03-18-2020, 01:05 PM
I wanted to post something a tad more optimistic on this board, because the news out there is scary and if you look at the numbers of cases (broke 200,000 today) and the deaths piling up, it is easy to get despondent.
I want to push back hard against two (opposite) ideas that are ciruclating. The first is that this pandemic is no big deal, which is something that was espoused early in the epidemic and even now, as pictures of teaming beaches in South Florida and interviews with young revelers attest to, is sadly persistent. Even if you personally are at low risk or if you get infected are able to recover, every one of us is capable of killing someone via the chain of transmission. By our actions, we are able to prevent others (maybe our higher risk friends and loved ones, maybe a healthcare worker, maybe a random stranger three or four links down the infection change, from dying). And so I look appalingly at people who say that this is no big deal and that they don't care if they get the disease because they are young and healthy and low risk.
The second thing I wanted to push back against is that we are powerless in the face of the pandemic. Yes, the numbers are starting to look staggering. Yes, it looks like we are becoming overwhelmed. Yes, controlling the epidemic will be hard. But it is not impossible. Specifically, R0, the basic reproduction number that was brought up early in the pandemic is not immutable. Yes, an R0 of 2-3 (is scary) because it means that for every infected patient you would expect two new people to become infected. This is visible as the exponential growth we've seen in cases. But here's the thing, R0 is not immutable. It is of course influenced by viral characteristics (how long it persists on surfaces, how much viral shedding it induces, and how easy it can infect a healthy person it comes into contact with). However, R0 is also influenced by a number of variables we can control, specifically the frequency and intensity of person-to-person contact or personal contact with infected surfaces. Getting the R0 down is what causes the curve to flatten (if the closer it is to 1, the "flatter" the curve is). And all it would take to stabilize the pandemic is to reduce that portion enough to bring R0 to 1 (stable disease) or below 1 (infections actually start to go down). If you reduce cumulative contact (and its intensity) by a factor of 2 to 3, R0 will in fact fall to 1 or below. That's the point of social distancing, washing hands, not touching your face, etc. Each of those actions, when done cumulatively by society, reduces the rate of transmission, and if done enough will actually get the pandemic under control and start to bring the number of cases down.
If you believe the numbers, China was able to do it effectively. And if you don't believe the Chinese numbers, South Korea was also able to do it effectively. South Korea was getting 750+ cases a day at the peak of their epidemic. They have brought that rate down to under 100 cases/day, and they now have more cases resolving than new cases (which means the number of patients infected is going down).
![[Image: skitch.png]](https://www.evernote.com/shard/s44/sh/d6286819-ee7c-402c-89c2-0866f0ec0e70/e870a2aadbedda4d/res/b74ba086-b122-49ea-a980-9b98fe52f821/skitch.png)
Now, of course, things will start to look worse before they get better because there are a lot of undiagnosed infections, and because of the latent period, what we know today really reflects what happened 1 - 2 weeks ago. But if we can get through the worst, and are able to bring the number of new infections down to a more manageable level, then it will be possible to keep the epidemic controlled long enough through more moderate social distancing measures (no large gatherings), enhanced hygiene (hand washing) and good old fashioned epidemic control measures (widespread testing, case identification, quarantine of cases, contact tracing, and isolation and testing of contacts).
The situation is not hopeless! And while I recognize the challenges ahead and the economic impact of all of this, I am actually reasonably optimistic that if we act, the worst predictions will not come to pass. But we all need to do our part.
BC
I want to push back hard against two (opposite) ideas that are ciruclating. The first is that this pandemic is no big deal, which is something that was espoused early in the epidemic and even now, as pictures of teaming beaches in South Florida and interviews with young revelers attest to, is sadly persistent. Even if you personally are at low risk or if you get infected are able to recover, every one of us is capable of killing someone via the chain of transmission. By our actions, we are able to prevent others (maybe our higher risk friends and loved ones, maybe a healthcare worker, maybe a random stranger three or four links down the infection change, from dying). And so I look appalingly at people who say that this is no big deal and that they don't care if they get the disease because they are young and healthy and low risk.
The second thing I wanted to push back against is that we are powerless in the face of the pandemic. Yes, the numbers are starting to look staggering. Yes, it looks like we are becoming overwhelmed. Yes, controlling the epidemic will be hard. But it is not impossible. Specifically, R0, the basic reproduction number that was brought up early in the pandemic is not immutable. Yes, an R0 of 2-3 (is scary) because it means that for every infected patient you would expect two new people to become infected. This is visible as the exponential growth we've seen in cases. But here's the thing, R0 is not immutable. It is of course influenced by viral characteristics (how long it persists on surfaces, how much viral shedding it induces, and how easy it can infect a healthy person it comes into contact with). However, R0 is also influenced by a number of variables we can control, specifically the frequency and intensity of person-to-person contact or personal contact with infected surfaces. Getting the R0 down is what causes the curve to flatten (if the closer it is to 1, the "flatter" the curve is). And all it would take to stabilize the pandemic is to reduce that portion enough to bring R0 to 1 (stable disease) or below 1 (infections actually start to go down). If you reduce cumulative contact (and its intensity) by a factor of 2 to 3, R0 will in fact fall to 1 or below. That's the point of social distancing, washing hands, not touching your face, etc. Each of those actions, when done cumulatively by society, reduces the rate of transmission, and if done enough will actually get the pandemic under control and start to bring the number of cases down.
If you believe the numbers, China was able to do it effectively. And if you don't believe the Chinese numbers, South Korea was also able to do it effectively. South Korea was getting 750+ cases a day at the peak of their epidemic. They have brought that rate down to under 100 cases/day, and they now have more cases resolving than new cases (which means the number of patients infected is going down).
Now, of course, things will start to look worse before they get better because there are a lot of undiagnosed infections, and because of the latent period, what we know today really reflects what happened 1 - 2 weeks ago. But if we can get through the worst, and are able to bring the number of new infections down to a more manageable level, then it will be possible to keep the epidemic controlled long enough through more moderate social distancing measures (no large gatherings), enhanced hygiene (hand washing) and good old fashioned epidemic control measures (widespread testing, case identification, quarantine of cases, contact tracing, and isolation and testing of contacts).
The situation is not hopeless! And while I recognize the challenges ahead and the economic impact of all of this, I am actually reasonably optimistic that if we act, the worst predictions will not come to pass. But we all need to do our part.
BC
