Accurate Coronavirus Information
What's Likely to Happen, What to Do
Bottom line: The best way to reduce US death rates now is immediate complete physical distancing.
Don't touch anyone but your partner, or people you are caretaking. Don't get within six feet of anyone else without wearing a bandana. If you have masks—donate them to your local hospital or clinic to keep health care workers at work).
Details and rationale below—
Curated information on the pandemic and what to do. Last updated March 29th, 2020; planning to update this so long as the pandemic lasts.
For the first time in human history, an exponentially surging epidemic with community spread was reversed, in China (for now).
This was thought to be impossible. With the following aggressive approach, they got from 3,400 new infections per day January 2020, to just 24 new infections on March 11th, 2020:
- Universal temperature checks—on boarding a train, entering a store, going back into your apartment building...
- On high temp, immediate conveyance to a fever clinic—attached to but separate from hospitals, then
- a technician in full-body suit takes your temperature, asks about symptoms, exposure
- tests white blood cell count, flu test that gives results in minutes. if negative
- puts you in a CT scanner as part of never before seen industrial-"scale, rapid CT scanning (200 scans a day per portable scanner, vs 30-60 min per super expensive scan in the US.
- if you have corona virus, you are immediately quarantined—no going back to home or office, just grouped with hundreds of others of your same age, gender and severity of symptoms. There is no home isolation. They found that 75-80% of infections were in family clusters; so for the good of their own family and society, there's no parents visiting kids, kids visiting parents--total lockdown until the symptoms pass.
Summarized from NYT daily podcast "Confronting a Pandemic," March 12 2020. Interestingly, this worked even though I've later learned that airport-style temperature checking can miss around 1/3 of cases, as well as have false positives, and that the Coronavirus test the Chinese use has similar low accuracy. Perhaps the overall zeal and sheer volume of testing and repeat testing makes up for these shortcomings? Hard to replicate keys to this success: an authoritarian state; compliant population that is OK with basically being nabbed off the street and sent straight to quarantine; and owning the world's production systems for things like thermometers, masks, and portable CT scanners.
Like the US, Italy was initially sanguine about the pandemic. They tinkered around the edges; then banned large gatherings, closed schools... dust they were resistant to social distancing, disruption of commerce or daily life, wanted sick people to stay at home. Then the pandemic went into exponential, daily explosion. Hospitals were swamped doctors had to choose who to give ventilators to and who to let die. Every business that was not a grocery store or pharmacy is closed. A country of 60 million people is on total, border to border lockdown.
It's possible it could be worse in the US than Italy.
Two days after Italy shut most of its economy down, in the US the headlines were "Trump defiant on testing and handshakes even as third Mar-a-Lago case emerges" and "Coronavirus is shutting down American life as states try to battle outbreak"
The US has the lowest rate of testing of any industrialized nation. In Santa Barbara County, only six tests had been done as of 3/12/2020 (15 as of 3/15/2020; one positive, six awaiting results). The combined testing capacity for Santa Barbara, Ventura, and San Luis Obispo Counties at this time was 42 tests per day.
Years of wealth extraction from the health care system have left us with barely any more ventilators and hospital beds than were already in use before the pandemic in this active flu season. In Santa Barbara County, we may need several thousand intensive care beds, and we have several dozen, and this is a wealthy area.
Wealth extraction and concentration have left the social safety net thin and frayed.
The main risk of the coronavirus outbreak isn’t that you’re going to get sick and die, it’s that so many people are going to get sick so quickly that our healthcare services and infrastructure are going to be completely overwhelmed, with lots of collateral damage.
From the excellent article Coronavirus will radically alter the U.S, 3/19/2020:
What happens next in this pandemic depends largely on our government, health institutions and 327 million inhabitants — all making tiny decisions on a daily basis with outsized consequences for our collective future.
When Jason Christie, chief of pulmonary medicine at Penn Medicine, got projections on how many coronavirus patients might soon be flocking to his Philadelphia hospital, he said he felt physically ill. They saw how quickly the surge would overwhelm the system, forcing doctors to make impossible choices — which patients would get ventilators and beds, and which would die. “They were terrified. And that was the best-case scenario.”'
The black dashed line in the graph below is the supply of critical care beds in the US, vs demand curves for there scenarios; No suppression (brown, 2.2 million deaths); closing schools and general physical distancing (green, the track we are on currently, 1.1 million deaths); isolating infected cases, which implies testing, (purple, 500,000 deaths). Note that "flattening the curve" also spreads it out to not a few weeks of disruption, but disruption continuing until there is a vaccine, which could be a year or more.
