The lockdowns commence. Mass hysteria grips the US

America is going the way of Wuhan very rapidly. Consider:

Lamont issues executive order banning gatherings of more than 250

[Connecticut] Gov. Ned Lamont is using emergency powers to prohibit gatherings of more than 250 people to try to check the spread of coronavirus infection, excluding religious services. […]

The executive order prohibits gatherings of more than 250 people for social and recreational events. The prohibition remains in effect until midnight April 30, unless modified by a subsequent executive order.

The current order covers community, civic, leisure, or sporting events, parades, concerts, festivals, movie screenings, plays, performances, and conventions. It does not apply to any spiritual gathering or worship service. […]

The order also states that violation of the prohibition on large gatherings is a felony offense. The crime carries a maximum prison sentence of five years and a maximum fine of $5,000.

New York Gov. Cuomo bans gatherings of 500 or more amid coronavirus outbreak

New York Gov. Andrew Cuomo on Thursday announced a ban on gatherings of 500 or more people across the state “for the foreseeable future” as public officials try to contain the fast-moving coronavirus outbreak that’s spread across 44 U.S. states and infected at least 127,800 people across the world.

How quickly the freedom to socialize in large groups gets thrown out the window over a respiratory virus that has so far killed [checks notes] two people in New York State and zero people in Connecticut. Does this order cover political protests, i.e. freedom of assembly?

That was Thursday. On Saturday, Hoboken, New Jersey became the first city in America to implement a mass curfew:

Hours after announcing that gyms, health clubs, day cares and movie theaters would join the list of closures in Hoboken, Mayor Ravi S. Bhalla announced the forthcoming curfew and additional restrictions.

The citywide curfew that begins Monday will be in effect from 10 p.m. to 5 a.m. and requires all residents to remain in their homes, barring emergencies. People who are required to report to work are exempted, the statement released late Saturday said.

What public health purpose is served by banning people from going outside between the hours of 10pm and 5am? Especially when bars, move theaters, etc. have already been ordered closed and restaurants have been ordered to stop serving food on the premises? I don’t know, but I do know that people in a state of terror are easier to manipulate and control.

The newspaper of record has a front-page story today with the headline “The Coronavirus Swamps Local Health Departments, Already Crippled by Cuts.” Imagine my surprise to learn that the headline refers to something other than an uncontrollable wave of sick bodies:

CHICAGO — A widespread failure in the United States to invest in public health has left local and state health departments struggling to respond to the coronavirus outbreak and ill-prepared to face the swelling crisis ahead.

Many health departments are suffering from budget and staffing cuts that date to the Great Recession and have never been fully restored. Public health departments across the country manage a vast but often invisible portfolio of duties, including educating the public about smoking cessation; fighting opioid addictions; convincing the reluctant to vaccinate their babies; and inspecting restaurants and tattoo parlors.

Now, these bare-bones staffs of medical and administrative workers are trying to answer a sudden rush of demands — taking phone calls from frightened residents, quarantining people who may be infected, and tracing the known contacts and whereabouts of the ill — that accompany a public health crisis few have seen before. […]

With the virus now consuming all attention, key functions have been put on hold. Some health departments are now making reductions in home health care and education on unwanted teenage pregnancy and other core issues. In Wayne County, Ohio, the health department called off upcoming seminars to vaccinate people in Amish communities, where parents are often reluctant to immunize their children.

I’m not pointing out the glaring discrepancy between headline and news content in order to minimize the problem that our hospitals are probably ill-equipped, maybe severely so, for a major outbreak – an issue I’ve addressed here.

I would, however, like to call attention to the way the media is fanning the flames of mass hysteria over a novel virus that is still not well understand and has still, despite the chain reaction of extreme global dislocations it has triggered, killed fewer than 6,500 people worldwide since its first documented case in either November or December 2019. And yes, I understand exponential growth, but the data is so vague at this point that it’s safe to assume that any “projection” (of death tolls, etc.) is total conjecture. Complacency is not the answer, but neither is fear.

