[Genuine Realist]

I read a lot more than I post here, but the disappointment over inadequate contact test and tracing has me a little puzzled. I was very impressed with the statistics on the number of mild and symptomatic cases, i.e., carriers who don't even know they have the disease.

Doesn't this phenomenon make any attempt to identify whole chains of infected somewhat problematic? Are containment efforts based on contact tracing doomed to failure for that reason? Intuitively, it would seem so.

[Genuine Realist]

I read a lot more than I post here, but the disappointment over inadequate contact test and tracing has me a little puzzled. I was very impressed with the statistics on the number of mild and symptomatic cases, i.e., carriers who don't even know they have the disease.

Doesn't this phenomenon make any attempt to identify whole chains of infected somewhat problematic? Are containment efforts based on contact tracing doomed to failure for that reason? Intuitively, it would seem so.

[Goose]

I read a lot more than I post here, but the disappointment over inadequate contact test and tracing has me a little puzzled. I was very impressed with the statistics on the number of mild and symptomatic cases, i.e., carriers who don't even know they have the disease.

Doesn't this phenomenon make any attempt to identify whole chains of infected somewhat problematic? Are containment efforts based on contact tracing doomed to failure for that reason? Intuitively, it would seem so.

Not at all. In fact, those cases will ONLY be found by contact tracing. Mildly ill persons don't normally get tested. However, some of the people infected by the mildly ill persons will get ill enough to be tested. The person who is ill will name the mildly ill person as a "close contact". That will cause two things to happen. First, the mildly sick person will be quarantined, period. They will not infect anybody else. Big win. Second, that mildly ill person will be tested and return a positive result. The "close contacts" of the mildly ill person will then be quarantined, preventing any spread from those people who are not yet sick. It is important to realize that we do have one thing going in our favor with this virus. We have a test. If you are contagious, you will test positive with high probability. That allows the second part of the operation above to work. Without a test, it is probably impossible to justify quarantine of "close contacts once removed". Tracking and tracing would still work, just not quite as well.

[Goose]

I read a lot more than I post here, but the disappointment over inadequate contact test and tracing has me a little puzzled. I was very impressed with the statistics on the number of mild and symptomatic cases, i.e., carriers who don't even know they have the disease.

Doesn't this phenomenon make any attempt to identify whole chains of infected somewhat problematic? Are containment efforts based on contact tracing doomed to failure for that reason? Intuitively, it would seem so.

Not at all. In fact, those cases will ONLY be found by contact tracing. Mildly ill persons don't normally get tested. However, some of the people infected by the mildly ill persons will get ill enough to be tested. The person who is ill will name the mildly ill person as a "close contact". That will cause two things to happen. First, the mildly sick person will be quarantined, period. They will not infect anybody else. Big win. Second, that mildly ill person will be tested and return a positive result. The "close contacts" of the mildly ill person will then be quarantined, preventing any spread from those people who are not yet sick. It is important to realize that we do have one thing going in our favor with this virus. We have a test. If you are contagious, you will test positive with high probability. That allows the second part of the operation above to work. Without a test, it is probably impossible to justify quarantine of "close contacts once removed". Tracking and tracing would still work, just not quite as well.

[BostonCard]

Exactly.

Remember, the R0 of the virus is estimated at between 2 and 3, so absent any intervention, on average each infected person will infect 2 to 3 susceptible people.  If R is > 1, the epidemic will increase exponentially; if R < 1 the epidemic will decrease and peter out.  Because of social distancing, right now R is somewhere in the 1 to 1.5 range in the US.  That means that cases are growing, slowly.  In order to "win" you don't have to stop all remaining infections; you just have to stop enough of them to get drive R to below 1.

So, let's say that on average 50% of patients are symptomatic.  You find a symptomatic patient, and trace both forwards and backwards.  If you alert and test most of that person's contacts, you should be able to catch all the symptomatic patients early (since now they are primed to look for symptoms and assume that their mild cough is actually COVID-19 and not their allergies), and you might catch the asymptomatic patients if you test them at the right time.  Even if you don't catch their asymptomatic contact, by telling them they've been exposed and to quarantine, even if it is not perfect, you can probably reduce their close personal contacts by 50%, enough to drive R to below 1.  You also trace backwards, and hopefully identify the person who infected them, who should test positive (symptomatic or not).  That will let you test all that patient's contacts.

Yes, the system won't be perfect.  But it doesn't have to be perfect as long as 1) there are reasonable measures to reduce transmission (social distancing protocols, mask wearing, etc.) and 2) you interrupt enough chains of transmission to drive R to below 1.  If you do all that, infections will go down over time (which incidentally makes your job easier).

BC

[BostonCard]

Exactly.

Remember, the R0 of the virus is estimated at between 2 and 3, so absent any intervention, on average each infected person will infect 2 to 3 susceptible people.  If R is > 1, the epidemic will increase exponentially; if R < 1 the epidemic will decrease and peter out.  Because of social distancing, right now R is somewhere in the 1 to 1.5 range in the US.  That means that cases are growing, slowly.  In order to "win" you don't have to stop all remaining infections; you just have to stop enough of them to get drive R to below 1.

So, let's say that on average 50% of patients are symptomatic.  You find a symptomatic patient, and trace both forwards and backwards.  If you alert and test most of that person's contacts, you should be able to catch all the symptomatic patients early (since now they are primed to look for symptoms and assume that their mild cough is actually COVID-19 and not their allergies), and you might catch the asymptomatic patients if you test them at the right time.  Even if you don't catch their asymptomatic contact, by telling them they've been exposed and to quarantine, even if it is not perfect, you can probably reduce their close personal contacts by 50%, enough to drive R to below 1.  You also trace backwards, and hopefully identify the person who infected them, who should test positive (symptomatic or not).  That will let you test all that patient's contacts.

