Spain Declares National Lockdown, Apple Closes All Stores Outside Greater China, US Death Toll Nears 50: Virus Updates
While EU bureaucrats in Brussels slammed President Trump over the European travel ban, claiming that he left them in the dark with his “unilateral” action, Spain – one of Europe’s largest countries, and the fourth-largest economy in the eurozone – on Sunday said it would adopt a draconian national travel ban on par with the national lockdown taking place in Italy.
On Friday, Sanchez declared the emergency for 15 days, saying that Spain would “mobilize all resources,” including the military, to contain the virus and help reverse the sharp rise in new infections over the past week. Part of the powers invoked by Sanchez allow the federal government to restrict movement of the Spanish people, to legally confiscate items and to seize control of Spanish industrial output – presumably a relic of Spain’s authoritarian past that makes this lockdown more similar to the Chinese Communist Party’s lockdown than anything happening in Italy. Even private hospitals can be commandeered for the government effort. The government can even impose ‘special measures’ to guarantee the food supply for the country. Even April elections in two northern regions could be delayed, the government said.
The decision came after Spain’s case total surpassed 4,000, and deaths climbed above 100. More cases and deaths were reported Saturday morning, along with the latest details about the Spanish emergency measures, which appear to be even more thorough than initially believed. On Saturday, total cases passed 5,000, and the number of confirmed deaths neared 200.
Then on Saturday, the Spanish government decided to kick things up a notch, perhaps having realized that the outbreak is now out of control and more restrictive controls on movement would be needed to contain it.
Spain’s Interior Ministry said Saturday that it would assu,e direct control of all police forces in the country, allowing them to direct police to enforce quarantines, with deadly force if necessary. In Madrid, the epicenter of the Spanish outbreak, a state of emergency will be imposed, including a curfew and lockdown measures intended to restrict movement and ensure social distancing.
El Pais, Spain’s newspaper of record, reported Saturday that the government had prepared a draft decree similar to Italy’s declaring a ‘nationwide lockdown’. According to reports, the lockdown will be rolled out nationwide on Monday, and people would only be able to go out to either work or buy essential items.
As the eurozone’s fourth largest country, Spain has a population of 47 million, roughly 13 million fewer people than Italy.
So far, no news of the lockdown has appeared on official government accounts. Earlier, PM Sanchez tweeted a PSA about ‘social distancing’ and hygiene practices.
Los profesionales sanitarios nos protegen con entrega y sacrificio, pero todos tenemos una misión frente al #Covid19.
Los mayores deben protegerse, evitar a toda costa la exposición. Los jóvenes tienen que mantener la distancia social para frenar contagios. Su papel será crucial. pic.twitter.com/nrWKGCQM6A
Already, airlines are cancelling flights over Spain’s new measure. British travel company Jet2 has canceled all flights to mainland Spain, the Balearic Islands and the Canary Islands. The cancellations were a result of Spain’s new measures, per CNN.
In the Netherlands, which has also seen an alarming spike in cases over the last week, confirmed on Saturday that infections had climbed by 155 TO 959, with two more deaths, while many cases and deaths likely remain unconfirmed.
On the corporate side of things, Apple announced Saturday morning that it would shutter all of its stores outside Greater China. The decision is notably ironic seeing as Apple just finished opening the last of its stores on the mainland late this week. The stores will be closed until March 27.
According to CNN, the company also pledged to commit $15 million to help with the worldwide recovery from the outbreak, “both to help treat those who are sick and to help lessen the economic and community impacts of the pandemic.”
In the US, while Walmarts, Targets and groceries across the country remain oddly barren of toilet paper, the Pentagon on Saturday suspended all domestic travel for personnel and their families during the outbreak. The new restrictions apply to “all DoD military and civilian personnel and their families assigned to DoD installations, facilities and surrounding areas within the US and its territories,” the department said in the statement, according to BBG.
Overnight, the death toll in the states climbed to 49 as Washington re-took the lead in total confirmed cases from New York, which held it briefly for a few hours Friday afternoon.
Across the US, 46,000 schools have closed, are scheduled to close, or were closed and later reopened, because of the virus outbreak, as 12 states declare two or three-week closures. At least 21 million students in the United States have been or will be affected by the closures. The acting ambassador from Brazil, who attended the dinner with Trump and Pence and Bolsonaro and his infected comms director, has tested positive for Covid-19 after reporting symptoms. But though some said that Trump sounded a little hoarse at yesterday’s press conference, he and his doctors insist he isn’t showing any symptoms.
A Rhode Island elementary school student who got an autograph from one of the Utah Jazz players who tested positive for the virus has also tested positive, shining another uncomfortable light on one player (Rudy Gomert’s) nonchalant and mocking behavior toward the virus, which clearly has a twisted sense of humor.
First Masks, Then Purell, Now Americans Panic Hoard Immunity-Boosting Products Amid Pandemic
The order has been relatively straight forward: Americans started panic hoarding 3M N-95 masks as early as mid-January, then loaded up on food and medical supplies in the last several weeks, including water, non-perishables, bleach, and Purell. Now it appears the next run has started, that is, immunity-boosting supplements as the Covid-19 virus crisis has morphed into a pandemic, expected to worsen in the weeks ahead.
Take, for example, Airborne Vitamin C 1000mg tablets (36 count box), currently unavailable from the Amazon seller Airborne, with other sellers making up the product over 100% from suggested retail price of about $16. This suggests, Americans are panic buying dietary supplements to boost their immune systems amid the virus outbreak.
Another dietary supplement to boost the immune system is Immune Support Packets, “currently unavailable” on the Amazon store via designs for health.
Here’s Rainbow Light Counter Attack, a product that supports immune system health, “currently unavailable” on the Rainbow Light’s Amazon store.
Panic hoarding products are evolving on a weekly basis. Last week Purell, this week it is immunity-boosting supplements. And the panic is for a good reason: Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, was quoted by Reuters on Friday morning as saying, “the next few weeks, for most Americans, what you’re going to see is an acceleration of cases.”
And with that being said, what do Americans panic hoard next week? Weapons and ammunition? Well, that has already started…
The ban on single-use plastic grocery bags is unsanitary – and it comes at the worst imaginable time…
The COVID-19 outbreak is giving new meaning to those “sustainable” shopping bags that politicians and environmentalists have been so eager to impose on the public. These reusable tote bags can sustain the COVID-19 and flu viruses—and spread the viruses throughout the store.
Researchers have been warning for years about the risks of these bags spreading deadly viral and bacterial diseases, but public officials have ignored their concerns, determined to eliminate single-use bags and other plastic products despite their obvious advantages in reducing the spread of pathogens. In New York State, a new law took effect this month banning single-use plastic bags in most retail businesses, and this week Democratic state legislators advanced a bill that would force coffee shops to accept consumers’ reusable cups—a practice that Starbucks and other chains have wisely suspended to avoid spreading the COVID-19 virus.
John Flanagan, the Republican leader of the New York State Senate, has criticized the new legislation and called for a suspension of the law banning plastic bags. “Senate Democrats’ desperate need to be green is unclean during the coronavirus outbreak,” he said Tuesday, but so far he’s been a lonely voice among public officials.
The COVID-19 virus is just one of many pathogens that shoppers can spread unless they wash the bags regularly, which few people bother to do. Viruses and bacteria can survive in the tote bags up to nine days, according to one study of coronaviruses.
