Accurate Coronavirus Information
What's Likely to Happen, What to Do

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Bottom line: The best way to reduce US death rates now is immediate complete physical distancing.
Don't touch anyone but your partner, or people you are caretaking. Don't get within six feet of anyone else without wearing a bandana. If you have masks—donate them to your local hospital or clinic to keep health care workers at work).

Details and rationale below—

 

Curated information on the pandemic and what to do. Last updated April 4th, 2020; planning to update this so long as the pandemic lasts.

On this page:

 

 


 

"Information hygiene"

Avoid contracting or spreading the pandemic of misinformation about Covid 19. The useful, accurate information below has been carefully curated, and sanitized of misinformation.

List of popular false information and true facts from a group of researchers in Canada

What it took to contain the pandemic in China

For the first time in human history, an exponentially surging epidemic with community spread was reversed, in China (for now).

This was thought to be impossible. With the following aggressive approach, they got from 3,400 new infections per day January 2020, to just 24 new infections on March 11th, 2020:

  1. Universal temperature checkson boarding a train, entering a store, going back into your apartment building...
  2. On high temp, immediate conveyance to a fever clinic—attached to but separate from hospitals, then
    1. a technician in full-body suit takes your temperature, asks about symptoms, exposure
    2. tests white blood cell count, flu test that gives results in minutes. if negative
    3. puts you in a CT scanner as part of never before seen industrial-"scale, rapid CT scanning (200 scans a day per portable scanner, vs 30-60 min per super expensive scan in the US.
  3. if you have corona virus, you are immediately quarantinedno going back to home or office, just grouped with hundreds of others of your same age, gender and severity of symptoms. There is no home isolation. They found that 75-80% of infections were in family clusters; so for the good of their own family and society, there's no parents visiting kids, kids visiting parents--total lockdown until the symptoms pass.

Summarized from NYT daily podcast "Confronting a Pandemic," March 12 2020. Interestingly, this worked even though I've later learned that airport-style temperature checking can miss around 1/3 of cases, as well as have false positives, and that the Coronavirus test the Chinese use has similar low accuracy. Perhaps the overall zeal and sheer volume of testing and repeat testing makes up for these shortcomings? Hard to replicate keys to this success: an authoritarian state; compliant population that is OK with basically being nabbed off the street and sent straight to quarantine; and owning the world's production systems for things like thermometers, masks, and portable CT scanners.

Italy's warning from the future—a week or two ahead of the US

Like the US, Italy was initially sanguine about the pandemic. They tinkered around the edges; then banned large gatherings, closed schools... dust they were resistant to social distancing, disruption of commerce or daily life, wanted sick people to stay at home. Then the pandemic went into exponential, daily explosion. Hospitals were swamped doctors had to choose who to give ventilators to and who to let die. Every business that was not a grocery store or pharmacy is closed. A country of 60 million people is on total, border to border lockdown.

Life as we have known it is about to be upended in the US

It's possible it could be worse in the US than Italy.

Two days after Italy shut most of its economy down, in the US the headlines were "Trump defiant on testing and handshakes even as third Mar-a-Lago case emerges" and "Coronavirus is shutting down American life as states try to battle outbreak"

The US has the lowest rate of testing of any industrialized nation. In Santa Barbara County, only six tests had been done as of 3/12/2020 (15 as of 3/15/2020; one positive, six awaiting results). The combined testing capacity for Santa Barbara, Ventura, and San Luis Obispo Counties at this time was 42 tests per day.

Years of wealth extraction from the health care system have left us with barely any more ventilators and hospital beds than were already in use before the pandemic in this active flu season. In Santa Barbara County, we may need several thousand intensive care beds, and we have several dozen, and this is a wealthy area.

Wealth extraction and concentration have left the social safety net thin and frayed.

The main risk of the coronavirus outbreak isn’t that you’re going to get sick and die, it’s that so many people are going to get sick so quickly that our healthcare services and infrastructure are going to be completely overwhelmed, with lots of collateral damage.

 

From the excellent article Coronavirus will radically alter the U.S, 3/19/2020:

What happens next in this pandemic depends largely on our government, health institutions and 327 million inhabitants — all making tiny decisions on a daily basis with outsized consequences for our collective future.

When Jason Christie, chief of pulmonary medicine at Penn Medicine, got projections on how many coronavirus patients might soon be flocking to his Philadelphia hospital, he said he felt physically ill. They saw how quickly the surge would overwhelm the system, forcing doctors to make impossible choices — which patients would get ventilators and beds, and which would die. “They were terrified. And that was the best-case scenario.”'

