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Sweden is strange, though. It looks like their strategy of staying open but social distancing has held Rt to near 1. Now, suddenly in the last three days, there's been an enormous and somewhat sustained spike. I can't find any news articles explaining it (uncounted cases, reclassified cases, ???). While infections stayed steady, the death rate decreased. .
It hasn't worked too as well as Sweden has planned but it's somewhat better than what the US has gone through. This goes to show their strength is in the healthcare system is much better than a privatized system we have.
America has the world's largest healthcare system but the least affordable. Something like a $1500 ambulance bill is unheard of in other 1st world countries. I went on a family vacation in Japan and my dad at the time fractured his arm in a car accident. Japan does not have any type of passenger insurance for taxis. But we went to a hospital he stayed overnight and for 2 days and came out with a cast. The total bill for us non-citizens was only about $800.
For Americans without insurance here, you're looking at a $7000 bill minimum.
It hasn't worked too as well as Sweden has planned but it's somewhat better than what the US has gone through. This goes to show their strength is in the healthcare system is much better than a privatized system we have.
America has the world's largest healthcare system but the least affordable. Something like a $1500 ambulance bill is unheard of in other 1st world countries. I went on a family vacation in Japan and my dad at the time fractured his arm in a car accident. Japan does not have any type of passenger insurance for taxis. But we went to a hospital he stayed overnight and for 2 days and came out with a cast. The total bill for us non-citizens was only about $800.
For Americans without insurance here, you're looking at a $7000 bill minimum.
I go to Taiwan for any non-emergency medical stuff and pay "full price". I'm pretty healthy, so it's mostly just screenings and maybe a quick consult. That would be $75-200 for a "new patient" visit in the USA. Plus I'd spend an hour in transit, an hour in the waiting room, then another hour in an exam room, making it a half-day visit. In Taiwan, the doctor and a nurse/data-entry person sit in the exam room and you come to them. You get assigned a number which you can track via a website. If you are in the area of the hospital, you can actually just walk right in 30 seconds before your number comes up (depending on how close you're willing to cut it) and make your visit take 20 minutes or less. Actual time with the doctor is about the same as what you get in the USA, and they don't fob you off on an RN.
Blood draw is an experience too. You wait in a line, then stick your arm over the phlebotomist's counter. I was in a line of 10 people. It took 3 minutes to get the entire line done! In my local hospital in the USA, if there are 3 people ahead of you for a blood draw, it's going to be an hour or more before they get to you!
I mean, if I had an inoperable brain tumor and a billion dollars, I guess I'd stay in the USA. However, for stuff that can be fixed by regular medicine that us proles can afford, places with universal health care are a much better value.
Back to the subject at hand:
Cases in Sweden are up, but deaths continue to decline. Despite the headlines, I would count their management of COVID-19 as quite good. Clearly NZ, Taiwan, Korea, China, and Japan are doing exceptionally well.
Iran is now experiencing a second wave after opening up on April 20th.
The United States is likely to follow, but the next two weeks will really tell the tale. Maybe the countermeasures we're taking will suppress the spread enough to even avoid the 1.0<Rt<1.3 slow burn scenario. Maybe there's something about the transmission of the virus we don't understand. No country has yet to suffer a catastrophic explosion of the virus, though some cities have. Clearly density of population is a major factor in how quickly the virus can transmit.
One month is the period of response overhang I would expect to see a slow increase in cases. Georgia is now a week past that point and, it is meeting expectations with a gradual rise in cases. If the increase continues for another 10 days and we're at 20% more new infections daily, by that point, that would indicate a dangerous new Rt. If we're not. If we're only >10% higher in new infections, then maybe we're out of the woods for the rest of the summer.
On the other hand, the rapid increase in places like AZ, Arkansas, Oregon, etc. is pretty worrying. These are not, what I would consider, places ripe for rapid increase in viral spread.
Cases in Sweden are up, but deaths continue to decline. Despite the headlines, I would count their management of COVID-19 as quite good. Clearly NZ, Taiwan, Korea, China, and Japan are doing exceptionally well.
Iran is now experiencing a second wave after opening up on April 20th.
The United States is likely to follow, but the next two weeks will really tell the tale. Maybe the countermeasures we're taking will suppress the spread enough to even avoid the 1.0<Rt<1.3 slow burn scenario. Maybe there's something about the transmission of the virus we don't understand. No country has yet to suffer a catastrophic explosion of the virus, though some cities have. Clearly density of population is a major factor in how quickly the virus can transmit.
