The big unknowns

We actually know quite a bit about this epidemic. We know the death rate is on the order of 1%, or at least 0.5% to 2%. We know it grows exponentially if left unaddressed. We know that this would eventually overwhelm the hospital system, causing massive death among people who don’t even have coronavirus. We know that most societies won’t allow that to happen and we know that it’s possible to prevent that outcome. So what are the big unknowns?

1. How long until a vaccine, or some other treatment?

2. What’s the tradeoff between economic harm and epidemic control, until we get a vaccine?

China is likely to provide the first test on the second question.  Here’s Bloomberg:

“This coronavirus is more comparable to influenza,” said Ben Cowling, a professor of epidemiology at Hong Kong University, who said it might take two months for fresh cases to emerge in China. “It spreads too easily, and most parts of the world don’t have the ability like China to do containment and control to get rid of it.”

China had no new domestic cases yesterday, for the first time.  It is still getting a few dozen new cases from international travelers, which are all quarantined for 14 days on arriving in China.  So it seems that domestic community transmission can be controlled.

One obvious question is whether other (less authoritarian) countries will also be able to put a lid on community transmission.  I don’t know the answer to that, although based on what we see in other East Asian counties, I’d say “to some extent, but perhaps less so than China.”

But first I’d like to consider a different question—the prospect for China itself.  The above reference to the virus popping up again in two months may sound like bad news, but it actually is not.  I presume that China has the following strategy in mind:

Continue quarantining inbound flights.  Even so, some cases will leak across the land border.  Each time a new domestic case is discovered, they’ll clamp down on that region hard, just as they did with Hubei province.  The hope is that life can go on as usual in provinces not directly affected.  Rinse and repeat until a vaccine is developed.

Normally, I’d be rather pessimistic about this strategy.  But there are two facts that suggest it just might work.  First, a new outbreak would likely be far less severe than the Wuhan outbreak was when the Chinese government finally got around to addressing it.  Thus the new round of tight controls would tamp down on things much earlier than in Wuhan.

Second, the response to the severe outbreak in Wuhan achieved success amazingly quickly.  Thus the second round of controls would probably be effective even more quickly.  China has learned a lot in the past 3 months.  I could see China having 5 or 10 such local clampdowns between now and the time a vaccine is developed, but still keep their economy functioning.

I am less optimistic about countries outside of East Asia.  Experts still don’t fully understand why new infections in East Asia are so low.  Some smaller countries seem to have effective policies.  But Japan does not, and still seems to have a low rate of new infection (although some question the Japanese data.)

I do know that East Asians were much more likely to wear masks even before the epidemic, and this article says the Japanese wash hands more often and touch each other less often than do Westerners (less hand shaking, etc.)  Yet it seems odd these factors would be decisive, given crowded subways in Japanese cities.

I think Tyler Cowen is exactly right when he suggests that if we tried the herd immunity approach then the hospital system would become overwhelmed, we’d freak out, and then we’d abandon the strategy at a time when it was too late to easily control the epidemic.  But he also points out that social distancing is hard to maintain in a Western society, and suggests a possible yo-yo-ing of policy.  The question is whether there’s some amount of social distancing that is consistent with less than a deep depression, but holds the R0 down below 1.0, say to 0.8 or 0.9.  And what amount of social distancing is that?

That’s the 6.4 trillion dollar question, and I have no idea what the answer is.

PS.  This video suggests that one difference between the East and West is that East Asian countries revamped their public heath systems after the SARS epidemic, to be ready for the next one.  The West did not.  Ironically, they have many more hospital beds than the US (per capita) despite spending much less on health care.  They are far more prepared than we are.

Think of “country immunity”.  Once a country has been infected by a major epidemic, it creates institutional “antibodies” making it less susceptible to the next one.


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48 Responses to “The big unknowns”

  1. Gravatar of Student Student
    19. March 2020 at 10:54

    This was a good post. Thanks.

    For the record, yesterday’s numbers implied the growth factor in the US was 1.74. The 15 day rolling average is 1.41.

