UKC

It's going to be awful over there. 

And Trump is looking for his scapegoat - currently GM: "all those people would have been fine if GM had made the ventilators" 

But the curves look bad in a country with a lot of poor people with no insurance.

Fake news. The curves are looking beautiful. Most beautiful curves ever. Everybody's saying it. Obama never had curves like these.

The best 

It is not that bad in most of the US, the US is a massive country. NY is in a mess, other states much less so. You can't really look at the US as one country in many ways.

Healthcare costs are typically just not paid anyway. It's why the US  Gov. spends so much on healthcare (more than the UK per person), and the stupidity of the system here.

Is this story a bit of an exaggeration? 

I'm not quite sure what happens in the US if you're struck down by the virus and have no insurance.

https://edition.cnn.com/2020/03/26/health/california-teen-coronavirus-death...

Sadly I think the essence will be real and repeated

See graph 20 and the following commentary. Mark suggests that most states are following Europe but some time behind (2-3 weeks). New York is not comparable to anything.

http://nrg.cs.ucl.ac.uk/mjh/covid19

edit: read the commentary

Some really interesting stuff - I've been wondering where to get just those graphs - thanks!

Utterly terrifying isn’t it?  The only comparison I can think of is Herbie’s dramatic storming of the race positions in “The Love Bug”.  

youtube.com/watch?v=4XWufUZ1mxQ&

I’m not sure, it’s hard to know the details. The law is pretty clear - everyone gets healthcare. I think it’s often more poor healthcare and over worked medics than a health insurance issue. My wife would regularly work 90 hr weeks 6 days a week.

my wife’s old hospital in NH has trouble because NY banned partners at births so they drive there for the birth. The law is you cannot turn them away so they have the birth their regardless.

The data is showing NY is flattening out. I’m not sure if we are looking at the same plot.

its going to be bad for sure but it’s a different scenario, different city/living. 
 

the graph I saw in your report shows the red line already pulling down from Italy.

some states will be bad, others growing much slower. Louisiana and Florida seem issues but also random other cities. We have started pretty aggressive social distancing a week ago but we won’t see change for at least a week.

Graph 19 is more informative than the last graph because it’s about health systems. That’s a huge issue in Italy so raw case numbers are less important than the density of COVD cases.

Re NY you can see in graph 20 there is some flattening so we will have to see. We’re certainly at the throw a few hail Mary’s stage though. But so far it’s not as bad as Italy but the peak is a few weeks off, or later if we successfully socially distance.

Piece in this week's New Scientist about this. It finishes with a paragraph about how Obama set up a permanent working group to advise on global health security and possible responses following the Ebola outbreak. Trump disbanded it in 2018.

New York hugely biases the overall US picture - 45% of the cases as of 26th March data

https://github.com/nytimes/covid-19-data/blob/master/us-states.csv if anyone wants to check my arithmetic! 

Cities are inevitably incubators the same as aircraft and cruise ships with the added issue that people get on and off frequently. c.f. the HRH Charles thread. 

The big difference is the population density.

its 8-9 times less dense than European countries. Much of that I’d just desert/mountains/trees but the cities are generally much more spacious. Which is why NYC was seeing so much early growth.

the death rate is also about 1.5% compared to 10% for Italy and that’s because there is much more testing, nowhere near enough still. In comparison Germany has a 0.5% death rate because they test so much. It’s all about the denominator as well as positive tests.

as I said we’ll see. Certainly going to be a very bad time and many will die. But I’d not be sat in the U.K laughing at the US over the coronovirus response.

It’s still Obama’s fault by the way...

Are you looking at the same graph? The cases per million in NY is already well above Italy and tracking the 22% exponent line

I appreciate there will be differences in testing, but the death rate is related to cases from 2 weeks ago. I really can't see how there's going to be anything other than a disaster there.

Those 'death rates' are inaccurate. Around 3% seems to be the most for when the virus knocks health care out of control (3% hardly being any reason to celebrate). The difference between those higher numbers you quoted (llike 10% for Italy) and likely reality is those large numbers of people with the virus with 'mild' symptoms who were not tested during the worst periods . Germany is 0.5% for the moment mainly as that is normal for a good  health system with widespread testing which still has ITU capacity.  In recent days the comments on the surprisingly low number of German deaths are not as common as they were before: today's 20% increase in deaths is towards the bad end of the international data.