We have to flatten the curve for the rate of new infections vs time, so health care resources don't get overloaded all at once. (The death rate is almost ten times greater when the health care system is overloaded; 0.5% vs 4-5%)
ALERT: shelter in place and physical distancing required for pandemic safety. Stay >6’ from all but partner, your small children. If closer contact is required for essential work, cover face with bandana. Donate gloves, goggles, all but one or two N95 masks to hospital or clinic. This is working to save lives elsewhere. Practice distance socializing for mental health and community cohesiveness.
Now is the time to physically distance from people you love to protect them.
- Rigorously implement physical distancing—I prefer physical distancing to "social distancing"...which sounds too close to "social isolation", which is its own health hazard. Family is kind of impossible to physically distance from past a certain point, which is why home isolation of sick people at home with family doesn't work well.
- Wash your hands as if your life depended on it— how to: video, poster in English, poster in Spanish
Handwash effectiveness...darker= better
- Minimize transmission of the virus to and from surfaces and the air—consider what others have touched or coughed on, and avoid, sterilize, wash...as appropriate.
- Wear a bandana to minimize transmission to/from yourself, help you to remember not to touch your face, and to send a message that helps others understand these are not normal times...without the social faux pax of wasting an N95 mask (see next item).
- If your work requires n95 masks, reduce and reuse them, and (after washing/ sterilization as needed) down-cycle them to the next, less critical use (washed N95 masks work pretty well for nasty construction dust, for example)
- Donate any N95 masks, gloves, eye protection to your local hospital or clinic where they can use it to keep from getting infected so they can keep working to save the life of you and people you love.
- Think of others—if you are young and healthy, you're chance of needing and not getting a ventilator is smaller...but you might infect someone older or immunocompromised who winds up dying.
NYT daily podcast "Learning to Live with Coronavirus," March 14, 2020
The coronavirus is killing far more men than women "we’re seeing another concerning trend, that the mortality in males seem to be twice in every age group of females"
- Encourage leaders to take this pandemic seriously, act boldly—to enforce physical distancing, and allocate public resources for health care and financial assistance. Socialized medicine is looking pretty good right now...
- Take heart; there is an upside to this—The Con Man presidency is probably over. Climate disrupting emissions are WAY down. More lives may well saved by these two factors than are lost in the pandemic.
- The need for climate change action may be easier to communicate—now there's a way to talk about an invisibly growing exponential threat that suddenly explodes and massively disrupts the economy, society, and life itself...and for which early action is greatly rewarded.
- Cultivate deep, non-contact connection with your people, and check on them regularly—through face time or phone. Don't worry about screen time when it comes to video chatting with your family and friends. Get creative. Rather than hug, try standing a feet away, look each other in the eye, and tell each other what you appreciate about each other...
- Connect deeply with your spouse, kids—or others you can't physically distance from. Be curious about them and your connection, and connect more deeply and well.
- Connect with nature, get fresh air—It's only humans carrying this virus; this is the ideal time to commune with your other relations— the plants, animals, birds, flowing water and air, rocks and trees...
- Exercise—in nature if you can, dancing at home if you can't.
Our brains are wired for linear change; things drift, you make a change, then you don't have to pay attention for a while. That's not what's happening.
In an exponential situation, it seems like nothing is really happening for a long time, then maybe something, than wham! every day is a totally different deal than the day before. Gathering of under 250 people are OK, then 50, then 10 people a few days later, and then as close as you can get to zero. Then, the storm will pass, and we'll come out blinking in a different world.
If exponential change is what you expect, you will a) not be surprised, and b) be able to get ahead of the curve, help flatten it, stay within the capacity of the health care system, and reduce mortality by almost 10x.
|Parameter||Regular mode||Pandemic mode|
|Physical connection||Engage in healthy social touch||Act like a crazy (but effective) germaphobe; no hand shaking, no hugging, except with people in your innermost circle, until unless they or you become infected|
|Emotional connection||Regular level connection||Connect extra deeply and authentically|
|Handwashing||Save water, soap, and paper towels||Remove all virus possible|
|Travel, events||Live it up||Withdraw physically, reach out digitally|
|Mental model of change||Linear||Exponential|
After a long, quiet incubation period, suddenly every day what makes sense is dramatically different than the day before, or the day after. With actual cases doubling about every 3 days, timely action makes all the difference:
instead of 10 Million cases in the United States if we wait 30 days, if we act 18 days sooner, we will have only 160,000 cases
Norway acted now, because it’s less economic impact to take drastic measures early than to do them later, and it saves a lot of lives and suffering by doing so. And Norway has only one confirmed death as of this writing.
