Nuking the Curve

There has been a lot of talk about ‘flattening the curve’ – slowing down the rate of growth of Wuflu so that it doesn’t overwhelm health system capacity.  like this:

But this is the wrong idea. You have to get R0 down close to 1.0 ( from around 3.0)  in order to really slow the growth –  ordinary influenza has an R0 of around 1.3 and  it grows way too rapidly.

Don’t aim at getting close to 1.0: aim at getting below. Basically, the region of parameter space that would correspond to ‘flattening the curve’ is tiny, and 90% of the way to a clear win.

There is no substitute for victory.

 

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89 Responses to Nuking the Curve

  1. NumberOneCustomer says:

    Eyeballing, the area under those curves looks basically the same.

    • Ken Smith says:

      Cases yes, deaths no. Good health care seems to have a huge impact on case fatality rates. When everybody who needs it gets good care, I suspect the CFR will be significantly less than 1%. Without health care, in an overwhelmed system, it will probably be closer to 4%. In the US, the difference between those two numbers could be millions of lives.

      • NumberOneCustomer says:

        Roger . I may have been a bit in my cups last night. But, also the Philly-vs-StLouis graph that’s been going around is death rates. But, I get that Dr Cochran was trying to communicate something different; and leaving something as an exercise to the audience.

      • NobobyExpectsThe... says:

        I dont know if 10k cases and 600 deaths is statistically significant yet, but Italy is already at 6%.

    • Harold says:

      The blue curve has more area.

    • cincodenada says:

      Yes, and that’s the point of the chart: both curves have roughly the same number of cases (area under the curve), because a huge portion of the population being exposed eventually is pretty much unavoidable at this point.

      The key is that in the blue curve, the peak number of cases active at one time is significantly lower. The death rate depends a lot on how well the health care system can cope with the load – without slowing things down, the number of cases active can exceed the capacity of the healthcare system, so more people die because we simply don’t have enough ventilators and facilities to treat them. That’s what’s happening in Italy right now.

      Flattening the curve makes it so that the cases are spread out more, so that there’s never more cases active at a given time than the system can handle (or at least, the system is less overtaxed at its worst)

      • gcochran9 says:

        The curve is not to scale: if it were, the demand curve, the number of people that will need respiratory therapy, would be 50 times higher than capacity. You have to beat the hell out of the epidemic to keep demand under capacity, move the R0 real close to 1.0 – and if you can do that, why not push it below 1.0?
        Most people in China are not going to catch it at the current rate : with luck and effort, they can stay locked down, or partly locked down, until an effective therapy or prevention is developed.

        We can too.

  2. steve sailer says:

    The key data out of Wuhan was that the massive knockdown had reduced R0 (R-Nought, I can’t figure out how to do a subscript 0) from a catastrophic figure over 3 to 0.3. If R nought is greater than 1 it spreads, if it is less than 1 it dies out. So, they are now talking about eliminating new cases of Wuhan flu in Wuhan by May. Here’s the preprint from last Friday:

    https://www.unz.com/isteve/stats-from-wuhan/

    Maybe the Chinese are just making up the data, I don’t know. But here’s some interesting evidence. Up until today, Grand Poobah Xi had only been sending disposable underlings to Wuhan. A few hours ago, Xi himself arrived in person in Wuhan.

    • gothamette says:

      I don’t think they are lying about numbers.

      I do think they might be lying about how this thing started. Wet market? Lab near Wuhan? Someone selling infected animals from the lab at the wet market?

      We still don’t know the intermediary species, which is a rather big deal.

      This could happen again – worse.

      • gothamette says:

        One of my takeaways from the article is that it undercuts the “it’s just another virus” crowd.

        My response to them is: right, we have lots of flu cases every year, lots of colds. It’s an every day occurrence. What if you get infected w/C19 and you have flu (or a simple cold)? You could be 25 and in the peak of health, and you’d be a goner.