Yes, the system won't be perfect.  But it doesn't have to be perfect as long as 1) there are reasonable measures to reduce transmission (social distancing protocols, mask wearing, etc.) and 2) you interrupt enough chains of transmission to drive R to below 1.  If you do all that, infections will go down over time (which incidentally makes your job easier).

BC

[Genuine Realist]

Exactly.

Remember, the R0 of the virus is estimated at between 2 and 3, so absent any intervention, on average each infected person will infect 2 to 3 susceptible people.  If R is > 1, the epidemic will increase exponentially; if R < 1 the epidemic will decrease and peter out.  Because of social distancing, right now R is somewhere in the 1 to 1.5 range in the US.  That means that cases are growing, slowly.  In order to "win" you don't have to stop all remaining infections; you just have to stop enough of them to get drive R to below 1.

So, let's say that on average 50% of patients are symptomatic.  You find a symptomatic patient, and trace both forwards and backwards.  If you alert and test most of that person's contacts, you should be able to catch all the symptomatic patients early (since now they are primed to look for symptoms and assume that their mild cough is actually COVID-19 and not their allergies), and you might catch the asymptomatic patients if you test them at the right time.  Even if you don't catch their asymptomatic contact, by telling them they've been exposed and to quarantine, even if it is not perfect, you can probably reduce their close personal contacts by 50%, enough to drive R to below 1.  You also trace backwards, and hopefully identify the person who infected them, who should test positive (symptomatic or not).  That will let you test all that patient's contacts.

Yes, the system won't be perfect.  But it doesn't have to be perfect as long as 1) there are reasonable measures to reduce transmission (social distancing protocols, mask wearing, etc.) and 2) you interrupt enough chains of transmission to drive R to below 1.  If you do all that, infections will go down over time (which incidentally makes your job easier).

BC

I understand the point of identifying cases. But the task seems to me herculean.

[Genuine Realist]

Exactly.

Remember, the R0 of the virus is estimated at between 2 and 3, so absent any intervention, on average each infected person will infect 2 to 3 susceptible people.  If R is > 1, the epidemic will increase exponentially; if R < 1 the epidemic will decrease and peter out.  Because of social distancing, right now R is somewhere in the 1 to 1.5 range in the US.  That means that cases are growing, slowly.  In order to "win" you don't have to stop all remaining infections; you just have to stop enough of them to get drive R to below 1.

So, let's say that on average 50% of patients are symptomatic.  You find a symptomatic patient, and trace both forwards and backwards.  If you alert and test most of that person's contacts, you should be able to catch all the symptomatic patients early (since now they are primed to look for symptoms and assume that their mild cough is actually COVID-19 and not their allergies), and you might catch the asymptomatic patients if you test them at the right time.  Even if you don't catch their asymptomatic contact, by telling them they've been exposed and to quarantine, even if it is not perfect, you can probably reduce their close personal contacts by 50%, enough to drive R to below 1.  You also trace backwards, and hopefully identify the person who infected them, who should test positive (symptomatic or not).  That will let you test all that patient's contacts.

Yes, the system won't be perfect.  But it doesn't have to be perfect as long as 1) there are reasonable measures to reduce transmission (social distancing protocols, mask wearing, etc.) and 2) you interrupt enough chains of transmission to drive R to below 1.  If you do all that, infections will go down over time (which incidentally makes your job easier).

BC

I understand the point of identifying cases. But the task seems to me herculean.

[Snorlax94]

I understand the point of identifying cases. But the task seems to me herculean.

A Herculean, impossible task -- you mean like defeating Nazi Germany or sending a man to the moon?

Other countries are able to test and trace, and some of the successful ones are good at it because they built up their capacity during previous outbreaks -- SARS, MERS, Ebola, H1N1.

Given the fact that these things are only becoming more common -- and, I've seen a scientist predict outbreaks will become more and more common in the future (due to increased development in jungles, increased travel, and Global Warming, which will make mosquito-based illnesses more common), this will just be part of the new, more frequent normal. Testing and Tracing is no greater juggernaut than being a team that went 1-11, facing a #1 U S C team as one of the greatest underdogs ever.

America needs to strap up, put on its pads and win. It has done so -- and won -- over and over in the past.

[Snorlax94]

I understand the point of identifying cases. But the task seems to me herculean.

A Herculean, impossible task -- you mean like defeating Nazi Germany or sending a man to the moon?

Other countries are able to test and trace, and some of the successful ones are good at it because they built up their capacity during previous outbreaks -- SARS, MERS, Ebola, H1N1.

Given the fact that these things are only becoming more common -- and, I've seen a scientist predict outbreaks will become more and more common in the future (due to increased development in jungles, increased travel, and Global Warming, which will make mosquito-based illnesses more common), this will just be part of the new, more frequent normal. Testing and Tracing is no greater juggernaut than being a team that went 1-11, facing a #1 U S C team as one of the greatest underdogs ever.

America needs to strap up, put on its pads and win. It has done so -- and won -- over and over in the past.

[BostonCard]

It's not like we don't contact trace in the US already.  Believe me, if there is a case of active tuberculosis, local public health officials are going to be all over that.  Even more prosaic, and delicate, contact tracing occurs all the time with sexually transmitted infections (though it is probably easier to get ahold of all someone's sexual partners, as long as they are being honest with you) than all a patient's "close contacts".

BC

[BostonCard]

It's not like we don't contact trace in the US already.  Believe me, if there is a case of active tuberculosis, local public health officials are going to be all over that.  Even more prosaic, and delicate, contact tracing occurs all the time with sexually transmitted infections (though it is probably easier to get ahold of all someone's sexual partners, as long as they are being honest with you) than all a patient's "close contacts".

BC

[Goose]

I understand the point of identifying cases. But the task seems to me herculean.

A Herculean, impossible task -- you mean like defeating Nazi Germany or sending a man to the moon?

No, it isn't even that hard. It is much more like garbage collection. It is well understood, totally necessary, and requires a significant but not gigantic staff to do the work.