Physical distancing must be ahead of the actual cases curve, which means being a week or so ahead of the reported cases curve:
Here's what my days are like:
|Date||# reported cases in Santa Barbara County/ tests||Physical distancing effort||Pandemic mode|
|March 6||0 cases/
|50%||Level 0-life as usual; with one more crisis that isn't discernibly affecting me. Last community dance with 50+ people, hugged, shook hands, and made PSA about handwashing technique and get ready. Barely washing hands after using bathroom.|
|March 11||0 cases/
|75%||Level 1–dress rehearsal; practicing really washing hands, physical distancing, elbow bumps. Wondering if we should get more food, washing hands 15 x a day.|
|March 12||0 cases/
|80%||Level 2–preparation; buying last of food, soap, disinfectant, medicine; discussing plans with housemates, checking on family and friends, sounding the alarm in earnest. Washing hands 20 x a day, sometimes right after I just washed them, when I may have touched something some one else touched. Meeting 3 feet away from at risk (but still healthy) people we're checking on. No touching even with elbow. Lots of explaining. Touch of panic, able to push it back.|
|March 15||1 case/
|90%||Level 3–cocooning; hunkering down with immediate family and housemates. After going to the market for possibly the last time in 3 weeks, took off "around people" clothes and wallet and put them in a designated drawer, washed hands, showered, and wiped down phone with alcohol. Took two long walks in the fresh air with my partner; video chat with far away family. Trying to wrap my mind around these changes, and imagine what life will be like in a week.|
|March 16||2 cases/
|95%||Level 4–physical isolation; Setting up so we can split the house in two in case some of the four of us get sick. Not going around others physically at all. Exercising in the fresh air far from people, communicating for hours with friends and family remotely.|
|—I am guessing from here on out—|
|March 26||1,000 cases||98%||Level 5–physical isolation between people with and without virus in same house; Separate bedrooms, bathroom, and provisional cooking facilities; mask on when interacting, constant online re-assurance of others, gratitude that water and power are still working.|
|June 21||200,000 cases||75%||Level 1–post-pandemic; people coming out of physical isolation to meet in person again at last, and cope with worldwide economic recession, hopefully more galvanized to at last effectively deal with climate disruption, a far greater threat than the coronavirus pandemic.|
- Transmission Methods (video; Anthony Fauci on Trevor Noah):
- Respiratory droplets, (coughing, sneezing) 
- Mouth to hand to mouth (handshake
- Fomites (infected clothes, furniture, sheets, hair, skin, vehicles, tools) 
- Fecal-Oral (ingesting infected fecal matter, flies landing on your food, touching your mouth with your hand after contact with a public door handle) 
- Possible airborne (different from droplets, airborne can be carried by dust in the air) 
- The Virus may persist on surfaces for up to 9 days, on some surfaces up to 27 days 
- Incubation period: 2–14 days  5-7 days, max 14
- Surfaces? Sneezes? Sex? How the Coronavirus Can and Cannot Spread (NYT)
- Can You Become Immune to the Coronavirus? It’s likely you can, at least for some period of time.
- More Americans Should Probably Wear Masks for Protection When researchers conducted systematic review of a variety of interventions used during the SARS outbreak in 2003, they found that washing hands more than 10 times daily was 55 percent effective in stopping virus transmission, while wearing a mask was actually more effective — at about 68 percent. Wearing gloves offered about the same amount of protection as frequent hand-washing, and combining all measures — hand-washing, masks, gloves and a protective gown — increased the intervention effectiveness to 91 percent.
- Simulating an epidemic This well-made video gives a sense of the math behind different pandemic interventions. Spoiler alert: while other interventions can flatten the curve and reduce overwhelm of the health system and mortality, identifying and isolating cases is the only way to reduce the total number of cases.
Is stealth transmission a thing?
On the one hand, there's this:
In Wuhan, where testing became widespread and more than seventy-two thousand coronavirus cases were identified, just one per cent never developed symptoms.
Aboard the Diamond Princess cruise ship, where, following an outbreak, more than three thousand passengers and crew were quarantined and tested—allowing one of the most complete evaluations of any affected population—six hundred and thirty-four people proved to have the virus. Most had no symptoms at the time of testing, but they proved to be pre-symptomatic: over several days, they developed recognizable signs of the disease. Just eighteen per cent were persistently asymptomatic.
