Comparing Corona Virus Success Stories with Abysmal Failures

[J.C.MacSwell]

2 minutes ago, Strange said:

It is this year. (See what I did there)

I will...

[CharonY]

43 minutes ago, J.C.MacSwell said:

I don't think China, especially, or the WHO have acted well...but there certainly was enough information out there that was, tragically, ignored or overlooked.

 

 

And even with the missteps and structural issues in China, at least they had the excuse that it was a new disease that they had to identify and develop a diagnostic tool against. Once they decided to move, it was incredibly fast (the scientific side of things) and perhaps needlessly harsh.

But a few months in, seeing all that is happening and virtually no response is something else entirely. As I have stated before, the CDC is usually on top of these things and if they were the ones handling it without interference, I would think that if the outbreak was in the US, the outcome would have been better. Yet seeing what the current administration has done (or rather not done), I am not so sure.

[MigL]

I have read that the funding freeze is for 6 months.
I have also read that the US has already made its contributions for the 2 year funding cycle.
 ( which is at odds with CharonY's claim that the US is behind in their funding )

That being said it is extremely short-sighted; you don't stop funding in the middle of a pandemic.
After the problem has been dealt with, you analyze what went wrong, and prepare for next time. But D Trump has an election to worry about, this year, and a lot of blame to shift.
The US has certainly made many mistakes in the Covid-19 response, and this could turn out to be a major one.
But so has China, and the WHO.
China should not be so critical of other nation's stupid actions, lest it be held accountable for its own.

[CharonY]

38 minutes ago, MigL said:

China should not be so critical of other nation's stupid actions, lest it be held accountable for its own.

I would agree with the the fact that China should not engage in public mudslinging and I am more than dismayed on their attempt to create a new narrative. I do think their failures were structural ones where medical advice was not shielded from political meddling combined with secrecy creating a recipe for disaster that could have ended far worse. That being said, there is at least some level of plausible deniability based on a mix of incompetence, awful reporting structure and error of judgement in an somewhat unknown situation. 

The US has none of these excuses. And at least the machinery started moving once they were past that point. According to NYtimes reports apparently the Chinese CDC really got memos regarding clusters of unexplained cases of pneumonia by Dec. 30 on 31st a team was dispatched to Wuhan, concurrent with notification of the WHO. The cases that were circulating were only then finally entered into a system that was part of a pandemic warning system (around Jan 3rd). The initial assessment before they were certain that a new disease was in circulation was finished by the 19th and on the 23rd the province was shut down. In-between (on the 12th) Chinese researchers released the full sequence of the virus. 

So somewhere around that point, the world knew what was coming. While responses have been slow and halting in many parts outside Asia, the US was one of the few Western countries who were still in active denial deep into the process with some first moves being done sometime in March, way after Italy was hit badly.

With regard to the WHO, not sure what they could have done much better. When they raised alarm regarding SARS they were criticized for damaging the economy. 

Quote

I have also read that the US has already made its contributions for the 2 year funding cycle.
 ( which is at odds with CharonY's claim that the US is behind in their funding )

In the link above there is a report on the payment status March 31st. And from it it looks like that in their balance 31-Dec-19 was 71mill and only 29 was collected leaving 41 mill as outstanding from their previous balance. Maybe they have paid it since then. China has an outstanding bill for 2020 but paid for 2019. From a quick look it appears that only few countries had outstanding bills for that year (most in the Middle East, from the looks of it).

But again, the commitment does not seem an arbitrary pledge, rather it appears to be something that is based on agreement of its member states.

 

[MigL]

6 minutes ago, CharonY said:

That being said, there is at least some level of plausible deniability based on a mix of incompetence, awful reporting structure and error of judgement in an somewhat unknown situation. 

So they can deny they messed up because of incompetence and political meddling in their reporting structure ?

8 minutes ago, CharonY said:

The US has none of these excuses.