Take San Mateo County as an example. They say they are currently doing it with a staff of about 100 people. The 14 day moving average is currently 28 cases a day. If each case had 10 close contacts (a very high number), that would be a steady-state of 280 people to contact in a day. A staff of 25 could undoubtedly do that, and they have more than that. LA County is another story. That is why the SIP getting the case load down was initially required. Unfortunately, in some places that didn't work so well and those places did not staff up to track and trace. As demonstrated above, they could have. It isn't all that hard. They just didn't do it. Different problem.

Just as an aside, quarantining 280 people every day for a two week period would result in 3920 people or 0.5% of the population being in quarantine (steady state). Easily tolerated. It would be "normal" that that rate would actually drop to zero pretty fast.

Other countries are able to test and trace, and some of the successful ones are good at it because they built up their capacity during previous outbreaks -- SARS, MERS, Ebola, H1N1.

Yes, and or they are in areas where epidemics of other types in nearby areas are common (Australia, New Zealand)

Given the fact that these things are only becoming more common -- and, I've seen a scientist predict outbreaks will become more and more common in the future (due to increased development in jungles, increased travel, and Global Warming, which will make mosquito-based illnesses more common), this will just be part of the new, more frequent normal. Testing and Tracing is no greater juggernaut than being a team that went 1-11, facing a #1 U S C team as one of the greatest underdogs ever.

America needs to strap up, put on its pads and win. It has done so -- and won -- over and over in the past.

Don't forget the effect of rapid, frequent, and common world travel . OK, you didn't, but I think this is the dominating factor =). I would bet you lots of money that is more significant than any of the other factors you mention. Epidemics used to travel slowly, so people had time to react. They don't any more. It is true that the exact nature of the threat greatly modulates the problem, but one can be sure another similar outbreak will happen and it will travel fast.

It's not like we don't contact trace in the US already.  Believe me, if there is a case of active tuberculosis, local public health officials are going to be all over that.  Even more prosaic, and delicate, contact tracing occurs all the time with sexually transmitted infections (though it is probably easier to get ahold of all someone's sexual partners, as long as they are being honest with you) than all a patient's "close contacts".

BC

Indeed we do trace TB and have for years. When it was more common, we had large staffs in each county health department to deal with it. That capability still exists, but is small. We just needed to expand it. Unfortunately.....

I must admit my hopeful scenario with the SIP was that we would get cases down to near zero. In some places, that happened. In others, it didn't. Nobody seems to know why, or care very much why. There is lots of speculation (on the Cardboard no less =)) that it is non-compliance, not wearing masks, ... Unfortunately, I haven't seen any real explanation based on data. My further hope was that with a good tracking and tracing system, social distancing would be come less important and we could re-open to a more normal condition. I don't need to shake hands or hug people, but I would like to go to dinner with friends, or maybe go to a football game. I don't mind wearing masks as a "normal" situation in public, so that is not an issue for me. However, that simply isn't going to happen unless and until we figure out how to get the case load down and develop a staff to track and trace that case load.

[Goose]

I understand the point of identifying cases. But the task seems to me herculean.

A Herculean, impossible task -- you mean like defeating Nazi Germany or sending a man to the moon?

No, it isn't even that hard. It is much more like garbage collection. It is well understood, totally necessary, and requires a significant but not gigantic staff to do the work.

Take San Mateo County as an example. They say they are currently doing it with a staff of about 100 people. The 14 day moving average is currently 28 cases a day. If each case had 10 close contacts (a very high number), that would be a steady-state of 280 people to contact in a day. A staff of 25 could undoubtedly do that, and they have more than that. LA County is another story. That is why the SIP getting the case load down was initially required. Unfortunately, in some places that didn't work so well and those places did not staff up to track and trace. As demonstrated above, they could have. It isn't all that hard. They just didn't do it. Different problem.

Just as an aside, quarantining 280 people every day for a two week period would result in 3920 people or 0.5% of the population being in quarantine (steady state). Easily tolerated. It would be "normal" that that rate would actually drop to zero pretty fast.

Other countries are able to test and trace, and some of the successful ones are good at it because they built up their capacity during previous outbreaks -- SARS, MERS, Ebola, H1N1.

Yes, and or they are in areas where epidemics of other types in nearby areas are common (Australia, New Zealand)

Given the fact that these things are only becoming more common -- and, I've seen a scientist predict outbreaks will become more and more common in the future (due to increased development in jungles, increased travel, and Global Warming, which will make mosquito-based illnesses more common), this will just be part of the new, more frequent normal. Testing and Tracing is no greater juggernaut than being a team that went 1-11, facing a #1 U S C team as one of the greatest underdogs ever.

America needs to strap up, put on its pads and win. It has done so -- and won -- over and over in the past.

Don't forget the effect of rapid, frequent, and common world travel . OK, you didn't, but I think this is the dominating factor =). I would bet you lots of money that is more significant than any of the other factors you mention. Epidemics used to travel slowly, so people had time to react. They don't any more. It is true that the exact nature of the threat greatly modulates the problem, but one can be sure another similar outbreak will happen and it will travel fast.

It's not like we don't contact trace in the US already.  Believe me, if there is a case of active tuberculosis, local public health officials are going to be all over that.  Even more prosaic, and delicate, contact tracing occurs all the time with sexually transmitted infections (though it is probably easier to get ahold of all someone's sexual partners, as long as they are being honest with you) than all a patient's "close contacts".

BC

Indeed we do trace TB and have for years. When it was more common, we had large staffs in each county health department to deal with it. That capability still exists, but is small. We just needed to expand it. Unfortunately.....

I must admit my hopeful scenario with the SIP was that we would get cases down to near zero. In some places, that happened. In others, it didn't. Nobody seems to know why, or care very much why. There is lots of speculation (on the Cardboard no less =)) that it is non-compliance, not wearing masks, ... Unfortunately, I haven't seen any real explanation based on data. My further hope was that with a good tracking and tracing system, social distancing would be come less important and we could re-open to a more normal condition. I don't need to shake hands or hug people, but I would like to go to dinner with friends, or maybe go to a football game. I don't mind wearing masks as a "normal" situation in public, so that is not an issue for me. However, that simply isn't going to happen unless and until we figure out how to get the case load down and develop a staff to track and trace that case load.

