The WHO Report on COVID-19

The Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) is the best source of information on COVID-19 that I have seen.

The Joint Mission consisted of 25 national and international experts from China, Germany, Japan, Korea, Nigeria, Russia, Singapore, the United States of America and the World Health Organization (WHO). The Joint Mission was headed by Dr Bruce Aylward of WHO and Dr Wannian Liang of the People’s Republic of China.

Some of the language is more pro-China than is usual in an academic report but the report is full of credible data.

The bottom line is that there is good news and bad news. The good news is that due to extraordinary intervention the epidemic in China has been brought under control and is slowing to manageable levels.

In the face of a previously unknown virus, China has rolled out perhaps the most ambitious, agile and aggressive disease containment effort in history. The strategy that underpinned this containment effort was initially a national approach that promoted universal temperature monitoring, masking, and hand washing. However, as the outbreak evolved, and knowledge was gained, a science and risk-based approach was taken to tailor implementation. Specific containment measures were adjusted to the provincial, county and even community context, the capacity of the setting, and the nature of novel coronavirus transmission there.

…. China’s bold approach to contain the rapid spread of this new respiratory pathogen has changed the course of a rapidly escalating and deadly epidemic. A particularly compelling statistic is that on the first day of the advance team’s work there were 2478 newly confirmed cases of COVID-19 reported in China. Two weeks later, on the final day of this Mission, China reported 409 newly confirmed cases. This decline in COVID-19 cases across China is real.

Based on a comparison of crude attack rates across provinces, the Joint Mission estimates that this truly all-of Government and all-of-society approach that has been taken in China has averted or at least delayed hundreds of thousands of COVID-19 cases in the country. By extension, the reduction that has been achieved in the force of COVID-19 infection in China has also played a significant role in protecting the global community and creating a stronger first line of defense against international spread. Containing this outbreak, however, has come at great cost and sacrifice by China and its people, in both human and material terms.

The bad news is that the WHO is worried that other countries do not have the capability or will to implement some of the same policies as China did.

Much of the global community is not yet ready, in mindset and materially, to implement the measures that have been employed to contain COVID-19 in China. These are the only measures that are currently proven to interrupt or minimize transmission chains in humans. Fundamental to these measures is extremely proactive surveillance to immediately detect cases, very rapid diagnosis and immediate case isolation, rigorous tracking and quarantine of close contacts, and an exceptionally high degree of population understanding and acceptance of these measures.

.. COVID-19 is spreading with astonishing speed; COVID-19 outbreaks in any setting have very serious consequences; and there is now strong evidence that non-pharmaceutical interventions can reduce and even interrupt transmission. Concerningly, global and national preparedness planning is often ambivalent about such interventions. However, to reduce COVID-19 illness and death, near-term readiness planning must embrace the large-scale implementation of high-quality, non-pharmaceutical public health measures. These measures must fully incorporate immediate case detection and isolation, rigorous close contact tracing and monitoring/quarantine, and direct population/community engagement.

I don’t think the WHO is the final authority on what to do, public health is their hammer. I have been dismayed, however, at the failure of the CDC, which surely prior to this crisis one would have rated as one of the best US organizations. As the NYTimes wrote:

The Centers for Disease Control and Prevention botched its first attempt to mass produce a diagnostic test kit, a discovery made only after officials had shipped hundreds of kits to state laboratories.

A promised replacement took several weeks, and still did not permit state and local laboratories to make final diagnoses. And the C.D.C. essentially ensured that Americans would be tested in very few numbers by imposing stringent and narrow criteria, critics say.

The failure of the CDC, which is a failure of the US government at the deepest levels, not just rot from the top, meant that we lost several weeks that we may have needed to avoid more stringent measures. We will know more in a week.

Read the whole thing.

Comments

China has certainly achieved an astonishing feat in the last few weeks which few (no?) other country could replicate.
Missing from the report is any acknowledgement of the delays and attempted coverups by local officials in the early weeks of the outbreak in Wuhan. Weeks of unimpeded transmission in late Dec / early Jan could have been prevented. Of course it is easy to lay the blame in hindsight but it seems that if the quarantine is rightly considered an achievement for the Chinese system then the politically-motivated coverups should be counted as well.

Yes, it's weird that a supposedly libertarian professor keeps beaming over statist information control and mass lockdowns. Who knows how much of the iron fist could have been avoided had the Chinese government been forthright to start with. The fact that it was distracted at the time by its ongoing repression of Hong Kong is something of a chef's kiss.

Here's an article about the cover-ups.

https://nypost.com/2020/02/29/china-officials-knew-of-coronavirus-in-december-ordered-cover-up-report-says/

They are state capacity libertarians. That means information control and mass lockdowns are a-okay!

Yeah, Tyler now sounds less like he's arguing for an efficient, capable small government, and more like he's full on admiring authoritarianism.

Surprise, surprise, surprise

This is an Alex post, but otherwise agreed.

I also think it is weird that a bunch of libertarian professors are so willing to take the WHO's report at face value. A bunch of Chinese professors and some international professors where given a tour for eight days by the Chinese government. The data comes entirely from China and was controlled by China. I hope the report is correct, but it reads like a love letter not a scientific paper. When you go back to the appendices are read the gaps in knowledge, it is pretty extraordinary. We still don't know the sensitivity or specificity of the diagnostic tests. We don't know the period of viral shedding. It is pretty clear that some healthcare workers in China have done something extraordinary. And, I hope this report is accurate, but I think some skepticism is in order.

"The data comes entirely from China and was controlled by China. "

One party dictatorships never lie. This is known.

Indeed and let's not forget all of Russia's "record setting" wheat harvests in the 70's and 80's that culminated in famine

The WHO is not exactly a libertarian think tank either. They've got their own political leanings.