The risk of spreading viruses was clearly demonstrated in a 2018 study published in the Journal of Environmental Health. The researchers, led by Ryan Sinclair of the Loma Linda University School of Public Health, sent shoppers into three California grocery stores carrying polypropylene plastic tote bags that had been sprayed with a harmless surrogate of a virus.
After the shoppers bought groceries and checked out, the researchers found sufficiently high traces of the surrogate to risk transmission on the hands of the shoppers and checkout clerks, as well as on many surfaces touched by the shoppers, including packaged food, unpackaged produce, shopping carts, checkout counters, and the touch screens used to pay for groceries. The researchers said that the results warranted the adaptation of “in-store hand hygiene” and “surface disinfection” by merchants, and they also recommended educating shoppers to wash their bags.
An earlier study of supermarkets in Arizona and California found large numbers of bacteria in almost all the reusable bags—and no contamination in any of the new single-use plastic bags. When a bag with meat juice on the interior was stored in the trunk of a car, within two hours the number of bacteria multiplied tenfold.
The researchers also found that the vast majority of shoppers never followed the advice to wash their bags. One of the researchers, Charles Gerba of the University of Arizona, said that the findings “suggest a serious threat to public health,” particularly from fecal coliform bacteria, which was found in half the bags. These bacteria and other pathogens can be transferred from raw meat in the bag and also from other sources. An outbreak of viral gastroenteritis among a girls’ soccer team in Oregon was traced to a resuable grocery bag that had sat on the floor of a hotel bathroom.
In a 2012 study, researchers analyzed the effects of San Francisco’s ban on single-use plastic grocery bags by comparing emergency-room admissions in the city against those of nearby counties without the bag ban. The researchers, Jonathan Klick of the University of Pennsylvania and Joshua Wright of George Mason University, reported a 25 percent increase in bacteria-related illnesses and deaths in San Francisco relative to the other counties. The city’s Department of Public Health disputed the findings and methodology but acknowledged that “the idea that widespread use of reusable bags may cause gastrointenstinal infections if they are not regularly cleaned is plausible.”
New York’s state officials were told of this risk before they passed the law banning plastic bags. In fact, as the Kings County Politics website reported, a Brooklyn activist, Allen Moses, warned that shoppers in New York City could be particularly vulnerable because they often rest their bags on the floors of subway cars containing potentially deadly bacteria from rats—and then set the bag on the supermarket checkout counter. Yet public officials remain committed to reusable bags.
A headline on the website of the New York Department of Health calls reusable grocery bags a “Smart Choice” – bizarre advice, considering all the elaborate cautions underneath that headline. The department advises grocery shoppers to segregate different foods in different bags; to package meat and fish and poultry in small disposable plastic bags inside their tote bags; to wash and dry their tote bags carefully; to store the tote bags in a cool, dry place; and never to reuse the grocery tote bags for anything but food.
How could that possibly be a “smart choice” for public health? Anyone who has studied consumer behavior knows that it’s hopelessly unrealistic to expect people to follow all those steps. If the Department of Health actually prioritized public health, it would acknowledge what food manufacturers and grocers have known for decades: disposable plastic is the cheapest, simplest, and safest way to prevent foodborne illnesses.
Instead, leaders in New York and other states are ordering shoppers to make a more expensive, inconvenient, and risky choice—all to serve a green agenda that’s actually harmful to the environment. The ban on plastic bags will mean more trash in landfills (because paper bags take up so much more space than the thin disposable bags) and more greenhouse emissions (because of the larger carbon footprints of the replacement bags). And now, probably, it will also mean more people coming down with COVID-19 and other illnesses.
UK’s Coronavirus Strategy: Just Let It Happen And Hope For Herd Immunity
The British government’s strategy to deal with the coronavirus outbreak is for 60% of the UK to become infected in order to develop “herd immunity” against the disease, according to The Independent.
In other words, when the thus-far unstoppable virus ravages England, it was all part of the plan.
“We think this virus is likely to be one that comes back year on year and becomes like a seasonal virus and communities will become immune to it and that’s going to be an important part of controlling this in the longer term,” said the government’s chief scientific adviser, Patrick Vallance, who added “60% is the sort of figure you need to get herd immunity.“
According to Vallance, isolating the population would only temporarily suppress the virus, but it would quickly re-emerge and the crisis would be repeated.
“If you completely locked down absolutely everything probably for a period of four months or more then you would suppress this virus,” he said, adding “All of the evidence from previous epidemics suggests that when you do that and then you release it, it all comes back again.“
Vallance’s comments echo those made by Prime Minister Boris Johnson earlier in the week, when he said the UK might have to just “take it on the chin.”
UNBELIEVEABLE – Johnson seriously suggests on TV to let #coronavirus run unhampered thru UK population.
Johnson proposes to let us “take it on the chin” & “allow the disease to move through the population”.
In other words… do nothing & accept death rates >10% for elderly. pic.twitter.com/FmBNUL2oRB
One possible flaw in their logic with encouraging roughly 40 million people to catch COVID-19 (which, even with a fatality rate of even 1 means 400,000 dead) – is that Chinese scientists have observed coronavirus patients relapsing and not walking away from the disease with natural immunity.
“For those patients who have been cured, there is a likelihood of a relapse,” Zhan Qingyuan, the director of pneumonia prevention and treatment at the China-Japan Friendship Hospital, said during a press conference last month.
“The antibody will be generated,” said Zhan.
“However, in certain individuals, the antibody cannot last that long.”
And according to Futurism, herd immunity – such as the idea behind “chicken pox parties” may or may not be a viable strategy.
The underlying idea behind a vaccination — or even “chicken pox parties” — is that exposure to a virus will trigger the immune system to generate antibodies that will shield that person from that virus in the future. But according to Chinese health officials, the antibodies created after a 2019-nCoV infection aren’t always strong enough to keep patients from getting sick again. –Futurism
Another issue is that between 10% – 15% of those infected require hospitalization, meaning roughly 4-6 million Britons would need an ICU – which typically means some type of oxygen support such as a ventilator. According tothe NHS, there are roughly 100,000 overnight beds available (‘general’ and ‘acute’) at any given time.
So what happens to the mortality rate when that same 10-15% of coronavirus patients who need hospitalization don’t have access to medical care, including life-saving ventilators?
How far do governments have to go in restricting the movements of its citizens to combat COVID-19?
This is an important question, because right now the most complete data set on how quickly it can be contained (or something close) come from China.
To compare the efficacy of China’s measures to those in other cities around the world, let’s start with current data through today from TomTom’s local traffic congestion readings for Wuhan, the epicenter of the outbreak (red line is current, blue line is 2019 average road congestion):
That’s our benchmark: extremely low levels of traffic congestion, some 80-95% below normal levels.
Next, let’s look at 2 major Italian cities:
Milan (near the center of the country’s outbreak) and Rome (capital city):
Milan:
Rome:
What we see: rather than traffic congestion being down +90% from normal, in Milan and Rome over the last 2 days it is only averaging 60% below average 2019 levels. A meaningful reduction, to be sure, but nothing like Wuhan.