[BostonCard]

The 1918 Flu pandemic spread quickly enough, and back then they traveled by boat to Europe and by railroad from one part of the US to another.

Yes, increased world travel has reduced the time to react from months to weeks, but the extent of the pandemic isn't due to the availability of jet travel.

BC

[BostonCard]

The 1918 Flu pandemic spread quickly enough, and back then they traveled by boat to Europe and by railroad from one part of the US to another.

Yes, increased world travel has reduced the time to react from months to weeks, but the extent of the pandemic isn't due to the availability of jet travel.

BC

[BostonCard]

If only congress had allocated money for testing and tracing...

https://www.businessinsider.com/democrat...ing-2020-6

BC

[BostonCard]

If only congress had allocated money for testing and tracing...

https://www.businessinsider.com/democrat...ing-2020-6

BC

[Genuine Realist]

If only congress had allocated money for testing and tracing...

https://www.businessinsider.com/democrat...ing-2020-6

BC

 
Or if we had the national service requirement that many (including yours truly) have advocated over the years. In addition to making citizenship valuable, you'd  hava a corps of workers ready for instant deployment.

The moon shot required a long, comparatively ponderous corporate build up. The better analogy is the draftee army of World War II, composed of young men who by and large had not settled into an established life. We could have such a force at the ready, for a variety of societal; needs. But we have chosen not to.

[Genuine Realist]

If only congress had allocated money for testing and tracing...

https://www.businessinsider.com/democrat...ing-2020-6

BC

 
Or if we had the national service requirement that many (including yours truly) have advocated over the years. In addition to making citizenship valuable, you'd  hava a corps of workers ready for instant deployment.

The moon shot required a long, comparatively ponderous corporate build up. The better analogy is the draftee army of World War II, composed of young men who by and large had not settled into an established life. We could have such a force at the ready, for a variety of societal; needs. But we have chosen not to.

[Genuine Realist]

Exactly.

Remember, the R0 of the virus is estimated at between 2 and 3, so absent any intervention, on average each infected person will infect 2 to 3 susceptible people.  If R is > 1, the epidemic will increase exponentially; if R < 1 the epidemic will decrease and peter out.  Because of social distancing, right now R is somewhere in the 1 to 1.5 range in the US.  That means that cases are growing, slowly.  In order to "win" you don't have to stop all remaining infections; you just have to stop enough of them to get drive R to below 1.

So, let's say that on average 50% of patients are symptomatic.  You find a symptomatic patient, and trace both forwards and backwards.  If you alert and test most of that person's contacts, you should be able to catch all the symptomatic patients early (since now they are primed to look for symptoms and assume that their mild cough is actually COVID-19 and not their allergies), and you might catch the asymptomatic patients if you test them at the right time.  Even if you don't catch their asymptomatic contact, by telling them they've been exposed and to quarantine, even if it is not perfect, you can probably reduce their close personal contacts by 50%, enough to drive R to below 1.  You also trace backwards, and hopefully identify the person who infected them, who should test positive (symptomatic or not).  That will let you test all that patient's contacts.

Yes, the system won't be perfect.  But it doesn't have to be perfect as long as 1) there are reasonable measures to reduce transmission (social distancing protocols, mask wearing, etc.) and 2) you interrupt enough chains of transmission to drive R to below 1.  If you do all that, infections will go down over time (which incidentally makes your job easier).

BC

I got my answer,  btw. The testing I thought was at issue was retrospective - tracing back to how the paint was infected,a la Tyhpoid Mary. That still seems to me virtually impossible.

But I think you mean prospective, tracing who the paint may have met and infected during the incubation period. That is much more doable.

[Genuine Realist]

Exactly.

Remember, the R0 of the virus is estimated at between 2 and 3, so absent any intervention, on average each infected person will infect 2 to 3 susceptible people.  If R is > 1, the epidemic will increase exponentially; if R < 1 the epidemic will decrease and peter out.  Because of social distancing, right now R is somewhere in the 1 to 1.5 range in the US.  That means that cases are growing, slowly.  In order to "win" you don't have to stop all remaining infections; you just have to stop enough of them to get drive R to below 1.

So, let's say that on average 50% of patients are symptomatic.  You find a symptomatic patient, and trace both forwards and backwards.  If you alert and test most of that person's contacts, you should be able to catch all the symptomatic patients early (since now they are primed to look for symptoms and assume that their mild cough is actually COVID-19 and not their allergies), and you might catch the asymptomatic patients if you test them at the right time.  Even if you don't catch their asymptomatic contact, by telling them they've been exposed and to quarantine, even if it is not perfect, you can probably reduce their close personal contacts by 50%, enough to drive R to below 1.  You also trace backwards, and hopefully identify the person who infected them, who should test positive (symptomatic or not).  That will let you test all that patient's contacts.

Yes, the system won't be perfect.  But it doesn't have to be perfect as long as 1) there are reasonable measures to reduce transmission (social distancing protocols, mask wearing, etc.) and 2) you interrupt enough chains of transmission to drive R to below 1.  If you do all that, infections will go down over time (which incidentally makes your job easier).

BC

I got my answer,  btw. The testing I thought was at issue was retrospective - tracing back to how the paint was infected,a la Tyhpoid Mary. That still seems to me virtually impossible.

But I think you mean prospective, tracing who the paint may have met and infected during the incubation period. That is much more doable.

[BostonCard]

Since it is hard to know exactly when someone was exposed and there is a fair bit of uncertainty around the incubation period, when you contact trace close contacts you are testing both prospective and retrospective contacts simultaneously, as long as you use a broad enough time period.  Retrospective contact tracing is harder, because you generally have to trace further back in time, and memories fade.