True, and this was seen with their report on the supposed increase in deaths due to the accident at Fukushima, which very few health physicists would agree with.

Seeing many people claiming that no other country could mobilise a response as effective as China’s. I wouldn’t argue the point, but does it thus follow that it is likely for another country to end up with more infections and deaths than the origin country of China?

On a proportional basis? Sure, easily imaginable. Early betting with good odds are likely imaginable regarding the Iranians

"Seeing many people claiming that no other country could mobilise a response as effective as China’s."

It's a somewhat valid point. The Chinese were welding shut the side doors of apartment buildings to prevent egress anywhere but the main guarded doors. People caught out on the street where they weren't supposed to be were lashed together and herded to central facilities.

They turned chunks of the country into a prison. The Chinese are more proficient at police states than almost any other country.

+1. China apologists conveniently ignore that its government repressed information early in the outbreak, and now the rest of the world is supposed to emulate that government's draconian measures as a paean to the glories of CCP despotism. One expects far more skepticism of such egregious spin from this blog.

The number one thing everyone can do without trading stores are clearing the shelves is wash your hands.

If you are eating out in the world, wash your hands at the restaurant before you do.

If you have been out in the world wash your hands first thing when you get home.

"raiding" stores

If washing your hands prevented infection, then thousands of medical workers in Wuhan who wore PPE to include masks and latex gloves would not be in the hospital.

The Feds are gonna botch this like they do everything.

So Skeptical shows up to troll against hand washing!

Is about cumulative odds in a society, buddy.

Again, someone who knows:

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public

Yes, wash your hands. You’re up at 4 am to tell the wrong audience to wash their hands. Great.

That’s obviously not going to prevent the spread of the disease.

Telling the public to “wash your hands!” is the equivalent of doing absolutely nothing. It’s completely useless.

Im sure China just skipped Tweeting “wash you hands, lol!” and went straight to quarantine for no reason.

Unreal

Yes prior, I’m sure the EU will also tweet “wash your hands.”

Pack it in Prior, we’ve saved the city! All done here.

If I am for something as simple and straightforward as hand-washing, you must be against it. What a putz.

That’s not what I’m saying, come on dude. Don’t be obtuse.

Tweeting “wash your hands lol” is not going to prevent this.

But going on the internet to fight "wash your hands" is somehow going to help?

"That’s obviously not going to prevent the spread of the disease."

To the extent that anyone is foolish enough to believe you, you increase the rate of infection.

Your posts are not just foolish, but evil.

#LITERALLYHITLER

It doesn't have to be big to be evil.

Make a positive change in the world.

The hand washing is not to prevent something that has already occurred, it is to slow the spread of a disease that continues to infect more people globally. This is why government officials in countries like the UK are tweeting about washing your hands.

My daughter argued with me when I told her that "Wash your hands" was useless advice. Not that I disagree that (effective) hand washing was effective, but that it was impractical. I'd really like to see real world statistics showing that washing hands "when you get home" significantly changes your odds of contagion. As for advising one wash before eating at a restaurant, isn't better advice not to enter restaurants? This advice reminds me of the drills American school children had to huddle under their chairs to "protect" them from a near-by nuclear detonation. The Wuhan epidemic should be compared to the Flint Water fiasco. It is natural for politicians to lie and cover-up. It is - or should be - obvious that you ought not have politicians running our medical/public health infrastructure. But I don't think the rest of the world should be so smug about the Chinese cover-up. Why hasn't India and Indonesia been mentioned in the context of incompetence? I digress.

A measure as cheap and simple as hand washing will slow the spread of COVID19. One can reasonably argue about effectiveness, but from a bang for the buck statistical perspective, it will be more effective than any other single measure that can be implemented right now, by basically everyone.

Will it prevent individuals from getting infected? Of course not. That game ended sometime in January anyways. The pandemic is here. Will hand washing slow its spread? Undoubtedly, though to what degree will only be determined later.

China deserves much more censure because its government has a pattern of incompetence . It should have learned not to repeat its mistakes after SARS but repeated them because of the very nature of the CCP that rules its government.

As I say above, it's about cumulative odds in a society. Or to use the right phrase for this blog, at the margin more hand washing means less communicable disease.

It's not a guarantee, no. So it doesn't have that emotional "hook" that it will keep you 100 percent safe. It's just a simple thing you can do for your own health, the health of your family, and the health of your community.

You can improve their odds.

You could take a water sample in Flint and publish your results without restriction. Good luck trying the same in January in Wuhan.

You could simply read what Alan highlighted below about handwashing.

Or read this tweet instead. Rishi Sunak (@RishiSunak)

The whole government is working closely together to tackle COVID-19. We are taking firm action to support your families, your businesses and the public services on which you rely.

We can all help fight this virus by washing our hands with soap and water for at least 20 seconds.

The Feds did botch this because they are headed by Donald Trump.

Did someone back to impersonate me at this hour?

That shows remarkably bad taste doesn't it?

Now is not the time to go soft, agent anonymous. Stick with your original intuition. And never ever adjust.

Hand washing is THE MOST IMPORTANT thing to do. Here's the direct quote from the report and shows that very close contact is required for transmission.

[i]COVID-19 is transmitted via droplets and fomites duringclose unprotected contact between an infector and infectee. Airborne spread has not been reported for COVID-19and it is not believed to be a major driver of transmission based on available evidence;however, it can be envisaged if certain aerosol-generating procedure sare conducted in health care facilities. [/i]

Maybe if you use bold, Skeptical will be able to read it.

No, even then he may remain Skeptical.

