Lessons from the “Spanish Flu” for the Coronavirus’s Potential Effects on Mortality and Economic Activity

That is the subtitle of a new paper by Robert J. Barro, José F. Ursúa,  and Joanna Weng, here is the abstract:

Mortality and economic contraction during the 1918-1920 Great Influenza Pandemic provide plausible upper bounds for outcomes under the coronavirus (COVID-19). Data for 43 countries imply flu-related deaths in 1918-1920 of 39 million, 2.0 percent of world population, implying 150 million deaths when applied to current population. Regressions with annual information on flu deaths 1918-1920 and war deaths during WWI imply flu-generated economic declines for GDP and consumption in the typical country of 6 and 8 percent, respectively. There is also some evidence that higher flu death rates decreased realized real returns on stocks and, especially, on short-term government bills.

I wonder if the economic cost isn’t higher today because we know more about how to limit pandemic spread and we also value human lives more, relative to economic output?

Kudos to the authors for such swift work.

Also from NBER here is Andrew Atkeson on the dynamics of disease progression, depending on the percentage of the population with the disease.  Here is an excerpt from the paper:

Even under severe social distancing scenarios, it is likely that the health system will be overwhelmed, which is indicated to happen when the portion of the U.S. population actively infected and suffering from the disease reaches 1% (about 3.3 million current cases).7 More severe mitigation efforts do push the date at which this happens back from 6 months from now to 12 months from now or more, perhaps allowing time to invest heavily in the resources needed to care for the sick. It is clear that to avoid a health care catastrophe as is currently being experienced in Italy, prolonged severe social distancing measures will need to be combined with a massive investment in health care capacity.

Under almost all of the scenarios considered, at the peak of the disease progression, between 10% and 20% of the population (33 – 66 million people) suffers from an active infection at the same time.

A not entirely cheery prognosis.

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This is nothing like the Spanish Flu and the losses are caused by the forced shutdowns on businesses, health club, restaurants, movie theaters, etc., by the government. They take two hot spots in Kirkland, WA, and NY City and turn it into a national crisis. Thank you, autocrat governors.

On the second paper, did H1N1 flu from 2009-10 overwhelm the system? Overwhelming majority didn't require hospitalization, neither will in this case. And Italy, should be Lombardy, Italy, as rest of the country is doing fine. Plus, our health care system is not socialized like Italy's with queues and shortages of any single payer system.

But Poe's law gets everyone in the end.

Woff Woff!

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"You won’t ever know if what you did personally helped. That’s the nature of public health. When the best way to save lives is to prevent a disease rather than treat it, success often looks like an overreaction." - Epidemiologist Mari Armstrong-Hough

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H1N1 had lower hospitalization rates and lower rates of severe illness compared to SARS2. Since H1N1 hit the young harder, it may be due to residual immunity from an ancestral strain of the virus that the elderly had and the young hadn't been exposed to yet.

SARS2 is new to humanity. Without any prior immunity, it's not surprising it has higher rates of moderate-severe illness, which need hospitalization and ICU level care. If SARS2 becomes endemic, repeat infections may cause milder symptoms similar to our current endemic respiratory viruses, but this is not certain due to novelty.

I know Hazel will chime in at some point so to forestall her, I am confident that there is little to no "abundance of caution" hospitalizations. The health care system, of which I am a part of, anticipates that we will be stretched, so it has taken measures to boost capacity by shifting elective procedures later as we deal with the first wave. There are also strict criteria for hospitalization based on degree of hypoxia and surrogate end organ damage. Just feeling short of breath is not enough to cut it.

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“The whole concept of death is terrible"

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The "Spanish" flu is racist against Mexicans.

But Poe's law gets everyone in the end.

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This is from VOX:

"The CDC covers a huge 20-44 age range in its data, but here’s what we know about that entire group: 14.3 percent hospitalized, 2 percent in the ICU, and 0.1 percent fatality rate."

Okay, this is of young people who go get tested or seek treatment. The huge part outside the CGC sample is all the youngsters in Florida and elsewhere who have antibodies to the virus, but are asymptomatic. In other words they were exposed, shrugged it off. They are healthy.

So, we see a 0.1% death rate even of those seeking treatment, in the 20-44 age group. One in 1,000. That somewhat lines up with the 1,100 crew members of Diamond Princess, not one of whom died, despite weeks and weeks of living and working in common quarters.

At the risk of sounding mercenary, the loss to GDP from COVID-19 deaths will be nothing like the Spanish Flu, in which the young died.