So you are right, you are mostly going to catch prospective contacts.  But that doesn't mean you don't try.  It's not about having to be perfect, but the more transmission chains you intercept, the further you drive down R, and the faster you drive down the burden of disease.

BC

[BostonCard]

Since it is hard to know exactly when someone was exposed and there is a fair bit of uncertainty around the incubation period, when you contact trace close contacts you are testing both prospective and retrospective contacts simultaneously, as long as you use a broad enough time period.  Retrospective contact tracing is harder, because you generally have to trace further back in time, and memories fade.

So you are right, you are mostly going to catch prospective contacts.  But that doesn't mean you don't try.  It's not about having to be perfect, but the more transmission chains you intercept, the further you drive down R, and the faster you drive down the burden of disease.

BC

[Goose]

The 1918 Flu pandemic spread quickly enough, and back then they traveled by boat to Europe and by railroad from one part of the US to another.



Yes, increased world travel has reduced the time to react from months to weeks, but the extent of the pandemic isn't due to the availability of jet travel.



BC

I still believe that the rapid and heavily used jet travel is in fact the driving force for the extent of this epidemic. How many people traveled from Wuhan to the USA in 1960? How many people from Wuhan would even consider traveling to Germany for a 3 day meeting in 1960? The answers are almost none and none. It isn't just that the delay from outbreak in China to COVID-19 positive people arriving in the USA was greatly reduced. That is bad enough, and cuts the reaction time way down. Worse still are two other factors.

First, the number of positive people arriving in the USA was much, much larger than would have been the case before jet travel became available, relatively cheap, and heavily relied upon in daily life. In point of fact, about twice as many people visit the the USA each month as were in the entire AEF in WW I. This does not include Americans returning home from travel. There is no way to manage such an influx to exclude positive people. The resulting influx creates an "instant epidemic". Just like hospital ICUs, epidemic response teams can be overwhelmed by sheer numbers. In the past, we had  exponential spread from a few patients. A small tracking and tracing organization could cope. When you have a flood of people burrowing into the population that is positive for COVID-19, there is no chance to contain it and many cases of exponential spread are inevitable.  Thus the extent in the USA. SIP becomes the only possible response.

Second, the "direction" from which the epidemic arrives is no longer predictable. The bad situation in New York/New Jersey was generated not by visitors from China, but rather people returning from Europe. In the past, the public health people could ask "Were you in China on this trip?" If you said no, they let you through, knowing you were probably not positive. However, many people got exposed in other nations at a time when those nations were not real hotbeds of disease. This is possible because easy travel allows people from anywhere to mix with people from anywhere, not just with "natives" of a given destination. International conferences are common today. Perfect spreading events. Before easy, fast jet travel such events were rare.

So yes, I think the travel climate made things much, much worse than they would have been in "the past". Not that I am trying to advocate going back in time. Rather, I am advocating recognizing that it is a new ball game and reacting accordingly.

[Goose]

The 1918 Flu pandemic spread quickly enough, and back then they traveled by boat to Europe and by railroad from one part of the US to another.



Yes, increased world travel has reduced the time to react from months to weeks, but the extent of the pandemic isn't due to the availability of jet travel.



BC

I still believe that the rapid and heavily used jet travel is in fact the driving force for the extent of this epidemic. How many people traveled from Wuhan to the USA in 1960? How many people from Wuhan would even consider traveling to Germany for a 3 day meeting in 1960? The answers are almost none and none. It isn't just that the delay from outbreak in China to COVID-19 positive people arriving in the USA was greatly reduced. That is bad enough, and cuts the reaction time way down. Worse still are two other factors.

First, the number of positive people arriving in the USA was much, much larger than would have been the case before jet travel became available, relatively cheap, and heavily relied upon in daily life. In point of fact, about twice as many people visit the the USA each month as were in the entire AEF in WW I. This does not include Americans returning home from travel. There is no way to manage such an influx to exclude positive people. The resulting influx creates an "instant epidemic". Just like hospital ICUs, epidemic response teams can be overwhelmed by sheer numbers. In the past, we had  exponential spread from a few patients. A small tracking and tracing organization could cope. When you have a flood of people burrowing into the population that is positive for COVID-19, there is no chance to contain it and many cases of exponential spread are inevitable.  Thus the extent in the USA. SIP becomes the only possible response.

Second, the "direction" from which the epidemic arrives is no longer predictable. The bad situation in New York/New Jersey was generated not by visitors from China, but rather people returning from Europe. In the past, the public health people could ask "Were you in China on this trip?" If you said no, they let you through, knowing you were probably not positive. However, many people got exposed in other nations at a time when those nations were not real hotbeds of disease. This is possible because easy travel allows people from anywhere to mix with people from anywhere, not just with "natives" of a given destination. International conferences are common today. Perfect spreading events. Before easy, fast jet travel such events were rare.

So yes, I think the travel climate made things much, much worse than they would have been in "the past". Not that I am trying to advocate going back in time. Rather, I am advocating recognizing that it is a new ball game and reacting accordingly.

[BostonCard]

No, it isn't even that hard. It is much more like garbage collection. It is well understood, totally necessary, and requires a significant but not gigantic staff to do the work.

Well, it is not helping that public health workers are being threatened.

https://www.washingtonpost.com/health/am...story.html

We are our own worst enemy.

BC

[BostonCard]

No, it isn't even that hard. It is much more like garbage collection. It is well understood, totally necessary, and requires a significant but not gigantic staff to do the work.

Well, it is not helping that public health workers are being threatened.

https://www.washingtonpost.com/health/am...story.html

We are our own worst enemy.

BC

[Goose]

No, it isn't even that hard. It is much more like garbage collection. It is well understood, totally necessary, and requires a significant but not gigantic staff to do the work.

Well, it is not helping that public health workers are being threatened.



https://www.washingtonpost.com/health/am...story.html



We are our own worst enemy.