Excellent point

These posts are silly. Yes washing your hands is important. But it, alone, is not sufficient to stop the spread of the disease. There's a whole list of items but the most basic are:

Wash your hands
Don't touch your face
Keep over 3 feet from other people
Wear a mask if you are sick with anything
Wear a mask yourself if it keeps you from touching your face

The pandemic is here - hand washing is not about stopping the spread, it is about slowing it.

Hand washing alone won't do it. If you touch your face after you touch anything contaminated, it doesn't matter that you washed your hands 12 times that day.

It has to be part of a broader strategy.

The pandemic is here - nothing you do will stop it. The only question is to what degree will handwashing slow the spread. And considering how easy and cheap handwashing is, able to done right now by anyone. The real question is why anyone would ever think it is a cure all, as compared to a method of slowing the spread of an already existing pandemic situation.

Geez, if only there had been an international information source as good as the internet during the 1665 bubonic plague pandemic in England.

But what is containment good for? I am no epidemiologist, but my intuition is that containment can only slow down the progression of the illness among the world population, not change the equilibrium, which will be attained when enough persons have contracted the illness and hav got somme immunity. (This, barring a vaccin, but I've heard no vaccin was to be expected any time soon). Is my intuition wrong?

Yes, it is. If the disease really has a 20% hospitalization rate or if 5% of cases need the ICU, it's of critical importance to reduce the percentage of the population that has the coronavirus at any given time, even if we all (or mostly) get it eventually, so that our healthcare system can cope with the load.

I would not offer myself as an expert either, just a random reader.

I think I've seen that in a typical pandemic less than half the people get the disease at all, and then smaller numbers die.

With good containment and hygiene you can increase the unexposed?

"Is my intuition wrong?" Yes. Per the WHO report, the goal is "flattening the curve," making the number of patients at the peak, within each geographical area, as few as possible, even if lengthening the epidemic is a result. The reason is that in a blow-out epidemic you run out of ventilators, oxygen masks, hospital beds, doctors, nurses, and respiratory therapists, which means people die who could have otherwise survive.

Little reported is the fact that the Chinese have excess hospital capacity, due to super-aggressive containment on the one hand, and reallocation of health services and facilities on the other (entire hospitals were commandeered to become coronavirus only, other patients were transferred to separate hospitals, and anything minor or elective has just been postponed, with net-based medical consultations for daily matters).

So death rates from other diseases could go up because of the corona virus crisis?

Yes, they do.

"Hospital capacity" in this context meaning a warehouse with cots.

And a crematorium.

Also -- if COVID-19 is like other respiratory viruses, infection rates will decline substantially when we get to the warmer months, and even if it is not, we will have fewer people catching COVID-19 while they already are battling the flu or common cold. Also, making it harder for viruses to spread tends to favor less virulent strains (the versions that are most likely to be very mild or asymptomatic are most likely to spread). And, of course, the slower the virus moves, the more time there is to produce and distribute more test kits, masks, anti-viral drugs, etc and determine the most effective treatment regimens.

The WHO report specifically says that that the seasonality of the virus is unknown. The Health Minister in Australia (where it is hot and dry) just stated that he expects an outbreak in Queensland.

Typical respiratory viruses have features that makes them less spreadable in summer weather, and whether coronavirus has those features is not yet known to my knowledge. However, there are population trends that favor lower spread in summer irrespective of the virus, like having children out of school and generally having less group congregation indoors.

Delaying to summer is a worthwhile goal that probably would help.

Australia is now starting its autumn, and its flu season will likely peak somewhere between June and August. Queensland is a bit less hot and dry in the winter.

Not only you "flatten" the curve as some other people pointed out, you can also stop the spread altogether. First, you consider model society that is uniform in number of people per square km, and then model some average human. As you might imagine, if he is unconstrained, he would cover a lot of ground and meet a lot of people during his infection period, this would be number N (this is lowered by physical containment). Out of those, he would infect some percent, let's name this X (this is lowered by washing hands etc). Then the total number of infected afterwards would be NX. Each one of those would produce another NX infections (if we don't consider double infections). So over time we would see an exponential of NX^(time). Obviously, at some point, that exponential hits a plateau (precisely, because everyone cannot be infected twice). Your intuition says that since it is exponential, you cannot stop it completely. But the real curve has plateau (as we already pointed out). This can be modeled the same way that non-ideal gases are modeled and has some part of the equation that shows that the smaller amount of potential people, can one meet in the infection period, the smaller the resulting spread would be. This behaves exactly as non-ideal gases, which (due to volume taken by the molecules) transform into liquid at certain pressure (this would be the density of people in our model) or temperature (this would be how much our people intreact). Sure at some point, even in liquid molecules move around (infections continue to spread), but it is no longer exponential, but rather linear. In this case, spreading of disease can already be modeled as Brownian movement. And you can quite easily stop it (in this case, building the proverbial walls around the infected population).

Thanks for your detailed answer. I think I understand your point. Lowering N will lower the plateau of the function "infected population".. However, lowering N requires extraordinary measures : containments, quarantines, closure of schools and workplaces, cancellation of political meetings, etc. Can these measures be maintained for a long period of time (say until a vaccine comes and a significant portion of the population is vaccinated, which could take years or even decades)? That seems impossible to me. As I see it, after a few months, the pressure to reopen schools, enterprises and let people move freely again will be too strong, N will go up and retrieve its normal level, and the plateau will remain unchanged.

On the other hand, I understand the arguments given by others and you as well that even with the same "plateau", you want to flatten the curve and attain the plateau of people having been infected later, so that even if eventually, the total number who has suffered from the virus is the same, at any given time, there are less people infected so hospitals are not saturated, and also less infected people die because we have more time
to discover effective anti-virals and efficient treatment...