      • mlamb0610 says:

        Stopping mass infection means we won’t get herd immunity. Wouldn’t we be dealing with another outbreak next year?

    • They can hardly make up the lack of deaths. If the spread had continued exponentially, there would be thousands of deaths every day now. So they’ve clearly reduced spread.

      (I guess they could have only pretended that hundreds were dying every day in February, and then make it seem like they stopped a rapid spread when it was really just slow linear growth or something from the start. But that seems way too elaborate and of questionable value. In general, death numbers are very reliable.)

      • Linear, Expo, or Nuked? says:

        Great, expo isn’t continuing for sure, but if they’re in linear growth right now, not actually nuking the curve, nor bending… what’s gonna happen when lockdown stops?

        And stop it must, whether by the will of the Chinese government, or by sheer defiance, or the black market.

  3. Ken Smith says:

    There are three strategies we can take, each with different tradeoffs:

    (1) China: nuke the curve.
    (2) Europe: flatten the curve.
    (3) Iran: hold my beer.

    South Korea seems to be somewhere between #1 and #2. The US, so far, seems to be somewhere between #2 and #3.

    #1 is obviously the best if you can make it work. I don’t know if the West can.

    #3 is obviously the worst – it’s not a strategy, it’s a lack of strategy. But it may have the benefit of getting the country through the epidemic and out the other side faster, this time with herd immunity. Iran will be putting together its shattered economy while the rest of us are still in lockdown.

    • ASR says:

      I agree entirely with Professor Cochrane’s analysis and your description of current policy responses to the new Corona virus. There’s no “rocket science” involved here. Most of responses of the world’s current leadership to the emerging pandemic have been fatally stupid. This suggests to me that the world desperately needs a new and entirely different type of leadership.

      • dearieme says:

        Pangolins?

      • gothamette says:

        The sad thing is, Trump started out sensibly but dropped the ball.

        • Difference Maker says:

          As soon as it reached Italy and South Korea, we knew that it would spread here in the US. That is because there is no willpower to do what must be done, what it takes to contain it in the initial stages.

          The left was already moaning about racism and overreaction, and Washington State and the Left Coast have a suspiciously high number of cases – no doubt in my mind the tech types demanding their international travel

        • Difference Maker says:

          As soon as it reached Italy and South Korea, we knew that it would spread here in the US. That is because there is no willpower to do what must be done, what it takes to contain it in the initial stages.

          The left was already moaning about racism and overreaction, and Washington State and the Left Coast have a suspiciously high number of cases – no doubt in my mind the tech types demanding their international travel

          • Difference Maker says:

            Ok, now that’s just mean. Many of the rank and file face worsening conditions from the excessive outsourcing and the like – it is the open borders mania of those states which is referred to

          • gothamette says:

            “. That is because there is no willpower to do what must be done, what it takes to contain it in the initial stages.”

            No, human societies are hierarchical, and the guy at the top is, for whatever reason, denying the facts that have been laid out here.

            Gregory Cochran should be advising the President – but even if he were, would Trump listen? The question answers itself.

            I actually think that Cuomo (NY State Governor) understands the situation. He’s deployed the National Guard in a “containment zone” in a part of New Rochelle. I don’t know what the situation is with respect to testing, though.

            • Difference Maker says:

              Since I could easily have become a millionaire over these weeks I will trust my judgment and beg to differ.

              Trump is the only big figure who pushed for the China travel quarantine. Schumer was busy moaning about its racism until circumstances made it prudent to delete the tweet. I think all that speaks for itself.

              if you cannot draw the correct conclusions then God help you. It is best to learn some humility

    • Coagulopath says:

      #3 is obviously the worst – it’s not a strategy, it’s a lack of strategy. But it may have the benefit of getting the country through the epidemic and out the other side faster, this time with herd immunity. Iran will be putting together its shattered economy while the rest of us are still in lockdown.

