thought they might have the disease, but who now, because they know they are negative, no longer stay at home but instead go out where they are much more likely to get infected.
30. March 2020 at 21:09
Dtoh,
I agree, testing the possibly exposed is what’s needed. It’s random sample testing that helps. Had we been doing that in January, we could have spotted this right away before it got everywhere. We needed a current population survey of the infected. Instead, we didn’t even have enough tests to test those who showed up sick. And what we did have took to long. We didn’t have enough PPE, not ventilators – we won’t have enough until like July. We are now forced to eat our shit sandwich. That sucks.
30. March 2020 at 21:11
*is not what’s needed….
30. March 2020 at 21:22
No claims can be made at all about China. Except they lie.
We should generally assume Wuhan has 10x the dead and the disease is still rolling in waves across the country.
To make Scott feel better we shall call it:
WINNIE THE FLU™
This makes clear Winnie caused the flu.
And Anyone who likes Winnie is an enemy of humanity.
30. March 2020 at 21:28
We lied too. It’s just like the normal flu. It will be over in a month. We have enough tests and PPE and ventilators. We will return to work by Easter. Same ole story here.
St. Augustine put it well:
“If you should ask me what are the ways of God, I would tell you that the first is humility, the second is humility, and the third is humility. Not that there are no other precepts to give, but if humility does not preceed all that we do, our efforts are fruitless.”
30. March 2020 at 21:29
Student, we’ll continue to ramp up fast. We should be at 200K+ tests a day next week.
Trump KNOWS how to terrify folks into action.
FWIW, here’s what’s needed:
Everyone in masks while working / shopping
2M tests per day next fall
Online only school 20-21 (kids alone are the vector that makes communities of workers sick all at once)- huge productivity gains here forever
Full Red zone / Green zone – nobody can leave red zones so that green zones keep working and can send medical resources to red zones without fear.
30. March 2020 at 21:41
“We lied too. It’s just like the normal flu. It will be over in a month. We have enough tests and PPE and ventilators. We will return to work by Easter. Same ole story here.”
that’s not what was said AT ALL and I will not continue to be nice with pox on both houses BS.
I KNOW what was said, bc I was around folks on the messaging.
You cant read anything said by MSM to judge what “we” said.
MSM = China sympathizers
Trump did say it’ll disappear as fast as it comes. He DID say, My admin in on top of this.
And if you didn’t UNDERSTAND this is going to hit us like a ton of bricks bc Trump shut down China travel – thats on MSM.
MSM SHOULD have said, “Holy Christ on a cracker! POTUS Trump clearly understands we are about to get hit by ball shrinking NIGHTMARE, he just shut down travel to China!
Is this sinking in?
Trump ACTS correctly, but the media refuses to view and describe his actions as first-mover smarter than them. Which harms America.
Imagine the other 5 networks ALL star into he TV and say like Walter Cronkite
POTUS TRUMP WOULD NOT SHUT DOWN CHINA TRAVEL unless our lives are all in danger!!!
—
Trump does not thave woo the beta boys.
The beta boys will be remembered like Chamberlain
China did this
NYC did this
and the media kept America from living in Trump’s world.
WE LIVE, whether Scott likes it or not IN TRUMPS WORLD.
30. March 2020 at 21:44
Proverbs 11:12
30. March 2020 at 21:47
We should have had 200k a day in January. “Terrify people into action”… how CCP. We were not prepared because we lack humility. Now we are preparing while we lunch on our shit sandwich.
30. March 2020 at 22:43
Impossible
We didn’t even have half the markers we needed.
Sorry, kiddo.
MUH TESTING is not logical. We simply are not SK, do don’t have the manu and skillset AT HOME to react that quickly.
YES, we should have been living n TRUMP WORLD years ago and moved tons of this stuff home even using tariffs. We will in the future.
BUT, you can attack Trump form right!
He should have stopped travel BEFORE Chinese New Year.
The media then should have CHEERED TRUMP the law and order isolationist.
This would have galvanized him to cut off EU faster. Trump would shit for joy if NYT cheered him on the front page.
THEN by March 2nd, he should have gone in and seized NYC and instituted martial law to force those 8M people to STAY IN THEIR TINY BOXES.
—-
These are your acceptable attacks on Trump – go nuts!
31. March 2020 at 00:19
Morgan Warstler is the reason WordPress with inline serial comments is not the way to go…you can’t just click on the next branch of the tree and skip all his typical Texas tough talk. Has anything good ever come out of that state? Can’t think of anything at the moment except maybe Texas Instruments. And BBQ. And peroxide blondes.