We know that people are less contagious while they have no symptoms, but not how much less. The success that Hong Kong and Singapore achieved by screening for people with fever- or flu-like symptoms suggests that the risk of asymptomatic contagion could be much lower than we thought.
On the other hand:
'Stealth transmission’ responsible for vast majority of cases, study says The explosive spread of the coronavirus in Wuhan, China, was driven by people whose disease was never diagnosed, a new study has found, suggesting that people with symptoms so mild that they may not have known they were sick unwittingly spread disease in China and ultimately around the world.
Loss of smell and taste may be an early, distinguishing symptom of the novel coronavirus.
Here are the most common symptoms and the percentage of people who had them:
- Fever: 88%
- Dry cough: 68%
- Fatigue: 38%
- Coughing up sputum, or thick phlegm, from the lungs: 33%
- Shortness of breath: 19%
- Bone or joint pain: 15%
- Sore throat: 14%
- Headache: 14%
- Chills: 11%
- Nausea or vomiting: 5%
- Stuffy nose: 5%
- Diarrhea: 4%
- Coughing up blood: 1%
- Swollen eyes: 1%
COVID-19 is a lower respiratory tract infection, which means that most of the symptoms are felt in the chest and lungs. That’s different from colds that bring on an upper respiratory tract infection, where you get a runny nose and sinus congestion. Those symptoms seem to be mostly absent for people with COVID-19, though they’re not unheard of.
The good news is that in China, most people who have gotten sick -- about 80% -- have had
mild* to moderate symptoms.
If you start to show symptoms, call your doctor's office. Don’t go there before calling -- that might spread the infection around the doctor’s office. They may want to talk to you on the phone in a telemedicine visit.
Well...depends on where you are and what resources are available. With luck, there will be community resources marshalled to help you. Most likely if you are in the US, you will be mostly on your own—
- Home isolation—keep your distance as much as possible, wear a bandana (your n95 masks should be donated to your hospital by now unless you are being cared for by an elderly person or some other high risk factor)
- 10 Things You Can Do to Manage COVID-19 at Home (Center for Disease Control video) OK, not great.
- Make sure someone knows you are sick and can help if you crash
- Actual Covid-19 infections (not shown)
- Reported Covid-19 infections (not shown)
- Health care system overwhelm, local collapse
- Covid-19 deaths
- Public awareness/ action
- Mental health crisis (not shown)
- Climate crisis — the big wave that we've been ignoring for decades
- Climate deaths—will likely be much lower thanks to the Covid-19 virus shocking people awake to the consequences of ignoring an exponentially growing, invisible threat until it is undeniable.
These curves are roughly, qualitatively right to give an idea of what's coming.
Estimated current infections is roughly right as a basis for decision making Confirmed infections are 'preciscely wrong' as a basis for decision making The confirmed infections are a few weeks—about four doubling times—behind current actual infections. If testing is low, the numbers are even further off. Deaths are more accurate, but further out of date; around six doubling times.
Timeline of events in Hubai graph and analysis. Note that true cases preceded official cases by 11±days
- Spreadsheet from Tomas Pueyo customized to calculate actual CA cases from CA deaths. You can copy this and make your own version.
- The Four Possible Timelines for Life Returning to Normal The coronavirus outbreak may last for a year or two, but some elements of pre-pandemic life will likely be won back in the meantime.
- The coronavirus isn’t a reason to put climate policy on hold. It’s a warning of the calamities ahead.
- We Can Safely Restart the Economy in June. Here’s How. Get tough now. Test widely to isolate those infected, and slowly revive businesses with workers and customers who have developed immunity.
- The only thing that matters now is the speed of your response—graphs showing the current action status by state and probable outcome
- Proper handwashing technique
- How to avoid COVID infection (Center for Disease Control video) OK, not great.
- US Center for Disease Control (CDC)
- California Department of Public Health
- The Dos and Don’ts of ‘Social Distancing’
- COVID-19 info (COVID-19 Pandemic Explained A Family Physician’s perspective on a new disease Leslie Waters MD, FAAFP)
- Informative graphs from Financial Times of London
- Amazing interactive graphs
- World, National and State Statistics .don't pay too much attention to these numbers without reading the article below
- The Sober Math Everyone Must Understand about the Pandemic..the count of actual virus infections doubles every ~3 days. So we hear that the US only has 1573 cases today (3/12/20) [update as of 3/15/20: 3115 confirmed cases) and it doesn’t seem like a lot. It would be better to report the estimated actual cases, since reported cases don’t tell us much. However, we know from China that the actual number of cases are at least 10x greater than the reported cases, because people get infected and do not display symptoms.