      Scott Alexander suggests that if a pandemic is going around and you KNOW you’re going to catch it, it’d be smart to deliberately infect yourself as soon as possible: that way you beat the rush and get medical care when it’s still available.

      But if lots of people start doing this, it won’t work: they’ll just accelerate the pandemic and collapse the medical system earlier than expected. It’s like leaving work early to avoid traffic: if everyone does it, they’ll recreate the traffic jams they hoped to avoid.

  4. It doesn’t really look like western governments are going to try and flatten, let alone nuke the curve. In Asia the engineers that run the country understand exponential functions; here, not so much.

    • David Chamberlin says:

      Understanding or not understanding exponential functions isn’t the reason Asia is flattening the curve so well and the west is screwing up. The two big reasons I see for the difference is 1)we aren’t scared enough yet and 2) lack of obedience to an autocratic government in the west. The USA has absolutely incompetent leadership at the head of CDC, so they probably don’t understand exponential functions but Europeans knew kinda sorta what to do but the people wouldn’t do it. In France they say “how can you rule a country with 200 kinds of cheese.” I love living in the west with our attitude most of the time, but now, it’s a BIG liability.

      But fear is mounting. In Italy the hospitals are already overloaded with 167 cases per one million people. https://www.worldometers.info/coronavirus/#countries That’s nuts. What are the hospitals going to be like when just 2 % of the population has Covid-19? We are going to see that, aren’t we. That by the way is a good link to check daily. Scroll down to confirmed cases by country to see new cases. It confirms exactly what Cochran is saying, if we don’t take extreme measures of social isolation like China, if we don’t test everybody like South Korea, we are going to be screwed like Iran.

      I’m 67 and I am planning on self isolating real soon. My one son manages a big office and says “we can’t work from home, we will lose 67% of our efficiency.” I just told him people will not come to work when the dry coughing starts among workmates and the government orders everyone to stay home. Better plan now as best as you can because it’s coming sooner than you think.

    • David Chamberlin says:

      “Hello class today we are going to learn about exponential functions.”
      reaction…snore and ignore
      “Hello class today you are going to learn stay in your goddamn house or you might die.”
      reaction… obey

      Something tells me the whole world will be playing musical chairs with hospital beds. Won’t that be fun?

  5. Boswald Bollocksworth says:

    The Taiwan Chinese and Hong Kongers are doing a good job. They’re wearing masks, so the sick people end up coughing into a mask, no into the environment.

    If we really wanted to keep people from getting sick we could. But it would take doing “weird” things like not eating out, working from home where possible, wearing masks in public, closing schools and letting the children be taught by wolves. Only have to be weird for about a year but that’s too much, instead a million people will die

  6. Michael says:

    “Eyeballing, the area under those curves looks basically the same.”

    Yes. That’s the point. Controlling for an equal number of patients, it’s best to space them out over a longer period so that the health care system is not overwhelmed, resulting in no treatment for some patients. Have100,000 hospitial beds? Keep the patients at any given time below 100,000. Have 10,000 respirators? Keep the number of patients needing them below 10,000.

    China actually had a two pronged strategy of flattening the curve and raising the capacity. They freed up capacity and built more capacity. And they did things like confiscate 80 percent of the output of a Japanese mask company’s Chinese factory output per a Japanese news interview the other night.

    Our host is not specific about how to nuke the curve, but I assume he means more severe and Draconian quarantines, movement restrictions, business shutdowns, and so forth.

  7. someguy says:

    I kind of liked/tolerated this guy but he fell for the fad too… :/ https://www.youtube.com/watch?v=Kas0tIxDvrg

  8. someguu says:

    Maybe OT – I don’t know how reliable this guy is but… https://youtu.be/HXW3-_qukSU

  9. gothamette says:

    But it’s just flu, according to the President. No one gets bent out of shape over that.

    When you have leadership like that, there’s no substitute for defeat.