@msgkings: “This site has a truckload of narcissistic goofballs commenting LOL” – projection noted, lol the joke’s on you, joker.
@Student – was impressed by your ability to quote scripture, that’s a lost art. Proverbs 30:6, for anybody who dares try and paraphrase Sumner, lol.
31. March 2020 at 00:37
Student,
200k random tests a day in January would have been completely useless. Incidence was so low at the point, that at 200k a day, we would have been lucky to find even a single case in a week.
31. March 2020 at 01:13
@dtoh
“””
One of the reasons I think testing does not have such a big impact is that we’re only considering one side of the equation…i.e. behavior of people who test positive. They stay home and don’t spread the infection. But with testing you get a large number of negative results, people who might have stayed home out of an abundance caution because they thought they might have the disease, but who now, because they know they are negative, no longer stay at home but instead go out where they are much more likely to get infected.
“””
When current test results are published (they should be), you not only stay at home to avoid infecting anyone, but to avoid being infected.
Apart from that random sampling against the total population should be done with antibody/ELISA-tests, not with PCR-tests. Ingredients are becoming scarce for PCR-tests and the overhead is unnecessary to get an representative overview of the overall infection rates. Certified ELISA-Tests are becoming available these days. They are much more efficient, but of course only work after infection (antibody). PCR is needed for clinical/emergency purpose, antibody/ELISA for statistics.
31. March 2020 at 01:35
An inaccurate, but quite efficient early-warning system for SARS2 can be sewage water. Microbiologists in the Netherlands are into this.
31. March 2020 at 04:34
Christian, I went to the pharmacy the other day and there were two products that were unavailable: masks and toilet paper.
Masks are mostly produced abroad, so we are constantly hearing about how producing masks abroad threatens our US supply (as if there would be a large domestic demand for masks in the absence of this virus). But I never heard this same argument for toilet paper so I went home and looked at my toilet paper—made in USA! Turns out, toilet paper (and paper towels too) are all produced in the US. US probably has a cost advantage in these kinds of paper products because of abundant forests.
Yet the media is constantly telling people that we have a shortage of masks because we can’t rely on overseas producers—yet the shortage of toilet paper is never used to say we can’t rely on domestic producers. I hear no fretting about supply chains or just-in-time production at all for toilet paper even though it is just as unavailable as masks right now. Instead, the shortage of toilet paper is blamed on suddenly increased demand.
A far more reasonable approach would be to treat the shortage of masks like we do the shortage of toilet paper—the inevitable result when demand suddenly spikes by a huge amount, which has nothing to do with supply chains.
31. March 2020 at 05:08
Dtoh,
How low was the incidence? We have no idea because we were not conducting random testing. I’d prefer forward looking data over gut feelings and reacting 1-4 weeks after the fact when people are sick and dying. Imagine if New Orleans knew of the prevalence in the local community prior to Mardi Gras (it would have also been helpful if gullible people weren’t told it was a big nothing burger, a hoax, such that they should party on)? How about if New Yorkers knew about the extent of people with the sickness before they crammed onto metro? What if people knew that their corner of the world had a low frequency of cases and so going out to eat was not that risky (maybe even less than the car ride there)?
Morgan, despite your prideful fist pounding, you sound like you are advocating nationalism. I get excess capacity in critical industries, but I hadn’t heard a peep about PPE production of pharmaceuticals from any of you all until March. Revisionist history is what it sounds like to me.
31. March 2020 at 05:21
Jens,
I think it’s fairly complex and varies from country to country. If you’re positive, how much more likely are you stay at home. If you’re negative, how much more likely are you to go out. Ratio of positive to negative. What’s the earliest in the infection cycle you can get a test results. How much transmission occurs between the earliest possible date for getting a test result and the time of a test result under a more rigid testing regime. How does transmissibilty change over the course of the infection. How effective is quarantine in protecting people in the same household. What percentage of transmission takes place within the household versus outside the household.
It’s a complex question, but my gut feel is that testing does not have a huge impact on transmission.
Testing to understand the spread and nature of the disease is a separate question. Ultimately, data is most valuable if it improves outcomes. The media and academics often want data for other reasons.
Also for data purposes, if you know the test regime/criteria and you know the percentage of positive results, there is enough existing data out there that the calculation of the actual case rate becomes very simple. You don’t need random sampling to figure it out.