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

Well we will see. I don’t know. I’m only married to a US MD who works at a massive academic hospital and live here. So far in my state (Mass), we’re not massively concerned. I’m more concerned because my wife will be front line once her maternity is over. But she’s already on conference calls daily about this.

testing is a huge factor in mortality rate estimates. In Italy the actual death rate is not 10%. If they are only detecting 10% it’s 1%, see below.

itll be bad. How bad we don’t know. We’ve been aggressively social distancing for 1-2 weeks. 
 

“Confirmed cases in the US have been growing very fast recently. The US testing procedures were very slow to get started, but are reported to have scaled up quickly. How much of the rapid increase in case data is due to this scale-up? This graph shows the US death rate, with Italy and France for comparison. When looking at confirmed cases, the US is roughly 15 days behind Italy, whereas when looking at death rates, the US is roughly 19 days behind Italy. This probably indicates that a small part of the recent increases is indeed due to improved testing, but the difference is nowhere near as large as Germany or Luxembourg, so the underlying infection rate must also be high. If this gap widens in the future, then this would be evidence that testing is getting ahead of the epidemic.

To put this in perspective if Italy is identifying just the ~10% of infections that need ICU care, the US is probably identifying very roughly ~30% of infections. (1.35 ^ 4 ~= 3)”

so the US is possibly identifying about 30% of infections. Washington have turned the tide and NY is starting to. I’m worried most about talk of quarantining a city like NY and people just flee.. that happened in Italy.

but also don’t look at Italy as a whole, these cases are largely concentrated in a very small geographical area, which is making it even worse. Likewise the US cases are 40-45% in NY. That leaves a lot of the country with a much lower case load.

so far mortality rates in the US have stayed at the 1-1.5% line but that is due to testing.

im not saying it’s going to be great at all, but I think it’s too early to say the whole nation is going to be a disaster.

remember we started social distancing on March 12th/schools closed, it has got progressively stricter but at least for the last 7 days we’ve been under pretty strict shelter in place or similar guidance. 

In terms of response we are 10 days to a week ahead of the U.K. until the data comes out in the next week or two I’m not sure we are seeing an accurate representation because most of the data is 10-14 days out due to the lag with incubation.

i think that’s why we were all amazed the UK took so long to respond.

You have an inarticulate, self obsessed, orange man child in charge.

Of course it's going to be a disaster!

We’ve good governors though. As I said above, the US can’t be seen as one country. It’s not quite like the EU but it’s more devolved than say the U.K. these disaster situations are very much managed at the state level.

Totally agree, I was trying to say that but obviously failed..

NY is most at risk of knocking healthcare out, it’s going to be close but estimates I saw from Fauci seemed to suggest they’d cope better than Italy. Time will tell.

Sadly I think your big cities (especially NY) are in serious trouble, despite some being pretty good historically at crisis mangement. Today's deaths were infected ~2 weeks back, if you extrapolate that it looks closest in doubling terms to a factor of 16 or 32 before current measures really start to kick in.

Massachusetts is solidly on the 35% daily increase line, along with Illinois, New Jersey and Michigan. Prepare for the worst.

You are possibly correct regarding detection, and almost certainly correct regarding a lower population death rate, owing to the lack of available tests for non-symptomatic cases; but the problem is that no-one really knows what the infection rate is - there is no data. NY death rates per million are currently much lower than in Europe. Is that because they are testing more people, or is it because they are earlier in the curve? Time will tell. Personally, I fear it is the latter.

Your wife is going to be in the front line of a medical tsunami, with too many patients, inadequate protection and no equipment. You and she need to get ready for that. She will be one of the heroes.

What date are you using?

NY started over 2 weeks ago from what I understood. 

Going off this for the state of MA

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

it’s a 23% increase today, 24-25% yesterday. (Still high but we are two weeks into social distancing here).

day to day variation is too great to say if that’s a change.

but she’s currently handling cases over the phone as she’s 36 weeks pregnant with twins, we’re meant to get 16 weeks leave but it sounds like they may cut that short because of this. We’re hoping they keep her doing telemedicine rather than in person for as long as possible with the twins being so young.