Thanks to all for your answers.

Shorter answer by Konstantinov Roman:

y' = Ay - By^2

(logistic equation aka Bernoulli equation, also known as the Verhulst equation, usually found in the first chapters of any introductory book on differential equations)

I don't think that it is simply a polynomial curve. Infections can have an exponential curve, if we don't make any precautions and the number of people met during the infection period is higher than 1/X. That means if NX is higher than 1. So in first approximation it should be an exponential curve NX^time (over the whole time it should be sigmoidal curve). However I also understand that at small enough N it should behave differently. We know that from how ebola infections evolved over time. Basically it infected too fast and killed any possible carriers. I still think there is something to gas-liquid behaviour there. Because if model people as molecules of gas, the number of unique molecules met by each molecule grows linear by time, and if each meeting exchanges infection, it grows exponentially. However in liquids the number of molecules met grows well below linearity. Perhaps infection rates are better modeled alike to heat transfer in gasses or liquids. Such models are not my forte, perhaps someone better at infection kinetics can answer that.

COVID-19 is similar to SARS. Drugs developed for SARS seem to also work with COVID-19 and accelerated mini-trials are underway to confirm the efficacy and safety of the treatment.

I didn't see anything in my quick scan of the WHO report regarding this so perhaps it is purely pharmaceutical marketing at work.

I am aware of only ONE drug that is going into clinical trials here in the US. Gilead who are at the forefront of anti-viral research did some screening and have forwarded remdesivir ( a putative drug for Ebola) to centers for clinical evaluation. Since it was previously tested, Phase 1 toxicity studies have already been completed which would shorten licensure if it is shown to be clinically active.

This Canadian centric news report from earlier today outlines both drugs. Perhaps my non-specialist mind understands the SARS related mechanism better than the Ebola related one. Understanding the fundamentals of clinical trials, even accelerated ines, is outside of my comfort zone.

Perish the very thought.

......"other countries do not have the capability or will..."

Or the necessary autocratic framework. Imagine locking down the borders of King and Snohomish counties in Washington state.

Of course the Trump Adminstration can lock down whatever borders it wants, whenever it wants. If necessary, ignoring the courts and especially Congress, filled with fearmongers looking forward to the deaths of American. The president is a man with vast experience running a business, unlike that loser Obummer.

Italy has been able lock down the borders of their outbreak. America has the capability, too.

Italy most certainly was not able to lock down the borders, which is the primary reason that COVID19 has been spreading throughout Europe over the couple few weeks.

Most of the recent spate of east coast US cases are from people who got out of Italy before anything serious was being done to sequester people who've been there.

A key lesson from China should have been that border controls and quarantine work pretty well if you act quickly. It would be nice to enact the low-cost measures to reduce the chance we need to enact the high-cost measures.

ha ha "Snohomish"

While I admit that the decline in COVID-19 cases in China is real, we can't trust the incident cases and death counts from China. They changed the incidence definitions multiple times, and the way that the cases are counted is an underestimate from what i read (i.e. cases that in other countries would be counted as coronavirus are not counted in China, particularly for mild symptom cases). I am also not sure about mortality statistics but in a totalitarian regimen, is not too difficult to replace cause of death "corona virus" by "regular flu", without the press noticing in a systematic way. On the other hand, they seem to be doing a much better job at handling this crisis than Iran. In general, autocratic nations with poor public health infrastructure are quite vulnerable. However, U.S. seems to be oddly vulnerable in comparison to other rich countries, due to the specifics of the health system.

"However, U.S. seems to be oddly vulnerable in comparison to other rich countries, due to the specifics of the health system."

For now, the US seems to be doing better than the rest of the world, despite the CDC's bureaucratic faceplant and despite being a hub of international travel. We'll see if it persists, but there's reason for some optimism.

After all, if there's one nation in the world with an excess of expensive specialists, nursing staff, equipment, and testing resources, it's the good ole US of A. The bug has become a feature.

"seems": aye, don't test, don't find.

Your best hope is your low population density both in the country and in your suburbs. Oh, and the fact that so many of you avoid using public transport.

All fair points.

It just works.

Also, like he said, it's not a bug anymore, it's a feature.

Aren't we supposed to love densely populated megacities and high-rise high density housing on this blog?

Unintended consequences, perhaps not unintended.

Bring out your dead!

Avoiding subways and buses and other crowded spaces is supposed to be an important way to avoid getting coronavirus or spreading it. Is that also an important way to avoid getting or spreading regular cold and flu? Is it okay if I care about that too?

.... "the failure of the CDC, which surely prior to this crisis one would have rated as one of the best US organizations. "

no, the CDC is a notoriously politicized (leftish) government bureaucracy. It is "surely" one of the worst Federal agencies.

It is highly inefficient and bloated, like most entrenched bureaucracies.

Well, there has been some improvement over the last three years in removing politicized (leftish) health professionals, there still seems to be a ways to go in getting rid of the 'control' part of CDC. One assumes that a further four years of a Trump Administration will be able to finally drain the swamp's pus.

I see that Brain-Dead Partisan Virus is also still spreading.
Why should anyone not named Joe Stalin care about the political beliefs of technical people? If your toilet is overflowing and the plumber pulls up with a Sanders bumper sticker will you tell him to get lost? If your car won't start and the repair shop still has an old Hillary sign in the window will you say "Forget about it"? Even Stalin realized his mistake after the Wehrmacht rubbed his nose in it.

The U.S. CDC played a crucial role over the last several months stopping an Ebola outbreak in Africa that no one is even talking about. China did not allow the U.S. CDC to join in the effort to stop the spread in China, and Trump gutted their funding and disbanded crucial parts of the team responsible for these outbreaks, so they may be a little behind the ball due, but I hardly think this situation is on them.