31. March 2020 at 05:38
It behaves according to a fractal pattern… where the rules that govern transmission between groups are the same as between individuals. It’s a pattern that repeats at increasing scales. Individuals, families, local communities, nations, etc… interactions between individuals, between family members, between local communities… it’s the same pattern. A mode where people are clustered into local groups with travel between the local groups is not that different than a mode where all people are randomly interacted with people from across the globe each day. The only difference is the speed of the spread.
Notice, that social distancing is working. Look at the USA. The last three days the growth factor (GF = delta new cases day t / delta new cases day t-1) has averaged like 1.02. We have almost reached the inflection where the change in the number of new cases today is smaller than it was yesterday. It’s working. Is it sustainable… doubt it, but once we get things manageable, we can start to experiment with opening things back up in socially distant, masked up ways. But we need masks first… and we need the capacity to test real time such that we can shut down hotspots and leave cold spots alone… if we aren’t there yet, we stay shut down.
I realize that crying over spilled milk (the fact that it would have been nice to be at that point a month ago) is useless… so let’s just get there now. We are on our way… but that doesn’t mean we did anything close to a good job. We sucked. Humility is key.
31. March 2020 at 05:45
Student
Of course we know the incidence. We know mortality rates, we know actual mortality. We know average days from infection until death. We know the increase in the rate of deaths. Similarly, we know the rate at which certain sets of symptoms present and the number of people with those symptoms. From all of this we can calculate current actual incidence, growth rates and the incidence at any point back in time.
On top of that nearly all the early cases were traceable, the first known case entered the U.S. on Jan 15 and was diagnosed on January 20th.
There were only 15 confirmed cases as late as February 15. Even if actual cases were higher by a factor of 10 (unlikely since nearly all cases at the point were traceable), it still would have required massive numbers of random tests to find even a single infected person in mid January. 200k tests a day would not have found a single infected person.
31. March 2020 at 05:49
1. Of course social distancing was working. There was never any doubt about that.
2. It’s totally not the same pattern between families and between local communities. Transmission increases with proximity and total time of exposure. That is not the same for family members and for strangers.
31. March 2020 at 06:02
Dtoh,
You make good points. But leading indicators are better than lagging indicators in things that grow exponentially. We need leading indicators.
The same exponential rules apply is my point. It’s clearly fractal. Now if you mean the transmission probability increases with the extent of interaction, I agree.
Just saying until we have enough masks and adequate information (leading indicators), we have to stay shut down. Once we have masks and leading indicators, we can start opening up and experimenting with millions of little behavioral changes all the while. We are going to be oscillating between shutting down and opening up for months, until we have treatments of vaccines. But there are things we need before we can even start oscillating.
31. March 2020 at 06:04
*treatments or…
31. March 2020 at 07:18
@dtoh:
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It’s a complex question, but my gut feel is that testing does not have a huge impact on transmission
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Its publicity has impact on private and public sector activity/decisions.
My gut feeling is that it lowers reproduction numbers, because it alarms decision makers (private + public).
This might change in future phases, when alarm senses have been overtaxed.
Of course it also depends on cultural context.
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You don’t need random sampling to figure it out.
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I do not think that one already knows enough to be able to do without it (Different test regimes in different countries, asymptomatic cases, age structure differences, …). It’s a verification tool. Small differences are important because of the speed of the process and the inaccuracies and delays in observation.
It will also be very interesting for individuals to know if they have antibodies. Not everyone who has them gets a PCR test.
31. March 2020 at 07:25
Scott:
The NYT article on Wuhan is good but it’s too one sided. It presents the central government’s side of the story without telling Wuhan’s side. No doubt Wuhan’s government was incompetent but I doubt they were acting brazenly without some tacit approval from central government.
This represents one additional problem of Western media coverage in China. Often the reporters are well sourced with Central Government or big cities but lack the depth to go deep inside China. The Chinese government is at fault for most of this due to its lack of press freedom. However, I think the Western sources could do better by interpreting local coverage and reaching out to local sources more via social media.
31. March 2020 at 09:25
Mark,
you make a good point. In Germany we miss four things: toilet paper, sanitizers, masks and certain medicines.
The production of toilet paper can easily be scaled up because very little is produced abroad. I don’t know where most disinfectants come from, but they are only alcohols, the chemical industry and distilleries have promised quick remedies.
Masks are more difficult, if you don’t want to sew by hand, you need special machines and the know-how, you can’t just conjure that out of a hat, even if some people seem to think so.