    There really is a lot of resistance on the right to the idea that this thing is bad news – there are articles in the National Review apologizing for saying that C19 is not flu. If you recognize C19 as a potentially catastrophic disease, you are being disloyal to the President.

    It’s become a partisan, politicized issue. On the state level, it’s simple incompetence, I think. I think Cuomo has half a brain cell, but Dump Blasio is a total idiot. Literally good for nothing. A more able man (Koch, Bloomberg, Giuliani) would have been advocating for more tests the day that guy got sick in Westchester. He’s done nothing since except campaign for Bernie.

    The American people have been abandoned.

    • Rosenmops says:

      I don’t think it is political. A lot of right wing preppers are taking the virus very seriously and just ignoring Trump. I must say I am disappointed in Trump’s response.
      But at least Trump isn’t letting a steady stream of infected Iranians into the country, like Trudeau is. Trudeau is completely brainless.

      • gothamette says:

        It is certainly political in the US. The right wing preppers are always screaming the sky is falling. Mostly the scoffers are on the diehard Trump team. Someone at National Review actually had to apologize to his readers that he’s taking C19 seriously.

        Like every other human drama, politics makes strange bedfellows.

  10. gothamette says:

    How does the test for SARS-CoV differ from the test for SARS-CoV-2?

    • amac78 says:

      General answer to gothamette (I don’t know the coronavirus specifics) — There are two types of clincal-chemistry tests for pathogens: Directly test for the organism (in blood/sputum) or instead evaluate the patient’s antibodies against the pathogen (in blood).

      Direct tests usually use PCR that is set up with “primers” that are specific to the pathogen’s DNA or RNA. If you are currently infected, the test should be positive.

      The other approach is to check to see if the patient has (or has had) an immune reaction to the pathogen, which means that there are antibodies directed against pathogen proteins that are circulating in the patient’s blood. It takes some time from when the infection takes hold, until detectable amounts of these antibodies are circulating. For coronaviruses, that may be 10 to 20 days. This test should be positive if you are fighting a current infection, or if you have successfully fought off an infection. The test should be negative if you were only recently infected, or if you were never exposed.

      The idea is to pick reagents that are specific to the pathogen. For direct tests, PCR primers specific to SARS-CoV or to covid-19. For antibody tests, seek to report only those patient antibodies directed to SARS-CoV or to covid-19.

      Cross-reactivity is possible, especially for antibody-based tests. Since covid-19 is new, its tests have to be rush jobs, and problems like this are more likely.

      Singapore used an antibody test in its successful contact-tracing efforts in February.
      How Singapore Connected the Dots on Coronavirus, The Diplomat, 3/4/20.

      • gothamette says:

        Thank you for this info – very interesting.

        I interpret this to mean that you cannot use a SARS-CoV test for a SARS-CoV-2 infection.

        • amac78 says:

          Re: using a SARS-CoV test to detect a SARS-CoV-2 infection — I looked in the literature, and people have thought about intra-coronavirus cross-reactivity. The best review of SARS-CoV diagnostics is from 2005 (Mahony & Richardson), so it doesn’t cover covid-19, obviously. For immunoassays, the target S2 protein of the two strains is 99% identical, so cross-reactivity is likely high.

          For PCR assays, some primer pairs for SARS-CoV detect many other coronaviruses, so likely covid-19 as well. The paper’s Table 3 shows the performance of three commercial PCR tests for SARS-CoV; you can see they are sub-optimal under real-life conditions. It’s likely that relying on cross-reactivity will lower their numbers. But they might still be useful for covid-19; “the best is the enemy of the good.” I would expect that these and other kits have been tried in outbreak areas; perhaps there’s a report on that at bioRxiv.org (or in a Reddit thread).

          • gothamette says:

            By lucky chance after I posted my question there was a scientist talking about a SARS-CoV vaccine… we didn’t make one because “SARS” flamed out… said it would have worked against SARS-CoV-2’s “evolutionally conserved” segments….

