1. On the issue of enclosure vs. outdoors, a reader alerted me to an article from 2009, by Richard A. Hobday and Jown W. Cason about the Spanish Flu outbreak, which seems to support my idea of treating patients in the parking lot. Here is the abstract, with my emphasis provided.
The H1N1 “Spanish flu” outbreak of 1918–1919 was the most devastating pandemic on record, killing between 50 million and 100 million people. Should the next influenza pandemic prove equally virulent, there could be more than 300 million deaths globally. The conventional view is that little could have been done to prevent the H1N1 virus from spreading or to treat those infected; however, there is evidence to the contrary. Records from an “open-air” hospital in Boston, Massachusetts, suggest that some patients and staff were spared the worst of the outbreak. A combination of fresh air, sunlight, scrupulous standards of hygiene, and reusable face masks appears to have substantially reduced deaths among some patients and infections among medical staff. We argue that temporary hospitals should be a priority in emergency planning. Equally, other measures adopted during the 1918 pandemic merit more attention than they currently receive.
2. D.F. Linton made some charts that smooth the 3DDRR.
3. Sweden, which is relying primarily on private decisions for social distancing, as of this morning was at 132 deaths per million, more than all but 7 other European countries. I was forwarded information that points to immigrant populations in Sweden having a disproportionately large share of infections relative to their share of Sweden’s population.
4. Health economist Jeffrey E. Harris writes,
New York City’s multitentacled subway system was a major disseminator – if not the principal transmission vehicle – of coronavirus infection during the initial takeoff of the massive epidemic that became evident throughout the city during March 2020. The near shutoff of subway ridership in Manhattan – down by over 90 percent at the end of March – correlates strongly with the substantial increase in the doubling time of new cases in this borough. Maps of subway station turnstile entries, superimposed upon zip code-level maps of reported coronavirus incidence, are strongly consistent with subway-facilitated disease propagation. Local train lines appear to have a higher propensity to transmit infection than express lines.
From my timeline: March 4. New York Health Commissioner Oxiris Barbot: There’s no indication that being in a car, being in the subways with someone who’s potentially sick is a risk factor.
5. Speaking of New York, today is the day that about 4000 deaths showed up that had not been previously reported. As of yesterday, New York was showing only 11,586 and the number of “new death” reported to day was 606. But today the total for the state is 16,251
6. Olivier Blanchard and Jean Pisani-Ferry write,
The extraordinary operations that are under way in most countries in response to the COVID-19 shock have raised fears that large-scale monetisation will result in a major inflation episode. This column argues that so far, there is no evidence that central banks have given up, or are preparing to give up, on their price stability mandate. While there are obviously some reasons to worry, central banks are doing the right thing and the authors see no reason to panic.
Take anything Blanchard says, put a minus sign in front of it, and you have my view.
7. Pat Bayer looks at death rates in Italy and sees flat declines post-peak. Pointer from Tyler Cowen. I think I am seeing the same thing in the ex-NY data in the U.S., and I am not happy about it.
8. I listened to a bit of the Sweden update that Tyler linked to, around minutes 12 through 16. It seems that there was a lot of voluntary social distancing, including an enormous reduction in the use of mass transit. Also, many of the deaths were in nursing homes. So perhaps we are not learning as much from the “Sweden experiment” as one might hope.
Good links.
I’m starting to lose the forest for the trees.
It seems like in the competition of “big Western countries handling this well,” in deaths per million, it’s
1. Germany 47
2. USA 106
3. UK 205
4. France 256
5. Italy 358
6. Spain 383
If someone were to examine “US minus NY/NJ/Deblasio” – those 48 states are a tie with Germany at 47 per million.
So all things considered, aren’t we doing decent job? (Whoever you want to credit).
What are we, grading on a curve? That bar is too low. “Decent” is perhaps Canada, at 32, or Israel at 16, but it’s possible to do a lot better than that:
Taiwan: 0.25
Japan: 1.4
Singapore: 1.7
New Zealand: 1.8
Australia: 2.5
South Korea: 4.6
“Sweden, which is relying primarily on private decisions for social distancing, as of this morning was at 132 deaths per million, more than all but 7 other European countries”
Not sure that this is as important as you make it out to be.
Questions:
1) do they have enough beds and ventilators? If Y, not sure what the issue is.
2) More importantly, since the virus isn’t likely to be going away and a vaccine is probably far off, are the Swedes better positioning themselves for the future (vs. the U.S.)
3) ASK always likes to ask us think two weeks ahead. So, ASK please provide your forecast for what Phase II will look like in the U.S. (i.e. when government restrictions start to be lifted). What will happen to the death rate and the spread? And will the sum of Phase I and Phase II in the U.S. be better or worse than what Sweden tried?