    At least based on this data (subject to crap in crap out effect). https://www.worldometers.info/coronavirus/country/us/

    This puts us on course for 13,350 total cases by 11:59 tonight and 18,833 by midnight tomorrow. That’s on course for over a million by April 1, 2020.

    I honestly expect the growth factor to drop soon… also probably should be subtracting out recoveries soon and they are building and they should have some level (if not total) immunity, right?

  2. Gravatar of MJ MJ
    19. March 2020 at 11:32

    If chloroquine ends up being a way to prevent corona, or at least reduce the R factor, I wonder if we could scale up production of it massively and have large parts of the population take it.

  3. Gravatar of Andrew Andrew
    19. March 2020 at 11:50

    Actually how long a vaccine is pretty well known. A minimum of 12momths and then some following by scale up. It would be foolish to think that a vaccine will help us with this round.

  4. Gravatar of ssumner ssumner
    19. March 2020 at 12:00

    MJ, If trillions of dollars are at stake, I have to assume the answer is yes.

    Andrew, Yes, we have some idea, but this is not a normal situation, so that creates a bit of uncertainty. Consider the shortage of vaccine for shingles. It’s unlikely that would apply to this case, as the pressure to ramp up production would be much more intense. We also don’t know if the first attempts at vaccine development will succeed.

    Also, will other countries like China try to move faster because they are less risk averse in regulation? And if they succeed, will we buy their product? Lots of unknowns. I don’t know enough to opine on this question.

    Having said that, I have no reason to question the 12-18 months that the press talks about, that seems plausible.

  5. Gravatar of Christian List Christian List
    19. March 2020 at 12:30

    Very good analysis, Scott. I agree completely. You cover all important points accurately.

    The current approach in China not only seems to save most lives, it seems to be best for the economy as well.

    The biggest unknowns for me right now are Europe and the US. They have to learn from China asap, but that is uncertain.

    Vaccinations take a long time, for whatever reasons, I assume it’s mostly excessive regulation. Anyways, we have to solve the problem way earlier and China showed us the way.

  6. Gravatar of P Burgos P Burgos
    19. March 2020 at 12:33

    If you don’t have mass gatherings, check everyone for a fever on a daily basis and before going on the subway and into a workplace, test everyone with symptoms, quarantine all suspected cases and their close contacts, why would you need a Hubei style lockdown? Taiwan and Singapore are doing just fine with little more than those measures, so why would China need to do more when they have very few active cases?

    That is what infuriates me about the US (and western response). Their was no reason that the nations of the West couldn’t have done what a democratic nation like Taiwan did, and very likely completely have avoided large outbreaks, extreme social distancing measures, and a huge recession. It was all very avoidable, and avoidable at very little cost.

  7. Gravatar of Christian List Christian List
    19. March 2020 at 13:01

    P.Burgos,

    Exactly. The same Western politicians who did not even recognize the crisis four weeks ago now claim that the crisis will continue in a severe way for months and years.

    Instead of focusing on the here and now, they talk such nonsense.

    “China critique” is also currently in vogue among these politicians and so-called experts. They ask questions such as: “What will China do when the cases flame up again?”

    These people are currently driving us with 180 mph towards a concrete wall, and their biggest concern seems to be that China has zero new infections.

    All China has to do now is making sure that the virus is not reintroduced from failing regions like Europe and the US. I would like to have the Chinese luxury problems, too.

    During the Sputnik shock back then, Western politicians at least admitted that we were lagging behind. Only when people realize that we are behind we can learn and improve.

  8. Gravatar of jw jw
    19. March 2020 at 13:05

    There’s another reason that could explain China’s success in halting the spread which isn’t necessarily related to the lockdown measures they took – maybe COVID-19 just isn’t that infectious.

    South Korea has had relatively few cases and the rate of infection has been slowing and they did not employ the extreme measures that China did. See this article https://www.sciencemag.org/news/2020/03/coronavirus-cases-have-dropped-sharply-south-korea-whats-secret-its-success

    If the transmission rate is lower than expected then the herd immunity approach may actually be a reasonable and more effective approach.