            I think he said that, I was distracted while the interview was going on. Now, I think I can figure out what that means on a dumbass level, but I’d appreciate your interpretation.

            • amac78 says:

              Sorry, I don’t know much about vaccine development. Finding that your SARS-CoV vaccine candidate is also effective against covid-19 (or vice versa) would be a good thing, so that isn’t it.

  11. Did some basic SIR modeling:

    Total population 327 million, 1 starting infection. 12 day course of disease, initial R0 of 3.5 (as per the stats from China that Steve linked.) Assume 5% of cases are critical, 2% of those critical cases die with ICU care, 5% with general hospital care, and 50% with no care. 90,000 available ICU beds and 900,000 available hospital beds.

    Run this model through to completion and it sweeps through the population in about a year, infecting most everyone (less about 9 million who escape), killing 5.4 million.

    Now, suppose we impose infection controls on day 80, right about when there’s 1000 deaths from this thing. And then we vary how strong those controls are: from 0.35 (what the Chinese managed) up to nothin’ at all. I stuck some plots up here: https://arguablywrong.home.blog/2020/03/10/epidemiological-modeling/

    First one shows how the # of deaths varies with the strength of our controls. If we impose Chinese-style controls, we get away with only 5K deaths, or 1000-fold fewer than without the controls. But the inflection point isn’t just at 1.0. In particular if we can get the R0 below about 1.5 that gets us down under 500K, or a 10-fold reduction. At 1.0 we get down to about 50K.

    You can see what’s happening if you look at the second plot. The vertical line is when we impose controls, the horizontal lines are ICU bed capacity and total hospital bed capacity. Right below an R0 of 1.5, we dip the # of critical cases low enough that we never exceed hospital capacity. The trick here though is that until you get R0 below 1.0 you’re still sweeping through most of the population, just more slowly, slowly enough that the hospitals can handle it. And that means that, for example, if you get R0 to exactly 1.0 you have to keep those infection controls in place for ~5 years or else you’ll be back up close to 5million dead again.

    But yeah, there are benefits to lowering R0 even if you don’t manage to get it below 1.

    • Craken says:

      There is also an upside risk, in the form of possible new treatments/vaccines, to lowering R-nought significantly, but not below zero. So your longer projections are likely too pessimistic. But, it’s clearly far better to go sub-zero.
      If a country lets cases mount too much, they will also lose the capacity to do effective contact tracing–which is a technique the Chinese used heavily to turn the epidemic.
      Also: if the West submits to the deluge, how will it render any assistance to those incapable to resisting on their own. The West, so far, has chosen not to resist. Most of the Rest have no choice.

      • The other thing to keep in mind is that different countries are taking different strategies, one way or another. If you just give up and let the epidemic roll through, you’re losing a ton of people, but the epidemic’s over in a year or so, when there’s too few susceptible people to sustain it anymore. If you do real solid infection control the way the Chinese have done (and Singapore, Taiwan, and Hong Kong), you stomp it hard enough that you’re done in a year or so as well, with most of that time in the contact tracing regime where you’re stomping individual small outbreaks.

        If you take the plan of stretching it out as long as possible, you’re looking at ~5 years of time to let it sweep through the whole population. And if, say, China has successfully eradicated the virus in year 1, they are going to be pissed as hell if you reintroduce it back into their population in year 2. Plus 5 years of massive economic disruption is a lot worse than a couple of months followed by a year of outbreak containment.

        • gothamette says:

          Redo your numbers with a more reasonable R0 of 2.0.

          Trump’s speech was OK. He seems to have changed his tune that C19 is just flu.

          • Sure. Otherwise the same parameters as above; if you’ve got better suggestions, let me know.

            With no control measures, it sweeps through more slowly, with less load on the hospital system, so the total deaths drops to 2.8 million, but it takes 608 days instead of about a year.