BC

Amen! This is an area where the county supervisors/commissioners/whatever have to stand up and give the public the "bad" news. The county health department has lots of legal power, and the county will back them up. You will be arrested and charged if you don't cooperate. Unfortunately (IMHO) the political operators in most counties are keeping the mouths tightly shut on the subject. Worse still, many county health offices have elected not to actually enforce their quarantine requests. "Don't ask, don't tell" of another sort is in full flower. I don't know to what extent compliance is a problem, but I do know that if nobody checks, it is unlikely compliance will be very good, especially for contacts that are feeling fine and see no reason not to live normally. Maybe that is why track and trace is approached without much urgency. If we aren't going to actually use the results, why bother?

[Goose]

No, it isn't even that hard. It is much more like garbage collection. It is well understood, totally necessary, and requires a significant but not gigantic staff to do the work.

Well, it is not helping that public health workers are being threatened.



https://www.washingtonpost.com/health/am...story.html



We are our own worst enemy.



BC

Amen! This is an area where the county supervisors/commissioners/whatever have to stand up and give the public the "bad" news. The county health department has lots of legal power, and the county will back them up. You will be arrested and charged if you don't cooperate. Unfortunately (IMHO) the political operators in most counties are keeping the mouths tightly shut on the subject. Worse still, many county health offices have elected not to actually enforce their quarantine requests. "Don't ask, don't tell" of another sort is in full flower. I don't know to what extent compliance is a problem, but I do know that if nobody checks, it is unlikely compliance will be very good, especially for contacts that are feeling fine and see no reason not to live normally. Maybe that is why track and trace is approached without much urgency. If we aren't going to actually use the results, why bother?

[Genuine Realist]

No, it isn't even that hard. It is much more like garbage collection. It is well understood, totally necessary, and requires a significant but not gigantic staff to do the work.

Well, it is not helping that public health workers are being threatened.



https://www.washingtonpost.com/health/am...story.html



We are our own worst enemy.



BC

Amen! This is an area where the county supervisors/commissioners/whatever have to stand up and give the public the "bad" news. The county health department has lots of legal power, and the county will back them up. You will be arrested and charged if you don't cooperate. Unfortunately (IMHO) the political operators in most counties are keeping the mouths tightly shut on the subject. Worse still, many county health offices have elected not to actually enforce their quarantine requests. "Don't ask, don't tell" of another sort is in full flower. I don't know to what extent compliance is a problem, but I do know that if nobody checks, it is unlikely compliance will be very good, especially for contacts that are feeling fine and see no reason not to live normally. Maybe that is why track and trace is approached without much urgency. If we aren't going to actually use the results, why bother?

I don't think the rights and wrongs here are quite that certain. In a nation of this size and complex pluralism,  a regime as authoritarian as that imposed with SIP was bound to meet resistance. This is NOT a compliant culture, which in most political situations is a Good Thing. We also have far more social energy than any other country, probably more than in Europe and China combined. There was always going to be pushback against these measures.

Also, in retrospect, although it's only been three months, the lockdown was imposed with incredible insensitivity. If there was any concern for the hundreds of thousands of hospitality workers, food servers, barbers and personal attendants suddenly without any means of making a living, I never heard it from any health officials. The official attitude often came down to a single word  . . .  tough. In retrospect again, maybe the better strategy would have been to limit the lockdown period drastically to a fortnight or soand create task forces to draft with some urgency the rules and regulations by which the sensitive industries and professions could begin to do business again. 

Finally, was the notion of 'flattening the curve' chimerical from the start? A goal that is not possible to achieve as a practical matter, because of the number of essential businesses and the quantum of non-compliance? If so, wouldn't it be better to accept the society as it is and work towards practicable goals of realistic containment than insist on the imposition of draconian controls with no set time limit?

The bottom line is that health officials are not infallible and the ultimate story may be that the policies adopted with some haste were massive overkill, and also somewhat arrogantly enacted. This hasn't been helped by the indifference to social distancing demonstrated in the recent protests by various officials (Gretchen Whitmer comes to mind). Debate and pushback were only to be expected against a regimen imposed as drastically and quickly as this one was.

[Genuine Realist]

No, it isn't even that hard. It is much more like garbage collection. It is well understood, totally necessary, and requires a significant but not gigantic staff to do the work.

Well, it is not helping that public health workers are being threatened.



https://www.washingtonpost.com/health/am...story.html



We are our own worst enemy.



BC

Amen! This is an area where the county supervisors/commissioners/whatever have to stand up and give the public the "bad" news. The county health department has lots of legal power, and the county will back them up. You will be arrested and charged if you don't cooperate. Unfortunately (IMHO) the political operators in most counties are keeping the mouths tightly shut on the subject. Worse still, many county health offices have elected not to actually enforce their quarantine requests. "Don't ask, don't tell" of another sort is in full flower. I don't know to what extent compliance is a problem, but I do know that if nobody checks, it is unlikely compliance will be very good, especially for contacts that are feeling fine and see no reason not to live normally. Maybe that is why track and trace is approached without much urgency. If we aren't going to actually use the results, why bother?

I don't think the rights and wrongs here are quite that certain. In a nation of this size and complex pluralism,  a regime as authoritarian as that imposed with SIP was bound to meet resistance. This is NOT a compliant culture, which in most political situations is a Good Thing. We also have far more social energy than any other country, probably more than in Europe and China combined. There was always going to be pushback against these measures.

Also, in retrospect, although it's only been three months, the lockdown was imposed with incredible insensitivity. If there was any concern for the hundreds of thousands of hospitality workers, food servers, barbers and personal attendants suddenly without any means of making a living, I never heard it from any health officials. The official attitude often came down to a single word  . . .  tough. In retrospect again, maybe the better strategy would have been to limit the lockdown period drastically to a fortnight or soand create task forces to draft with some urgency the rules and regulations by which the sensitive industries and professions could begin to do business again. 