Now, here are 3 European capital cities to consider:
Paris:
Berlin:
London:
What we see: a small decline in Paris versus the end of last week, but none in Berlin or London. Not good…
Finally, 3 US cities with large numbers of COVID-19 cases:
New York:
San Francisco:
Seattle:
What we see: work-from-home is clearly having an impact this week as compared to late last week, especially in NY and San Francisco. None, however, look anything like Wuhan.
Takeaway from these comparisons:
Authoritarian China was able to curtail human activity in ways western countries have thus far not come close to replicating. It is too early to say if that difference will yield materially different trajectories for the spread of COVID-19. There are many other factors to consider, after all, ranging from environment to public awareness and personal actions. Still, the data here shows what western countries may have to consider if their slower actions thus far fail to contain the virus.
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Relief For “Hard” Times: PornHub Offers Free Premium Access To Italians Under Lockdown
At the time of a global humanitarian crisis that presents an existential threat to the human race, every person and corporate needs to step up and do their part to help address the problem head on.
And who better to lead by example than PornHub, who has offered free premium service as a show of solidarity to those in Italy who are in lockdown/quarantine, milling around the house a lot and – uh, looking for something to do.
PornHub put out a press release on Thursday and also said it would donate the proceeds from its Modelhub platform after Italy put forth a lockdown due to the coronavirus outbreak, according to the Daily Mail.
As if Italians needed a reason to be horniner than usual…
“Forza Italia,” the press release says. “We love you! PornHub has decided to donate its percentage revenue from ModelHub platform from March to help Italy during the outbreak.”
The release continues: “To help you during these weeks at home, for the whole months you can access PornHub Premium free of charge, with no need of using your credit card.”
PornHub is currently the world’s largest porn site. The Daily Mail reports that it was “used” more than 42 billion times last year. Not quite the terminology we would use, but to each site, its own.
Italy had ranked seventh on PornHub’s Top 20 Countries by traffic in 2019. The U.S., Japan and the UK were the Top 3.
Porn sites have been cashing in on the outbreak with platforms posting videos of couples in hazmat suits and facemasks.
Male porn star “Spicy” commented: “I think people are attracted to COVID-19 themed porn the same way people who are scared of their shadow are attached to horror movies: We are all searching for things that make us come alive.”
Better to come alive than come dead, we guess.
He continued: “COVID-19 is something that brings fear and mystery to pretty much everyone in the world right now… You need to be able to feel something, and what better way to make you feel something than the global crisis we are all in right now.”
‘Deserted Wuhan’ and ‘TSA Agent Detains Woman Suspected of Coronavirus’ have become two popular videos, with couple engaging in sex acts in what appears to be medical facilities.
Hey, it’s safer than doing it in the front seat of a Model X on Autopilot!
Covid-19 – more then 100,000 infected around the world, six countries where tourists are prohibited from traveling and 17, which are recommended to be avoided.
“Defender Europe 2020” – 40,000 participants from 17 NATO countries (and Georgia).
One would like to ask: who will win? And soon we can check it out.
Polish Minister of Defense Mariusz Blaszczak has already announced the existence of a secret document:
“The use of the Armed Forces of the Republic of Poland in anti-epidemic, sanitary and hygienic measures, the provision of medical care and the elimination of biological pollution and infections.”
Surely such secret instructions are also available in other countries participating in the exercise.
Although it would be better not to test the ability of NATO doctrines to withstand the modern virus.
And then what? Cancel? This makes no sense. Although many are already starting to support this idea. Currently on the Internet you can find many petitions for the abolition of the exercise. Under them are the signatures of thousands of Europeans.
But in such important issues as ensuring the security of Europe, it would be foolish to take into account the opinion of ordinary citizens who are not versed in this issue.
With the exception of civilian petitions, there are opinions of scholars and professional military personnel.
According to the professors, the large troop movements within the framework of Defender Europe 2020 can contribute to the spread of corona virus infection throughout the European continent. And at the present time, the transfer of American troops to European ports is on the peak. And the source of a dangerous virus can be not only people. But also the transport in which dust particles containing the virus remained.
The first cases of corona virus have already been detected in Germany, Poland. Italy is a hotbed of infection. In the United States, 1635 cases of corona virus infection were recorded, 41 people died. According to a Pentagon spokesman, Ryan McCarthy, Lieutenant General Christopher Cavoli and several other members of his headquarters could become infected with the new corona virus.
But there is positive news from doctors. Of more then 100,000 infected, more than 52,000 people recovered. In addition, the Chinese say they seem to have created a vaccine. But it’s too early to talk about its effectiveness.
Covid-19 makes serious adjustments to plans for major official events.
Geneva Motor Show was canceled. A similar fate threatens the annual European Eurovision music contest. Endangered football Champions League, Europa League threatened. As part of these events, matches are already being held without spectators. The fact of holding the Summer Olympic Games in Japan is questionable. The matter of their cancellation or rescheduling is seriously considered.
The first canceled military events appear.
Thus, the Finnish Ministry of Defense announced that Finnish troops will not take part in NATO’s major “Cold Response 2020” exercise. The U.S. and Israeli military exercises “Juniper cobra missile defense”, as well as the joint U.S.-South Korean exercises, have been canceled.
Against this background, it would be logical if not to cancel, then at least postpone the “Defender Europe 2020” exercise.
On February 28, the US Under Secretary of Defense for Personnel signed instructions recommending that all military commanders take comprehensive measures to preserve the health of military personnel and members of their families located in foreign countries. One of the points of the document provides for the possibility of reducing the scale or canceling exercises and other combat training activities. Moreover, commanders of expeditionary military formations are vested with the rights to impose restrictions.
In connection with the rapid spread of corona virus in Europe, a ban has been imposed on visits by the US military to crowded places and local institutions.
But the instructions of the US military official are unlikely to extend to the exercises “Defender Europe 2020”. Their real cancellation is possible only in the case of mass deaths among US soldiers. Otherwise, the exercise will be carried out according to plans.
Because along with a demonstration of American military power, Defender is an economic project.
The sale of arms to NATO countries should bring billions of dollars, which the American leadership is definitely not ready to give up.
“A Tsunami Has Arrived” – Spanish Tourism Collapses
Anyone with the slightest bit of common sense has ditched their dream trip to Europe as Covid-19 steamrolls across the continent, with Italy, France, Spain, and Germany, so far experiencing the brunt of the virus outbreak.
As a result of mass quarantines and businesses’ shuttering their doors, Europe’s travel industry, accounting for 782 billion euros to GDP in 2018 and 14.4 million jobs, is on the verge of a deep correction.
In particular, we’re going to focus on Spain, where authorities have reported 2,277 confirmed cases, 55 deaths, and 183 recoveries. Spanish officials imposed limits on holding large public events to cut down on the transmission risk of the virus.
The fear of the outbreak has led to a bust in the Spanish travel industry, as of Thursday, Reuters reports that occupancy rates at hotels have crashed.
CEHAT (Confederacion Espanola de Hoteles y Alojamientos Turisticos (Spain’s hotels and tourist accommodations federation)) Secretary-General Ramon Estalella told Reuters that many hotels have “no new bookings” as tourists stay away from the country during the virus crisis.
“A tsunami has arrived. A meteorite has fallen on us, and we have to see how we survive,” Estalella said.
He has requested the Spanish government to take quick action to protect the travel industry from a massive bankruptcy and job loss wave that could decimate hotels and or the industry as a whole.