The black dashed line in the graph below is the supply of critical care beds in the US, vs demand curves for there scenarios; No suppression (brown, 2.2 million deaths); closing schools and general physical distancing (green, the track we are on currently, 1.1 million deaths); isolating infected cases, which implies testing, (purple, 500,000 deaths). Note that "flattening the curve" also spreads it out to not a few weeks of disruption, but disruption continuing until there is a vaccine, which could be a year or more.

 

 

What to do to

We have to flatten the curve for the rate of new infections vs time, so health care resources don't get overloaded all at once. (The death rate is almost ten times greater when the health care system is overloaded; 0.5% vs 4-5%)

 

Philadelphia did not cancel a parade in the 1918 flu epidemic, St. Louis did:

 

Bay Area is Flattening the Curve Early data indicates effectiveness of Shelter in Place

Suggested alert for your area:

ALERT: shelter in place and physical distancing required for pandemic safety. Stay >6’ from all but partner, your small children. If closer contact is required for essential work, cover face with bandana. Donate gloves, goggles, all but one or two N95 masks to hospital or clinic. This is working to save lives elsewhere. Practice distance socializing for mental health and community cohesiveness.

Act like an increasingly crazy germaphobe ahead of the infection curve

 

Now is the time to physically distance from people you love to protect them.

Handwash effectiveness...darker= better

 

NYT daily podcast "Learning to Live with Coronavirus," March 14, 2020

The coronavirus is killing far more men than women "we’re seeing another concerning trend, that the mortality in males seem to be twice in every age group of females"

 

'Distance Socializing' and other ways to stay as healthy and balanced as possible

The only way to stay ahead of the curve is to reboot your brain in exponential pandemic mode

Our brains are wired for linear change; things drift, you make a change, then you don't have to pay attention for a while. That's not what's happening.

In an exponential situation, it seems like nothing is really happening for a long time, then maybe something, than wham! every day is a totally different deal than the day before. Gathering of under 250 people are OK, then 50, then 10 people a few days later, and then as close as you can get to zero. Then, the storm will pass, and we'll come out blinking in a different world.

If exponential change is what you expect, you will a) not be surprised, and b) be able to get ahead of the curve, help flatten it, stay within the capacity of the health care system, and reduce mortality by almost 10x.

 

 

 

Parameter Regular mode Pandemic mode
Physical connection Engage in healthy social touch Act like a crazy (but effective) germaphobe; no hand shaking, no hugging, except with people in your innermost circle, until unless they or you become infected
Emotional connection Regular level connection Connect extra deeply and authentically
Handwashing Save water, soap, and paper towels Remove all virus possible
Travel, events Live it up Withdraw physically, reach out digitally
Mental model of change Linear Exponential

 

What does keeping ahead of the exponential curve look like?

After a long, quiet incubation period, suddenly every day what makes sense is dramatically different than the day before, or the day after. With actual cases doubling about every 3 days, timely action makes all the difference:

instead of 10 Million cases in the United States if we wait 30 days, if we act 18 days sooner, we will have only 160,000 cases

Norway acted now, because it’s less economic impact to take drastic measures early than to do them later, and it saves a lot of lives and suffering by doing so. And Norway has only one confirmed death as of this writing.

Physical distancing must be ahead of the actual cases curve, which means being a week or so ahead of the reported cases curve:

 

Here's what my days are like:

Date # reported cases in Santa Barbara County/ tests Physical distancing effort Pandemic mode
March 6 0 cases/
? tests
50% Level 0-life as usual; with one more crisis that isn't discernibly affecting me. Last community dance with 50+ people, hugged, shook hands, and made PSA about handwashing technique and get ready. Barely washing hands after using bathroom.
March 11 0 cases/
? tests
75% Level 1–dress rehearsal; practicing really washing hands, physical distancing, elbow bumps. Wondering if we should get more food, washing hands 15 x a day.
March 12 0 cases/
7 tests
80% Level 2–preparation; buying last of food, soap, disinfectant, medicine; discussing plans with housemates, checking on family and friends, sounding the alarm in earnest. Washing hands 20 x a day, sometimes right after I just washed them, when I may have touched something some one else touched. Meeting 3 feet away from at risk (but still healthy) people we're checking on. No touching even with elbow. Lots of explaining. Touch of panic, able to push it back.
March 15 1 case/
15 tests
90% Level 3–cocooning; hunkering down with immediate family and housemates. After going to the market for possibly the last time in 3 weeks, took off "around people" clothes and wallet and put them in a designated drawer, washed hands, showered, and wiped down phone with alcohol. Took two long walks in the fresh air with my partner; video chat with far away family. Trying to wrap my mind around these changes, and imagine what life will be like in a week.
March 16 2 cases/
25 tests
95% Level 4–physical isolation; Setting up so we can split the house in two in case some of the four of us get sick. Not going around others physically at all. Exercising in the fresh air far from people, communicating for hours with friends and family remotely.
      —I am guessing from here on out—
March 26 1,000 cases 98% Level 5–physical isolation between people with and without virus in same house; Separate bedrooms, bathroom, and provisional cooking facilities; mask on when interacting, constant online re-assurance of others, gratitude that water and power are still working.
June 21 200,000 cases 75% Level 1–post-pandemic; people coming out of physical isolation to meet in person again at last, and cope with worldwide economic recession, hopefully more galvanized to at last effectively deal with climate disruption, a far greater threat than the coronavirus pandemic.