Finally, was the notion of 'flattening the curve' chimerical from the start? A goal that is not possible to achieve as a practical matter, because of the number of essential businesses and the quantum of non-compliance? If so, wouldn't it be better to accept the society as it is and work towards practicable goals of realistic containment than insist on the imposition of draconian controls with no set time limit?

The bottom line is that health officials are not infallible and the ultimate story may be that the policies adopted with some haste were massive overkill, and also somewhat arrogantly enacted. This hasn't been helped by the indifference to social distancing demonstrated in the recent protests by various officials (Gretchen Whitmer comes to mind). Debate and pushback were only to be expected against a regimen imposed as drastically and quickly as this one was.

[BostonCard]

Finally, was the notion of 'flattening the curve' chimerical from the start? A goal that is not possible to achieve as a practical matter, because of the number of essential businesses and the quantum of non-compliance? If so, wouldn't it be better to accept the society as it is and work towards practicable goals of realistic containment than insist on the imposition of draconian controls with no set time limit?

I'm not sure what you mean here.  We have dramatically flattened the curve.  Even in states where there is an increase in cases, R is on the order of 1.2 - 1.4, not as high as the R0 of 2.5 - 3.  That means that while the number of cases are increasing, they aren't increasing as fast it would have in the absence of measures.  And we reducing the restrictions.  I think in an ideal world, you titrate the restrictions to ensure R is slightly less than 1, loosening them as long as case counts are declining and tightening them as case counts start to climb.

I think Europe is (generally) a good case study.  I posted a plot of the number of cases in Europe versus the United States post peak, and you could see that the number of cases in Europe dropped dramatically compared to the US.  In most places (excepting Sweden), the lockdowns were harsher and more dramatic than in the US.  And you can draw a direct line from that to declining number of deaths and cases.  As a consequence, they are also able to relax their lockdowns more aggressively.  The benefits of the lockdown are immediately apparent to most Europeans.  The US is caught in a bit of a purgatory.  We are locked down enough to cause economic pain and provoke a backlash, but not effectively enough to prevent cases from rising in a bunch of places.

Perhaps that is the source of your frustration.  But I can assure you that things would almost certainly be worse in a world where there were no restrictions whatsoever.  We have seen that story play out: Italy, Spain, New York prior to lockdowns, Brazil and Mexico now.  While things aren't looking great in Florida, Texas, Arizona, California and a few other places, we still aren't talking about things spiraling out of control.

BC

[BostonCard]

Finally, was the notion of 'flattening the curve' chimerical from the start? A goal that is not possible to achieve as a practical matter, because of the number of essential businesses and the quantum of non-compliance? If so, wouldn't it be better to accept the society as it is and work towards practicable goals of realistic containment than insist on the imposition of draconian controls with no set time limit?

I'm not sure what you mean here.  We have dramatically flattened the curve.  Even in states where there is an increase in cases, R is on the order of 1.2 - 1.4, not as high as the R0 of 2.5 - 3.  That means that while the number of cases are increasing, they aren't increasing as fast it would have in the absence of measures.  And we reducing the restrictions.  I think in an ideal world, you titrate the restrictions to ensure R is slightly less than 1, loosening them as long as case counts are declining and tightening them as case counts start to climb.

I think Europe is (generally) a good case study.  I posted a plot of the number of cases in Europe versus the United States post peak, and you could see that the number of cases in Europe dropped dramatically compared to the US.  In most places (excepting Sweden), the lockdowns were harsher and more dramatic than in the US.  And you can draw a direct line from that to declining number of deaths and cases.  As a consequence, they are also able to relax their lockdowns more aggressively.  The benefits of the lockdown are immediately apparent to most Europeans.  The US is caught in a bit of a purgatory.  We are locked down enough to cause economic pain and provoke a backlash, but not effectively enough to prevent cases from rising in a bunch of places.

Perhaps that is the source of your frustration.  But I can assure you that things would almost certainly be worse in a world where there were no restrictions whatsoever.  We have seen that story play out: Italy, Spain, New York prior to lockdowns, Brazil and Mexico now.  While things aren't looking great in Florida, Texas, Arizona, California and a few other places, we still aren't talking about things spiraling out of control.

BC

[dabigv13]

We aren't talking about it yet but we should probably start. Many states are at new highs, and any lockdown restrictions we take now (and we aren't really doing anything dramatic) won't show in the numbers for several weeks. I think the next phase of the pandemic will be multiple areas of the US going through their own NYC style experience where the hospitals and morgues get overwhelmed.

Yakima's hospital system full in WA. Children's hospitals admitting adult patients in Texas. When NYC was the only spot, all the other unaffected places could ship them ventilators, supplies, and medical volunteers. The next phase where multiple areas are overwhelmed will get a lot uglier.

[dabigv13]

We aren't talking about it yet but we should probably start. Many states are at new highs, and any lockdown restrictions we take now (and we aren't really doing anything dramatic) won't show in the numbers for several weeks. I think the next phase of the pandemic will be multiple areas of the US going through their own NYC style experience where the hospitals and morgues get overwhelmed.

Yakima's hospital system full in WA. Children's hospitals admitting adult patients in Texas. When NYC was the only spot, all the other unaffected places could ship them ventilators, supplies, and medical volunteers. The next phase where multiple areas are overwhelmed will get a lot uglier.

[Genuine Realist]

Finally, was the notion of 'flattening the curve' chimerical from the start? A goal that is not possible to achieve as a practical matter, because of the number of essential businesses and the quantum of non-compliance? If so, wouldn't it be better to accept the society as it is and work towards practicable goals of realistic containment than insist on the imposition of draconian controls with no set time limit?

I'm not sure what you mean here.  We have dramatically flattened the curve.  Even in states where there is an increase in cases, R is on the order of 1.2 - 1.4, not as high as the R0 of 2.5 - 3.  That means that while the number of cases are increasing, they aren't increasing as fast it would have in the absence of measures.  And we reducing the restrictions.  I think in an ideal world, you titrate the restrictions to ensure R is slightly less than 1, loosening them as long as case counts are declining and tightening them as case counts start to climb.

