Comparing Corona Virus Success Stories with Abysmal Failures

[swansont]

Yeah, about Sweden...

"Sweden: 22 Scientists Say Coronavirus Strategy Has Failed As Deaths Top 1,000"

https://www.forbes.com/sites/davidnikel/2020/04/14/sweden-22-scientists-say-coronavirus-strategy-has-failed-as-deaths-top-1000/#1f42483e7b6c

[CharonY]

5 minutes ago, swansont said:

Yeah, about Sweden...

"Sweden: 22 Scientists Say Coronavirus Strategy Has Failed As Deaths Top 1,000"

https://www.forbes.com/sites/davidnikel/2020/04/14/sweden-22-scientists-say-coronavirus-strategy-has-failed-as-deaths-top-1000/#1f42483e7b6c

Actually I do think that this call is premature as well. We would need to look retrospectively at total hearlth burden to assess how damaging this strategy was. There is some truth that they are currently doing worse than their neighbours with over 2000 deaths, compared to 205 (Norway) or 427 (Denmark). Another issue is that Sweden has reported fewer tests, which increases uncertainty somewhat. So while the current trajectory does not look great, I think it takes a bit longer to ascertain whether it is total failure or not.

[Ghideon]

Several valid points regarding Sweden have been made in posts above. My experiences so far: 
-There is not enough data available to state anything conclusive regarding the current approach here in Sweden. It's too early.
-Most decisions so far seem to be based on scientific evidence.
-As far as I can tell there are good models, adjusted to local conditions but maybe not adjusted to Corona yet
My guess* is that the lack of data makes it hard to run the models with a valid set of parameters, models have been proven to work in other situations may or may not produce good predictions. The models' predictions are open for various interpretations. Data in this early stage can support both a lockdown and an open strategy; there is an overlap. Both may be sound scientific interpretations, there are scientists (and others) on both sides in the discussion.

 

I can't guess if this policy will have a good or bad outcome. But I can see the logic behind the attempt to balance for instance:
-Base decisions on local conditions, not so much on what others have done.
-Try to close down enough to allow for health care to cope and adjust. But do not close down more than that. 
-Try to make recommendations that people will choose to follow over an extended period of time, it is not a three weeks sprint run for a vaccin.

There are lots of other observations to add but that would turn this into blog post. If there is interest in some specific aspect I'll try to answer or find sources.

*) I do not have studied the numbers and methods enough claim any insight (yet). 
 

 

[CharonY]

Perhaps it helps to highlight some of the basic ideas behind the models underlying many of the strategies currently in play. A simple, but frequently used one are SEIR models or their variations. These are simple differential equations calculating how the rate at which folks move from Susceptible to Exposed to Infected and finally to Recovery status. You can think it as a simple compartment model in which the population is part of either of these  compartments. Values such as effective reproduction number (how many people an infected person infects), length for which a person is infectious, initial number of infectious people and so on then determine the movement of the population through these compartments.

From there, one looks at the expected number of infected folks at any given time and often using age-adjusted models (as well as other info, if available) one can estimate how many folks at any given time might need hospitalization. As the capacities can vary significantly, especially in larger countries, usually more local modelling is conducted to understand the health impact of different infection rates.

The major factor that measures such as social distancing and shutdowns are affecting are therefore the expected number of folks being infected in a given time frame (essentially by adjusting the effective reproduction number). This is pretty much an established effect by now, with different estimates for different measures (and areas). So basically the major strategies revolve around these measures, as well as increasing health care capacities, if possible. So one might allow the transmission to increase a little, provided that the health care facilities are free, but may want to shut down again, once they go up.

Two critical things we need to know, but don't know yet is how efficient immunization is going to be (either via vaccine or via infection) as well as a how long potential immunity will last. There are models for that, which in the simplest case just has a flow back from Recovered populations back to Susceptible after a certain time.

 

 

[MigL]

IIRC Italy and some other European countries have had their R0 number ( R naught or reproduction number ) at less than 1 for over a week before they started cautiously lifting some restrictions.
I know we're not near there in Ontario, yet there is talk of lifting some restrictions in the coming week.

Then again, our largest hot spots are metro Toronto and retirement homes, and it's a big province.
( I see more old people out and about than young; what are they thinking ? )

[CharonY]

Technically, it would be the effective reproduction number (or R sometimes referred to as Rt) as R0 refers to the basic reproduction number which is absent of any intervention of disease transmission and where no immunity exists (though in press I see the terms used rather liberally). In case of SARS-CoV-2 it is even a bit more complicated as both numbers would be the same at the beginning of the infection process as there was no immunity and also no intervention. 