More than 2.65 million jobs in Spain are reliant on tourism, accounting for 159 billion euros to GDP in Spain, or about 11.7% of GDP. The crisis is so bad at the moment for Spain’s tourism industry, on top of an existing economic downturn, that a full-blown recession could be nearing.
President Trump’s travel restrictions on 26 European countries, including Spain, to help combat the spread of the virus, for the next month, could further pressure tourism for the first half of the year.
Spain’s economy is coming to a crawl this week with mass gatherings banned, schools and universities canceled, and a reduction in business hours.
All soccer matches in the country have been suspended for two weeks after Real Madrid put its team in quarantine for virus infection fears.
The government’s virus prevention measures come as Spain’s Queen Letizia tested positive for Covid-19. The leader of Vox, a right-wing political party in the country, tested positive for the virus on Thursday. Both government officials are in quarantine.
Take note of how the virus outbreak is grinding Europe’s economy to a halt, especially triggering a bust in tourism and services. Community spreading in America is already underway, the same shutdowns in Europe are going to happen here.
The Coronavirus Disease 2019 (COVID-19) has now reached more than 45 countries in Europe, where (as of March 12) more than 30,000 people have tested positive for the disease, according to a Gatestone Institute tally based on calculations from European health ministries.
The disease is spreading fast: more than 28,000 coronavirus cases (93% of all cases) in Europe were confirmed during just the first twelve days of March. The number of new cases has been doubling, on average, every 72 hours.
Italy is Europe’s worst-affected country, followed by Spain, France and Germany. Twelve other European countries have reported coronavirus cases in the triple digits: Switzerland, Norway, Sweden, Denmark, the Netherlands, the United Kingdom, Belgium, Austria, Greece, the Czech Republic, Finland and Iceland.
In Europe as a whole, more than 1,200 people — 4.0% of those confirmed as having been infected — have died from COVID-19.
The European Center for Disease Prevention and Control (ECDC), in a risk assessment, warned that the actual number of COVID-19 cases in Europe could be far higher due to under-detection, particularly among mild or asymptomatic cases that do not lead to a visit to the hospital.
In an interview with Britain’s Channel 4 news, Dr. Richard Hatchett, Chief Executive Officer of the Coalition for Epidemic Preparedness Innovations, a Norway-based international alliance for developing vaccines against infectious diseases, explained the long-term dangers of the COVID-19, not only for Europe, but globally:
“The threat is very significant… There are many epidemiologists who talk about the potential of the virus in terms of attack rates globally that could be between 50% and 70% of the global population.
“It is important to recognize that the virus is here and that it has tremendous potential to be disruptive, to cause high rates of illness and even high rates of death….
“I don’t think we are dealing with the flu here… this is a virus that is now circulating in a population that has absolutely no immunity to it…. You might have an attack rate that is three times higher than seasonal flu with a mortality rate that is ten times higher.
“The most concerning thing about this virus is the combination of infectiousness and the ability to cause severe disease or death. We have not since 1918 — since the Spanish flu — seen a virus that combined those two qualities in the same way. We have seen very lethal viruses — Ebola’s mortality rate in some cases is greater than 80% — but they don’t have the infectiousness that this virus has. They don’t have the potential to explode and spread globally….
“I think that what we are seeing is a virus that is many, many times more lethal than the flu, and a population that is completely vulnerable to it, and we are seeing its ability to explode. It has increased in some countries over the last two weeks by one thousand-fold and many countries are seeing ten-fold or one hundred-fold increases in cases. There is nothing to stop that expansion from continuing unless those societies move aggressively, engage their publics, implement multiple public health interventions, including introducing social distancing….
“We need to modify our behavior. We need to start practicing that now. We have to modify our behavior in ways that reduces the risk of transmitting the virus…. One challenge that we face is that people who are young and are generally healthy won’t perceive personal risk and they will govern their behavior based on what they perceive their personal risk to be. I think we need to start thinking in terms of the social risk. If I have a cold and I go to work and shake hands with my older colleague who has a chronic medical condition, I could be responsible for that colleague’s death. We all need to think about our responsibility to each other as we govern our behavior. We can’t view the epidemic in terms of our personal risk, we need to act collectively in a cooperative manner….
“I don’t think it’s a crazy analogy to compare this to World War 2… I think this is an appropriate analogy and the mindset that people need to get into….
“We don’t see any way that a vaccine can be available much more rapidly than 12 to 18 months, and even it if were to be available in 12 and 18 months, that would literally be the world record for developing and delivering a vaccine. We would not have seven billion doses of that vaccine in 12 months.
“This is a virus that is going to be with us for some time. There are many epidemiologists who believe that this virus is likely to become globally endemic and be with us in perpetuity…. I think this is a virus that we are going to be dealing with for years.
“This is the most frightening disease that I have ever encountered in my career. That includes Ebola, MERS and SARS. It’s frightening because of the combination between infectiousness and a lethality that appears to be many-fold higher than flu.”
After months of complacency, European leaders are beginning to acknowledge the scale of the unfolding crisis.
In Germany, Europe’s most populous country, Chancellor Angela Merkel, in her first public comments on the coronavirus, warned that more than two-thirds of the population — 58 million people — could get infected. During a press conference on March 11, nearly three weeks after the crisis in Germany began, she admitted:
“The virus has arrived in Europe, it is here, and we must all understand that. As long as there is no immunity in the population, no vaccines and no therapy, then a high percentage of the population — experts say 60% to 70% — will become infected.”
Merkel said that her government’s top priority was to slow down the contagion to prevent a collapse of the German healthcare system. Nevertheless, Germany has not implemented social distancing measures such as those in other European countries, including Italy, Spain and France.
In Britain, a leaked government report estimated that in a worst-case scenario, up to 80% of the population — 53 million people — could become infected with the coronavirus, and that half a million Britons could die from COVID-19. A survey conducted by The Doctors’ Association UK, a trade association for British doctors, found that only 1% of doctors in the country believe that the National Health Service is prepared to deal with a major outbreak of coronavirus.
In Ireland, one of Europe’s smaller countries with only 4.8 million inhabitants, healthcare officials said that 40% of the population — 1.9 million people — will almost certainly become infected with the coronavirus. Most of those would become sick within a three-week concentrated burst, which would place “intense pressure” on the healthcare system. Those figures were effectively confirmed by Paul Reid, CEO of the Health Service Executive (HSE), which manages the delivery of all public health services in Ireland.
In Spain, where the number of confirmed cases of coronavirus has increased exponentially in recent days, hospitals are overwhelmed and the healthcare systems in the most affected regions are in danger of collapse. In Andalusia and the Basque Country, hundreds of doctors and nurses have been quarantined to prevent hospitals from becoming centers of infection.
In Madrid, the head of the regional government, Isabel Díaz Ayuso, said that medical professionals expected a significant increase in coronavirus cases this coming weekend and that the spread of the virus would peak over the next three weeks.
In France, President Emmanuel Macron said that the coronavirus epidemic was the country’s worst health crisis in a century and announced that schools throughout the country would close indefinitely beginning next week. “We are just at the beginning of this crisis,” Macron said. “In spite of all our efforts to break it, this virus is continuing to propagate and to accelerate.”