The media is staging a heroic fight to say COVID-19 affects everyone. Yes, but mostly the elderly with co-morbidities.

The economic losses from COVID-19 will largely stem from the shutdowns, and the expense of taking care of elderly with co-morbidities (often elderly smokers).

Again, very mercenary perhaps, but should we talk about "lives saved" or "life years saved"?

You're assuming that all the other youngsters have "shrugged it off". Where is your evidence for this? It's also possible that most of them have not yet been infected.

Without more serological or random population testing, it's impossible to get a good handle on prevalence, which you need to make a good decision on when (not whether) to reopen the economy.

Finally, fatality rates are not finalized yet. The spread in the US is still so new that the first batch to get sick have just been admitted or ventilated. You have to follow this cohort to completion (dead vs recovered+discharged) which may not happen until about 3 weeks from now. If you go by worldinfo, you'll see that they have a separate breakdown for dead vs recovered. Everyone not accounted for there is still in the middle of treatment. That's the vast majority of everyone diagnosed with the disease.

e.g. Rand Paul is now positive. He looks to be in the incubation or presymptomatic phase. If he does develop symptoms, based on the usual course of severe disease, he may progress to be mildly symptomatic in 5 days, and then develop hypoxia 2 days after that, ARDS after 2 more days, get intubated, and then linger for 2 weeks on the vent before his family pulls the plug. He doesn't count as part of the CFR until this whole episode has concluded.

The point of the shutdown is to:
1. Ramp of testing capability, both PCR and serology
2. Allow the supply chain to adjust for PPE production
3. Get a better handle on actual prevalence and CFR. Everything out there now is a best guess estimate and could be too high or too low.

This is not precisely correct, depending on country - Everyone not accounted for there is still in the middle of treatment.

Countries with adequate testing resources are using them to test people before declaring them recovered, though they were never in treatment, just quarantine. Testing is basically the only tool available to gain accurate information. even with all of testing's various existing flaws.

With Paul now positive, we could fairly accurately track how many people he infected, and get a bit more data about spread in the U.S. Except that does not seem to be how the system works in the U.S., much less quarantining him and everyone in his household for the next 14 days, plus everyone, and their household, who was in a setting where transmission was reasonable - an aide who worked with him over two days, involving several hours of sharing space during that time.

If everyone acted like that, instead of like Sen. Paul, the U.S. would be in a better place, completely ignoring Paul scoffing at the disease he now has, or voting against funding to fight the disease he has quite likely spread to several other people.

I don't see how we're disagreeing in any way.

I've long been saying here that you have to divide people into:
1. Never infected
2. Active infection (can subdivide this into home, hospital, or ICU)
3. Dead
4. Recovered

There is a lag in detection between 1->2 and lag in progression between 2 -> 3 or 4, which is why we need to track where a patient is on the progression rather than raw numbers.

Now there is a wide discrepancy in data because of how states have chosen to restrict or be liberal about testing. NY state from all sources has been testing a lot of people. Now I'm not certain about their methodologies as in whether they're only testing people sick enough to be admitted into the hospital (the old restrictive rationing of testing) or have ramped up to do more outpatient testing as well.

I will say this. Right now no state in the US has enough supplies to test asymptomatic people on a routine basis (outside of selectively with very high risk exposures to known positive cases).

Treatment was the point. Most people with covid19 aren't treated, but only with effective testing do you know how many have recovered. Clearly, people still requiring breathing assistance have not recovered by one measure, even if they test negative for covid19. This fact will be a challenge to measure, at least in the U.S., where there seems to be endless ideological discussions regarding every single aspect of an onrushing, and clearly unavoidable, pandemic. And even in countries with better testing and record keeping in general, there will be differences in reporting, with some people arguing about those differences endlessly. Even when there is no difference, such as between how the Germans and Italians report covid19 deaths using precisely the same criteria.

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"The media is staging a heroic fight to say COVID-19 affects everyone. Yes, but mostly the elderly with co-morbidities. "

The shutdown will affect every business. Yes but mostly businesses with co-morbidities like taking on too much debt and making bad investments. At the risk of sounding like a real capitalist, the risk of losing a few of those business will actually make our industries stronger. We need to build herd immunity in corporate America now.

well played +1

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It's not just corporate America, which can survive a few months (although not necessarily the employees). It is my favorite Vietnamese restaurant, my gym, and where my kid plays soccer all winter. None of these would exist in a a 6-18 month scenario.