Scott says masks are very easy, and not a problem, but something about this theory cannot be entirely correct. The price of the masks has increased by many factors, 3000% and more. This is money lying on the street, yet it’s oftentimes not picked up. If production was as easy as others say, someone would pick up the money.
95 percent of surgical masks and 70 percent of respirators used in the US were made overseas before the crisis, now you are right, total demand increased by a factor of 10 or 100 or maybe 10,000. So I read a few articles and they all say that the very few US mask companies have started scaling up massively already in January.
But if you’ve only produced 5% of the mask demand so far, then of course you can’t scale up as easily as if you’ve served, say, 30-50% of the market, because you simply have much fewer machines and much smaller factories. If your base is only 5, instead of 20, 30 or 50, then you will of course notice this when you upscale, the factors will come through fully.
Scott always takes Taiwan as an example, which I find ridiculous because Taiwan was one of the largest mask producers in the world before the crisis hit. Of course Taiwan can satisfy its own demand rather quickly, they are a small country that overproduced its own pre-crisis demand many, many times over. All they have to do now is upscale their existing factories and reduce exports if necessary.
The next two major problems are ventilators and drug precursors. Most western countries produce virtually no drug precursors at all, so have fun upscaling from zero.
Compare that to toilet paper, where you can scale up from 80, 90 or 100. I’m glad the covidiots are all hoarding toilet paper, the one thing that doesn’t matter at all – and won’t even run out.
In our country you couldn’t buy toilet paper for 3-4 days, but meanwhile the stocks are filled again. This is absolutely not the case with the masks, it could take months until you can buy masks on the open market again. Meanwhile, American, Asian and European governments outbid each other at the mask manufacturers for the last remaining batches.
31. March 2020 at 09:53
Christianlist,
You can make a mask out of folded cloth (I using high thread could cotton pillow cases) and hair bands (or cut strips of stretchy socks). Using this while I get up to speed on this old sewing machine a relative got my better half for Christmas like 15 years ago haha.
Who would have guessed 1 year ago I’d be cutting up pillow cases and teaching myself to sew… wild times.
31. March 2020 at 11:57
Here’s how the series of events unfolded for me:
1. Wall Street Journal begins reporting on the events unfolding in Wuhan in January. My reaction: Hmm, this is interesting, but remember SARS? This sounds like a similar thing. Health authorities are likely to get it under control.
2. China locks down Wuhan and Hubei Province and introduces severe movement restrictions for the whole country (or most of it?). World Health Organization officials say this is unlikely to do any good, and there is no evidence that movement restrictions stem the spread of respiratory viruses. My reaction: Huh? How could it not stem the spread?
3. Cases are detected in the US. News reports say that local health departments are tracing contacts of anyone who tests positive and quarantining contacts. News reports suggest that this will stretch the resources of local health departments if it needs to be done on a wider scale. My reaction: it sounds like we have this under control. We will have a few cases pop up, but whenever someone tests positive, we’re containing it. We’re likely to have a much better outcome than China, because we had advance notice.
4. Suddenly, Italy quarantines several towns in the northern part of the country. This growing problem was flying under the radar of the news outlets I was following (primarily the WSJ and the FT). The first I heard of it was the quarantine. Soon after, many more cases started appearing in the US with travel history to Italy. My reaction: this is not good. We were doing okay with isolating cases when the primary risk was travelers from China. Now we have imported cases from a country where we may not have realized it was so prevalent. Who knows how many people have inadvertently brought the virus from Italy? Bad news.
5. Scott Sumner posts three videos on March 8th which explain the math and science of the pandemic in stark relief. None of this information was clearly communicated in the news sources I’d been following. I couldn’t think about anything else all afternoon. This is a huge problem! We’re in for a major outbreak with large-scale disruption.
6. US States begin issuing stay-at-home orders. I expected various reactions like this, after listening to the videos mentioned in the previous number.
7. Information emerges that large numbers of cases are asymptomatic. Tests of the entire town of Vo, Italy found that 3% of the population was positive, but half of positive tests came from people with no symptoms (reported in the FT). A mathematical modeling paper in Science used Chinese data to estimate that 79% of confirmed positive cases probably caught the virus from an undetected case. Finally, the scale of the problem is coming into view for me. Early in the outbreak, encouraged by the statements from the WHO that asymptomatic transmission was not likely to be the primary mode of spread, I believed that the early efforts to isolate contacts of known cases in the US was sufficient. Clearly, though, other cases went undetected and silently spread the virus under the radar. At this point, the debacle over testing came into clearer focus. Before understanding this, my reaction to the slow roll-out of testing was that it was unfortunate, but probably not a big deal. We didn’t have many cases, and tests were still being done.