In Italy, more than 12,000 people are infected with coronavirus. On March 9, Prime Minister Giuseppe Conte ordered a nation-wide lockdown. The quarantine of Europe’s third-most populous country, with 60 million inhabitants, bans non-essential travel to, from and within Italy; prohibits all public events; and requires that people maintain a distance from each other of at least one meter (three feet). The restrictions were subsequently extended: all restaurants and bars, as well as all stores, except for grocery stores and pharmacies, have been ordered closed.
Dr. Daniele Macchini, who works at the Humanitas Gavazzeni hospital in Bergamo, ground zero of the coronavirus crisis in Italy, warned about the dangers of complacency:
“After thinking for a long time if and what to write about what is happening to us, I felt that the silence was not at all responsible. I will therefore try to convey to people more distant from our reality, what we are experiencing in Bergamo during these pandemic days from Covid-19.
“I myself looked with some amazement at the reorganization of the entire hospital in the previous week, when our current enemy was still in the shadows: the wards slowly ’emptied,’ the elective activities interrupted, the intensive therapies freed to create as many beds as possible. All this rapid transformation brought into the corridors of the hospital an atmosphere of surreal silence and emptiness that we still did not understand, waiting for a war that was yet to begin and that many (including me) were not so sure would ever come with such ferocity.
“Well, the situation is now nothing short of dramatic. No other words come to mind. The war has literally exploded, and the battles are uninterrupted day and night. One after the other, the unfortunate people come to the emergency room. What they have is much more than the complications of a flu. Let’s stop saying it’s a bad flu.
“Now, however, that need for beds in all its drama has arrived. One after another, the departments that had been emptied are filling up at an impressive rate. The display boards with the names of the sick, of different colors depending on the operating unit they belong to, are now all red and instead of the surgical operation there is the diagnosis, which is always the damn same: bilateral interstitial pneumonia. Now, tell me which flu virus causes such a rapid tragedy?
“An epidemiological disaster is taking place. There are no more surgeons, urologists, orthopedists, we are only doctors who suddenly have become part of a single team to face this tsunami that has overwhelmed us.”
On March 11, U.S. President Donald J. Trump announced a 30-day ban on continental Europeans traveling to the United States. “The European Union failed to take the same precautions and restrict travel from China and other hotspots,” Trump said. “As a result, a large number of new clusters in the United States were seeded by travelers from Europe.” The restrictions, which will go into effect at midnight on March 13, will not apply to the United Kingdom, and exemptions will be made for U.S. citizens. “This is the most aggressive and comprehensive effort to confront a foreign virus in modern history,” he said.
With everything that’s happening about the Coronavirus, it might be very hard to make a decision of what to do today. Should you wait for more information? Do something today? What?
Here’s what I’m going to cover in this article, with lots of charts, data and models with plenty of sources:
How many cases of coronavirus will there be in your area?
What will happen when these cases materialize?
What should you do?
When?
When you’re done reading the article, this is what you’ll take away:
The coronavirus is coming to you.
It’s coming at an exponential speed: gradually, and then suddenly.
It’s a matter of days. Maybe a week or two.
When it does, your healthcare system will be overwhelmed.
Your fellow citizens will be treated in the hallways.
Exhausted healthcare workers will break down. Some will die.
They will have to decide which patient gets the oxygen and which one dies.
The only way to prevent this is social distancing today. Not tomorrow. Today.
That means keeping as many people home as possible, starting now.
As a politician, community leader or business leader, you have the power and the responsibility to prevent this.
You might have fears today: What if I overreact? Will people laugh at me? Will they be angry at me? Will I look stupid? Won’t it be better to wait for others to take steps first? Will I hurt the economy too much?
But in 2–4 weeks, when the entire world is in lockdown, when the few precious days of social distancing you will have enabled will have saved lives, people won’t criticize you anymore: They will thank you for making the right decision.
Ok, let’s do this.
1. How Many Cases of Coronavirus Will There Be in Your Area?
Country Growth
The total number of cases grew exponentially until China contained it.
But then, it leaked outside, and now it’s a pandemic that nobody can stop.
As of today, this is mostly due to Italy, Iran and South Korea:
There are so many cases in South Korea, Italy and Iran that it’s hard to see the rest of the countries, but let’s zoom in on that corner at the bottom right.
There are dozens of countries with exponential growth rates. As of today, most of them are Western.
If you keep up with that type of growth rate for just a week, this is what you get:
If you want to understand what will happen, or how to prevent it, you need to look at the cases that have already gone through this: China, Eastern countries with SARS experience, and Italy.
China
Source: Tomas Pueyo analysis over chart from the Journal of the American Medical Association, based on raw case data from the Chinese Center for Disease Control and Prevention
This is one of the most important charts.
It shows in orange bars the daily official number of cases in the Hubei province: How many people were diagnosed that day.
The grey bars show the true daily coronavirus cases. The Chinese CDC found these by asking patients during the diagnostic when their symptoms started.
Crucially, these true cases weren’t known at the time. We can only figure them out looking backwards: The authorities don’t know that somebody just started having symptoms. They know when somebody goes to the doctor and gets diagnosed.
What this means is that the orange bars show you what authorities knew, and the grey ones what was really happening.
On January 21st, the number of new diagnosed cases (orange) is exploding: there are around 100 new cases. In reality, there were 1,500 new cases that day, growing exponentially. But the authorities didn’t know that. What they knew was that suddenly there were 100 new cases of this new illness.
Two days later, authorities shut down Wuhan. At that point, the number of diagnosed daily new cases was ~400. Note that number: they made a decision to close the city with just 400 new cases in a day. In reality, there were 2,500 new cases that day, but they didn’t know that.
The day after, another 15 cities in Hubei shut down.
Up until Jan 23rd, when Wuhan closes, you can look at the grey graph: it’s growing exponentially. True cases were exploding. As soon as Wuhan shuts down, cases slow down. On Jan 24th, when another 15 cities shut down, the number of true cases (again, grey) grinds to a halt. Two days later, the maximum number of true cases was reached, and it has gone down ever since.
Note that the orange (official) cases were still growing exponentially: For 12 more days, it looked like this thing was still exploding. But it wasn’t. It’s just that the cases were getting stronger symptoms and going to the doctor more, and the system to identify them was stronger.
This concept of official and true cases is important. Let’s keep it in mind for later.
The rest of regions in China were well coordinated by the central government, so they took immediate and drastic measures. This is the result:
Every flat line is a Chinese region with coronavirus cases. Each one had the potential to become exponential, but thanks to the measures happening just at the end of January, all of them stopped the virus before it could spread.
Meanwhile, South Korea, Italy and Iran had a full month to learn, but didn’t. They started the same exponential growth of Hubei and passed every other Chinese region before the end of February.
Eastern Countries
South Korea cases have exploded, but have you wondered why Japan, Taiwan, Singapore, Thailand or Hong Kong haven’t?
Taiwan didn’t even make it to this graph because it didn’t have the 50 cases threshold that I used.
All of them were hit by SARS in 2003, and all of them learned from it. They learned how viral and lethal it could be, so they knew to take it seriously. That’s why all of their graphs, despite starting to grow much earlier, still don’t look like exponentials.
So far, we have stories of coronavirus exploding, governments realizing the threat, and containing them. For the rest of the countries, however, it’s a completely different story.
Before I jump to them, a note about South Korea: The country is probably an outlier. The coronavirus was contained for the first 30 cases. Patient 31 was a super-spreader who passed it to thousands of other people. Because the virus spreads before people show symptoms, by the time the authorities realized the issue, the virus was out there. They’re now paying the consequences of that one instance. Their containment efforts show, however: Italy has already passed it in numbers of cases, and Iran will pass it tomorrow (3/10/2020).