Of course, they have almost the same excuse.
Their political leaders are idiots, and they meddle in things they don't understand.

Why apply different standards to the US and China ?

[J.C.MacSwell]

2 minutes ago, MigL said:

So they can deny they messed up because of incompetence and political meddling in their reporting structure ?

Of course, they have almost the same excuse.
Their political leaders are idiots, and they meddle in things they don't understand.

Why apply different standards to the US and China ?

Same reason you would hold Canadian Government/s to higher scrutiny than, say India?

[CharonY]

1 hour ago, MigL said:

So they can deny they messed up because of incompetence and political meddling in their reporting structure ?

No, not the messing up things. I was more referring to the narrative that they deliberately hid things knowingly. I.e. they knew that they had a spreading disease on their hands and decided to suppress that. 

The USA also messed things up, but after having all the information that China at that point didn't have. So even without the expectation that the US would have reacted better under the same circumstances, I certainly expect them (or anyone else) to react better with the knowledge at hand. 

To make the wrong steps based on structural issues in a situation with incomplete information is different from choosing to take the wrong steps when presented with all the information.

  

1 hour ago, J.C.MacSwell said:

Same reason you would hold Canadian Government/s to higher scrutiny than, say India?

That is perhaps also a part of it. As long as medical professionals have to work within a system that has strong political influence, it is somewhat expected to have slower reaction times and more mismanagement. The US used to be (much) better in that regard.

 

[MigL]

1 hour ago, J.C.MacSwell said:

Same reason you would hold Canadian Government/s to higher scrutiny than, say India?

Sure but I would be the one to criticize the Canadian Government.
I would not expect the Indian Government to criticize the Canadian one, JC.

How does the saying go ?
" When you live in a glass house, don't throw stones."
That is what China should be taking away from this.

[CharonY]

2 minutes ago, MigL said:

Sure but I would be the one to criticize the Canadian Government.
I would not expect the Indian Government to criticize the Canadian one, JC.

How does the saying go ?
" When you live in a glass house, don't throw stones."
That is what China should be taking away from this.

Well from what I have seen the US has been heavily pushing the anti-Chinese narrative and China has responded in kind. Both are crap, but I am not sure whether the saying actually fits well here.

[J.C.MacSwell]

10 hours ago, CharonY said:

That is perhaps also a part of it. As long as medical professionals have to work within a system that has strong political influence, it is somewhat expected to have slower reaction times and more mismanagement. The US used to be (much) better in that regard.

 

I was also thinking you would be more critical of the US Governments as they are, at least in theory, more responsible to you.

[Danijel Gorupec]

To move away a little from the current discussion... I don't think the WHO's greatest sin was inadequate reporting from China. I can understand this (China keeps strong control over information flows). But it seems that between epidemics WHO failed to establish standards on how to collect and report disease statistics. Now we have non-comparable data all around the world. How can epidemiologists (and economists and politicians) make informed decisions using this data? This is the source of my disappointment with WHO.

[dimreepr]

19 hours ago, MigL said:

Defence is a national edeavor, Dimreepr.
The WHO is a worldwide, multinational organization.
Vast difference.

China should be the last to complain about the situation the world finds itself in.

Who in the, political, world acted with due diligence?

Besides national defence usually turns into a lot of dead people; if only we could learn to cooperate 

[CharonY]

2 hours ago, Danijel Gorupec said:

To move away a little from the current discussion... I don't think the WHO's greatest sin was inadequate reporting from China. I can understand this (China keeps strong control over information flows). But it seems that between epidemics WHO failed to establish standards on how to collect and report disease statistics. Now we have non-comparable data all around the world. How can epidemiologists (and economists and politicians) make informed decisions using this data? This is the source of my disappointment with WHO.

The issue there is that the WHO cannot force countries to run their health system in a specific way. Even a single country might report things differently in each province/state/ prefecture. 

2 hours ago, dimreepr said:

Who in the, political, world acted with due diligence?

