It's wild that California has been locked down for a full month and the reproduction number is still hovering around 1 and even went up a couple of days ago.
If that's actually true, we shouldn't expect to see a quick decrease in cases and we probably aren't on track to end the lockdown any time before at least June. I can't help but wondering if the unlimited outside time under the guise of "exercise", but which people are clearly taking advantage of by going to hang out with friends in the park, has anything to do with it. Or perhaps it's the lack of masks in indoor areas like grocery stores that has prevented a bigger drop (in SF, only starting today has that finally changed).
For all that California has been praised for acting quickly, it still feels like we've really been slow playing this lockdown by being so lenient, and without really having gained anything. And it doesn't really seem like there's any urgency anymore around continuing to increase testing, even though we know that's needed to open back up. Now we're going to be stuck inside for weeks or months longer than we would have needed to be if we had just copied what successful countries (Taiwan, South Korea) did from the beginning.
> I can't help but wondering if the unlimited outside time under the guise of "exercise", but which people are clearly taking advantage of by going to hang out with friends in the park, has anything to do with it. Or perhaps it's the lack of masks in indoor areas like grocery stores that has prevented a bigger drop (in SF, only starting today has that finally changed).
Unlikely to both. Outdoor transmission is rare and I'd question if grocery store transmission (with heavy amounts of social distancing) is common given other countries historically being able to trace the majority of covid infection sources.
First off, as you allude to lockdowns are less effective than you think - we managed in norcal to drop from 1.43 to 0.98 (https://www.medrxiv.org/content/10.1101/2020.04.12.20062943v...). Which is really good (uncontained to contained) in one sense, but shows you how slow containment is.
The containment difficulties lie in:
1. Household transmission still takes place after lockdown.
2. Huge variances within population sub-groups. R within folks with little human contact (WFH, etc.) was probably barely above 1 before the lockdown -- essential workers with heavy human contact already had the highest R and because they are still working (i.e. not really locked down), still have an R > 1 for quite some time.
3. Essential workers tend to live with other essential workers -- creating a multiple generation transmission chain (#1 and #2)
4. Group living outbreaks (symptoms of #3). e.g. in Santa Clara county, nursing homes are becoming a larger percentage of new cases over time. Something like 20% of new cases in the last 2 weeks. A single homeless shelter in SF is responsible for 20% of cases in the last 2 weeks.
5. At some point, you just are going to reach some level of herd immunity within the most susceptible groups -- in a sense the lockdown is more of a quarantining of a large percent of the population and letting everyone else get herd immunity.
CA definitely has high urgency in increasing testing - honestly, if you just hired a bunch of people to contact trace, you could probably go back to the March 15 pre-SIP world now.
All good points, I’ve wondered about the differences between different groups as well as far as herd immunity. Haven’t heard it discussed much, maybe because it’s super problematic to explicitly call that a plan - let’s let the working class all get it, and then everyone else can go back to normal.
How was the reproductive rate 1.5 before the lockdown though? The latest estimates I’ve seen put R0 at 5.7.
R0 is before interventions AND is environmentally related. Wuhan & NYC covid has way higher R0 than California Covid because of higher density/public transit usage. Additionally, effective R was already well below R0 by the first week of march (pre-lockdown) because of heavy (mostly voluntary) measures already in place. (WFH, more washing of hands, avoidance of mass gatherings, etc.)
Finally, I'm speaking a bit tongue-in-cheek calling it the "essential worker herd immunity plan". I doubt public health officials, rushing to do something, explicitly realized this would happen -- but with a bit of thought [1], it was a pretty expected outcome. [sort of how nursing home outbreaks occurring when we didn't - and still don't -- quarantine employee or give them heavy PPE was expected)
[1] It's pretty unfortunate there isn't a public or academic comment period to evaluate the SIP orders (after issuance) and almost no useful data being given about cases. There's a lot that doesn't make a lot of sense -- important restrictions missing and unnecessary restrictions present. My biggest pet peeve is allowing babysitters to come to any workers' houses, but it being disallowed to send your kid to a babbysitter's house, when adults are more likely to transmit than children.
His source data for California is almost certainly wrong. If you go look at it in the csv its got a bunch of repeats and obvious gorp.