But aside the nitpick, the idea is indeed to surf the number close to one and hope to keep new cases low(ish). In some areas this does not seem feasible with still relatively high (or unknown) transmission rates.

[Danijel Gorupec]

8 hours ago, CharonY said:

...we need to know, but don't know yet is how efficient immunization is going to be...

This part interests me: If it turns out that immunization is very inefficient (very short-term), what options do we have? What strategy would work best?

[swansont]

4 hours ago, Danijel Gorupec said:

This part interests me: If it turns out that immunization is very inefficient (very short-term), what options do we have? What strategy would work best?

What have the countries which have had the most success done? 

[Ghideon]

14 hours ago, CharonY said:

A simple, but frequently used one are SEIR models or their variations.

Thanks, variations of SEIR is in use here. There is also a full scale model of the population on individual level, microsim*, but AFAIK not yet adopted to the new situation. Your post helped me in the right direction for further reading.

 

 

56 minutes ago, swansont said:

What have the countries which have had the most success done? 

Neighbour countries here have adopted other policies and have a lower number of deaths now. A better protection of the elderly people and/or people seems to be one important factor where others seem to have been doing a better job than Sweden. The underlaying reasons for that will probably be analysed and debated for years.
I think your question is interesting because "success" needs to be defined one way or another In the context of the thread,  Success Stories must be possible to separate from Abysmal Failures to be able to improve policies. Otherwise it will be tricky to compare policies and improve. I do not know if success now in the early phase is a guarantee for success in the long run.

 

*) https://books.google.se/ extract

https://arxiv.org/pdf/0902.0901.pd

Quote

microsimulation model that uses official anonymized register data collected from all individuals living in Sweden. Individuals are connected to households and workplaces and represent crucial links in the Swedish social contact network. This enables significant policy experiments in the domain of epidemic outbreaks.

 

Edited April 28, 2020 by Ghideon
Better source

[dimreepr]

1 hour ago, Ghideon said:

Neighbour countries here have adopted other policies and have a lower number of deaths now. A better protection of the elderly people and/or people seems to be one important factor where others seem to have been doing a better job than Sweden. The underlaying reasons for that will probably be analysed and debated for years.
I think your question is interesting because "success" needs to be defined one way or another In the context of the thread,  Success Stories must be possible to separate from Abysmal Failures to be able to improve policies. Otherwise it will be tricky to compare policies and improve. 

Cooperation seems to lead to a more successful outcome...

1 hour ago, Ghideon said:

I do not know if success now in the early phase is a guarantee for success in the long run.

It's not, but it does give us a longer run up...

Edited April 28, 2020 by dimreepr

[MigL]

What about this vaccine being developed at Oxford, which has been able to skip several stages of testing. as it uses the same mechanism used for a MERS vaccine previously developed.
They say if final testing proves successful, they could have 3 million units ready by the fall.

[Alex_Krycek]

Basically what it comes down to:

The French prime minister, Édouard Philippe, has begun outlining the schedule for the end of the coronavirus lockdown in France to MPs in the Assemblée Nationale.

Philippe began saying the situation was unique. “Who could have envisaged a France where schools, universities, cafés, restaurants, the majority of businesses, libraries … beaches, stadia … would be closed. We have never known this situation in our country. Not during the war, not during the occupation, not during previous epidemics,” he said.

“The country cannot be locked down for a long time … it is efficient against the virus, to stop its spread and the saturation of our hospitals and protect vulnerable people.”

“An instrument is only useful if in the long term the positive effects are greater than the negative … We have to proceed to a progressive end of lockdown.”

Philippe said he would outline the “national strategy” to end the lockdown. In medical terms “we have to learn to live with the virus …no vaccine will be available in the short term, there is no treatment and we don’t have what they call herd immunity”.

Philippe said it was implausible to think the virus would just “disappear of it’s own accord”.

[dimreepr]

"Stand ye calm and resolute,
Like a forest close and mute,
With folded arms and looks which are
Weapons of unvanquished war.

And if then the tyrants dare,
Let them ride among you there;
Slash, and stab, and maim and hew;
What they like, that let them do.

With folded arms and steady eyes,
And little fear, and less surprise,
Look upon them as they slay,
Till their rage has died away:

Then they will return with shame,
To the place from which they came,
And the blood thus shed will speak
In hot blushes on their cheek;

Rise, like lions after slumber
In unvanquishable number!
Shake your chains to earth like dew
Which in sleep had fallen on you:
Ye are many—they are few!"

Shelley

[CharonY]

2 hours ago, swansont said:

What have the countries which have had the most success done? 

The most common element is more extensive contact tracing and follow-ups with testing at the beginning of the infection cycle. I.e. getting ahead of the curve. 