Or, in other words, what happens when the government decides to lift its “stay at home” orders at which time only a sliver of the population will have been exposed to the virus and a vaccine is nowhere to be found? That’s what Phase II in the U.S. is all about.
If the death rate is say 1% then you should multiply the “deaths/million” number by 100 to get the fraction infected per million (with a lag of a few weeks).
So when one says Sweden is 7th worst in Europe, another way to say it is they have the 7th most people immune to the virus. And they did it with a smaller economic impact than anyone else.
As long as a) the health care system is not overloaded and b) a vaccine is not coming along in 1-2 years, deaths at a manageable pace are a good sign because it means more immunity is being built up. Everywhere else that seems to be doing better is most likely just postponing those deaths for a month.
Interesting point. I have no idea how to achieve this, but isn’t the name of the game how do we get to herd immunity the quickest without overwhelming the health care system?
It would help to know the immigrant component of the Swedish data. Many certainly do not share the cultural characteristics of the native born. Immigrants may be as much as 20% of the population.
8. I’m not sure it’s possible to learn anything from Sweden based on current numbers. The potential benefits of their approach are a) they’re better positioned to avoid a 2nd wave of infections, and b) their results are not so catastrophically worse that they would have justified pumping obscene amounts of money into the economy in a desperate hope to keep it afloat. Neither of these can be evaluated now.
I would expect their numbers now to be worse than those countries that locked down. That doesn’t mean that their approach isn’t the correct one.
“Take anything Blanchard says, put a minus sign in front of it, and you have my view.”
ASK:Blanchard
Rand:Kant
(I’m somewhat certain that the animus goes deeper than just a rational disagreement over his models)
Re: No. 9 (Sweden)
I listened to the full interview of Sweden’s Chief Epidemiologist (Anders Tegnell). Here are telegraphic notes (paraphrases) of what I understood Tegnell to have said:
• Policy failure was localized to nursing homes (failure to protect the most vulnerable). Many reforms are needed in nursing homes. Nursing are mainly hospices; majority of residents enroll with six-months life expectancy. Almost half of Covid-19 deaths have been elderly residents of nursing homes. General reforms are needed to establish best practices and training at nursing homes. Testing lagged badly at nursing homes.
• Insufficient testing capacity was the 2nd major problem. Testing is still scarce. Strategic priorities for testing are 1) hospital and medical personnel, 2) residents and personnel at nursing homes, and 3) personnel in essential services.
• In order to ascertain distance to herd immunity, serological testing to establish prevalence of antibodies (prior infection) in populace will be necessary. Such testing isn’t there yet.
• School closures would de facto pull 20% of medical personnel away from hospitals because parents (including medical personnel) would have to stay home with children.
• Stringent measures might become necessary in remote towns.
• Sweden is halfway thru major wave of pandemic. Now seeing slowdown of contagion in Stockholm. One third of populace “has been involved” (exposed?). Summer probably will diminish contagion. But this virus, unlike SARS and MERS, won’t go away. Key will be to achieve original goal of shield or isolating the vulnerable (esp. those in elder care) much more effectively.
• Compared to the flu, this virus is deadly because it spreads widely and quickly, and because many get sick at same time; conditional on infection, death risk isn’t much greater than the flu if the individual receives timely care.
• Poll indicates 75% support Swedish approach, 20% want more attention to economy, and 5% want more stringent public-health measures.
• Skeptical of face masks (except in hospitals and nursing homes) because they tempt people who are symptomatic to go out with a mask instead of properly staying at home.
• Need stockpiles of PPE and other public-health readiness supplies, but the Regions and the State each want to saddle the other with responsibility for stockpiling. (Health care system is Regional in some important ways.)
The majority of people in Swedish nursing homes enter with a six month life expectancy? I am really looking forward to “excess death” figures for 2020 in a year or so.
Treating patients in the parking lot is a nice idea. Especially here in Canada where, if you care, it’s still winter. Canadian winter.
Lessons from Sweden:
1) if your government does nothing and you finally notice that you’re dying at four times the rate of your neighboring countries, you « voluntarily « distance yourself. Like the French and Russian soldiers who in 1917, after 3 years of slaughter for no victory, voluntarily shot their officers.
2) if you do nothing, yes the frail and elderly will die at four times the rate of your neighbors.
3) if you do nothing, yes the poor and the migrants will die at four times the rate of your neighbors. Who cares? It’s not as if there’s a refugee shortage nowadays.
4) if only people in the last 15 centuries had understood the miracle of herd immunity we would have been rid so easily of Tb, measles, smallpox, plague, cholera, yellow fever by the 1700’s without wasting our resources on those stupid medications and vaccines.