One month is the period of response overhang I would expect to see a slow increase in cases. Georgia is now a week past that point and, it is meeting expectations with a gradual rise in cases. If the increase continues for another 10 days and we're at 20% more new infections daily, by that point, that would indicate a dangerous new Rt. If we're not. If we're only >10% higher in new infections, then maybe we're out of the woods for the rest of the summer.
On the other hand, the rapid increase in places like AZ, Arkansas, Oregon, etc. is pretty worrying. These are not, what I would consider, places ripe for rapid increase in viral spread.
I guess the next few weeks will tell. But I'm starting to think lockdowns will have to happen again, not nationwide, but in the states or areas where the rapid increases are happening.
As for seemingly unlikely places with the new increases, it probably comes down to the fact that outside of NYC and the NE in general, most places probably never actually reached a true peak, since distancing and lockdowns stopped the spread of the virus early enough. The curve just looked smaller, and shorter than it actually would be if unabated. It was more a man made curve, if you will rather than a true Bell curve. NYC and those areas had higher peaks and likely have much higher levels of immunity due to the dense populations and inability to distance, as you mentioned.
Unfortunately, these increases indicate we are nowhere near out of the woods, and this could drag on for many years, if there isn't a strong treatment or vaccine. And I'm not so sure when or if we will have a vaccine or that it will really do a lot for the situation. I think treatments are the more likely scenario, and are already being used as doctors learn more from treating patients over time.
I see the slow burn as the most likely scenario... we were finally seeing results from the lockdowns, in the states that have had them the longest, but from what I gather it took longer to have an effect than expected. Now that it was just starting to slow it, most states are in process of opening up. Therefore, we'll start to have spikes again as it is able to spread more easily.
Natural, herd immunity is no good way out of this, given the amount of deaths and serious illnesses that would result from this being allowed to run through the population. But I don't see how we can keep a lid on this for so many years, though treatments will likely do a lot of good on that.
Also, I don't see the public accepting multiple lockdowns, but I see no other tool to get it back under control once it spikes to where the hospitals are overwhelmed.
My hope was it could be losing some of its virulence given some of the news coming from doctors out of Italy and Pittsburgh. Also the number of deaths still seemed to be continuing down in some areas that were seeing spikes of new infections. However, the ICU use in AZ is worrying and seems to go against that idea. And of course Brazil, South America, etc.
Um, there was never a plan. The protests happened well after every Tom, Dick and Harry cried about wearing a mask, being told what to do, and already out doing god knows what.
Outdoor activity, even in close proximity is generally a poor transmitter of CV19.
And how can there be, when COVID-19 isn't taken seriously by the current administration?
The White House’s top economic advisers on Friday shrugged off concerns of a potential “second wave” of the coronavirus, reflecting President Donald Trump’s eagerness to continue reopening broad swaths of the country even as cases of Covid-19 are spiking in more than a dozen states.
“There is no emergency. There is no second wave. I don’t know where that got started on Wall Street,” Larry Kudlow, director of the National Economic Council, told “Fox & Friends.”
And how can there be, when COVID-19 isn't taken seriously by the current administration?
The White House’s top economic advisers on Friday shrugged off concerns of a potential “second wave” of the coronavirus, reflecting President Donald Trump’s eagerness to continue reopening broad swaths of the country even as cases of Covid-19 are spiking in more than a dozen states.
“There is no emergency. There is no second wave. I don’t know where that got started on Wall Street,” Larry Kudlow, director of the National Economic Council, told “Fox & Friends.”
Well, he's right about one thing. There's no emergency [yet].
There is certainly a second wave--unless you want to say that the first wave never even crested, and we're just headed back up again after a short period of "flattening the curve".
The bad news is that overall cases are RAPIDLY increasing. Testing maxed out a few weeks ago, so you can't explain the massive wave hitting Florida and Arizona as increased testing. The more moderate waves in Texas and California look to be from economic opening. Sweden is also getting hit by a pretty sizable wave of new cases.
The good news is that this is not [yet] reflected in deaths. Death rates are going to increase, but they have not kept pace with the flat or increasing rate of detected cases. Interventions are becoming more successful.