  9. Gravatar of Student Student
    19. March 2020 at 13:08

    Burgos,

    I think it has something to do with our tendency to think we are entitled to do whatever we want and rules don’t apply to us. I know people that flew to Florida for spring break. The Florida beach scene is going to be the next Lombardy region in like 3-5 weeks. And the governor is going to be hated for it… even tho the dummies boozing it up in large groups are just, if not more, responsible.

    Let’s hope and pray the curve bends. Today is the feast day of St. Joseph…

  10. Gravatar of Jim Bowerman Jim Bowerman
    19. March 2020 at 13:10

    major tick down in hypermind 2020 NGDP expectations to 1.75%…was at 2.55% just yesterday 🙁

  11. Gravatar of P Burgos P Burgos
    19. March 2020 at 13:12

    Also, there are some other things to consider. First is how quickly we can find out if existing anti-viral drugs are effective in treating Covid-19 patients. If we can find and mass produce a couple of those, I would suspect that would reduce the duration and severity of cases. Also, how quick can we develop and mass produce antibody treatments? Given how frequently healthcare workers get infected, how quickly does a Corp of healthcare workers develop with immunity from previous infections? Also, how quick does testing develop?

    To think that things won’t improve until a vaccine is mass produced seems unlikely to me.

  12. Gravatar of Carl Carl
    19. March 2020 at 13:29

    I think Christian List from this comment section and the other doctors you’ve been reading are rightfully conservative about the hopes of dramatically shortening the timeframe for producing a vaccine. Consider these words of caution from a professor of virology on the risks of rushing a vaccine: https://www.nature.com/articles/d41586-020-00751-9

    Decades ago, vaccines developed against another coronavirus, feline infectious peritonitis virus, increased cats’ risk of developing the disease caused by the virus (T. Takano et al. J. Vet. Med. Sci. 81, 911–915; 2019). Similar phenomena have been seen in animal studies for other viruses, including the coronavirus that causes SARS.

  13. Gravatar of Christian List Christian List
    19. March 2020 at 14:02

    Carl,

    I don’t agree with this guy. We have too much excessive regulation. Not to mention that “safety guarantees” are completely irrelevant in a dying patient, and there are more than enough of these patients around right now.

    With vaccinations it’s a bit different, because you vaccinate healthy people. But in this area, too, I am in favor of animal experiments being largely skipped right now, or simply carried out in parallel with experiments on humans. Results are always difficult to transfer from animals to humans anyhow.

    I have heard that in America there are already vaccination trials on humans. That’s really great. And again, we can’t wait for the vaccinations anyhow. We can defeat the virus without vaccination – and we have to.

  14. Gravatar of Christian List Christian List
    19. March 2020 at 14:16

    I mean vaccine regulation is absurdly difficult to understand. The latest vaccination trials are all about mRNA, which is simply sprayed into the nose.

    We come into contact with thousands or even millions of different antigens every day.

    However, if very few antigens or even only mRNA are sprayed into the nose, then the regulatory authorities make this enormous fuss.

    You have to understand that these are the same politicians, experts, and authorities that are deliberately trying to infect millions of people with a living virus in the abstract hope to create something like “herd immunity”, and thousands of deaths.

    But when a company takes the virus and puts tiny dead fragments in a nasal spray and wants to do human trials asap, the same politicians and bureaucrats say: “Wait a minute. This is extremely dangerous and unsafe! Did you test the spray on rats and monkeys for at least three years???

    This is complete utter madness.

  15. Gravatar of Carl Carl
    19. March 2020 at 14:17

    @Christian
    Okay. Thanks. Sounds like we’ve skipped the animal trials. I assume then we are in Phase I of the vaccine development process as described here https://www.historyofvaccines.org/content/articles/vaccine-development-testing-and-regulation. And, I assume you have to go through Phase II and Phase III as well. What could a safe abbreviated timeline for these phases possibly look like?