A 4.7% increase is a gutting? There are ebola funds left over that Congress won't allow to be used for coronavirus though.

Yes 4.7% is gutting, when you consider that funding could have been increased by 47%. (I’m using “Bernie-math”.)

Why not 147%?

What the heck ...

This comment makes no sense. One of the issues CDC is currently facing with this response is the lack of staff. Core public health programs are already stretched thin due to vacancies, and that's before even dealing with an international public health emergency. Where are the staff supposed to come from? It's not like CDC can just surge the number of employees they have to handle something like this. There are consequences to degrading federal agencies over time.

Shift some people from the school lunch and other nannyism programs to help? Probably not folks who are exactly qualified to be useful I'd guess though.

Which undoubtedly explains why the WHO did not mention the curative powers of interest rate or tax cuts.

Nor any mention of extremely high interest paying Pandemic bonds either.

Coronavirus Outbreak Tests World Bank’s Pandemic Insurance

https://www.wsj.com/articles/coronavirus-outbreak-tests-world-banks-pandemic-insurance-11582136298

The WHO report seems to paint a rather rosey colored picture in many ways. Not too surprising but some interesting data. Also a bit interesting in what was left out (but I suppose that falls into the pro-Chinese aspect of the report)

I think suggesting the error by CDC here is some form a major government failing is perhaps more like government bashing than based on meaningful data.

Clearly this was a case of rush to get something out so mistakes will undoubtedly happen. No organization is going to be 100% perfect. To claim a failed institutional outcome I think one needs more than one data point -- nothing like that is offered.

Additionally, no mention about how little data was being shared by China with other countries or even WHO early on. That just puts others that much more behind in the learning curve, which would then increase the likelihood that initial test kits designs might be less than what is needed. I'm not sure what the failure mode was here for the kits (again, not really spelled out in the post) or what a reasonable correction period might be.

It might also be worth noting the the Chinese CDC was saying within the past couple of weeks that their testing include false negatives with a probability of 50 to 70 percent.

Perhaps it does make some sense not to broadly target testing if the testing is that unreliable. I might guess that telling someone that might be infected that they are free of disease may actually increase the spread more than simply leaving untested people to limit their own activities.

"I think suggesting the error by CDC here is some form a major government failing is perhaps more like government bashing than based on meaningful data."

Eh, no the CDC screwed up royalty. Their's an independent investigation ongoing.

"A top federal scientist sounded the alarm about what he feared was contamination in an Atlanta lab where the government made test kits for the coronavirus, according to sources familiar with the situation in Atlanta.

Driving the news: The Trump administration has ordered an independent investigation of the Centers for Disease Control and Prevention lab, and manufacturing of the virus test kits has been moved, the sources said."

https://www.axios.com/cdc-lab-coronavirus-contaminated-6dc9726d-dea3-423f-b5ad-eb7b1e44c2e2.html

On the CDC, my reaction has been to cut them some slack. As I've said, after working in clinical diagnostics, I know these things things are hard.

And certainly everyone who has worked in science or engineering knows that management has a tendency to demand things because they want them, and not to necessarily understand the reasons things take time.

The post-mortem I have seen is that we had a single pipeline for the test, a reagent did not work at scale, creating false positives, with the CDC sought to control.

Possibly one lesson learned is that there should have been parallel paths to development.

But I'm not totally convinced that a blame game can even be played. No human effort can ever be expected to have 100% odds of success. Bad luck can happen. It is a little bit like that story, "for the want of a nail a shoe was lost.."

For the want of the single reagent, the CDC's reputation was lost?

You’re being obtuse as per usual. The CDC:

- Botched their own test and test roll out, which was both useless and months late
- Refused for weeks to allow anyone else to come up with their own tests, which meant the only test available was in short supply and giving false positives
- Botched the quarantine of repatriated Americans on Travis AFB so badly they spread it to the community
- Still have no plan whatsoever to contain the virus outside of “buy moar mask” and tweeting “wash your hands, lol!”

This is the only reason we need the CDC, and they failed utterly in their ONE job

I am willing to trade stories with anyone else who has worked in clinical diagnostics, but that's not you.

That’s not a response.

They had one job, $12 billion annual budget and screwed it up worse than the communist party of China.

Well that is Dilbert's pointy-haired boss response. Zero understanding of internal processes, but a demand to have it now.

Screwing up job #100 is OK for a gov agency. But a gov agency must be crystal clear on what their top 10 jobs are, and they must be prepared to solve those. Of course those jobs are hard. That's why we're dramatically overpaying the agency to solve them. CDC failed here.

This was the same thing with the VW emissions scandal. You'd THINK a gov agency would be renting random rental cars and checking their emissions to see how they did "in the wild" occasionally. Becuase that's why we're putting so much money into NHTSA, DOT, EPA. But no, we later find out that all these gov agencies never tested a damn thing, they just took the automakers word for it and they had no idea how a car actually measured 1 or 2 years after being on the road. And it took a group of college kids that ask "Why do our measurements not match the gov data?"

In all cases, the gov punted on jobs 1..20--the hard jobs and the very things they were established to do. And they instead worked on job #2392, which is easy and makes them feel good. You know, a big budget research item on making comic books that show more girls in science.

This is gov workers in general: Ignore the important jobs, focus on the easy minutia.

These agencies are generally inept across the board. And yes, inept people have trouble solving hard problems.