Italy on full lockdown

It has been less than seven weeks since Wuhan and nearby cities began to impose travel bans – and only three weeks since Hubei province itself (population: ~58 million) was placed on full lockdown by the authorities.

Now the Western, democratic world is witnessing its first lockdown on a similar scale, with Italy (population: 60 million) extending quarantine measures across the whole country.

At this rate, how long before Governor Cuomo blocks the roads and trains out of New York City?

Bonus: notes from a very interesting podcast chat with Scott Adams and Naval Ravikant.

The effectiveness of a mass quarantine

Hypothesis: The effectiveness of a mass quarantine is greatly reduced when the target population is given several hours’ advance notice of it.

Item (Wuhan):

A sudden overnight quarantine, with a 7-hour grace period for people to leave, has predictably led to this. Can an epidemic both be severe enough to justify a lockdown of 10m people and sufficiently under-control to allow this?

Item (Northern Italy):

There was chaos and confusion in the hours before Conte signed the decree, as word leaked to the news media about the planned quarantine. Students at the University of Padua in northern Italy who had been out at bars on a Saturday night saw the rumors on their cellphones and rushed back to their apartments to grab their belongings and head to the train station.

Hundreds of passengers, some wearing face masks and rubber gloves, crammed onto the last local train leaving Padua at 11:30 p.m. Anxious students wrapped scarves around their heads, shared sanitizing gel, and sat on their suitcases in the aisles. No conductor came by to check tickets.

More supply chain disruption

Chris Martenson of Peak Prosperity talks about how the Indian government has banned the export of 26 active pharmaceutical ingredients (APIs) due to coronavirus (Reuters report here):

And more:

And here’s an excellent interview with Cornell professor David Collum on coronavirus, what we don’t know, and erring to the side of caution:

What are they spraying?

Episode II: Attack of the Bleach? (Source)

Robots are also being enlisted in the Corona Wars:

SNAFU! comments:

This thing must still be raging in China. It’s obvious too that N. Korea must be getting SLAMMED by this thing if S. Korea and Japan are affected. Wonder if this could lead to the death of the little fat bastard and calamity or an opportunity.

Also its apparent that WHO is not declaring a pandemic for one reason alone. Economics. A pandemic declaration could literally destroy globalization (although many here seem to doubt that).

Last thing.

You know what everyone is missing about the Spanish flu? The first wave wasn’t anything. It was considered a seasonal flu and was basically ignored by any and everyone. When it came around the next year (after mutating) is when we saw massive deaths.

My view of this thing has changed. I think its gonna sputter out by the end of March, early April.

Later this year and early next is when we’re gonna get body slammed by this thing. I think most will forget about this thing (except for govts and the scientist that work for them) and you’ll see everyone attempt to go back to normal just in time for this thing to go sideways just in time for the Christmas season.

Stock up on masks this summer. I believe you’ll be ok for the first wave of this thing.

Good news for alcoholics

Bulgaria’s disease control agency weighs in on coronavirus: hard liquor helps!

Meanwhile, here’s an update on that British expat who caught coronavirus in Wuhan – the one who drank whiskey and honey to help with his symptoms. Scary stuff:

For most people who catch the virus, it won’t get any worse than this, it may not even get that bad, but for Connor the scariest part was still to come. He actually felt like he was recovering from the flu and was feeling optimistic about going back to work when one morning he woke up struggling to breathe.

“It scared me because breathing is a necessity of life, like if you have the flu, you really feel like you’re going to die, but you’re really not. But when your lungs get affected, that’s where it scared me. And I couldn’t take a full breath. And the breaths I did take, it sounded like I was breathing through a bag. It was very crackly, and I could only take half breaths. If I walked to the kitchen, for instance, I’d be breathing really shallow and really fast.”

Connor continued drinking hot water to try and clear it up but, a day later when things didn’t improve, he went to hospital.

On 5 December he had a day of blood tests, x-rays and breathing tests. The next day, two weeks after he’d first caught the cold, the results came back that he had pneumonia.

Connor is a healthy 25-year-old.