  16. Gravatar of Tom Brown Tom Brown
    19. March 2020 at 15:09

    Vaccines take a long time because you HAVE to make sure they’re safe, otherwise you might just be making a bunch more people sick. I think it just takes time to wait and see if they’re safe or not after injecting volunteers.

    Or so I’ve read.

    We’ve skipped the animal trials it sounds like: https://www.entrepreneur.com/article/347709

  17. Gravatar of Kgaard Kgaard
    19. March 2020 at 15:30

    The answer is already obvious: Chloroquine. It’s not even a debate anymore. The issue is why the CDC was not forthcoming with this knowledge. They have known since 2005 that it is effective against coronavirus.

    The precedent for what is happening is one of those 1880s stock manipulation scandals by the railroad barons.

  18. Gravatar of Tom Brown Tom Brown
    19. March 2020 at 15:31

    Student, thanks for that link. Looks like we’re ahead of schedule: it’s 4:30 PM now PST and this is what it reports:

    Cases: 13,795
    Deaths: 207
    Recovered: 108

  19. Gravatar of Steve Steve
    19. March 2020 at 15:36

    Scott, thoughtful post, I’d just like to add your comments really highlight the importance of aggressive testing, without explicitly doing the math.

    You wrote the following two lines:

    Each time a new domestic case is discovered, they’ll clamp down on that region hard, just as they did with Hubei province

    some amount of social distancing that is consistent with less than a deep depression, but holds the R0 down below 1.0, say to 0.8 or 0.9

    I would argue China achieved R0 of 0.3 to 0.5 in Hubei with a hard clampdown. That suggests the US could cycle between two weeks of freedom (R 2.0-3.0) and two weeks of hard lockdown (R 0.3-0.5), a.k.a. Cowen’s yo-yo and get an R0 of 0.9 across months. Or the US could have a depressing level of work-from-home, closed malls and gyms, and no gatherings of 10 or more…for a YEAR…and still be stuck with R0 of 0.9! The idea of trying to maintain stasis with a taxed but not crushed hospital system feels a lot like the viral version of battle of Verdun.

    But with aggressive testing, you could have most of the country mostly free, and hard lockdowns only in localities with epidemic flare-ups. It helps a lot to granularize the data. Community transmission is the enemy and dealing with it through aggressive testing pays dividends. The cost of millions of tests should be measured against the trillions in GDP that testing enables.

  20. Gravatar of Benjamin Cole Benjamin Cole
    19. March 2020 at 15:41

    I have been accused of “wanting” millions of deaths from Covid-19

    I guess I could posit that Scott Sumner “wants” to crush the GDP, cut tŕhe stock market in half and collapse our financial system.

    But an interesting point is raised. How much lost GDP is Scott Sumner willing to tolerate in exchange for saving one life?

    I have suggested we will lose about $9 trillion of GDP over the next several years and save about 90,000 lives, which comes out to about $100 million dollars per life. By the way, these are lives of old people.

    Still a couple uncertainties. As we do not have a vaccine and we are not willing to lock down everybody permanently… are we crushing our economy just to win a few more months of life for potential victims?

    Why is nobody doing a cost-benefit analysis?

    Probably, as hysteria has set in. Public officials cannot afford to appear to be callous.

  21. Gravatar of Carl Carl
    19. March 2020 at 15:52

    @Benjamin Cole

    Why is nobody doing a cost-benefit analysis?

    See the blog post you’re commenting on beginning with “What’s the tradeoff between economic harm and epidemic control, until we get a vaccine?”

  22. Gravatar of Student Student
    19. March 2020 at 16:26

    Tom,

    We are ahead. This shit is accelerating right now (hopefully once the social distancing we have done… by the non idiots that get it… will show up in within a week) but right now this is accelerating. Yesterday’s growth factor was 1.7! That’s way way faster than it even seems. We are losing right now. Bigly.

    If this continues, we are on pace to hit 1 million cases in like 7-10 days!