It looks like we're right on schedule for a horrific summer. By July 4th, by the testing and death numbers [because deaths do lag positive tests by about 2 weeks] are going to be pretty scary.
At the same time, it's starting to look like death rates are dropping. I think we're going to end up (as a population) below 0.2% CFR. Elderly people in communal settings got hit first, hardest, and thoroughly. Nursing homes are COVID-19 charnel houses, and a preponderance of them probably were hit in the initial wave. There will be more, there will be more deaths, but I think the initial deaths were biased high by nursing homes.
I still expect we will see between 1-2M American deaths before this thing is done, but they will be the oldest and sickest among us. It's pretty clear that we've given up trying to protect them. There won't be any more lockdowns. Shiploads of young healthy people are going to die. Remember, this is still 30-60X more dangerous than influenza. However, it doesn't look like the 1918 Spanish Flu. As we thought initially, children are more-or-less safe. It's 30X more deadly than the flu for younger adults (but almost none of them die from influenza anyway) and it's 60X more deadly for boomers. Lots of dead boomers by the time this is done. Even more dead in the 65+ age group.
No more lockdowns are coming. The USA government response is exhausted and we are near minimum infections and rising. NOW is the time to take personal protective action and make any other preparations (life insurance, will, etc) if you are over 17 years old with a comorbidity, or if you are over 50 (40?) with any sort of health problem, or if you are over 60, regardless of health.
NOW is the time to take personal protective action and make any other preparations (life insurance, will, etc) if you are over 17 years old with a comorbidity, or if you are over 50 (40?) with any sort of health problem, or if you are over 60, regardless of health.
Good points.
In the fullness of time, many books will be written about why a country as rich, powerful, and scientifically advanced as the United States failed quite so badly at coping with a public-health emergency that experts had predicted for many years.
I guess the next few weeks will tell. But I'm starting to think lockdowns will have to happen again, not nationwide, but in the states or areas where the rapid increases are happening.
As for seemingly unlikely places with the new increases, it probably comes down to the fact that outside of NYC and the NE in general, most places probably never actually reached a true peak, since distancing and lockdowns stopped the spread of the virus early enough. The curve just looked smaller, and shorter than it actually would be if unabated. It was more a man made curve, if you will rather than a true Bell curve. NYC and those areas had higher peaks and likely have much higher levels of immunity due to the dense populations and inability to distance, as you mentioned.
Unfortunately, these increases indicate we are nowhere near out of the woods, and this could drag on for many years, if there isn't a strong treatment or vaccine. And I'm not so sure when or if we will have a vaccine or that it will really do a lot for the situation. I think treatments are the more likely scenario, and are already being used as doctors learn more from treating patients over time.
I see the slow burn as the most likely scenario... we were finally seeing results from the lockdowns, in the states that have had them the longest, but from what I gather it took longer to have an effect than expected. Now that it was just starting to slow it, most states are in process of opening up. Therefore, we'll start to have spikes again as it is able to spread more easily.
Natural, herd immunity is no good way out of this, given the amount of deaths and serious illnesses that would result from this being allowed to run through the population. But I don't see how we can keep a lid on this for so many years, though treatments will likely do a lot of good on that.
Also, I don't see the public accepting multiple lockdowns, but I see no other tool to get it back under control once it spikes to where the hospitals are overwhelmed.
My hope was it could be losing some of its virulence given some of the news coming from doctors out of Italy and Pittsburgh. Also the number of deaths still seemed to be continuing down in some areas that were seeing spikes of new infections. However, the ICU use in AZ is worrying and seems to go against that idea. And of course Brazil, South America, etc.
This is why I say that at this point the vaccine effort is the only real national plan. Strict social distancing, crowd prevention, mandatory face masks in public, and overall great health hygiene by all would greatly stabilize rates, but as you mentioned, the public in general will not accept all of these measures for any sustained period of time. So until there is a vaccine and effective preventive treatment (some of the antibody treatments would be very promising), nothing will stop the spread.
The plan is really to put all hope in a vaccine, combined with improving treatments. The thought was that as the summer/heat increased, this would die down (so people were willing to do some of the measures for a couple months). That is showing to not be the case, and things will get even more grim as we get into fall/winter (when flu, cold, etc are thrown into the mix). A vaccine (even if only partially effective, as long as it is safe) is the only hope for curbing this.
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