I feel bad for the CDC since it's hard to show "success" (i.e. diseases prevented or lives saved) in most case compared to failures, which all receive public scrutiny. The comments about CDC's $12 billion budget is hilarious, since most of those funds were appropriated for specific purposes like chronic disease prevention and maintaining our day-to-day public health infrastructure. Expecting a federal agency to magically expand capacity overnight to deal with a completely novel public health threat is unrealistic. If you want the government to control these threats, then the surge capacity for emergency response needs to be built and paid for in advance.

This is not a completely novel public health threat. Just in the last few years we've dealt with Ebola, swine flu, SARS, MERS, to name a few. We've been a mutation or two away from something disastrous a bunch of times. It should have been obvious that we just needed to get a little more unlucky. The virus might be different, but the kind of problems we are facing are not different. I'm reminded of the Challenger disaster, where post-accident investigation showed we'd gotten close to disaster a bunch of times but didn't do anything responsive.

I don't see much fault in messing up the first batch of tests, that sort of thing happens. I do see fault in enforcing the CDC as the sole source of tests. And I do see fault in not having a quicker acting plan to cut off flights and enforce quarantines, which is the one really effective measure deployed so far.

And it's noteworthy that plans to manage air travel and quarantine are not expensive and don't require a standing army of staff. They require a bit of thinking at HQ, some liaison with Congress to say "please don't say dumb things about keeping the borders open if we have to do this," some liaison with airlines and airports, and some liaison with the armed forces who can set up quarantine areas relatively quickly.

It should be no problem to cut Washington off from the rest of the U.S. Not that I would want to be the liaison to Congress saying "please don't say dumb things about keeping the borders open if we have to do this," to liaison with airlines and airports, and to liaison with the armed forces who can set up lines of defense in depth relatively quickly.

Yeah, it should have been no problem to have had a plan for doing so, a criteria for when you'd need to do so, and to have vetted all that. That seems like the absolute minimum we should have expected.

Seems the idea of the American military shooting American citizens on American soil was not jarring enough.

The real objection I had expected was that there is absolutely no way for the American military to hermetically seal the borders of Washington state, in the same fashion that it is impossible to seal the borders from a UK businessman who took a train to Milan, enjoyed a couple of days in the Lombardy countryside before taking another train to Vienna, who then flew to Geneva, followed by driving to Zurich before flying from there to a conference in NYC. All before the first reported Italian case.

Hi other anonymous.

As I say, I'm willing to cut some slack, but in the interest of continuous process improvement .. maybe next time don't put all eggs in one basket, if that's what it was.

How many billions would the CDC need to say “no travel to Iran or Italy or SK?” Zero.

Or impose mandatory quarantine on Americans returning from Iran or SK or China or Italy? Little to nothing.

This isn’t a failure of funding it’s a complete failure of inaction.

There’s a reason China acted with such drastic measures. The CCP didn’t send a WeChat saying “wash your hands lol” and call it a day. They built 12 temporary hospitals and quarantined a city of millions.

So .. you are a libertarian who wants someone at the CDC to have signature authority on travel bans? Who wants the CDC to have the command and control to build 12 hospitals?

A fight against the COVID-19 pandemic is, to paraphrase Neil Armstrong, one small step for man, one giant leap for more powerful international government. Communicable disease will now be the justification for almost any repressive activity by any government. Disease experts will be the spokesmen for a myriad of nation-state policies. Exotic afflictions from the tropics will be used to justify the closing of borders to the north. Quarantine facilities will house those who object to whatever methods the authorities adopt to maintain their grip on the population. The world has reached a new and infinitely more dangerous point in advanced civilization, not in terms of detecting and treating disease but rather in regulating the behavior of everyone on earth.

this is great, I was hoping to get an update from the Chinese government on how they're doing in this crisis.

When I was doing clinical diagnostics, and we were adding new tests, we had the luxury of a three-to-five year development cycle.

If somebody had told us we should do it in three months because we had to .. would that have even made sense?

We froze hardware, software, and reagents for a solid 6 months of clinical testing before release. If an error was found which required a redesign, that triggered months more of testing.

Absolutely anything rushed is going to have far less reliability than the medical community and the public has come to expect.

Yes, I agree that the problems with the diagnostic tests are explainable, but limiting testing to only people travelling from Wuhan and not allowing other labs to do the test are harder to justify. Maybe they didn't want tests being used broadly because specificity and selectivity were unknown.

Maybe that is something Alex could apply his economic skills to.

Consider a test that might have 90, 95, 99, 99+ accuracy. At what point should you use it?

If attempting to prevent a pandemic maybe the question is whether it’s type 1 or type 2 errors ?

But why is the CDC the only one failing at this? And why did they insist on being the single point of failure?

I'm guessing when all is said and done, Pence will be assigned all the blame for the fact that only the CDC seems utterly incapable of doing its job compared to other OECD health agencies.

Would also give the Boss the excuse to pay his trump card and switch the VP candidate to the hale(y) and hearty Nikki

Can't see how Pence could take any blame, but I'd wholeheartedly go along with Nikki as VP.

I wanna see Nikki neked.

I have not seen published numbers for the accuracy of anyone's tests.

It is possible that some countries have decided to go gung-ho with less reliable tests.

Maybe they are doing involuntary quarantine even with a high false positive rate? Maybe they're doing involuntary quarantine, knowing the false negatives let something slip through their fingers?

There seems to be a fraction of commentors who are unwilling (I'd think not unable) to figure out why CDC didn't want test kits from 3rd party sources. I bet if they put on their smart hats, they will figure it out. By the way, email me, and for $100 you can have my guaranteed to work test kit - good for 300 tests, less than $0.50 per test. (S/H extra).