    At this rate, we are gonna need national guard in the streets enforcing social distance. I don’t think we have it in us to do that. And I would have every second of it. We just have to many dummies here. People that don’t listen or are just plain stupid.

    I will provide and update tomorrow (like anyone care what a nobody like me thinks anyways… and they are right to think that).

    I fear we are accelerating right now. Just look at the beaches in Florida. That’s our Italy right there.

    Feds should step in and tell the governor there he is a clown. But they won’t. And it’s apparent there is enough travel between the fractals (the local communities) that thats gonna spread all over when they come back from spring break.

    We are in deep shit.

    My only hope is that once that deep shit gets deep enough, we gonna go china (to the extent we can). But if it doesn’t happen by April 1… out health care system is gonna get swamped. And we are gonna eat our lunch man. And it’s not gonna taste good. It’s gonna be a crap sandwich.

  23. Gravatar of LC LC
    19. March 2020 at 16:27

    Scott:

    I have to be a bit of contrarian on your post as I am fairly optimistic about Western countries going forward. The reason I am optimistic is we are in an open and free society and people will choose to do the right thing out of self interest. I agree with Justin Fox in his Bloomberg column today that we will not be locked down for 18 months because social distancing actions today will buy us some time to try different solutions. An excellent example already emerging is special store hours for the vulnerable population. This is a bottom up solution that couldn’t have come from a centralized bureaucracy. The important thing for government now is to actually get out of the way of people trying to do good. Here, there are bad examples all abound, but a really bad one is FDA regulations is limiting the source of surgical masks imported from China. (There are lots of people willing to contribute to buy more masks for our doctors but are stuck because masks have to be FDA certified.) If our government were really interested in public welfare, they would tear down all sort of national borders and let freedom of trade help us. (One other example that really would help us is to have NBA games play overseas in East Asia. We get something for fans to look forward to, TV revenue for our networks and money into our economy.) There are lots of ways people can think of doing good if we just let them and not lock them into a silly “America First” mindset.

  24. Gravatar of Student Student
    19. March 2020 at 16:28

    *i would hate every second of it….

  25. Gravatar of Benjamin Cole Benjamin Cole
    19. March 2020 at 16:32

    Carl—

    Yes, you’re correct, but I don’t see anyone cooking up numbers like I have.

    Are you willing to lose $100 million of GDP for every life saved? Do you have a number in mind?

    Yes, I sound tremendously callous. But such calculations are made everyday in every nation’s healthcare system.

    You know what is crazy? It appears no one is planning on eradicating Covid-19, we are only planning on limiting peak load. Without saying so the “herd immunity” strategy is being followed.

    So we may give up $100 million dollars of GDP per life saved, and that life will be saved for a few months of an old person’s life.

    ——

    Side note. Scott Sumner is puzzling why certain Asian nations are not having Covid-19 outbreaks. It may be that Thailand already had a similar outbreak and some immunity was gained. When the Spanish Flu came around, older people did not die. The theory is older people had already been naturally inoculated.

  26. Gravatar of Student Student
    19. March 2020 at 17:00

    Ben,

    If we have a V shape recovery like Scott suggested powerfully the other day we might, then all that comes back quick. It’s just number money. Now if I were retired drawing a living off that, I might feel like you… tho I doubt it, money is not my father or mother or my wife. I’d prolly spend all my money trying to save them for even 3 years more. Cuz that’s my life. That’s what i live for. Not my boat or my car or my vacations.

    I am sad tonight. We all are starting to see what’s about to happen. And it’s ugly.

  27. Gravatar of Christian List Christian List
    19. March 2020 at 17:03

    @Carl
    You are right about the phases, it’s only phase I so far. Normally phases I to III last 4-10 years altogether. Apparently, it can now be reduced to 1 to 1.5 years.

    Only about 6% of the vaccines will get through, so you would have to try at least 10-20 vaccines simultaneously to have a decent chance.