            Control measures again get implemented when we hit 1000 deaths, but that’s now on day 174 instead of 80, again because of the slower spread. Getting down to an R0 of ~1.5 again drops us down low enough to avoid overloading the hospital system, dropping deaths down to ~400K. Getting all the way down to R0=1 drops us to 25K, and the further benefit is roughly logarithmic in the regime around R0=1, down to 2.5k dead at R0=0.35. Marginal benefit in terms of reduced deaths of additional reduction in spread is highest right above R0=1.5, and then right above 1.0.

            Total length of the epidemic spikes right around R0=1.0, and gets shorter drastically as the R0 comes down below that.

            Now, if your polity is wise and imposes controls when there’s fewer deaths, on day 130, when you’ve only got 30 deaths (i.e., nowish), you get better results, but only if you can contain the spread. Keeping it above 1.0 doesn’t benefit much, but 0.35 gets you down to ~80 total deaths, and 0.75 to ~150. Even just under 1.0 keeps you under 2.5K deaths. Sooner is better, especially if you can actually control the disease.

            • gothamette says:

              With no control measures, it sweeps through more slowly, with less load on the hospital system, so the total deaths drops to 2.8 million, but it takes 608 days instead of about a year.

              Ugh. Unacceptable.

              Need to nuke this curve, yes.

            • gothamette says:

              Two days ago NYC had 46 cases.

              Today, 62.

              By your algorithm, where will we be in one week? Month?

    • Freddy says:

      this is very interesting (though disheartening), thank you. Is there a way I can look at your code/model?

      • In Python (2.7):

         
        
        from __future__ import division, absolute_import, print_function
        import numpy as np
        import matplotlib.pyplot as plt
        from collections import namedtuple
        
        PopState = namedtuple("PopState", ["day", "susceptible", "infected", "dead", "recovered"])
        EpiParams = namedtuple("EpiParams", [
            "days_infected", 
            "infection_rate", 
            "frac_critical", 
            "frac_dead_icu",
            "frac_dead_hospital",
            "frac_dead_home",
            "start_day",
            "controlled_infection_rate",
        ])
        
        ICU_BEDS = 90000
        HOSPITAL_BEDS = 900000
        
        def update_state(state, params):
            day = state.day
            S = state.susceptible
            I = state.infected
            D = state.dead
            R = state.recovered
            N = S + I + D + R
            
            if day == params.start_day:
                print("State on transition:")
                print(state)
            
            days_betw_contacts = params.days_infected / params.infection_rate
            if day >= params.start_day:
                days_betw_contacts = params.days_infected / params.controlled_infection_rate
            
            new_infections = (I * S) / (N * days_betw_contacts)
            recovered_infections = (I / params.days_infected) * (1 - params.frac_critical)
        
            # For critical cases, we split into ICU, hospital, and home care, in descending order
            C = I * params.frac_critical;
            C_icu = min(C, ICU_BEDS);
            C_hospital = 0 if C < ICU_BEDS else min(C - ICU_BEDS, HOSPITAL_BEDS)
            C_home = 0 if C = 1:
                state = update_state(state, params)
                infections.append(state.infected)
                deaths.append(state.dead)
            return infections, deaths, state
        
        total_population = 327 * 1e6
        init_state = PopState(
            day=1,
            susceptible=total_population - 1, 
            infected=1, 
            dead=0, 
            recovered=0)
        params = EpiParams(
            days_infected=12, 
            infection_rate=3.5, 
            frac_critical=0.05, 
            frac_dead_icu=0.02,
            frac_dead_hospital=0.05,
            frac_dead_home=0.5,
            start_day=79,
            # Modify this parameter to vary the strength of infection controls
            controlled_infection_rate=3.5,
        )
        
        infections_over_time, deaths_over_time, final_state = run_model(init_state, test_params)
        
        
        • Sorry, cut off some of the code there. Here’s the whole thing:

          
          PopState = namedtuple("PopState", ["day", "susceptible", "infected", "dead", "recovered"])
          EpiParams = namedtuple("EpiParams", [
              "days_infected", 
              "infection_rate", 
              "frac_critical", 
              "frac_dead_icu",
              "frac_dead_hospital",
              "frac_dead_home",
              "start_day",
              "controlled_infection_rate",
          ])
          
          ICU_BEDS = 90000
          HOSPITAL_BEDS = 900000
          
          def update_state(state, params):
              day = state.day
              S = state.susceptible
              I = state.infected
              D = state.dead
              R = state.recovered
              N = S + I + D + R
              
              if day == params.start_day:
                  print("State on transition:")
                  print(state)
              
              days_betw_contacts = params.days_infected / params.infection_rate
              if day >= params.start_day:
                  days_betw_contacts = params.days_infected / params.controlled_infection_rate
              
              new_infections = (I * S) / (N * days_betw_contacts)
              recovered_infections = (I / params.days_infected) * (1 - params.frac_critical)
          
              # For critical cases, we split into ICU, hospital, and home care, in descending order
              C = I * params.frac_critical;
              C_icu = min(C, ICU_BEDS);
              C_hospital = 0 if C < ICU_BEDS else min(C - ICU_BEDS, HOSPITAL_BEDS)
              C_home = 0 if C = 1:
                  state = update_state(state, params)
                  infections.append(state.infected)
                  deaths.append(state.dead)
              return infections, deaths, state
          
          total_population = 327 * 1e6
          init_state = PopState(
              day=1,
              susceptible=total_population - 1, 
              infected=1, 
              dead=0, 
              recovered=0)
          params = EpiParams(
              days_infected=12, 
              infection_rate=3.5, 
              frac_critical=0.05, 
              frac_dead_icu=0.02,
              frac_dead_hospital=0.05,
              frac_dead_home=0.5,
              start_day=79,
              # Modify this parameter to vary the strength of infection controls
              controlled_infection_rate=3.5,
          )
          
          infections_over_time, deaths_over_time, final_state = run_model(init_state, test_params)
          
    • gothamette says:

      “R0 of 3.5”

      Why so high?

    • kpkinsunnyphiladelphia says:

      Arguably wrong, what would happen to the model if, say, we get a vaccine that works by, say, day 365? or day 480, particularly if we start right away with people over 70 and those with immune compromised system.?

      • Depends on the control measures you’ve put in and how many people you can vaccinate daily. You’d basically be adding another term that moves people from the “susceptible” to the “recovered” bucket without being infected. With an uncontrolled epidemic, a year from now is way too late; the disease will have mostly run its course by then. If you’ve banked on “flattening the curve”, the disease will be spreading more slowly and you might have a chance of being useful. I wouldn’t want to depend on it, though.

  12. Smithie says:

    Nuking the curve―space―no substitute for victory.
    win.

    Okay, you’ve won over my support for Project Orion, but what annoys me is that I can’t figure out who your confederate was that primed me.

  13. Rob says:

    I was wondering about whether Cfluwu is essentially a vector-borne disease. People can walk around infectious for weeks before they get symptoms. Children don’t develop symptoms, so they don’t stay home. If they shed significant virus, then they are essentially a vector. Malaria doesn’t make mosquitos sick, and it spreads just fine. What’s the evolutionary pressure for Cfluwu to get less virulent?

    It just jumped to people, so maybe it hasn’t adapted well yet, and maybe strains that get people sicker faster have an advantage? Maybe it’s under pressure to make children sick, so they spread the virus even better? But then they’d stay home, and that strain might not actually spread better.

    Is there any chance that less deadly strains will have an evolutionary advantage and provide cross-immunity with more virulent strains? Is it actually under pressure to get more virulent?

    Seems like an important thing to know.