Yikes. The positives are that as far as I understand she and the newborns will be at low risk. Do whatever you can to avoid her getting a heavy viral load in a short time. A back-office support role would be ideal, there are plenty of those available.

Caveat, I have no professional expertise in these subjects, but I have had a lot of time to research. It is very tempting to take a positive view of the data - try to avoid this.

Take care and stay safe.

it does seem young kids generally do ok.

its tough for her, it’s the balance between motherhood, protecting the kids and helping out her colleagues and patients. I’m hoping she could just possibly be the one holding the fort with the oncology patients and not front line COVID but she’s going to be going back to lots of sick and exhausted Drs who have been on the frontline. Hopefully (being selfish) by then at least the first wave will have passed through, supply lines will have improved and treatments standardized. They are still pretty much making it up and doing different trials all over the world. Even how they can re-purpose other machines for ventilator like assistance. 

More from watching the data from lots of places including this, which, unlike the major local newspapers, isn't a hassle with sign-ins/paywalls.

https://gothamist.com/news/coronavirus-statistics-tracking-epidemic-new-yor...

Really hope things turn out well for your family.

Thanks

https://www.nytimes.com/2020/03/20/health/coronavirus-data-logarithm-chart....

Its still bad but we can already see in the logarithmic graph we are seeing it trend downwards. The above article was written before the article you showed (wish we could paste images here), but in your article the graphs "Positive Cases by County and NYC (Log Scale)" you can see it is starting to flatten, so we are coming out of exponential growth.

It's the next 3-5 days we should really start to further see the impact of the social distancing measures. If we don't then we are really in deep trouble. 

Yeah, luckily you guys can rely on the leadership of...oh wait, never mind.

He may be an inarticulate, bumbling man child - but he's our inarticulate bumbling man child!

(actually I think Boris has done an ok job, much more on message and clearer than he could have been - we will only find out which country took the 'right' or least bad approach in a year or so.)

I’d echo Roadrunner on the size and diversity of the US. It’s something we all know, but personally I didn’t really *grasp* it until moving here - the sheer size of the place. I’m near Santa Fe in New Mexico. We have low population density going for us - about 2 million in an area larger than the UK. On the negative side, a small healthcare system and pockets of extreme, third world level poverty. Not helped by significant levels of meth alcohol and opiate/oid addiction. So far 208 cases in the state and 2 deaths. I work for the Fire Dept (who run EMS in the county) and my wife works for an Urgent Care as an EMT. A couple of weeks ago we were both getting slammed, mostly people worried but testing negative. Since the governor’s ‘Stay at home’ order on Monday things are best described as eerily quiet. It certainly seems to have cut down on the bullshit calls- nobody’s calling for an ambulance unless they really need one.

So far we just feel really lucky- both youngish and in good health, job security, and 5 acres to lie low on between shifts. A lot of friends and family aren’t so well placed.

Agreed. One depressing thing is how people are already lining up on partisan lines. Regardless of how thing pan out, people will use it to justify their existing world view and tribal identity. Diehard Trumpers are already claiming it’s a liberal plot.

Case data is unreliable as population testing declines as the health system problems increase (so more positives get missed). Look at Italy case data vs death data and deaths should be heavily rounding there now given when the case data logarthmic rounding looks like where NY is now. The UK looked like it might be rounding off on the logarithmic graph of total deaths just two days ago but the last two days wreaked that....

I'm not saying it will be worse than you think but its best not to make optimistic predictions just yet.

Of course, but looking at data all we have is testing really. Deaths happen weeks after infection so they don’t tell us much about what is going on now. It seems most people don’t die of coronavirus for at least a week, if not two plus weeks. My wife’s hospital are seeing most people in a bad way suddenly decline on around day 10. 
 

so while deaths are obviously sound data they don’t really let us know what impact current measures are having. Positive cases (which of course are influenced by testing) change sooner.

im not sure I’m optimistic, I’m just waiting and seeing. All we can do is isolate. 
 

yeah, we’re also lucky. Two salary earners. My job seems secure but with 1 nearly 3 kids my job isn’t crucial because almost all my salary goes on childcare, I’m working now more for my long term career and sanity than finances. So we can survive on my wife’s salary. But as a teacher I think I’ll be ok but I am in an independent school so not as secure as a public school teacher. We’re actually having a normal family life, it’s strange, we’ve never had this.