(For programmers outside the medical community, a six-month code freeze is completely unbelievable. And yet it's necessary, to test with thousands and thousands of known samples, to get something like 99.99% accuracy. We normally expect that or better. To not get one answer in a thousand wrong.)

100 - 99.99% != "one in 1000"

It's anonymous. He's terrible at math.

Oh, you are right, but I think the problem is the same when you have low numbers of nines generally.

"I have been dismayed, however, at the failure of the CDC, which surely prior to this crisis one would have rated as one of the best US organizations."

Would one, indeed?

Our Centers for Disease Control (and Prevention) began to become our Centers for Dissemination of Coronaviruses back in the Obama era, no? I do recall some violations of lab protocols only a handful of years ago, a cursory web search yielded this:

https://www.scientificamerican.com/article/bio-unsafety-level-3-could-the-next-lab-accident-result-in-a-pandemic/

"Trust experts, who are incapable of error" seems a wild message of dubious entertainment value, even in these wild days of dubious entertainments.

So you're blaming Obama for covid-19. Geez, maybe you could work in LBJ and FDR too?

I think we should go a little easier on the CDC about the contaminated test kit. It is incredible how easy it is for biological reagents to become contaminated, even with very careful procedures. Often it's impossible to figure out why, just some bacteria or something floating around that got in an open bottle. Then you have to clean the whole lab, throw out the bad stuff, and start over.

So far, I think the CDC has been affected more by bad luck than incompetence.

So, will it be bad luck or incompetence that is the preferred explanation for the results one can expect from Pence leading a major public health response, based on his previous record?

The CDC refused to use the widely available WHO test. The test that Italy and South Korea have now used 10's of thousands of times.

They botched the creation of their tests.

They (and the FDA) refused to let other labs around the country use any other test for 2 weeks.

An independent expert visited the Atlanta lab last week and immediately blew the whistle that things were going badly.

The Federal government had to shift the test making to a different lab.

There is evidence that we've had an outbreak around the Washington area for 6 weeks that was undetected because we had only run 450 tests for the entire country until last week.

This is an amazing level of incompetence.

Weren't you just arguing a day or two ago that 6 weeks of undetected spread in Washington was impossible?

No, I made the statement that if it had been spreading for 6 weeks that we know because their would be deaths among the elderly. Since there were no reported deaths it seemed unlikely. (I never said impossible).

And then Washington reported 4 deaths from coronavirus yesterday afternoon.

I have no problem with changing my opinion if the facts change. The facts changed.

The current number of fatalities in Washington state is 9, including two who died on Fed. 26.

Our awareness of facts, and the accuracy of how those facts are conveyed can certainly change. And it is fair to say that ignorance of the facts is something that everyone is familiar with. The problem is not denying or asserting something with confidence when one is ignorant. Fashionable as it has become in the last 3 years, it is not a good way to deal with a developing situation.

"The problem is not denying or asserting something with confidence when one is ignorant. "

There's also that reading comprehension issue, whereby I say:

" It's probably been in the Washington area for less than 3 weeks. "

And you translate that in your mind to:

"Weren't you just arguing a day or two ago that 6 weeks of undetected spread in Washington was impossible?"

But that's a personal issue for you to work on.

"language is more pro-China than is usual in an academic report"

Communist propaganda is good now.

" but the report is full of credible data."

Says who? Its data complied and controlled by the Party.

The who gets an F for coordinating with health leaders in the East Asia region. Can't even get the list of countries right.

covid is the federal govts work, since 2014 the cdc has been run by robots the dod and intel could force the cdc to walk out of the building and spread diseases, traveling from airport to airport like the 12 monkeys movie

People are beating up on the CDC about allowing other Covid-19 tests, but I believe it is the FDA that regulates medical tests, and they just changed policy to allow limited test use before the “Emergecy Use Authorization” went through its full bureaucratic course:

http://www.fda.gov/regulatory-information/search-fda-guidance-documents/policy-diagnostics-testing-laboratories-certified-perform-high-complexity-testing-under-clia-prior

Now when will China be honest about how many died in the Great Leap Forward famine?

"when will China be honest about how many died in the Great Leap Forward famine?" Well done; it's only March and already you've won the annual award for the lamest piece of whataboutery.

I could still as the raccoon from the guardians of the galaxy, ha very funny, take control of the federal reserve and the president of the usa, but America is the garbage now and nobody wants it other than terrorists and communists, the only people who try to capture America are the bad guys, nobody else wants it. Europeans don't want America, Asians don't want America its the garbage, witches and babylonia

sorry Matthews, I had brian Williams via the marine kid, I could've helped Matthews MSNBC was one of mine, they trashed it with the witch klan. seriously the tolouse and his brother had meade and the bureau and that's why deniro is shot in the face and that's why cyber and space force exist because a fucking wiccan pile of shit and his useless pile of shit family trashed the usa via ambush, now America is Christianity's enemy. the trumpet didn't choose more Christians, useless Babylonian garbage trumpet

I really didn't expect anyone to oppose hand washing, but here's the thing the WHO and the CDC know:

Hand washing is not theater.

It may reduce infection rate of coronavirus, but we *know* that it will reduce all-cause mortality. If more people wash their hands, before preparing food or eating, when they come home, fewer people will be hospitalized and fewer people will die.

This has the immediate benefit that fewer people get sick, but also the secondary benefit that the total demand on the healthcare infrastructure is reduced.

That is the capacity issue others were talking about above.

Your reading comprehension is better than this.

I don’t oppose hand washing, I oppose “wash your hands lol!” as the containment strategy for the Corona virus.

It’s been a complete failure by the CDC and FDA and they had more than 2 months to prepare for this. Complete. Failure.

The CDC removed testing statistics from the website today, and apparently the promise of “one million testing kits” by 3/6 was complete bs. They’re now quietly saying max capacity is 10,000.