The state needs to reduce property taxes so landlords could freeze or reduce rent to those businesses. Insurance companies should act similarly.

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The only way to really save the economy is to put an end to the pandemic. Half steps and poor justificaiton will not have the economy. Does anyone really believe that big conventions or Disneyworld will reopen just to save the economy independent of the health risk? Does anyone really believe that pro sports will come back while a pandemic is raging? Does anyone believe that restaurants and hotels will be full again while a pandemic rages. How can the U.S. economy function fully if the rest of the world is shut down?

Trying to help the economy while ignoring the Covid-19 Pandemic gives all of the economic power to the most irresponsible companies and punishes responsible companies.

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So that pandemic lasted 3 years (1918-1920)? If COVID-19 lasted that long, our economic system based on contract law will collapse. Law depends on extenuating circumstances or acts of God not happening all that often. Or else we risk burdening our legal system and must be forced to flatten that curve too.

I've been thinking hard about how to balance these competing priorities. I agree it's inevitable that we have to lift the harsh activity restrictions, since deaths of despair count just as much as medical deaths. But we can do so in a smart and evidence based way.

First, we have to suppress and measure the size of the first wave (prior to current lockdown) because of our delay in preparing for it. Does it overwhelm the hospitals? What looks to be the true prevalence and CFR for different groups?

We can also learn a lot medically to affect CFR - e.g. What role does ACE inhibitor play? Does chloroquine/azithromycin have any clinical benefit? What about remdesivir?

As I mentioned above, we also need to ramp up testing and PPE.

After that, I suggest allowing low risk individuals to go back to work practicing some low hanging fruit changes we have learned from Asia - universal masking when outside, frequent hand washing, no handshakes/hugs/kisses with strangers, temperature checkpoints in public spaces, banning large scale gatherings, and early/frequent testing including backtracing positives. All travelers coming from other countries should be on a 14 day home monitoring program. I'm +/- about schools at this point. They are a good vector for horizontal spread between unrelated clusters, but thankfully we don't have to worry about them for the rest of the summer.

The most at risk should be encouraged to stay home and maximally socially distance. This should get us until better treatment or a vaccine is developed.

Look to Spain or Italy. Assuming (as a totally absurd number) that for every confirmed case in Italy there are 1000 unknown cases, about 10% of people in Italy have been infected with ncovid-19. That means the health care system collapsed at that load. If the last desperate measure of total lock down does not work, how do you think the Italian situation will look with a 20% infected rate? The Spanish have an idea, which is why there is zero talk in Spain of letting up on their lockdown - instead, they have extended and tightened it.

In the U.S., which is still behind Italy or Spain by a week or two, there is talk of letting up restrictions at the same point where the Italians and Spanish first implemented theirs, with the results we can all see in collapsing care and hundreds of deaths per day in each country. This American thinking is just bizarre. since what is happening in Italy, Spain, Germany or France is a best case scenario resulting from the sort of strict measures being taken in those countries. Measures that have not even actually started in the U.S., when they could have more effect.

Viruses don't care, it is only people that make choices. And if Sen. Paul is an example of a doctor in the U.S. making choices that are likely to spread the disease among his colleagues and co-workers, it might just be best to give in to the counsel of despair, and let hundreds of thousands of Americans die, since American society cannot do better than that anyways.

As for masks? Only for medical professionals in general, and there seems to be very little difference in transmission in Europe. Effective contact tracing and effective quarantining seem orders of magnitudes more effective than mask wearing - especially when all masks are required by medical professionals for the foreseeable future, as one can see in Europe. There is no harm in people feeling they are contributing, and making their own masks and wearing them in public - unless they have a cough, and think that a mask is enough, instead of self-isolating for 14 days.

I agree with you that we have enough evidence already of overwhelmed health care systems, but since there is still a lot of skepticism on these forums and elsewhere, we need to have domestic proof to convince people.

See:
1. Hubei gets overwhelmed. Detractors say it's just China and their shoddy hospitals.
2. Lombardy gets overwhelmed. People question Italian data or say it's due to Italy being older than normal or more smokers.
3. NYC (will) get overwhelmed. People will say it's unique to the city because of close proximity of people or because it's in a cold climate.
4. The warmer city of New Orleans (will) get overwhelmed. People will say oh the disease just affect big cities that have had major large scale gatherings like Mardi Gras.
5. Finally, the disease hits a rural area and overwhelms the small local hospital with 1 ventilator.

Then maybe we can finally admit that all regions are at risk, and that there is no American exceptionalism.