Washington State
You’ve already seen the growth in Western countries, and how bad forecasts of just one week look like. Now imagine that containment doesn’t happen like in Wuhan or in other Eastern countries, and you get a colossal epidemic.
Let’s look at a few cases, such as Washington State, the San Francisco Bay Area, Paris and Madrid.
Washington State is the US’s Wuhan.The number of cases there is growing exponentially. It’s currently at 140.
But something interesting happened early on. The death rate was through the roof. At some point, the state had 3 cases and one death.
We know from other places that the death rate of the coronavirus is anything between 0.5% and 5% (more on that later). How could the death rate be 33%?
It turned out that the virus had been spreading undetected for weeks. It’s not like there were only 3 cases. It’s that authorities only knew about 3, and one of them was dead because the more serious the condition, the more likely somebody is to be tested.
This is a bit like the orange and grey bars in China: Here they only knew about the orange bars (official cases) and they looked good: just 3. But in reality, there were hundreds, maybe thousands of true cases.
This is an issue: You only know the official cases, not the true ones. But you need to know the true ones. How can you estimate the true ones? It turns out, there’s a couple of ways. And I have a model for both, so you can play with the numbers too (direct link to copy of the model).
First, through deaths. If you have deaths in your region, you can use that to guess the number of true current cases. We know approximately how long it takes for that person to go from catching the virus to dying on average (17.3 days). That means the person who died on 2/29 in Washington State probably got infected around 2/12.
Then, you know the mortality rate. For this scenario, I’m using 1% (we’ll discuss later the details). That means that, around 2/12, there were already around ~100 cases in the area (of which only one ended up in death 17.3 days later).
Now, use the average doubling time for the coronavirus (time it takes to double cases, on average). It’s 6.2. That means that, in the 17 days it took this person to die, the cases had to multiply by ~8 (=2^(17/6)). That means that, if you are not diagnosing all cases, one death today means 800 true cases today.
Washington state has today 22 deaths. With that quick calculation, you get ~16,000 true coronavirus cases today. As many as the official cases in Italy and Iran combined.
If we look into the detail, we realize that 19 of these deaths were from one cluster, which might not have spread the virus widely. So if we consider those 19 deaths as one, the total deaths in the state is four. Updating the model with that number, we still get ~3,000 cases today.
This approach from Trevor Bedford looks at the viruses themselves and their mutations to assess the current case count.
An update about what we’re able to infer about the Washington State #COVID19 outbreak from screening and viral sequencing by @UWVirology and @seattleflustudy. 1/12
The conclusion is that there are likely ~1,100 cases in Washington state right now.
None of these approaches are perfect, but they all point to the same message: We don’t know the number of true cases, but it’s much higher than the official one. It’s not in the hundreds. It’s in the thousands, maybe more.
San Francisco Bay Area
Until 3/8, the Bay Area didn’t have any death. That made it hard to know how many true cases there were. Officially, there were 86 cases. But the US is vastly undertesting because it doesn’t have enough kits. The country decided to create their own test kit, which turned out not to work.
These were the number of tests carried out in different countries by March 3rd:
Turkey, with no cases of coronavirus, had 10 times the testing per inhabitant than the US. The situation is not much better today, with ~8,000 tests performed in the US, which means ~4,000 people have been tested.
Here, you can just use a share of official cases to true cases. How to decide which one? For the Bay Area, they were testing everybody who had traveled or was in contact with a traveler, which means that they knew most of the travel-related cases, but none of the community spread cases. By having a sense of community spread vs. travel spread, you can know how many true cases there are.
I looked at that ratio for South Korea, which has great data. By the time they had 86 cases, the % of them from community spread was 86% (86 and 86% are a coincidence).
With that number, you can calculate the number of true cases. If the Bay Area has 86 cases today, it is likely that the true number is ~600.
France and Paris
France claims 1,400 cases today and 30 deaths. Using the two methods above, you can have a range of cases: between 24,000 and 140,000.
The true number of coronavirus cases in France today is likely to be between 24,000 and 140,000.
Let me repeat that: the number of true cases in France is likely to be between one and two orders or magnitude higher than it is officially reported.
Don’t believe me? Let’s look at the Wuhan graph again.
If you stack up the orange bars until 1/22, you get 444 cases. Now add up all the grey bars. They add up to ~12,000 cases. So when Wuhan thought it had 444 cases, it had 27 times more. If France thinks it has 1,400 cases, it might well have tens of thousands
The same math applies to Paris. With ~30 cases inside the city, the true number of cases is likely to be in the hundreds, maybe thousands. With 300 cases in the Ile-de-France region, the total cases in the region might already exceed tens of thousands.
Spain and Madrid
Spain has very similar numbers as France (1,200 cases vs. 1,400, and both have 30 deaths). That means the same rules are valid: Spain has probably upwards of 20k true cases already.
In the Comunidad de Madrid region, with 600 official cases and 17 deaths, the true number of cases is likely between 10,000 and 60,000.
If you read these data and tell yourself: “Impossible, this can’t be true”, just think this: With this number of cases, Wuhan was already in lockdown.
With the number of cases we see today in countries like the US, Spain, France, Iran, Germany, Japan, Netherlands, Denmark, Sweden or Switzerland, Wuhan was already in lockdown.
And if you’re telling yourself: “Well, Hubei is just one region”, let me remind you that it has nearly 60 million people, bigger than Spain and about the size of France.
2. What Will Happen When These Coronavirus Cases Materialize?
So the coronavirus is already here. It’s hidden, and it’s growing exponentially.
What will happen in our countries when it hits? It’s easy to know, because we already have several places where it’s happening. The best examples are Hubei and Italy.
Fatality Rates
The World Health Organization (WHO) quotes 3.4% as the fatality rate (% people who contract the coronavirus and then die). This number is out of context so let me explain it.
It really depends on the country and the moment: between 0.6% in South Korea and 4.4% in Iran. So what is it? We can use a trick to figure it out.
The two ways you can calculate the fatality rate is Deaths/Total Cases and Death/Closed Cases. The first one is likely to be an underestimate, because lots of open cases can still end up in death. The second is an overestimate, because it’s likely that deaths are closed quicker than recoveries.
What I did was look at how both evolve over time. Both of these numbers will converge to the same result once all cases are closed, so if you project past trends to the future, you can make a guess on what the final fatality rate will be.
This is what you see in the data. China’s fatality rate is now between 3.6% and 6.1%. If you project that in the future, it looks like it converges towards ~3.8%-4%. This is double the current estimate, and 30 times worse than the flu.
It is made up of two completely different realities though: Hubei and the rest of China.
Hubei’s fatality rate will probably converge towards 4.8%. Meanwhile, for the rest of China, it will likely converge to ~0.9%:
I also charted the numbers for Iran, Italy and South Korea, the only countries with enough deaths to make this somewhat relevant.
Iran’s and Italy’s Deaths / Total Cases are both converging towards the 3%-4% range. My guess is their numbers will end up around that figure too.