Besides national defence usually turns into a lot of dead people; if only we could learn to cooperate 

Taiwan had a task force from the SARS days that spring into action. South Korea quickly assembled one. Likewise Singapore. One could have emulated them (or not weakened ones own pandemic response team, for example). 

[MigL]

23 minutes ago, CharonY said:

The issue there is that the WHO cannot force countries to run their health system in a specific way.

But they should not give them a pass when they fumble badly, either.

Many of us will be skeptical of this report because of the source ( Fox originally )

https://www.msn.com/en-ca/news/world/2-wuhan-whistleblowers-missing-months-after-helping-expose-coronavirus-outbreak-activists-say/ar-BB12HUcu?ocid=msedgntp

but if there's even an ounce of truth to it, China has a lot to answer for, and the cover up may be larger than anyone imagined.

[CharonY]

The suppression of free speech by the Chinese government is definitely wrong. However, I am skeptical regarding large-scale misinformation for several reasons. The biggest one is that one strictly follows the data, everything we learned from China so far largely lines up with models with data from other countries. For example, if they were covering up deaths, by now we would see an unexplained shift in fatality  rates outside China, but that does not seem to be the case.

They did change the reporting several times, including not counting asymptomatic cases as infected, but it kind of makes sense from a clinical viewpoint, as they isolated all cases but treated symptomatic and asymptomatic cases differently (and moved the former to the latter category once symptoms manifested, it is an inelegant way to avoid double counting). But all it did was to increase the published death rate. So if there is huge cover-up of sorts, it is unclear what they hid, as at least on the scientific side of things regarding the virus nothing has fundamentally changed in our understanding.

[MigL]

12 minutes ago, CharonY said:

So if there is huge cover-up of sorts, it is unclear what they hid

That is usually the point of cover-ups.

13 minutes ago, CharonY said:

regarding the virus nothing has fundamentally changed in our understanding

But it has changed our response.
No-one took it seriously at first, because China, the epicenter of infection, did not seem very worried about it.
If our understanding hadn't fundamentally changed, and the gravity was understood at the same time as China did, almost all nations would have stopped flights and closed borders with China, as China itself isolated Wuhan province.

[Danijel Gorupec]

1 hour ago, CharonY said:

The issue there is that the WHO cannot force countries to run their health system in a specific way.

Sure. I didn't mean it that way. What I meant is that member states pay fee to WHO because, among else, they want to be guided into certain harmonization (at least I hope so). However WHO failed to provide workable and attractive plans and/or initiative that would help states to establish this.

[CharonY]

 

59 minutes ago, MigL said:

That is usually the point of cover-ups.

But it has changed our response.
No-one took it seriously at first, because China, the epicenter of infection, did not seem very worried about it.
If our understanding hadn't fundamentally changed, and the gravity was understood at the same time as China did, almost all nations would have stopped flights and closed borders with China, as China itself isolated Wuhan province.

That is nonsense. Plenty of folks took it seriously, their pandemic responses teams activated early January. China shut down whole provinces and tanking their economy and risking unrest. That alone was a strong signal (and WHO raised their warning levels at the same time). I mean seriously, what would have been a warning sign if not that? Obviously China (as well as other countries hit by SARS) took it seriously at the latest toward the end of January (again, there was an unprecedented shutdown). Other countries, including US and Europe did not react until late February to March. Folks such as the RKI in Germany have acknowledged that they should have done more contact tracing, for example. 

In addition it is a weird cover up that managed to create perfectly predictive data. So far transmission rates, lethality, effects of age and comorbidity all seem to line up with data all over the world so either they new the correct numbers and fudged it to much or they covered up something that had no impact on our undersanding. In that case if something was covered up, what would it even theoretically be? Everything that happened in China is now happening elsewhere with the same intensity (or worse, depending on the response). So what  is being covered up that so well matches all observations so far? I do not expect the Chinese government to be forthright, but it is silly to assume that this causing in poor responses elsewhere as, again everything that came out of China so far was shown to be fairly predictive. In addition to all that, there was also data coming out from countries that started early testing, so by February we also had range of strategies on display, including total lockdown (China), enhanced contact tracing eventually followed by testing (e.g. Taiwan, Singapore, Vietnam, South Korea). Well, or nothing.  