    @Tom

    otherwise you might just be making a bunch more people sick

    The question is how people are supposed to get sick at all. The regulation is many decades old when attenuated vaccines or even live vaccines were used in research. Nowadays, only fragments or mRNA are used. The serious question is how one should become seriously ill from this. You only have to make sure that the vaccine is effective and that it is not too allergenic. This can’t be so hard. In the worst case scenario you simply have a vaccine that doesn’t work.

    @Benjamin
    Your three trillion is just out of thin air.

    You also pretend that your solution doesn’t cost anything, but in reality your solution is the most expensive and most deadly solution of all, while the solutions of Taiwan, Singapore, Japan, China are best regarding the economy and regarding human suffering.

    Now suck on that Tin-Foil Hat.

  28. Gravatar of Ray Lopez Ray Lopez
    19. March 2020 at 17:07

    Have I been banned, again? We’ll see if this post shows up…

    John Ioannidis is a pioneer in p-hacking in statistics. Dr. Sumner once drew a blank on his name. Heh. We all do brain farts however.

    RL

    Reason – https://reason.com/2020/03/18/coronavirus-quarantine-imperial-college-london-covid-19/

    John Ioannidis, a professor of medicine at Stanford University, raises some of these issues in a terrific post for Stat. Ioannidis wonders whether long-term and “draconian countermeasures” to combat coronavirus can be justified, given how uncertain they are to work and how little data we have about COVID-19’s true mortality rate

    [article largely goes on to validate Ben Cole’s arguments]

  29. Gravatar of Christian List Christian List
    19. March 2020 at 17:15

    German media says this was shown on Iranian TV recently:

    Her appearance on state television was the alarm call for the people of Iran. At prime time, the science journalist Afruz Eslami, herself a trained doctor, presented three possible corona scenarios for the country, which a professor at the renowned Sharif University of Technology in Tehran had calculated.

    In the best case scenario, if the population strictly adheres to contact and hygiene rules, medical care functions and all risk areas are quarantined, 120,000 Iranians could become infected and 12,000 could die.

    With mediocre discipline, the figure would be 300,000 infected and 110,000 dead.

    If, on the other hand, the population did not change its behaviour, the health system would collapse and in the end 3.5 million people would die – at least that is what the computer models of economics professor Alinaghi Mashayekhi predict.

    —-

    The regime must be in really deep shit if they sent something like this, and then even presented by a woman.

  30. Gravatar of mbka mbka
    19. March 2020 at 18:12

    Christian List,

    re: vaccine, I do have some hope that China will find a way quicker. Not so much because of the nature of their politics, but because they’re in the phase the US was in from about 1865-1929 – it’s their “Gründerzeit” with growth and a general optimism and trust that technology and engineering can fix things, and the practical and pragmatic approach that comes with it. Plus, it’s just so big.

    re: Singapore, sadly, while local transmission is fairly controlled with a trickle of new cases per day, we’re now importing about 30 cases a day, mostly returning residents who bring it in from Europe. Authorities expect this to continue for the next week or two. Not out of the woods yet.

  31. Gravatar of Christian List Christian List
    19. March 2020 at 18:31

    mbka,

    this would then be the third Sputnik shock. Has China ever developed a completely new vaccine before? I don’t think so. I don’t think they will be the first. My money’s on the usual suspects: USA or Europe, and in the latter case with focus on Germany or Switzerland.

  32. Gravatar of Lorenzo from Oz Lorenzo from Oz
    19. March 2020 at 18:38

    There is scholarship which connects in group/out group feeling up to xenophobia with disease.

    That is without the Beijing regime doing its bit to stoke xenophobia.
    https://twitter.com/wutingzy/status/1240661305792565248

  33. Gravatar of mbka mbka
    19. March 2020 at 18:41

    Christian,

    hard to tell. I genuinely don’t know, I oscillate between under and overestimating what comes out of China. Their capabilities in implementation and production are impressive. Innovation had good headline numbers recently (patents etc) but whether it’s actually innovative in a useful practical way, especially in non electronic areas, is hard to tell. But here is what really took me by surpirse this last year. Huawei is basically able to offer 5G to the entire world – if they’re allowed to – and no single Western company can match it. So no matter how they may have simply copied technology in the past, all of a sudden they have a product that is novel, unmatched, and the ability to produce it. So who knows, maybe China can pull it off in biotech too.