American Hospital Association webinar guesstimates 480,000 deaths

A leaked slide from a presentation given to the American Hospital Association on Feb. 27 estimates that coronavirus could result in 96 million cases, 4.8 million hospitalizations and 480,000 deaths in the US:

The American Hospital Association, which represents thousands of hospitals and health systems, hosted a webinar in February with its member hospitals and health systems. Business Insider obtained a copy of the slides presented.

The presentation, titled “What healthcare leaders need to know: Preparing for the COVID-19” happened February 26, with representatives from the National Ebola Training and Education Center.

As part of the presentation to hospitals, Dr. James Lawler, a professor at the University of Nebraska Medical Center gave his “best guess” estimates of how much the virus might spread in the US.

Here’s the slide:

Note the last point – “Prepare for disease burden roughly 10x severe flu season.” This is the part the “just the flu, bro” idiots are missing. Even with a “low” fatality rate of 0.5% and “only” 5% of cases requiring hospitalization, a surge of coronavirus cases will overwhelm the US hospital system. Flu doesn’t do this.

And this is why, despite my growing skepticism that coronavirus is the global existential threat many fear it is, I am extremely concerned that the US is not properly equipped and prepared to manage the inevitable outbreaks here and is not doing enough to slow the spread of this highly contagious virus.

As usual, John Robb was ahead of the curve on this. See my Feb. 29 summary of his analysis:

The big problem is that there is very little slack in our health care system, as John Robb details in his latest Global Guerrillas Report. He points out that the US had about 1.5 million hospital beds in 1975, whereas now it has about 0.9 million despite the population being 50% higher. Run the numbers – it would only take a surge of as little as 100,000 patients to overwhelm the system.

The flu results in between 140,000 and 960,000 hospitalizations each year (source).

Related: An engineer on why coronavirus will break the US healthcare system.

Corona’s extremely low death toll

This is what I can’t wrap my head around. If coronavirus is a true global public health emergency… then why have only ~3,500 people (reportedly) died from it, the vast majority of them in China? As pandemics go, this is pretty lame. Furthermore, the death toll seems to be increasing in a linear rather than exponential fashion:

Not to be callous, but that is a really *tiny* number of people on a global scale. For comparison, the swine flu epidemic in the US killed some 11,690 people, including 1,180 children, in 2009, and as I recall, the US mostly shrugged that off.

On a Chinese scale, ~3,000 deaths over two months is basically a rounding error. That’s fewer than the number of people that died in the flooding of May through August 2010, which barely elicited comment at the time (I think it was mentioned once in my office in Shanghai that summer and I never heard anyone speak of it again).

Of course, the death toll could get way higher as this virus spreads to every corner of the globe… but the point is, it hasn’t yet. We’re still chugging along in the low 4-digit range, and it seems we’re going to be “stuck” there for a while, unless there is a sudden surge in the number of deaths – perhaps in a country or region where the health care system has broken down and the hospitals become super-incubators of the disease. But so far (with the possible exception of Iran), that doesn’t seem to have happened yet.

if this virus is truly dangerous – dangerous enough to warrant locking down half the population of the world’s largest nation – we should be seeing tens or hundreds of thousands, perhaps millions of deaths worldwide by now, should we not? What gives?

Final thought: the above assumes that China is accurately reporting the death toll. If the actual body count is far greater than 3,000 – could that be hidden? Could China sweep 100,000 deaths under the rug? As returned expat Nate Mesics suggested to me, in a country with 14,000 times that number, it’s possible. How about a million? In China, anything is possible.

Exponential growth

I think most people have heard (in one form or another) the old story in which the inventor of chess asks his king to reward him with a quantity of rice, according to the following rule: a single grain of rice is to be placed on the first chess square, doubled on each successive square. The bemused king readily agrees, only to find that he needs to place more than a million grains of rice on the 20th square and more than 18 quintillion (18,000,000,000,000,000,000) grains of rice on the 64th square. D’oh!

And yet, despite the popularity of this fable, it appears that most people really do not understand the awesome power of exponential growth. For example, does the average American grasp the implications of this chart?