[MigL]

Well you can call it 'nonsense', but we are having a discussion ( friendly I hope ) of differing opinions.
We both seem to agree there seem to be, some signs of a 'cover-up', but, while you're of the opinion similar outcomes for China and the rest of the world, imply there was/is no cover-up, I am proposing the possibility that the cover up is working as intended, and we don't know what is being cover up.

If everyone can ( and probably should ) believe the worst regarding D Trump ( sometimes without conclusive evidence, see Hydroxychloroquine thread ), what makes the Chinese Government such 'angels', incapable of wrong-doing ?

[CharonY]

6 hours ago, MigL said:

We both seem to agree there seem to be, some signs of a 'cover-up', but, while you're of the opinion similar outcomes for China and the rest of the world, imply there was/is no cover-up, I am proposing the possibility that the cover up is working as intended, and we don't know what is being cover up.

I am not talking about whether China might or might not have been forthright or who is more or less honest. That is not terribly productive in itself, and I am mostly concerned about facts we know or which are  missing.

What I am saying is that if there was a cover-up, it does not appear to had any functional consequences. Therefore there was no reason to not to heed the warnings. Or conversely, stating that folks were taken by surprise due to China hiding the infection is ridiculous, given the massive lockdown on the 23rd of January and the inaction of e.g. the US between then and March. If they hid something, and the something does not change our knowledge on the infection, why would it matter? It would then all be a discussion about who is bad and who is not, and not about whether the information is reliable and useful.

And that is a very dangerous stance, because you are essentially saying we should throw out all the data from China as they are all wrong. Luckily (or sadly) by now we also have data in other countries that a very similar picture, pretty much invalidating that assumption. And here is the other thing, we are science oriented forum, so data is king. If we look at that dispassionately we (so far) do not find strong evidence of any meaningful manipulation (aside the points I mentioned before, which are not really hidden). So I am asking, what is the benefit of just assuming things with evidence, other than becoming more vulnerable to manipulation and spin?

There is already the narrative that the one pushing the responsibility to WHO and China rather than acknowledging failures in own responses.  Because from the latter we can learn and improve, but the former will keep us in blissful ignorance (until the next outbreak hits). 

Let me be clear, there are two major narratives, mostly pushed by the US at this point. One is that the inability of China (or willingness) to report on the original clusters of pneumonia up to the end of December has cost the world time to react. The issue with that is even after that only few countries started to implement measures whereas the US and others have done little until March. And there are emerging reports that intelligence services have notified folks of these clusters of infections almost as soon as the Chinese CDC, and drew their own conclusions (but apparently not resulting in any reactions from the administration) And even in March before the lockdown, folks were not asked at airports regarding their travels. So that does not line up. Associated with that is that folks could have closed borders earlier. The issue with that one, is I believe that either in the US or Canada more infections were coming from Europe than from China.Which is why the big world-wide waves started actually way later than anticipated (as China was shutting down).

The second is that China is hiding some big secret, which, for some reasons, does not change epidemiological data in any relevant way. So not only it is not clear what is missing, it also fails to show any impact (at least on the scientific side of things). But again, it does not impact folks to learn about the virus, nor to implement meaningful measures, as you insinuated earlier (how can it if it does not change the meaning or interpretation of the published data?). 

If one does not take responsibility to ones own failures (in China's case free distribution and discussion of information, in the US' case acting on actually available information and in many other countries learning from timely and effective responses in other countries), these issues will crop up again. And there is not guarantee that the next one will not have an origin in, say, North America.