For me, none of this has to do with thinking that the US is superior to China. It involved gradually coming to understand the nature of this virus better and gradually coming to realize (too late) that our response was not sufficient to contain it. Perhaps I was late to understand aspects of the problem that many people understood earlier, but from my perspective, it was reasonable to think that we would have a better outcome than China — not because we are better overall, or because we are freer, but because we had advance warning. China had no advance warning, by definition. They couldn’t be looking for a virus that they knew nothing about until it was already spreading. We could be looking for it from the very start. It was only later that I realized that looking for it involved a lot more testing than just testing people with symptoms. That’s a much harder problem to solve, especially for a country as large as ours, and we were totally unprepared. Even if we started in January, we might not have been able to ramp up testing to that extent.
31. March 2020 at 12:33
Morgan,
On a second or third read, you make better points than I gave your credit for… Now don’t let it go to your head (you seem apt to do that)… cuz this hasn’t gone well. But I’ll at least acknowledge some of them…
Bottom line tho… let’s just do better from this point forward. We are all in this together. Let’s just get it done from this point forward.
31. March 2020 at 13:29
dtoh, I remain agnostic on Japan, but still think testing is really important. I should have been tested in February, I had the coughing/fever symptoms, went to the doctor, had flown across the Pacific in late January, and gone through a packed LAX. I’m exactly the sort of person they should have been testing. The community spread in America was discovered when a lady in Seattle tested against government regulators who denied her permission, and discovered the outbreak. That’s insane.
Another mistake was ignoring the data from that online thermometer company.
LC, You may be right about the story, but they also relied on whistleblowers.
Christian, Masks are a very low tech product. Look at what the US did in WWII and tell me we can’t produce lots of masks if we put our mind to it. We sat around for months, twiddling our thumbs. That’s the real problem. Not to mention our failure to stockpile masks—as if we’d never face a pandemic. WTF?
Marc, Good comment.
31. March 2020 at 16:08
Scott,
1. I agree that testing/quarantining/banning travelers coming from areas with high incidence of infection is really important. Random testing where incidence is very low makes no sense. Widespread testing at the beginning of an epidemic is not practical because of cost. If we prep for every possible emergency there will be no resources left over for normal consumption.
2. I’m a big proponent of thermometers. Non-invasive temperature monitoring at entrances to schools, companies, airports, train stations, public places is a very cost effective way to identify and isolate potential carriers. It also discourages people from “cheating” and coming out when they have slight coughs or fevers.
3. Masks are low tech. Producing them in quantity is very high tech. I work with a company that is now making face shields for physicians. We had nothing to do with medical products or had even thought about it a week ago. We’re currently delivering 10k face shields a day to area hospitals. Ramping up will take a while. If anyone believes that companies are not selflessly working their buts off to figure out ways they can help, they are completely clueless about human virtue and the way firms work. If anyone believes that government can plan this and figure out who should be making what, they are living on a different planet.
Planning for emergencies (insurance) is always a trade off. There may be in the future, but there is currently not a mask (or PPE) shortage. Saying should have, could have, would have after the fact totally lacks credibility.
31. March 2020 at 16:10
For the record… if you have ever taken apart and messed with a sewing machine… Thomas Saint must have been a genius. This thing is more complicated in conception than any hemi engine I have ever worked on. It’s an amazing contraption. I can’t believe how someone conceived of this as a machine. Pretty amazing.
31. March 2020 at 16:12
*thomas saint… damn phone.
1. April 2020 at 09:22
dtoh, You said:
“Producing them in quantity is very high tech.”
Are we less sophisticated than Taiwan? How did it ramp up production so rapidly?
I could make a mask for myself at home that would be 90% as effective as an actual mask.
No, I didn’t suggest random testing, rather aggressive testing around outbreaks or suspected cases.
Look, we know how Taiwan prevented a big outbreak. We could have done the same, and didn’t. It’s that simple. I’m not blaming Trump or any other single individual, but it’s clear that East Asia did a far better job than the West. Perhaps because they’d been through SARS.
And we could have stockpiled masks at very low cost. Might it make sense to spend 1% as much money stockpiling stuff for a future pandemic as our military spends stockpiling weapons for the type of war that will probably never be fought?
I’m not blaming industry, the free market doesn’t have the incentive to provide this sort of insurance against low probability events.
I agree about thermometers. Have you heard of Kinsa?
https://healthweather.us/?mode=Atypical