  34. Gravatar of Benjamin Cole Benjamin Cole
    19. March 2020 at 18:42

    Christian List: I hope the outlook for about a 15% contraction in GDP for the next three years is pessimistic. That would represent about a $9 trillion decrease in GDP, cumulative.

    On the other hand, the economy of Greece contracted by about 25% after the 2008 Global Financial Crisis, and has pretty much stayed there.

    And perhaps in the US we will save more than 90,000 lives.

    But do the math. Come up with some other numbers. The costs versus benefits just doesn’t seem to pan out.

    Moreover, I keep coming back to it. What Western governments are adopting is the herd immunity strategy, but spread out to avoid peak load. As we have no vaccine this may be the best strategy.

    China appears to have succeeded with its police state-lockdown strategy. Japan is an island and Singapore a very small nation.

    Western governments, whether they want to say it out loud or not, are going with the herd immunity strategy.

    Pious and pompous pettifogging is not policy.

  35. Gravatar of Christian List Christian List
    20. March 2020 at 02:16

    Western governments, whether they want to say it out loud or not, are going with the herd immunity strategy.

    Again, that is not a strategy. It’s not even a prediction. That’s why you can now easily integrate the “lockdown”- and the “spread out to avoid peak load”-strategy into your statements. After all, you didn’t do that in the beginning, so this is a little progress.

    But again, it is not a strategy and it is not a prediction. The only statement you make is that – at some point in history – a lot of people will get sick, some will survive, some will die, and when enough people have survived, then maybe those people will be immune, and then at some point maybe the whole herd will be immune. Oh really, who would have thought so? This is not a statement about anything, and certainly not a strategy.

    The Süddeutsche Zeitung yesterday gave a good summary of the situation: Rutte, from the Netherlands, is the last prime minister who still seems to have some sort of your “strategy” in his head. Pretty crazy.

    The article ends with: “The Netherlands have 1,000 intensive care beds for 17 million people.”

    But do the math. Come up with some other numbers. The costs versus benefits just doesn’t seem to pan out.

    Again, your whole mistake is that you do not see the basic problem at all. The whole hospital system is going to be totally overloaded. In your “strategy” in the UK by about eight times, and this is the “good” scenario of your strategy.

    Do you think something like that would not have a massive negative impact on the economy? That’s really ridiculous. If you argue like that, why don’t we just abolish all hospitals. Obviously, we don’t need them. That would save a lot of money. Anyone who has a heart attack, accidents, deep wounds, pneumonia, a stroke or cancer, from now on we just let them die.

  36. Gravatar of Ewan Ewan
    20. March 2020 at 02:44

    “Ironically, they have many more hospital beds than the US (per capita) despite spending much less on health care.”

    Might there be something more than an irony here? Might there be a lesson on the more efficient way of providing health care?

    I don’t pretend to know. I’m asking. There are often statistics quoted that countries with significant public sector health care spend less and get a better service. False? Or a statistical artefact? Or an element of truth worth learning from?

    P.S These blogs (both “bad” and “good”) are a exceptionally informative. Thank you for taking the time and trouble.

  37. Gravatar of Student Student
    20. March 2020 at 04:24

    Well I forgot to check at 11:59 last night so I am going off the number reported on the chart for March 19. That was 13,789.

    That is really close to trend growth (a touch higher). Yesterday’s growth factor was 1.42. The 15 day rolling average is 1.41. We are still multiplying by 10 every 8 days.

    Go take a look at the count for March 11, 2020. On that day total cases were 1,301. On March 19, 2020 (8 days later) it was 13,789. This is undeniable at this point. When will this curve bend? If it doesn’t, we are over 1 million cases by 4/1/2020.