 

 

[sangui]

My question may look weird but : Doesn't Italy have a really different death ratio than China ?

And if it's true, doesn't it mean than China may have cover some death ? 

[Strange]

1 hour ago, sangui said:

My question may look weird but : Doesn't Italy have a really different death ratio than China ?

And if it's true, doesn't it mean than China may have cover some death ? 

So, a quick look gives me the following for deaths/cases:

Italy: 22,170 / 168,941 = 13%

Spain: 19,315 / 184,948 = 10%

China: 4,632 / 50,333 = 9%

Germany: 4,051 / 137,698 = 2.9%

Korea: 230 / 10,635 = 0.2%

So, if the differences were due to covering up the figures then Germany and South Korea are far worse offenders. The truth is, there are a great many factors that contribute to the differences between countries. Some that spring to mind immediately:

• Age and health of the population
• Social structure (in Italy families of 3 or more generations often live in close proximity)
• How much testing is done (this reduces the case fatality rate by increasing the number of cases detected)
• How early action is taken
• How stringent the measures are (just asking people to stay home, actively tracing all contacts, quarantining all suspected contacts, etc)
• How well the population obeys the rules
• What are the definitions of "case" and "death": only those confirmed with a test? number of people tested vs number of tests done? all those with symptoms? only deaths in hospital?
• Quality of data collection (in Italy, many areas have, apparently, been too busy to fill in paperwork)
• Honesty of governments/media

I'm sure there are many other factors as well. I don't think we will know the answers to a lot of the questions about this virus for many years.

 

[J.C.MacSwell]

1 hour ago, Strange said:

I'm sure there are many other factors as well. I don't think we will know the answers to a lot of the questions about this virus for many years.

I wonder how many discernible factors could potentially correlate with the viral loads sufficient to trigger incubation, and stretching those, getting an idea how those viral loads affect outcomes for those that become known cases? Obviously no one's going to due any proper double blind testing of this, especially for vulnerable individuals within populations.

Also, If you are never symptomatic, test negative for the virus, but test positive for antibodies, does this count as a known case?

[MigL]

Italy has currently tested an equal number of people per 1M population as Spain.
Roughly twice as many per capita as the US has.
Only countries with higher testing rates ( and not by much ) are Germany, Switzerland, Portugal, Israel, Norway, the UAE, Qatar, Estonia, and relatively small countries like Iceland , Cyprus, San Marino, Luxenberg and Andorra.
They have done more testing than Singapore and Hong Kong, and double the testing of South Korea.
China doesn't even report their testing per capita...

https://www.worldometers.info/coronavirus/

Then there is the death rate underreporting...

https://www.theglobeandmail.com/world/article-chinas-coronavirus-death-toll-rises-sharply-after-wuhan-announces/

Maybe world 'pressure' is starting to have an effect.

 

T

Edited April 17, 2020 by MigL

[CharonY]

1 minute ago, MigL said:

Italy has currently tested an equal number of people per 1M population as Spain.
Roughly twice as many per capita as the US has.
Only countries with higher testing rates ( and not by much ) are Germany, Switzerland, Portugal, Israel, Norway, the UAE, Qatar, Estonia, and relatively small countries like Iceland , Cyprus, San Marino, Luxenberg and Andorra.
They have done more testing than Singapore and Hong Kong, and double the testing of South Korea.
China doesn't even report their testing per capita...

https://www.worldometers.info/coronavirus/

Then there is the death rate underreporting...

https://www.theglobeandmail.com/world/article-chinas-coronavirus-death-toll-rises-sharply-after-wuhan-announces/

 

 

T

A few things, the coverage varies a lot between different countries also the case when folks are being tested. Considering that a lot of outbreaks are actually localized rather than nation-wide (depending on size of the country). One thing to look at that sometimes is helpful is how many tests come back negative. Italy also does some post-mortem testing, which other countries don't for example. So roughly 15% of all tests currently administered still come back positive. Contrast that with South Korea where less than 2% of all cases come back positive. 