The UKs downward dip of deaths the other day was apparently because they changed the timings of when they count and report. That day was only 8hrs  

Hence the big number the next day when that reporting period picked up additional cases, then down a little the day after.

Look at what’s happening in India. US an paradigm of planning by comparison.

https://covid19.healthdata.org/projections?fbclid=IwAR0lQ3o1Q8M5F9QO7FuVGQG...
 

this is state by state predictions of total deaths, bed usage and peak resource use.

fauci says he expects between 100-200 thousand deaths. This is predicting 80,000 but with an estimated range of 50-160 thousand. They aren’t that far off in terms of projections.

Of course bed shortage won’t be as bad as we are rapidly building field hospitals but we’re only ~2 weeks off the peak wave coming through because we started socially distancing too late.

You are seriously comparing the most powerful nation in the world with a huge developing nation with hundreds of millions living in slums? India in comparative terms arguably has a pretty good record of dealing with disease outbreaks. This virus is a perfect storm for such a country but how things turn out is for an unknown future .  

https://www.who.int/csr/don/archive/country/ind/en/

Paradigm, or paragon? 

Probably both

What are saying? Indians dont count!? 

Its pretty clear they arent saying that.  As opposed to pointing out that India has a couple of additional challenges the US doesnt and so using them as a comparison is nuts. Although that said both do have a right wing populist leader keen on stirring things up and keeping the country divided.

I suspect you're seeing a mirror of Wuhan and Europe / Lombary & Italy - NY is your Wuhan / Lombardy, and just as its exponential growth starts to abate, everywhere else is going to kick in like Europe's / rest of Italy's did. What you need to know is how many cases can your healthcare system handle and how long it'll take to get there. You might be on a 24% curve but I doubt it will be enough to keep you out of trouble.

I'm not saying it is going to be fine at all. We are looking at 100,000 dead so I'm not in anyway being optimistic. 3000 dead already which is more than in 9/11 and we are two weeks off peak deaths. There will certainly be big trouble, we don't have enough equipment and many thousands will die. That is unavoidable.

But cases have slowed down for the last 2/3 days in NY and MA and we are on around a 15% increase a day, and a 6 day doubling time (according to the link below), so social distancing is working, but there's still issues with it. With the more strict social distancing kicking in last week these numbers should drop further but we've already had 3000 dead and its going to go up a lot. 

https://cnycentral.com/news/local/watch-gov-cuomos-daily-covid-19-briefing-...

Nobody's laughing, more watching in horror. We've f*cked up as bad as the US and it's debatable whether our blithering idiot in chief is any less dangerous than yours. Still, at least we'e only panic buying bog roll and pot noodle not semi automatic weapons!

jk

Boris is mendacious and self serving but certainly not an idiot in the same sense as Trump. He is at least well disposed to science.

Where do they even think they're going to use those while the schools are all shut?

More like he is well disposed to Dom who is well disposed to science. I'm betting on some interesting biographies about the inner workings of government on pandemic science and and logistics, in years to come.  The best science said lockdown slightly earlier (but what was said by the UK was confused and shifting and I think will not stand up well to retrospective analysis),. The best logistics said start moving on tests and PPE way earlier (the current position on delays is scandalous in my view... it will be costing many lives,  including unnecessary deaths of health workers). Then of course we have starting the health and social care fight with one hand tied behind our back, thanks to austerity. The most galling point to me has probably gone unnoticed by most... several of the lead scientists saying our public health arrangements are respected throughout the world,  when the tories 'gutted' Public Health by moving it to cash strapped  local authorities... just try talking to those who work in it.

Quite; I saw some of this move happen up close, it seemed very counter productive.

It was the deputy CMOs Q&A the other day where she basically said that testing was only a good strategy for poor countries.  I think that’s where I gave up and decided too many of the scientific advisors are playing the political game first; I can see why they might have too but that just shows how broken the whole system is.