  38. Gravatar of Student Student
    20. March 2020 at 04:25

    We are on pace to hit 19,452 today at 11:59 and 27,439 by tomorrow (March 21, 2020).

  39. Gravatar of Student Student
    20. March 2020 at 04:28

    I forgot…. There is one good sign. The prior two days the growth factor as been > 1.7. Yesterday it was 1.41. While that super exponential still, it is less than 1.7.

  40. Gravatar of ssumner ssumner
    20. March 2020 at 09:46

    LC, I actually mostly agree with you. My pessimism is about the economy, I don’t expect the epidemic to be as bad as forecast.

    Ben, You said:

    “Japan is an island”

    LOL. An “island” with 125 million people. Do you think our problem comes from Canada and Mexico? North America is an island.

  41. Gravatar of ssumner ssumner
    20. March 2020 at 09:54

    Burgos, You said:

    “That is what infuriates me about the US (and western response). Their was no reason that the nations of the West couldn’t have done what a democratic nation like Taiwan did, and very likely completely have avoided large outbreaks, extreme social distancing measures, and a huge recession. It was all very avoidable, and avoidable at very little cost.”

    Yup.

    Jim, Unfortunately the Hypermind market doesn’t seem to have done too well. In fairness, the Fed forecasts (NY, Atlanta) for Q1 are even worse.

    Carl, Ben doesn’t actually read my posts.

  42. Gravatar of Steve Steve
    20. March 2020 at 10:36

    Their was no reason that the nations of the West couldn’t have done what a democratic nation like Taiwan did

    Keep in mind Taiwan knew there was person-to-person transmission on December 31, but the WHO announced no person-to-person transmission on January 14, at China’s behest. China has been spewing disinformation both openly and surreptitiously for the duration of the outbreak.

    https://twitter.com/sehof/status/1239418439799734273
    Taiwan’s Vice President, the epidemiologist Chen Chien-jen, accuses the @WHO of ignoring Taiwan’s warning on 31 December of the possibility of human-to-human transmission.

    https://twitter.com/WHO/status/1217043229427761152
    Preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission of the novel #coronavirus (2019-nCoV) identified in #Wuhan, #China🇨🇳.

  43. Gravatar of Scott H. Scott H.
    20. March 2020 at 10:50

    @JW

    Another hypothesis that fits that data is that COVID-19 is very contagious, but some populations come built with high levels of immunity.

  44. Gravatar of Christian List Christian List
    20. March 2020 at 10:58

    @Steve
    In recent days, the Chinese regime has claimed that the virus did not originate from China.

    It is now being sold as a foreign disease, which most likely originated from the US or Europe.

    This conduct does not create trust, nor does it provide the transparency that we urgently need.

  45. Gravatar of jw jw
    20. March 2020 at 12:08

    @Scott H

    That seems like a fairly implausible hypothesis since COVID-19 is a new virus – why would some populations already have immunity while others don’t?

  46. Gravatar of Steve Steve
    20. March 2020 at 12:26

    @Christian List

    Yes, that is an egregious example of disinformation about the Wuhan CCP Virus.

    Over the past 8 weeks I have seen tons of troll accounts saying “It’s just the flu” “mortality is only 0.1%” or “Chinese folk remedy cures Covid.” My spidey sense tingles, as I’d like to know who the real identities are behind all this disinformation.

  47. Gravatar of Scott H. Scott H.
    20. March 2020 at 13:18

    @jw

    COVID-19 is a corona virus. Corona viruses are common. The common cold is a form of corona virus. Maybe if you have enough immunity to some of those other corona viruses it translates into a form of immunity for this virus. Populations are notorious for having different levels of immunity to different diseases.

  48. Gravatar of H_WASSHOI (Maekawa Miku-nyan lover) H_WASSHOI (Maekawa Miku-nyan lover)
    20. March 2020 at 18:34

    https://note.com/kyoshimine/n/n6bf078a369f9
    (Japanese language source,but beneficial information for other countries)

    I think Japan is doing very efficient policy with non-SARS experienced limited resources.

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