[J.C.MacSwell]

Canada's 2 most populous provinces are taking very different approaches to reopening, Ontario signalling intent to be much more cautious than Quebec.

Both have been hit fairly hard, but Quebec more so. Quebec plans to open schools back up fairly soon.

https://www.theglobeandmail.com/canada/article-quebec-ontario-take-different-paths-to-reopening-provinces-from/

[Danijel Gorupec]

So, some countries and provinces are reopening already...  Will this make a pressure on others to reopen too? I mean, capitalism still works: those who can produce their products will find new customers, those who cannot produce will lose their regular ones.

So no, I wouldn't claim success only because my country still has roughly 97-98% of population intact by the virus(*).

 

(* I just multiplied confirmed cases by 50 - this gives 2.5% of population).

[iNow]

The governor in my state is re-opening most things on Friday, but many of the local businesses I love and frequent have already responded and posted things on their various social pages that can be paraphrased as... "Uhh... yeah, we're really glad the government is so optimistic and that's all well and good, but we're most decidedly NOT re-opening until we see more reductions in cases for a few weeks in a row. Absent that, we're not willing to put our staff and customers at risk... Hope shouldn't be Plan A and for now we'll stick to limited online ordering and curbside pickup."

Meanwhile, the POTUS wants to re-open schools for May before summer starts, too. So tired of being led by incompetent grifters. 

[MigL]

Didn't think social distancing would be much of a problem in the wide-open spaces of Iowa  .
Stay safe.

Edited April 28, 2020 by MigL

[swansont]

I think even Iowa has cities.

[iNow]

Yes and our county is the hardest hit in the state. The meat packing plants, however, are a close second (especially now that Trump has ordered them to stay open despite their strings of mass infection and lack of worker protection). 

On another note, it seems the costs of staying locked down are actually lower than opening rapidly

https://arstechnica.com/science/2020/04/the-value-of-lives-saved-by-social-distancing-outweighs-the-costs/

Quote

evidence from the 1918 flu pandemic suggests that cities with more aggressive lockdown responses had stronger economic recoveries.

There’s more than one way to think about the economics of lockdowns, and a paper due to be published in the Journal of Benefit-Cost Analysis has an entirely different approach. It accepts that lockdowns will hurt the economy compared to business-as-usual but calculates whether that cost is outweighed by the lives that will be saved by social-distancing measures.

The answer is yes—by $5.2 trillion. That’s an estimate that changes based on a range of different assumptions, but it represents what the authors consider the most realistic scenario.

 

[J.C.MacSwell]

5 hours ago, iNow said:

The governor in my state is re-opening most things on Friday, but many of the local businesses I love and frequent have already responded and posted things on their various social pages that can be paraphrased as... "Uhh... yeah, we're really glad the government is so optimistic and that's all well and good, but we're most decidedly NOT re-opening until we see more reductions in cases for a few weeks in a row. Absent that, we're not willing to put our staff and customers at risk... Hope shouldn't be Plan A and for now we'll stick to limited online ordering and curbside pickup."

Meanwhile, the POTUS wants to re-open schools for May before summer starts, too. So tired of being led by incompetent grifters. 

It does seem premature for Iowa to ease up at all, never mind re-open most things. They really haven't established any control of the growth in the number of cases under the current restrictions.

[iNow]

29 minutes ago, J.C.MacSwell said:

It does seem premature for Iowa to ease up at all, never mind re-open most things.

It does, indeed 

[MigL]

Iowan daily new case number does seem kind of high for the total number of cases ( all depending on testing of course ).
I can't get a history of Iowa's daily case numbers, but yesterday's single data point, would indicate new cases are still climbing rapidly.
Most places will wait until new case numbers decline for a period of time before considering partial lifting of the lockdown.

Edited April 29, 2020 by MigL

[iNow]

10 minutes ago, MigL said:

Iowan daily new case number does seem kind of high for the total number of cases ( all depending on testing of course ).
I can't get a history of Iowa's daily case numbers, but...

FYI:  https://en.m.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Iowa#Statistics

 

[iNow]

On 4/27/2020 at 10:39 AM, Alex_Krycek said:

Let's see what those numbers look like after three more months.  

For now, at least, institutional investors, asset allocators and managers appear to agree with me about keeping the lockdowns in place (some handy charts at the link):

https://www.institutionalinvestor.com/article/b1ldfxffpnl8yz/The-II-Fear-Index-Investors-Expect-Long-Lockdown

Quote

Nearly three-quarters of institutional investors think it’s too soon to reopen the economy, according to this week’s II Fear Index.

<...>

Just 26 percent of surveyed managers and asset owners said that their country’s economies should be reopened as soon as possible, compared to 74 percent backing continued shutdowns.