The "real" fatality rate is probably lower than the 2-3% reported for the simple reason that many asymptomatic folks will remain unknown. What we start doing now is testing for antibodies that will detect "invisible" infections. Some preliminary local data has been provided for Germany for example (in Gangelt, one of the hotspots of infections) and the death rate there when accounting for undetected cases was closer to 0.4%.

In other words the observed crude death rate is also a factor of tests being administered as well as the other factors Stranger mentioned. And of course there is also a matter of definition, as some calculate it based on symptomatic cases exclusively, i.e. case fatality. This basically would only count the likelihood of dying after developing symptoms (a couple of countries including China have waffled a bit in terms of what to report as a case).

 Again, it would be silly to assume that the world would have reacted differently if China had reported a few percentage points higher or lower.

With regard to testing, the reporting was a bit all over the place. Typically two or more tests are administered and initially Italy for example listed counted each test but I think they switched to individuals at some point. That caused a bit confusion to calculate test coverage and makes some data not comparable.

Other Countries (such as Germany or US) either did not publish a totals list or referred to individual states (which may or may not have reported). With regard to reporting, I know I got test numbers from Wuhan (via the provincial reporting)a while back but I do not know enough Chinese to effectively dig out data. There was a report in the province in Guangdong which showed about 320,000 tests at the end of February (or 2820 tests per million people).  It does look that only from 66 countries we can get convenient national data (although again, they may be different in terms of what is being reported). 

The correction of death rates on the other hand does look more like an attempt at transparency rather than obfuscation. Most countries will under report deaths unless they do post-mortem testing in all suspicious cases. And countries with limited capabilities will obviously under report more.

To be clear, China is definitely not a source that can be trusted with the same level as many other countries. While there is no evidence of systematic data manipulation they could, in theory reduce overall positive as well as death numbers, thus keeping the ratios constant (again, no evidence that they did). But, and this is the important bit, even if they did, and even if they are in a worse shape than they seem to be, it is no freaking excuse for the other countries to not at least create emergency plans and scenarios the moment China started reporting on the outbreak. Cases outside of China (including US) were already been reported leading up to February but without evidence of community spread. So why wasn't there more contact tracing or any kind of travel screening (as shown in other countries shutting down borders is not even necessary). I am repeating myself here, but it is not about whether China is a reliable partner or not. It is about why folks did not act even with the available information (regardless whether they were 100% accurate or not, as you will never get perfect data in a novel outbreak).

Infectious disease experts have been making some noise early on and the CDC has made all the right statements come February. And then there is the gaping lack of action until Italy was hit and Europe was starting to get nervous. I suspect much of it is because often Europe looks toward the US in these situation as especially Germany is often unwilling to take lead. Germany produces a lot of the components for the tests and has decent capacity of PPE production and I think I got a notification sometime around March where only then they were asked to increase their production. I.e. folks did not think that they needed the surplus (which is why the first weeks in Germany there was an abysmal rate of tests until they managed to ramp it up). There was a whole lot that could be done and it is perhaps no surprise that countries with with SARS experience responded better. What the rest of the world needs to understand is that infectious diseases will be with us and regardless where you live, there is always a chance for deadly outbreaks. The tendency to think that if something happens elsewhere will never impact us or that where we live is clean and disease-free is an illusion. I am expecting that this situation is a teachable moment for countries that ignored the pandemics and epidemics that have been less consequential for them, but am dismayed that some countries (including China and the US) are instead playing the blame game, as if diseases would care about any of that.

7 hours ago, J.C.MacSwell said:

I wonder how many discernible factors could potentially correlate with the viral loads sufficient to trigger incubation, and stretching those, getting an idea how those viral loads affect outcomes for those that become known cases?

There is some evidence that higher viral loads correlate with worse outcomes. Studies are limited, but I can dig them out if you want.