The data assumptions in the model itself is questionable; as someone pointed out below, he's basically modeling the generating process involved in giving people tests (put a different way: the spread of test availability). Which is pretty useless. For myself I wouldn't have gone through the trouble he did to make it more sciencey looking; exponential smoothing and sqrt(n) would give you virtually the same picture.
At the same time other countries like Belarus have done nothing and haven’t done worse than CA. Or consider Sweden has ~81% of the rate of COVID per capita as the UK and has ~65% of the death per capita as the UK but no lockdown.
Edit. I don’t mean to go against the prevailing opinions but it seems like something that merits more research. There’s a lot we don’t know about this virus.
TL;DW: Preventing transmission in the long term is impossible and the actual fatality rate is likely on the order of 0.1%, so general lockdowns are pointless and being driven mostly by political considerations (something must be done and this is something). Just protect the elderly and weak.
> actual fatality rate is likely on the order of 0.1%
This is ludicrously optimistic. The virus has already killed over 0.1% of the entire population of New York City, and it's barely starting to wind down (i.e. will probably hit 0.2%). It's also approaching 0.1% of the entire populations of several of the hardest hit areas across the US (Bergen County, NJ; Chelsea, MA; Orleans Parish, NJ), with the most optimistic antibody and random sampling studies suggesting no more than one-third of the total populations infected at this point.
Some of the most reasonably optimistic numbers that are being bandied about nowadays are three to four times higher than that (0.3-0.4%), though I think the majority of the evidence points to a range more like 0.5-1.0%.
His thinking is that a) fatalities are on the order of 0.1% (might be 2-3x higher) and that b) 50% of the population of the UK, Sweden and (presumably) NYC is already infected.
I agree that this seems overly optimistic, but the high end of that range seems plausible in light of the figures we're seeing, no? That is, if we're at 0.1% fatalities at (say) 25% infected, then that would imply 0.2% at 50%.
The current estimate is that 2/3rds of deaths "due to" C19 are just people who would have died anyway dying a little early.
The relevant number is excess deaths due to C19, which are hard to estimate during a pandemic. That will be much lower than these numbers being reported.
Agreed. The Swedish doctor was throwing around speculative numbers (e.g., 50% of UK and Sweden have already been infected) with absolutely no data or references to back it up. I find it hard to believe that he can be taken seriously by anyone.
UK was slow to lockdown and currently has the fastest-rising death counts in Europe, so they're probably not the best comparison. Sweden has several multiples of the per capita death rates of its Scandivanian neighbors, and it's growing faster than many other European countries (passed Switzerland's total death count yesterday and will probably pass its per capita count tomorrow).
It's still possible it will look wiser in the long-term, but it certainly doesn't so far.
Don't forget the effect of voluntary lockdown. Looking at the Google mobility data for Belarus and Sweden suggests there is a lot of self-isolation going on.
Sweden has a higher per capita death rate than the US, for a different comparison. And the president of Belarus said on Monday that "No one will die of coronavirus in our country. I publicly declare this". He is the first and only president of Belarus and has been in power for 26 years.
It’s crazy that things aren’t getting more out of control in Sweden. I guess we’ll see if it’s just early or if they continue to be fine over the next month and beyond.
1. The symmetrical curve in some of the influential models is so wildly unhelpful from a policy+PR perspective. It's so far from what is likely to happen.
2. There's some thought that one of China's most impactful moves was moving confirmed cases to dedicated quarantine centers, so they don't infect household members. Household transmission is huge - so reducing that number will reduce the scope and length of the epidemic.
I don't know about California, but around me, not sure the social mixing is primarily outdoors. A decent number of people are still going over to friends' houses, taking kids on play dates, etc. Granted, far fewer than a month ago, but people aren't all staying in their own homes.
Especially in places who have not had a significant impact as of yet, I expect compliance with the lockdown to wane as we go forward. To use Oregon as an example, it is definitely plateaued and looks like it's slipping a bit. Probably because out of 4 million people we're only seeing perhaps 5 deaths a day from COVID19, and it doesn't seem to be increasing.
It doesn't help that we have a weak governor and nothing even resembling a plan. So people are starting to make their own judgement call and going about their business. I see a noticeable increase in the number of people having gatherings of friends & family at their home.