This is the "martyr system" at work. We sometimes have to see severe carnage before we can be moved into action. Get on with the dying, NYC!

In a 'virus-aware' way

https://www.ftportfolios.com/Blogs/EconBlog/2020/3/23/cut-the-politicians-pay

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Follow-up/addendum:

For arriving travelers, a 14 day observed home monitoring or a nasal swab with a rapid point of care test + temperature screen, or proof of antibodies from prior infection (similar to yellow fever vaccine requirements for certain countries).

One problem is that the US has followed an uneven strategy. This makes for a fascinating epidemiological study down the road (e.g. how do different actions by nearby but similar states affect the spread of SARS2) but will cause problems by reintroduction of disease from domestic travelers. It would have been easier with a synchronized national 21 day quarantine and take the up front economic hit to reset afterwards, instead of drip dripping it piecemeal.

But now since we can't lock down borders between states, we should limit flights out of lingering "hotspots" and implement the above airport screening.

The leadership of the U.S. cannot seem to even have a strategy, much less follow one to the point of being uneven.

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we risk burdening our legal system

It needs to be burdened into a different paradigm.

Data for 43 countries imply flu-related deaths in 1918-1920 of 39 million, 2.0 percent of world population, implying 150 million deaths when applied to current population.

There's no validity to that implication.

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Here are projections under various scenarios and comparisons to other countries; document reviewed and contributed to by epidemiologists: https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca

Note the significance of public health systems and early actions.

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Okay... a good chunk of the country is going to get it, and even with severe social distancing measures, the health system is going to be overwhelmed anyway (leading to only a short reprieve on the potential benefit of all these actions). This all points to just letting this bugger rip.

Letting her rip means most people will not go out as the disease rages anyways, all countries will break all contact with the U.S. while it rages (and likely long afterwards), and the total collapse of the American health care system will mean many people will unnecessarily die from that collapse alone.

But go ahead, let her rip. It is likely that such a policy will be taught in a thousand years as an example of what happens when basic public health concepts are not used to manage a pandemic.

If you take that second paper seriously (I don’t know if you should) anything that we’re even contemplating doing will be ineffective. The hospital system gets overwhelmed if the infection rate is 1%! If that is the case, there is no bending the curve. So if you buy these analyses, we are doomed. That analysis implies let ‘er rip. Post another analysis that is significantly rosier, and I might change my mind. But most of the analyses I’ve seen have predicted (even with extreme social distancing) 20 percent infection rates. Tell me what the marginal impact is of letting the disease progress uninhibited.

Italy may have a 1% infection rate right now, as it appears that for every reported case, there are 10 reported cases. Now imagine how Italy would look if they had done nothing at all.

To put it a bit differently - do you want to hit a tree at 60mph, or do try everything to slow down before hitting the tree, given that it is impossible to avoid the tree. Let her rip is basically saying 60mph is the same as 30mph.

What is the marginal impact of hitting the tree at 60 rather than 30? How much does your probability of dying decrease? How much does the probability of lifelong injury decrease? Then, we should measure that against the cost of slowing the car down, which it is at this point that the analogy falls apart. Do I have to shove a passenger from the car to slow it down? I don't think it is too much to want an answer to these questions. So if the hospitals get overwhelmed a little slower, what is the marginal impact on deaths? And what happens when you start to let up on the social distancing measures?

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You go do that. I'll hide out on my private Caribbean island and watch from a safe distance.

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Thanks Thanos,

Unless you are strapping on a "do not intubate" bracelet, you are not really saying let it rip.

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Here is the first CBA I have seen attempted in any fashion: https://theincidentaleconomist.com/wordpress/economic-cost-of-flattening-the-curve/. Lots of assumptions, but this is a good starting point. I am deeply troubled that up to this point, economists have ignored this type of analysis and instead decided to pretend to be epidemiologists.

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The "severe staffing shortages" on the article sounds interesting. More (and higher paying) jobs for the rest of us if we survive!

Even now the price of "to-go" meals that are replacing normal restaurant fare should be much higher than in the recent past and employees that deal with the public should expect dramatically greater compensation in exchange for keeping their employers' businesses alive.

But then again, the very most dangerous jobs aren't particularly well-compensated. Lumberjacks, roofers, commercial fishermen, air taxi pilots, etc. aren't among the highest paid occupations despite being the most likely to die on the job. Trading burgers for cash at Jack-In-The-Box isn't going to raise your income much even if customers are passing away in the line to the food window.