- Santa Barbara County Public Health Information Portal updated daily.
- NEW Cottage Infectious Disease Specialist Breaks Down the COVID-19 Virus and Pandemic A Must Watch for Understanding the Disease (Santa Barbara Independent)
- The SB Independent has a Coronavirus News page that also has the county statistics for the number of tests performed and number of people being monitored.
- Cottage Hospital has provided this informational and comprehensive clinical update presentation on Covid 19.
- NYT daily podcast (consider subscribing to support their good work)
- The Atlantic (consider subscribing to support their good work)
- Washington post
- Interview with an anxiety specialist on how to relate with the current times mindfully.
- How to Work With Fear and Pain in a Moment of Crisis by Emily Horn
- The Great Unpatterning Continues. Make Sure You Take Advantage Of It. by Caitlin Johnstone
- Taking Care of Your Mental Health in the Face of Uncertainty by Doreen Marshall, Ph.D.
- 7 science-based strategies to cope with coronavirus anxiety by Jelena Kecmanovic
- The Neuroscience of Fear and 5 Helpful Tips by Rachel Posner
- Finding steady ground: strengthening our spirits to resist and thrive in these times
- Facing COVID-19 With Community Instead of Fear by Lornet Turnbull
- What Can the Coronavirus Teach Us? by Bill McKibben
- The Psychology Of Uncertainty: How To Cope With COVID-19 Anxiety by Bryan Robinson
- I survived solitary confinement. You can survive self-isolating
- This is a really lovely podcast about how we are evolved to be kind in ways that are often overlooked.
- The only thing that matters now is the speed of your response—graphs showing the current action status by state and probable outcome
- What every mayor needs to know about the coronavirus from Seattle's mayor
- Convert manual drinking fountains, faucets to automatic/ hands free
- Megan McArdle: When it comes to the coronavirus, we elites got it wrong. So did you populists.
- Landing at Dulles Airport, I encountered a case study in how to spread a pandemic
- Keeping the Coronavirus from Infecting Health-Care Workers What Singapore’s and Hong Kong’s success is teaching us about the pandemic. [Summary] Here are their key tactics, drawn from official documents and discussions I’ve had with health-care leaders in each place. All health-care workers are expected to wear regular surgical masks for all patient interactions, to use gloves and proper hand hygiene, and to disinfect all surfaces in between patient consults. Patients with suspicious symptoms (a low-grade fever coupled with a cough, respiratory complaints, fatigue, or muscle aches) or exposures (travel to places with viral spread or contact with someone who tested positive) are separated from the rest of the patient population, and treated—wherever possible—in separate respiratory wards and clinics, in separate locations, with separate teams. Social distancing is practiced within clinics and hospitals: waiting-room chairs are placed six feet apart; direct interactions among staff members are conducted at a distance; doctors and patients stay six feet apart except during examinations. What’s equally interesting is what they don’t do. The use of N95 masks, face-protectors, goggles, and gowns are reserved for procedures where respiratory secretions can be aerosolized (for example, intubating a patient for anesthesia) and for known or suspected cases of COVID-19. Their quarantine policies are more nuanced, too. What happens when someone unexpectedly tests positive—say, a hospital co-worker or a patient in a primary-care office or an emergency room? In Hong Kong and Singapore, they don’t shut the place down or put everyone under home quarantine. They do their best to trace every contact and then quarantine only those who had close contact with the infected person. In Hong Kong, “close contact” means fifteen minutes at a distance of less than six feet and without the use of a surgical mask; in Singapore, thirty minutes. If the exposure is shorter than the prescribed limit but within six feet for more than two minutes, workers can stay on the job if they wear a surgical mask and have twice-daily temperature checks. People who have had brief, incidental contact are just asked to monitor themselves for symptoms.
- The nightmare of rationing health care Doctors and nurses need to talk now about the difficult choices ahead.
- ‘I've Been Walking Around for the Last Week Seeing What’s Coming’ A conversation with a physician on the front lines of the fight against the coronavirus
- Split houses in two, with separate bedrooms, bathrooms, and provisional kitchens for healthy vs infected individuals
- Convert manual faucets, switches, doors to automatic/ motion sensor/ hands free versions
- Add handwash stations everywhere
- Ramp up production of components for hands free hardware
These images summarize an excellent article by Tomas Pueyo, which was shared 28 million times in a week. The full article is a 24 min read.
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