South Korea is the most interesting example, because these 2 numbers are completely disconnected: deaths / total cases is only 0.6%, but deaths / closed cases is a whopping 48%. My take on it is that a few unique things are happening there. First, they’re testing everybody (with so many open cases, the death rate seems low), and leaving the cases open for longer (so they close cases quickly when the patient is dead). Second, they have a lot of hospital beds (see chart 17.b). There might also be other reasons we don’t know. What is relevant is that deaths/cases has hovered around 0.5% since the beginning, suggesting it will stay there, likely heavily influenced by the healthcare system and crisis management.
The last relevant example is the Diamond Princess cruise: with 706 cases, 6 deaths and 100 recoveries, the fatality rate will be between 1% and 6.5%.
Note that the age distribution in each country will also have an impact: Since mortality is much higher for older people, countries with an aging population like Japan will be harder hit on average than younger countries like Nigeria. There are also weather factors, especially humidity and temperature, but it’s still unclear how this will impact transmission and fatality rates.
This is what you can conclude:
Excluding these, countries that are prepared will see a fatality rate of ~0.5% (South Korea) to 0.9% (rest of China).
Countries that are overwhelmed will have a fatality rate between ~3%-5%
Put in another way: Countries that act fast can reduce the number of deaths by a factor of ten. And that’s just counting the fatality rate. Acting fast also drastically reduces the cases, making this even more of a no-brainer.
Countries that act fast reduce the number of deaths at least by 10x.
The problem is that items such as ventilators and ECMO can’t be produced or bought easily. A few years ago, the US had a total of 250 ECMO machines, for example.
So if you suddenly have 100,000 people infected, many of them will want to go get tested. Around 20,000 will require hospitalization, 5,000 will need the ICU, and 1,000 will need machines that we don’t have enough of today. And that’s just with 100,000 cases.
That is without taking into account issues such as masks. A country like the US has only 1% of the masks it needs to cover the needs of its healthcare workers (12M N95, 30M surgical vs. 3.5B needed). If a lot of cases appear at once, there will be masks for only 2 weeks.
Countries like Japan, South Korea, Hong Kong or Singapore, as well as Chinese regions outside of Hubei, have been prepared and given the care that patients need.
But the rest of Western countries are rather going in the direction of Hubei and Italy. So what is happening there?
What an Overwhelmed Healthcare System Looks Like
The stories that happened in Hubei and those in Italy are starting to become eerily similar. Hubei built two hospitals in ten days, but even then, it was completely overwhelmed.
Both complained that patients inundated their hospitals. They had to be taken care of anywhere: in hallways, in waiting rooms…
From a well respected friend and intensivist/A&E consultant who is currently in northern Italy:
1/ ‘I feel the pressure to give you a quick personal update about what is happening in Italy, and also give some quick direct advice about what you should do.
I heavily recommend this short Twitter thread. It paints a pretty stark picture of Italy today
Healthcare workers spend hours in a single piece of protective gear, because there’s not enough of them. As a result, they can’t leave the infected areas for hours. When they do, they crumble, dehydrated and exhausted. Shifts don’t exist anymore. People are driven back from retirement to cover needs. People who have no idea about nursing are trained overnight to fulfill critical roles. Everybody is on call, always.
Francesca Mangiatordi, an Italian nurse that crumbled in the middle of the war with the Coronavirus
That is, until they become sick. Which happens a lot, because they’re in constant exposure to the virus, without enough protective gear. When that happens, they need to be in quarantine for 14 days, during which they can’t help. Best case scenario, 2 weeks are lost. Worst case, they’re dead.
The worst is in the ICUs, when patients need to share ventilators or ECMOs. These are in fact impossible to share, so the healthcare workers must determine what patient will use it. That really means, which one lives and which one dies.
“After a few days, we have to choose. […] Not everyone can be intubated. We decide based on age and state of health.” —Christian Salaroli, Italian MD.
Medical workers wear protective suits to attend to people sickened by the novel coronavirus, in the intensive care unit of a designated hospital in Wuhan, China, on Feb. 6. (China Daily/Reuters), via Washington Post
All of this is what drives a system to have a fatality rate of ~4% instead of ~0.5%. If you want your city or your country to be part of the 4%, don’t do anything today.
This is a pandemic now. It can’t be eliminated. But what we can do is reduce its impact.
Some countries have been exemplary at this. The best one is Taiwan, which is extremely connected with China and yet still has as of today fewer than 50 cases. This recent paper explain all the measures they took early on, which were focused on containment.
They have been able to contain it, but most countries lacked this expertise and didn’t. Now, they’re playing a different game: mitigation. They need to make this virus as inoffensive as possible.
If we reduce the infections as much as possible, our healthcare system will be able to handle cases much better, driving the fatality rate down. And, if we spread this over time, we will reach a point where the rest of society can be vaccinated, eliminating the risk altogether. So our goal is not to eliminate coronavirus contagions. It’s to postpone them.
The more we postpone cases, the better the healthcare system can function, the lower the mortality rate, and the higher the share of the population that will be vaccinated before it gets infected.
How do we flatten the curve?
Social Distancing
There is one very simple thing that we can do and that works: social distancing.
If you go back to the Wuhan graph, you will remember that as soon as there was a lockdown, cases went down. That’s because people didn’t interact with each other, and the virus didn’t spread.
The current scientific consensus is that this virus can be spread within 2 meters (6 feet) if somebody coughs. Otherwise, the droplets fall to the ground and don’t infect you.
The only way to truly reduce that is with social distancing: Keeping people home as much as possible, for as long as possible until this recedes.
This has already been proven in the past. Namely, in the 1918 flu pandemic.
Learnings from the 1918 Flu Pandemic
You can see how Philadelphia didn’t act quickly, and had a massive peak in death rates. Compare that with St Louis, which did.
Then look at Denver, which enacted measures and then loosened them. They had a double peak, with the 2nd one higher than the first.
If you generalize, this is what you find:
This chart shows, for the 1918 flu in the US, how many more deaths there were per city depending on how fast measures were taken. For example, a city like St Louis took measures 6 days before Pittsburgh, and had less than half the deaths per citizen. On average, taking measures 20 days earlier halved the death rate.
Italy has finally figured this out. They first locked down Lombardy on Sunday, and one day later, on Monday, they realized their mistake and decided they had to lock down the entire country.
Hopefully, we will see results in the coming days. However, it will take one to two weeks to see. Remember the Wuhan graph: there was a delay of 12 days between the moment when the lockdown was announced and the moment when official cases (orange) started going down.
How Can Politicians Contribute to Social Distancing?
The question politicians are asking themselves today is not whether they should do something, but rather what’s the appropriate action to take.
There are several stages to control an epidemic, starting with anticipation and ending with eradication. But it’s too late for most options today. With this level of cases, the two only options politicians have in front of them are containment and mitigation.
Containment
Containment is making sure all the cases are identified, controlled, and isolated. It’s what Singapore, Hong Kong, Japan or Taiwan are doing so well: They very quickly limit people coming in, identify the sick, immediately isolate them, use heavy protective gear to protect their health workers, track all their contacts, quarantine them… This works extremely well when you’re prepared and you do it early on, and don’t need to grind your economy to a halt to make it happen.
I’ve already touted Taiwan’s approach. But China’s is good too. The lengths at which it went to contain the virus are mind-boggling. For example, they had up to 1,800 teams of 5 people each tracking every infected person, everybody they got interacted with, then everybody those people interacted with, and isolating the bunch. That’s how they were able to contain the virus across a billion-people country.