I did not say "lol" I said "let's wash our hands" as the thing we all have the immediate power to do.

Why Skeptical is so much fun to read can be summed up in two simple quotes.

The first is from now - I don’t oppose hand washing, I oppose “wash your hands lol!” as the containment strategy for the Corona virus.

The second is from around 9am - Telling the public to “wash your hands!” is the equivalent of doing absolutely nothing

The juxtaposition is a perfect illustration of someone who seems to have no interest in anything but trolling.

But in the interest of helping your reading comprehension, here is a comment in bold, from someone attempting to correct your ignorance.

Hand washing is THE MOST IMPORTANT thing to do. Here's the direct quote from the report and shows that very close contact is required for transmission.

COVID-19 is transmitted via droplets and fomites duringclose unprotected contact between an infector and infectee. Airborne spread has not been reported for COVID-19 and it is not believed to be a major driver of transmission based on available evidence; however, it can be envisaged if certain aerosol-generating procedures are conducted in health care facilities

rubbish. I told my kids to wash their hands but also told them it isn't very useful since it often wasn't practical to do. I note that few here (I didn't see anyone, but tl;dr) said to avoid touching your face. I also see few advocating avoiding public exposure. Both of which are better advice than "wash your hands". ... depending on context.

not to mention frequent use of hand sanitizer... (not "anti-bacterial", btw but alcohol based anti-viral ones). Packets can be 'practical' in far more situations than a sink, soap and water. And a bottle in your work space should be easy for many to finagle.

65-70% alcohol. Not higher than that, it's not as affective.

effective.

Tyler and Alex, can we please get an Edit feature!

Alan was quoting directly from the WHO report, so do let them know that such information is rubbish.

al shabaab is not a Tennessee resident, pa and ny should be getting hit, al shabaab aimed the Syrian war, yes Syrias war is a war on ny state, al shabaab aimed it at all those guys killed in plane crashes and cops and Catholics, but we won, the good guys, yes mostly Christians but also good Chinese Japanese and gentiles,

yes Puerto rico was leveled twice intentionally because ask Bloomberg, the govt picks losers not winners and losers, hes wrong I don't pick anyone and I can control most of any govt via the military industrial complex, its private capital and its not mammons, the rich are lucky to be a part of it, the rich are gollums and the devil in their wealth kills them eventually,

I bailed out brian Williams and he had cavuto and the marines and the dod sponsored his show and the cops and Matthews deserved better but its like being a dad, a bunch of work and no rewards, its like being the worlds dad with a bunch of ungrateful little shits everywhere

sorry, I have a bunch of political actors in my airspace for super Tuesday, i'm fair the unions did well, the rich and poor won, but the middle class should be expanding, and now African americans should have a better floor without a ceiling

now back to raising interest rates never a useless trump economy and my tax cut was wasted on the socialist democrat trump my economy and my tax cut wasted on trump, interest rates should have been raised consistently since 2018, trump ran up a bunch of debt and then shot himself in the foot, loser

meanwhile
denver sociologists/democrats help reelect the donald
by advocating! the spread of coronavirus to their fello/a americans

https://pluralist.com/candi-cdebaca-coronavirus-trump-supporters/

Actually, Brazil performed pretty well. Its controls worked and beautifully and everything indicates it succeeded in putting the situation under control. Compare and contrast with fellow Latin countries such as Ecuador and Italy.

Yawn. Another excellent AlexT troll post to get hundreds of replies. He knows how to work the audience.

The only thing of interest to me is if this curve not just 'flattens' but starts to fall (new Covid-19 virus cases in China):

https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

So far the curve has slowed down but not stopped rising. When and if it stops rising, I'll believe the WHO report. I personally think China is faking the numbers, but we'll see.

...is how the virus liquifies your insides. Like you told us earlier.

Did the paper mention how China started out by silencing those who spoke out and denying the fact of the virus, as well as not allowing effective treatment of it? And only started this innovative solution once they had allowed it to become a global pandemic?

See this short paper for more on what I say:
https://www.mahahealthcenter.com/wisdom-from-ancient-medical-texts/2020/2/27/before-times-our-times-and-times-to-come-coronavirus-covid-19-etc

I keep hearing about how the US for profit driven health care system is the best in the world, so where is the cheap, fast, accurate, ie, very low false positive, COVID-19 test from a for profit US corporation?

They would at least be able to sell the test outside the US in developing nations to drive the Trump administration to authorize its use in the US.

I grew up in Indiana among farmers who planted corn and tomatoes early even knowing the risk of cold weather was worth the high profits from being first to market with ripe day old or less tomatoes and sweet corn. They were targeting a window of a week or two of being the only supplier in the region.

Why isn't profit, rent, from being first, and selling for 25-50% more than a commodity test with no economic profit, driving faster test kit production than the government? The US can't be more than 25% of the global market, and there is no regulation in most of the global market to prevent free market sales.

Do economists advising for profit businesses actually believe in for profit free markrts?

I'm still trying to find the rationale for the CDC not allowing testing? And why would such authority exist, anyway?

I believe it's ostensibly concern that unregulated testing could prove unreliable and thereby do more harm than good.

But it's common for a government agency, often in the pocket of an important contractor, to insist that the commercially available solution just won't do and they'll need to develop their own government version. See, for example, the Northrop Grumman Zuma failure.

Partly it's a desire to be in charge of the money, partly it's faith in the people you've always worked with, partly it's belief in the superiority of people working for the common good over profit, and partly it's just hubris.

History is littered with examples. If you give someone the power to exclude competitors, they'll often come to think that the competitors aren't adding much anyway.

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