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At the risk of sounding like a mercenary, when COVID kills off enough Boomers then all those high paying jobs they've been hoarding will be open to the winners of this Darwinian process. Praise the Lord for natural selection.

It's interesting to observe that there are still some Lamarckians around.

After all, when it comes to immune systems and offspring, Lamarckian 'evolution' is a proven mechanism. From ncbi.nlm.nih.gov/pmc/articles/PMC4765028/
For several decades in the 20th century, IAC has fallen out of fashion in mainstream biology, and worse, has been central to several pseudo-scientific fads the foremost of which was the infamous Lysenkoism [8, 9]. However, over the last few decades, an increasing number of findings on apparent directional, adaptive mutations as well as heritable epigenetic changes apparently directly caused by environmental factors have suggested partial rehabilitation of IAC [10–12].

Among the genetic phenomena that might involve IAC, the prokaryotic adaptive immunity mediated by CRISPR-Cas (Clustered Regularly Interspaced Short Palindromic Repeats- CRISPR-ASsociated genes) systems is arguably the most compelling case [10–12]. The CRISPR-Cas immune response involves insertion of pieces of foreign DNA, such as a viral or plasmid genome, specifically into the CRISPR array (these inserts are denoted spacers because they are positioned between repeats in the CRISPR array; the sequences in the foreign DNA that give rise to spacers are accordingly denoted protospacers, and this first stage of the CRISPR immune response is known as adaptation), followed by utilization of the processed CRISPR transcript (crRNA) as guides for inactivation of the cognate target [13–19]. The net result is the acquired, heritable, highly specific and efficient protection against the cognate (parasitic) element. Characteristic of immune mechanisms coevolving with parasites, the CRISPR-Cas systems show extreme diversity, with 6 distinct types and 19 subtypes identified on the basis of protein domain compositions and genomic loci architectures [20, 21].

Phenomenologically, the CRISPR-mediated immunity has all the ingredients of IAC, or Lamarckian evolution: the genome of a bacterium or archaeon is modified in a highly specific manner, in response to a specific environmental challenge (such as virus infection), resulting in a highly specific and efficient adaptation to that particular challenge.

prior still thinks people will be impressed that he knows how to use Wikipedia.

Nobody is impressed, though they might be impressively amused, to see you have no idea that a link to ncbi.nlm.nih.gov means a link to the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health.

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On the Diamond Princess the passengers had an average age of 58. All the passengers who died were older than 70. All. True there are some still very ill who might add to the number. Whether any of them is under 70 I don't know: maybe the over-70s die faster and a few under-70s will die soon. But as of yesterday the 8 dead were all over 70.

I gather that among the crew none has died. I suppose there may have been a "healthy worker" effect, but still. None.

Right on. The elderly with co-morbidities are at risk.

I think we have a gerontocracy now. Everyone running for president is 70+ years, and we will shut down the entire economy to limit risks to elderly (mostly smokers).

This could cost $20 million per life saved. But in Italy a doctor pointed out nearly all deaths are associated with co-morbidities. If we "pro-rate" the deaths, say count each death as one-quarter due to COVID-19, we get to $80 million per life saved.

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My theory is that the RT-PCR has some limitations for measuring acute disease. The nature of PCR in general is that it is good at detect DNA or viral RNA, which it can even do for DNA in 10000 year old fossils. That's why you can pick up viral RNA on surfaces hours-days after the fact. It doesn't mean that detected material is infectious. It may have lost its capsule layer and be nothing more than decaying RNA.

Similarly if we swab your nasopharynx we may detect viral RNA, but has it invaded your cells and is actively replicating or is it crud that got caught in the nasal mucus that we're incidentally catching? For asymptomatic people that would matter - are they truly asymptomatic (personally I think it's doubtful) or did the virus just not latch on deep enough or in significant enough quantity to cause the infection?

That's why relying on lab tests as a gold standard without clinical correlation is dangerous. It's similarly why nasal swabs days after an infection has passed can still show residual detectable virus.

Biology is complicated and doesn't fit together beautifully like an econ model. This is also why home testing will be a failure.

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I don't want to be a pessimist and say that America's national response is breaking down, but that's kind of my worry this morning.

"Effects on Mortality and Economic Activity"

If we can't decide what we're trying to do, we don't get the best of either world.

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And if you are going to let it rip, maybe wait until N95 masks are being produced in consumer quantities?

If the rest of you are going to live like animals, I want my mask and gloves for shopping.