This is not what Western countries have done. And now it’s too late. The recent US announcement that most travel from Europe was banned is a containment measure for a country that has, as of today, 3 times the cases that Hubei had when it shut down, growing exponentially. How can we know if it’s enough? It turns out, we can know by looking at the Wuhan travel ban.
This chart shows the impact that the Wuhan travel ban had delaying the epidemic. The bubble sizes show the number of daily cases. The top line shows the cases if nothing is done. The two other lines show the impact if 40% and 90% of travel is eliminated. This is a model created by epidemiologists, because we can’t know for sure.
If you don’t see much difference, you’re right. It’s very hard to see any change in the development of the epidemic.
Now what did researchers think the impact of reducing transmission would be?
The top bloc is the same as the one you’ve seen before. The two other blocks show decreasing transmission rates. If the transmission rate goes down by 25% (through Social Distancing), it flattens the curve and delays the peak by a whole 14 weeks. Lower the transition rate by 50%, and you can’t see the epidemic even starting within a quarter.
The US administration’s ban on European travel is good: It has probably bought us a few hours, maybe a day or two. But not more. It is not enough. It’s containment when what’s needed is mitigation.
Once there are hundreds or thousands of cases growing in the population, preventing more from coming, tracking the existing ones and isolating their contacts isn’t enough anymore. The next level is mitigation.
Mitigation
Mitigation requires heavy social distancing. People need to stop hanging out to drop the transmission rate (R), from the R=~2–3 that the virus follows without measures, to below 1, so that it eventually dies out.
These measures require closing companies, shops, mass transit, schools, enforcing lockdowns… The worse your situation, the worse the social distancing. The earlier you impose heavy measures, the less time you need to keep them, the easier it is to identify brewing cases, and the fewer people get infected.
This is what Wuhan had to do. This is what Italy was forced to accept. Because when the virus is rampant, the only measure is to lock down all the infected areas to stop spreading it at once.
With thousands of official cases — and tens of thousands of true ones — this is what countries like Iran, France, Spain, Germany, Switzerland or the US need to do.
But they’re not doing it.
Some business are working from home, which is fantastic.
Some mass events are being stopped.
Some affected areas are in quarantining themselves.
All these measures will slow down the virus. They will lower the transmission rate from 2.5 to 2.2, maybe 2. But they aren’t enough to get us below 1 for a sustained period of time to stop the epidemic. And if we can’t do that, we need to get it as close to 1 for as long as possible, to flatten the curve.
So the question becomes: What are the tradeoffs we could be making to lower the R? This is the menu that Italy has put in front of all of us:
Nobody can enter or exit lockdown areas, unless there are proven family or work reasons.
Movement inside the areas is to be avoided, unless they are justified for urgent personal or work reasons and can’t be postponed.
People with symptoms (respiratory infection and fever) are “highly recommended” to remain home.
Standard time off for healthcare workers is suspended
Closure of all educational establishments (schools, universities…), gyms, museums, ski stations, cultural and social centers, swimming pools, and theaters.
Bars and restaurants have limited opening times from 6am to 6pm, with at least one meter (~3 feet) distance between people.
All pubs and clubs must close.
All commercial activity must keep a distance of one meter between customers. Those that can’t make it happen must close. Temples can remain open as long as they can guarantee this distance.
Family and friends hospital visits are limited
Work meetings must be postponed. Work from home must be encouraged.
All sports events and competitions, public or private, are canceled. Important events can be held under closed doors.
Then two days later, they added: No, in fact, you need to close all businesses that aren’t crucial. So now we’re closing all commercial activities, offices, cafes and shops. Only transportation, pharmacies, groceries will remain open.”
One approach is to gradually increase measures. Unfortunately, that gives precious time for the virus to spread. If you want to be safe, do it Wuhan style. People might complain now, but they’ll thank you later.
How Can Business Leaders Contribute to Social Distancing?
If you’re a business leader and you want to know what you should do, the best resource for you is Staying Home Club.
It is a list of social distancing policies that have been enacted by US tech companies—so far, 328.
They range from allowed to required Work From Home, and restricted visits, travel, or events.
There are more things that every company must determine, such as what to do with hourly workers, whether to keep the office open or not, how to conduct interviews, what to do with the cafeterias… If you want to know how my company, Course Hero, handled some of these, along with a model announcement to your employees, here is the one my company used (view only version here).
4. When?
It is very possible that so far you’ve agreed with everything I’ve said, and were just wondering since the beginning when to make each decision. Put in another way, what triggers should we have for each measure.
It enables you to assess the likely number of cases in your area, the probability that your employees are already infected, how that evolves over time, and how that should tell you whether to remain open.
It tells us things like:
If your company had 100 employees in the Washington state area, which had 11 coronavirus deaths on 3/8, there was a 25% chance at least one of your employees was infected, and you should have closed immediately.
If your company had 250 employees mostly in the South Bay (San Mateo and Santa Clara counties, which together had 22 official cases on 3/8 and the true number was probably at least 54), by 3/9 you would have had ~2% chances to have at least one employee infected, and you should have closed your office too.
[Updated as of 3/12] If your company is in Paris (intramuros), and it has 250 employees, today there’s a 95% chance that one of your employees has the coronavirus, and you should close your office by tomorrow.
The model uses labels such as “company” and “employee”, but the same model can be used for anything else: schools, mass transit… So if you have only 50 employees in Paris, but all of them are going to take the train, coming across thousands of other people, suddenly the likelihood that at least one of them will get infected is much higher and you should close your office immediately.
This math is selfish. It looks at every company’s risk individually, taking as much risk as we want until the inevitable hammer of the coronavirus closes our offices.
But if you’re part of a league of business leaders or politicians, your calculations are not for just one company, but for the whole. The math becomes: What’s the likelihood that any of our companies is infected? If you’re a group of 50 companies of 250 employees on average, in the SF Bay Area, there’s a 35% chance that at least one of the companies has an employee infected, and 97% chance that will be true next week. I added a tab in the model to play with that.
Conclusion: The Cost of Waiting
It might feel scary to make a decision today, but you shouldn’t think about it this way.
This theoretical model shows different communities: one doesn’t take social distancing measures, one takes them on Day n of an outbreak, the other one on Day n+1. All the numbers are completely fictitious (I chose them to resemble what happened in Hubei, with ~6k daily new cases at the worst). They’re just there to illustrate how important a single day can be in something that grows exponentially. You can see that the one-day delay peaks later and higher, but then daily cases converge to zero.
But what about cumulative cases?
In this theoretical model that resembles loosely Hubei, waiting one more day creates 40% more cases! So, maybe, if the Hubei authorities had declared the lockdown on 1/22 instead of 1/23, they might have reduced the number of cases by a staggering 20k.
And remember, these are just cases. Mortality would be much higher, because not only would there be directly 40% more deaths. There would also be a much higher collapse of the healthcare system, leading to a mortality rate up to 10x higher as we saw before. So a one-day difference in social distancing measures can end exploding the number of deaths in your community by multiplying more cases and higher fatality rate.
This is an exponential threat. Every day counts. When you’re delaying by a single day a decision, you’re not contributing to a few cases maybe. There are probably hundreds or thousands of cases in your community already. Every day that there isn’t social distancing, these cases grow exponentially.