The caseload represented by the blue line looks tiny, right? Comment by LZ (Investing in Chinese Stocks):

I’ve been posting the covid-19 case count with two x-axis to show the growth rate more clearly, but for today I put them both on one axis. It shows the rest of the world has a similar number of cases and a similar slope pre-quarantine China.

Even after China initiated a full lockdown on Wuhan, followed by strict nationwide travel restrictions and work closures, it still experienced exponential growth because of cases already in the system. Given the U.S. response to this point, I think it is almost inevitable U.S. cases will soar past China’s.

Note that the full lockdown on Wuhan was implemented January 23.

Here is the same chart with a secondary vertical axis:

In the absence of the kind of brutal containment measures that China has imposed, how widely will coronavirus spread in the US? I’m not sure; I’ve been trying to get a clearer picture of that, but my understanding is that it will likely spread very widely indeed. Harvard epidemiologist Marc Lipsitch predicts, with certain caveats, that the number of infections could reach 40 to 70% of adults worldwide:

Why do I think 40-70% infected? Simple math models with oversimple assumptions would predict far more than that given the R0 estimates in the 2-3 range (80-90%). Making more realistic assumptions about mixing, perhaps a little help from seasonality, brings the numbers down. Pandemic flu in 1968 was estimated to _symptomatically_ infect 40% of the population, and in 1918 30%. Those likely had R0 less than COVID-19.

The next important question is, what is the fatality rate? As far as I can tell, scientists have only a very rough grasp of what that might be, mostly because we have no idea how many people are walking around with undiagnosed infections. One Chinese study published in the Journal of the American Medical Association finds a case fatality rate (CFR) of 2.3%.

Let’s take the lower end of Professor Lipsitch’s estimate and assume that 40% of American adults (209 million x 0.40 = 83.6 million) get infected. With a 2.3% fatality rate, that equates to 1.9 million deaths.

But the fatality rate could be far lower in the US than in China for any number of reasons: perhaps our health care system is better equipped to handle an outbreak, or the far lower incidence of smoking and better air quality in the US mean that patients are less likely to have the kind of underlying respiratory conditions that increase morbidity.

Assuming a lower CFR of 1%, we are talking about 836,000 deaths, or roughly the population of San Francisco.

The incompetence of the CDC

CDC headquarters campusPerhaps there is another explanation for the fact that while South Korea (population: 52 million) has somehow managed to test more than 121,000 people for coronavirus, the US (population: 333 million) had tested only 472 people as March 1 – before deciding to stop disclosing the number of tests.

Perhaps there is an explanation aside from the usual bureaucratic incompetence and/or corruption. If so, I’d like to hear it.

For the record, what I wrote last Monday (Feb 24) is now becoming the conventional wisdom:

It’s easy to mock China, but the US is comically inept. We sat on our hands for a month while China locked down hundreds of millions of people to prevent the spread of a mysterious virus. What is our plan when the pandemic starts claiming victims here? There are probably thousands of undetected cases in major cities already. I hope I’m wrong, but the US will have no one to blame but itself if this thing explodes in our faces.

Then there’s this dumbassery:

San Antonio officials say a patient who was mistakenly released from the Texas Center for Infectious Disease facility spent two hours at a mall after she was let go.

Mayor Ron Nirenberg gave a brief statement on Monday in regard to the incident. During the press conference, he said the patient went to the mall around 5:30 p.m. to 7:30 p.m. and spent most of that time sitting at the food court by herself. Officials add she also went to a local hotel.

At least three people came into contact with her at the hotel, and even with that, the risk factor is low.

On Sunday, when the news broke, Nirenberg said that the patient was released from isolation at a local healthcare facility Saturday because she met the criteria for release, including two negative test results.

However, the patient later returned to isolation after a pending, subsequent lab test came up positive for the virus that causes COVID-19.

“The fact that the CDC allowed the public to be exposed to a patient with a positive COVID-19 reading is unacceptable,” Nirenberg said.

The CDC says they are retesting the individual.

The US has not been taking this situation seriously enough. We will pay the price.