I speculate that everywhere in the US will see slight increases currently due to Easter weekend, regardless of shuts downs and mandated distancing. It didn't stop everyone from church going or visiting family.
Or may be the infection is already so widespread as some studies suggest that any observed changes is just a noise and all the lockdowns/etc. don't affect it much. Sweden for example isn't that different despite different approach.
Without wide testing we don't really know and are just blindly drifting along the 5 stage model - denial, anger (that is lockdown), and now we're moving onto the negotiating with all that conditional reopening. It is pretty telling that anger to negotiating stages change is happening without improvement of the real situation.
Those are the numbers https://www.statista.com/statistics/1104709/coronavirus-deat... . The whole Europe and US have the highest deaths per capita in the world. Comparing to the peers - Western Europe - Sweden is midway in the list (and just above US) pretty much evidencing the point that whatever actions have been taken in all those countries it just doesn't seem to matter much.
> Sweden is midway in the list (and just above US) pretty much evidencing the point
Sweden is surely not "midway in the list" unless in an imaginary world where one thinks that all European countries fit on the accidental 13-item (!) part of the whole list of the Statista site.
Try it again but with the list of all European countries and considering the actual values and let me know if that "point" still exists. Especially when adding the countries which were able to do more testing than Sweden and introduced at least a bit stronger measures. E.g. Austria is comparable to Sweden in size, was potentially significantly more exposed in the begin, bordering Italy, and having three times less deaths per capita at the moment.
Moreover, people also mention Sweden as an example of "different" but in Sweden the Universities are also closed and everybody who can works from home too. The difference in "appearance" exists, but also among how much testing is being done and what is reported.
Many people are commenting from an American perspective, where "universities closed and everybody who can works from home" is the post-lockdown state we're trying to get to. American schools and universities end their academic year between mid May and early June, so we probably won't be sending people back to school until the fall term starts.
>Sweden is surely not "midway in the list" unless in an imaginary world where one thinks that all European countries fit on the accidental 13-item (!) part of the whole list of the Statista site.
Sweden peers are the old EU-15 plus Switzerland and Norway (i.e. Europe excluding the former Eastern Bloc countries). That makes the Sweden's 8th position in the list exactly the middle.
>Try it again but with the list of all European countries
you sure wouldn't think that Poland, Albania, Russia or Ukraine are the peer countries to compare Sweden with?
Sweden is currently 11th in deaths per capita, as everybody can see.
The only ones worse in the world currently are: San Marino, Belgium, Andorra, Spain, Italy, France, UK, Netherlands, Sint Maarten and Switzerland. From these, San Marino has 30K citizens, Andorra 70K, Sint Marteen 40K, so these three are practically irrelevant and misleading to compare.
So the only "real" (in size) countries in the whole world currently reported worse than Sweden are:
Belgium, Spain, Italy, France, UK, Netherlands and Switzerland.
How is that some "middle"? Note that specifically UK, Netherlands and Switzerland had longer bet on "herd immunity building, avoid other measures" than the rest of Europe. And I guess Belgium was just as incompetent as years before, having for years no government.
If anything, it is a good evidence of lockdowns working.
The need for social distancing isn't going to diminish until there's herd immunity, whether through exposure or vaccination. That's at least one and possibly several years out. We're going to need to settle on distancing measures we can actually sustain for those years. Masks in grocery stores are part of that. Wiping the live entertainment industry off the face of the earth is part of that (sadly). Cold turkey on every form of IRL socialization isn't.
If that's actually true, we shouldn't expect to see a quick decrease in cases and we probably aren't on track to end the lockdown any time before at least June. I can't help but wondering if the unlimited outside time under the guise of "exercise", but which people are clearly taking advantage of by going to hang out with friends in the park, has anything to do with it. Or perhaps it's the lack of masks in indoor areas like grocery stores that has prevented a bigger drop (in SF, only starting today has that finally changed).
For all that California has been praised for acting quickly, it still feels like we've really been slow playing this lockdown by being so lenient, and without really having gained anything. And it doesn't really seem like there's any urgency anymore around continuing to increase testing, even though we know that's needed to open back up. Now we're going to be stuck inside for weeks or months longer than we would have needed to be if we had just copied what successful countries (Taiwan, South Korea) did from the beginning.