I think Europe is (generally) a good case study.  I posted a plot of the number of cases in Europe versus the United States post peak, and you could see that the number of cases in Europe dropped dramatically compared to the US.  In most places (excepting Sweden), the lockdowns were harsher and more dramatic than in the US.  And you can draw a direct line from that to declining number of deaths and cases.  As a consequence, they are also able to relax their lockdowns more aggressively.  The benefits of the lockdown are immediately apparent to most Europeans.  The US is caught in a bit of a purgatory.  We are locked down enough to cause economic pain and provoke a backlash, but not effectively enough to prevent cases from rising in a bunch of places.

Perhaps that is the source of your frustration.  But I can assure you that things would almost certainly be worse in a world where there were no restrictions whatsoever.  We have seen that story play out: Italy, Spain, New York prior to lockdowns, Brazil and Mexico now.  While things aren't looking great in Florida, Texas, Arizona, California and a few other places, we still aren't talking about things spiraling out of control.

BC

I meant the absolute flattening that was the ultima thule.  We all hoped that SIP would produce a curve that flattened to the vanishing point

My question was more about marginal utility than the tactic. No one with any sense doubts that SOME lockdown of SOME duration was required. The issue is whether the marginal value of the lockdown beyond a certain point in time justified the return in terms of case reduction. I don't think anyone really knows, but it's a question that should be asked.

As for European comparisons, continental Europe is not the same as the US (duh). I'd say that the comparisons favor the US in almost every way EXCEPT discipline in a pandemic. You'd have to factor in different modes of public mobility, different employment patterns, above all, the radically pluralistic nature of US society. We pull in every direction, a Good Thing, generally - you hardly need be reminded of the havoc docile populations can wreak - but not so good in a pandemic, no question. 

These are perspectives, not answers. All I'll say for sure is that pushback was inevitable against the imposition of the protocols, and that a fair amount of non-compliance was inevitable. The question of whether the means here was excessive in terms of what ends could realistically be achieved is a valid one.

[Genuine Realist]

Finally, was the notion of 'flattening the curve' chimerical from the start? A goal that is not possible to achieve as a practical matter, because of the number of essential businesses and the quantum of non-compliance? If so, wouldn't it be better to accept the society as it is and work towards practicable goals of realistic containment than insist on the imposition of draconian controls with no set time limit?

I'm not sure what you mean here.  We have dramatically flattened the curve.  Even in states where there is an increase in cases, R is on the order of 1.2 - 1.4, not as high as the R0 of 2.5 - 3.  That means that while the number of cases are increasing, they aren't increasing as fast it would have in the absence of measures.  And we reducing the restrictions.  I think in an ideal world, you titrate the restrictions to ensure R is slightly less than 1, loosening them as long as case counts are declining and tightening them as case counts start to climb.

I think Europe is (generally) a good case study.  I posted a plot of the number of cases in Europe versus the United States post peak, and you could see that the number of cases in Europe dropped dramatically compared to the US.  In most places (excepting Sweden), the lockdowns were harsher and more dramatic than in the US.  And you can draw a direct line from that to declining number of deaths and cases.  As a consequence, they are also able to relax their lockdowns more aggressively.  The benefits of the lockdown are immediately apparent to most Europeans.  The US is caught in a bit of a purgatory.  We are locked down enough to cause economic pain and provoke a backlash, but not effectively enough to prevent cases from rising in a bunch of places.

Perhaps that is the source of your frustration.  But I can assure you that things would almost certainly be worse in a world where there were no restrictions whatsoever.  We have seen that story play out: Italy, Spain, New York prior to lockdowns, Brazil and Mexico now.  While things aren't looking great in Florida, Texas, Arizona, California and a few other places, we still aren't talking about things spiraling out of control.

BC

I meant the absolute flattening that was the ultima thule.  We all hoped that SIP would produce a curve that flattened to the vanishing point

My question was more about marginal utility than the tactic. No one with any sense doubts that SOME lockdown of SOME duration was required. The issue is whether the marginal value of the lockdown beyond a certain point in time justified the return in terms of case reduction. I don't think anyone really knows, but it's a question that should be asked.

As for European comparisons, continental Europe is not the same as the US (duh). I'd say that the comparisons favor the US in almost every way EXCEPT discipline in a pandemic. You'd have to factor in different modes of public mobility, different employment patterns, above all, the radically pluralistic nature of US society. We pull in every direction, a Good Thing, generally - you hardly need be reminded of the havoc docile populations can wreak - but not so good in a pandemic, no question. 

These are perspectives, not answers. All I'll say for sure is that pushback was inevitable against the imposition of the protocols, and that a fair amount of non-compliance was inevitable. The question of whether the means here was excessive in terms of what ends could realistically be achieved is a valid one.

[burger]

While things aren't looking great in Florida, Texas, Arizona, California and a few other places, we still aren't talking about things spiraling out of control.

BC

California probably isn't fully out of control.  And I guess you could make an argument that Florida and Texas aren't truly awful (I would disagree, but the numbers aren't completely insane yet).  But I don't see how anyone can say Arizona isn't out of control.

Of course, if these trends continue at the current rates for a few more weeks, then all of these states are in big, big trouble.

Edit: I added NY for perspective.

[burger]

While things aren't looking great in Florida, Texas, Arizona, California and a few other places, we still aren't talking about things spiraling out of control.

BC

California probably isn't fully out of control.  And I guess you could make an argument that Florida and Texas aren't truly awful (I would disagree, but the numbers aren't completely insane yet).  But I don't see how anyone can say Arizona isn't out of control.

Of course, if these trends continue at the current rates for a few more weeks, then all of these states are in big, big trouble.

Edit: I added NY for perspective.