I guess we've all agreed that the "masks don't work" advice was fake

Did you follow the discussion? There are separate issues. The one I found most convincing is that we random citizens should lay off the N95 masks because health care workers need them. It *is* true that anything less than N95 is much more "partial" protection. And it *is* true that when people wear masks and practice bad hygiene they do no good.

When I was waiting in the jury pool a couple weeks ago there were two guys wearing "flu masks" (less than N95). One would randomly pull his down and wear it under his chin for a while. Th other would pull his down to rub his face with bare hands. Neither wore gloves.

Still, I'd like a "flu mask" for partial protection when shopping. I'd also wear gloves and try to follow good procedures. I think that means put them on in the car, and throw both away after leaving the store and getting in the car again.

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throw both away after leaving the store and "before" getting in the car again

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If you dig into the Atkeson paper, you see that he assumes an R of 1.6 with severe social distancing. That's a pretty pessimistic assumption. Recall that if R falls below 1 globally, as it did in Hubei, the disease gradually disappears even without a vaccine.

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No Spanish flu lessons, but last night the news reported that a county official had surveyed 150 local childcare facilities, and found - worryingly! - that more than half were closed. The official said were working on figuring out how to get them reopened.

Who wins this one? Especially when they are the selfsame people?

In other news, easily called in advance, the city school district blew off the touted plans for online education, citing the socioeconomic differential in home technology, not citing how vastly easier is this path.

The other thing the local news is on about is the danger of grocery shopping (despite lines to get in, an employee stationed at the entrance with wipes for hands, and another wiping down all the carts, as well as a policeman). The NextDoor folks who are choosing not to leave their homes to shop report that grocery orders take at minimum a week to process, or depending on the service two if you get unlucky and they missed you before the week was out, and you are placed in the queue again.

I've always been fond of the local news channel, but am now worried they've been possessed by the same malady affecting the national media, and they would happily close the stores and see us all starve to death. Or all sign up to be Favor drivers, like my next-door neighbor who lost his job, so we can gain admission to the store.

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"Even under severe social distancing scenarios, "

How much distancing is actually happening in crowded cities?

https://imgur.com/JPlOhwZ

You can always find a picture of where it isn't,
But,
You can go down a commercial street with no people on it
To show
Where it is.

Pictures aren't the message.
Ask yourself: What are statistically sound measures of measuring whether people are complying.
Take a poll.

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Here is a Gallup poll on how people are employing social distancing and other measures: https://news.gallup.com/poll/297035/americans-rapidly-answering-call-isolate-prepare.aspx

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Notice that we've stopped hearing the gloating about how Trump supporters are going to be hardest hit because they wouldn't obey the medical guidance.

This really has been a disaster for Democrats. They would have been better off trying to urge a mass sell off in September. As it is it’s looking like they might be creating a red wave that is going to go medieval on Chicoms asses.

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"More severe mitigation efforts do push the date at which this happens back from 6 months from now to 12 months from now or more"

6 months? I honestly have dont understand where that is coming from and the paper isnt very clear.

At the current pace (we will see what the current social distancing does to this progression once it kicks in; hopefully we see some results early next week), we are multiplying by 10 every 7.93 days!

Look at the data, you can see this very simply. On march 23 there were 43,734 total cases. 7 days prior there were 4,663, with 3,680 on march 15. A 15 day rolling average of the growth factor is 1.389 (way into exponential territory still).

At the current rate, we are going to hit 4 million total cases in the USA in 20 days. Suppose we get the growth factor to 1.1 in a week... we are still going to hit that 3.3 million in like 30 days.

OMG, my bad. I was searching the wrong pdf. Embarrassing. It’s all there and clear. Going to have to think it through. Thanks for posting. My prior (pretty flexible at this point I must say however) is that this is going to be quicker than 6 months. The trend growth is just so consistent and rapid.

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Under almost all of the scenarios considered, at the peak of the disease progression, between 10% and 20% of the population (33 – 66 million people) suffers from an active infection at the same time.

On the Diamond Princess, about 11% of the passengers and crew had a symptomatic illness. That's with close quarters, common dining facilities, common ventilation system, &c.

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If indeed there's a small remaining belief in the supernatural, maybe those with that belief should admit that the human race has fallen in favor before God and that He has decided to punish those that have disobeyed Him. God can't be pleased that the most educated and aware people in history continue to tailgate on the freeways, watch porn, marry persons of the same sex, advocate abortions and do business on Sundays. It's unlikely to be any different than it was for the residents of Sodom and Gomorrah, a divine holocaust. It may not be too late for some but it's inevitable for many.

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