  14. dearieme says:

    “the infection fatality rate. Currently, these estimates range from 0.5% to 0.94% indicating that COVID-19 is about 10 to 20 times as deadly as seasonal influenza” The S Koreans have been testing so hard that it’s possible that they’ve tested almost everyone infected: their figure for case fatality rate is (I read) is 0.7%, which agrees pretty well with the prediction.

    Mind you, the Koreans have probably kept the infection rate low enough that they can treat the victims in hospital. Most (all?) western countries will fail to achieve this, I dare say.

    https://themoderatevoice.com/how-big-will-the-coronavirus-epidemic-be-an-epidemiologist-updates-his-concerns/amp/

    • David Chamberlin says:

      The average age of those religious wackos in South Korea that caught Covid 19 is young. The average age of those that died in Italy is really old. Look at these numbers to confirm the huge variation in mortality rate by age. https://www.worldometers.info/coronavirus/coronavirus-age-sex-demographics/

      Having said that, you are right. The mortality rate drops down considerably when everybody that should get tested does get tested.

    • David Chamberlin says:

      This link is a detailed medical mouthful https://www.youtube.com/watch?v=U7F1cnWup9M but it may very well be a big part of the reason China and South Korea are doing so well in their battles to both fight the spread of Covid-19 and limit the mortality rate lately. The combination of chloroquine and zinc seems to be working (not blind tested so no proof!) to limit Covid-19 from being flu like, 80% of the time, into a killer.

      I’ve long contended the big difference between the long term results of the 1918Spanish Flu and Covid-19 will be 102 years of medical progress that has occurred between the two. The incredibly ingenious world wide medical community may not mass produce a vaccine that comes to the rescue in time but If this works, it is great news.

      • David Chamberlin says:

        Correction. a combination of zinc and chloroquine seems to be working to limit the ability of Covid-19 to spread within our cells. the reason why is within the link provided.

  15. Pingback: Crushing the Coronavirus Curve | Libertarian Party of Alabama Unofficial

  16. Pingback: Crushing the Coronavirus Curve - Libertarian Guide

  17. Pingback: Crushing the Coronavirus Curve – R3publicans

  18. uhoh says:

    I’d be curious to know what everyone here’s estimate of the eventual number of deaths is. Saya we restrict to 2020 US deaths, and to within an order of magnitude. I think 10k-100k sounds about right.

    • David Chamberlin says:

      Huge variation in outcomes depending on factors we don’t yet know the outcome of. No sense in estimating yet.

    • uhoh says:

      The unknown factors are what makes it a fun exercise!

      • David Chamberlin says:

        I’m with you on that. Fascinating, like watching history on fast forward. But I have a huge high side on that possible death total of yours factoring in percentages infected and mortality rate BUT….. I think modern medicine can come to the rescue, I just don’t know how, or when.

  19. MEH 0910 says:

  20. Gord Marsden says:

    In the great scheme of evolution this won’t even leave a mark

  21. Difference Maker says:

    btw I have not seen anywhere Trump claimed “it’s just the flu” nor will I deign to spend time on it. In the very first press conference he mentioned the deaths from flu * and I took it ominously as a bad sign, indeed, he knew that the spread was uncontained and unknown and that things were looking dark.

    Whoever claiming otherwise looks like another case of autism, or TDS

    • Difference Maker says:

      In fact it was the other side that was shrieking “it’s just the flu” now that I think of it. Lol! The political games within political games

  22. Pingback: The Time Of The Golden Agers | The Z Blog

  23. archandsuperior says:

    Point of clarification, what do you mean by “regular influenza grows way too rapidly?” As in it overwhelms available health infrastructure if the strain is particularly bad, or as in it spreads so quickly that it is endemic?

    • gcochran9 says:

      Flu grows rapidly enough that it can saturate the available, susceptible population in a time frame of no more than months. Since, with coronavirus, nobody has prior immunity, and since sends way more people into the ICU than influenza, letting it grow at the rate of influenza leads to mass death.

  24. SR says:

    Greg, what is your take on Michael Osterholm’s take on COVID-19?

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