Transmission

Is stealth transmission a thing?

Not clear.

On the one hand, there's this:

In Wuhan, where testing became widespread and more than seventy-two thousand coronavirus cases were identified, just one per cent never developed symptoms.

 

Aboard the Diamond Princess cruise ship, where, following an outbreak, more than three thousand passengers and crew were quarantined and tested—allowing one of the most complete evaluations of any affected population—six hundred and thirty-four people proved to have the virus. Most had no symptoms at the time of testing, but they proved to be pre-symptomatic: over several days, they developed recognizable signs of the disease. Just eighteen per cent were persistently asymptomatic.

We know that people are less contagious while they have no symptoms, but not how much less. The success that Hong Kong and Singapore achieved by screening for people with fever- or flu-like symptoms suggests that the risk of asymptomatic contagion could be much lower than we thought.

 

On the other hand:

'Stealth transmission’ responsible for vast majority of cases, study says The explosive spread of the coronavirus in Wuhan, China, was driven by people whose disease was never diagnosed, a new study has found, suggesting that people with symptoms so mild that they may not have known they were sick unwittingly spread disease in China and ultimately around the world.

How do you tell if you have coronavirus?

Loss of smell and taste may be an early, distinguishing symptom of the novel coronavirus.

 

Here are the most common symptoms and the percentage of people who had them:

(from WebMD, based on World Health Organization analysis of more than 55,000 confirmed cases in China)

COVID-19 is a lower respiratory tract infection, which means that most of the symptoms are felt in the chest and lungs. That’s different from colds that bring on an upper respiratory tract infection, where you get a runny nose and sinus congestion. Those symptoms seem to be mostly absent for people with COVID-19, though they’re not unheard of.

The good news is that in China, most people who have gotten sick -- about 80% -- have had mild* to moderate symptoms.

*Note: this widely reported "80% mild" idea is misleading, because in China where this statistic came from, “mild” cases were not like a mild cold. ″‘Mild’ was a positive test, fever, cough — maybe even pneumonia, but not needing oxygen,” Bruce Aylward of the WHO told The New York Times. ”‘Severe’ was breathing rate up and oxygen saturation down, so needing oxygen or a ventilator. ‘Critical’ was respiratory failure or multi-organ failure.”)

What to do if you get sick

If you start to show symptoms, call your doctor's office. Don’t go there before calling -- that might spread the infection around the doctor’s office. They may want to talk to you on the phone in a telemedicine visit.

 

Well...depends on where you are and what resources are available. With luck, there will be community resources marshalled to help you. Most likely if you are in the US, you will be mostly on your own—

What does the future hold?

There is a wave train of exponential curves coming our way

Including these:

These curves are roughly, qualitatively right to give an idea of what's coming.

 

The only thing that matters now is the speed of your response

Interactive graphs showing the current action status by state, timeline for action vs probable outcome

 

Estimated current infections should be the top line statistic and basis for decision making

Estimated current infections is roughly right as a basis for decision making Confirmed infections are 'preciscely wrong' as a basis for decision making The confirmed infections are a few weeks—about four doubling times—behind current actual infections. If testing is low, the numbers are even further off.  Deaths are more accurate, but further out of date; around six doubling times.

Timeline of events in Hubai graph and analysis. Note that true cases preceded official cases by 11±days

 

 

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Detailed analysis

These images summarize an excellent article by Tomas Pueyo, which was shared 28 million times in a week. The full article is a 24 min read.

 

 

 

 

 

 

 

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