His inaction in the earlier part of the year then divergence from WHO recommendations suggests some difficulty separating politically motivated pseudo science from actual science. Johnson's failure of leadership put us here, it wasn't inevitable.

Jk

Boris's inaction on lockdown was following exceptionalism in the expert advisors' view on the science (compared to the WHO advice). The government trusted the research groups providing their models too much. The delay was only a few days but that's a lot in exponential growth, the bigger problem at that point was the behavioural science: the UK public needed to be convinced it was justified for it to work (something the advisors also based on science); even when the lockdown did happen huge sections of the public ignored it.

Yes, this is his failure of leadership, the dithering, the mixed messages, the game playing. That and an apparent unwillingness to learn from others ahead of us and adapt our planning, we had months of warning yet here we are, not prepared, little time bought, running to get ahead of a breaking tsunami.

Jk

How do you know this? I would expect the advisors would have given a range of options which the politicans and special advisers then selected from based on a mix of factors.

I know the government have been announcing extremely loudly they have been following scientific advice but in case you havent noticed they have a bit of a habit of lying.

I know because its all over the scientifc discussion on the subject. In particular,  British epidemiologists and virologists saying we should not be doing what was proposed on herd immunity (what they initially said), and should have been following WHO advice. The government politicians might have a habit of lying but the CMO and CSA don't, and deserve respect... the reasons for the errors in what they said are not public as yet.

I am not sure how that contradicts the politicans having a choice of options? Are you saying all those other options were hidden from them? Including the WHO advice?

Unless the politicans do something insanely nuts they would be rather unlikely to publicly contradict them based on the damage that would do.  So lie, maybe not, but not tell the entire truth quite probable.  I mean we can take charlies test and that the medical officer wasnt actually honest saying "yeah its was because he is royal and we were worried about his contact with the queen".

Those are not totally apolitical roles, lying for the government is not necessary but picking your battles and biting your tongue is if you want to get things done. All we really know is that any difference in opinion between senior advisers and government were not, in the short term at least, resigning matters, if you want to maintain influence to shift policy it is sometimes necessary to stick with it. The time wasting 'herd immunity' policy was focused on maintaining economic normality (a forlorn hope), not primarily on public health. I'd be astonished assuming we ever get to learn the truth of the matter to find it came from the scientific advisers rather than the economic and political.

jk

I broadly agree but I still  think many are exaggerating the potential dishonesty of the leading government scientific advisors on this (the irony, that I've been one of those complaining about blind trust of these semi-political roles on other threads, hasn't escaped me). We also have public information coming from other scientists;  a notable example being some of those who gave government advice, subsequently complaining on social media they didn't agree with herd immunity as a target.  It's currently pretty hard to hide bad science from those who are scientifically minded, even though exact reasons why the content of goverment announcements made and the line taken on answering questions won't be known for a while yet (if in some cases at all). The biggest and most serious misinformation was about testing and PPE. I really think if Boris had called for a lockdown those few days earlier, the UK population would not have listened. It took those images (often more emotive than anything) and the big increases in deaths last sunday for most people to 'get it'.

I think people should think more on systems issues as well, in terms of testing and PPE. One thing that has changed a lot in my long career (and those of my friends and family) in public service is a big rise in managerialism. Information flow in the management chain is too often much poorer than it used to be and higher levels of management are more reluctant to challenge the most senior management. Hence, what leaders say may be ill advised, and sometimes even almost impossible on the ground. This is why the Mid-Staffs scandal happened. Still what is reported this lunchtime, on testing and PPE, on what is happening on the 'coal face', fails to match government reassurance.

Its not dishonesty as such but that they are very unlikely to contradict the politicians publically unless what they do is so insanely harmful they feel they have no choice. So sticking specifically with your claim that the politicians were following their expert advisers advice. How are you so certain? Have you seen the briefing documents provided to Johnson and co.

Again I am not sure of how this supports your case that the government was following the advice. You seem to be acknowledging here that they would have been given a range of information.

That an assumption and is apparently one shared by the behaviourial scientists at No10. Its worth noting though that others disagree and take the position that the nudge approach is flawed when it comes to fast response.

Well yes but that is a separate discussion.

This isn't just a medical crisis,  It is also an economic, social and diplomatic one.  The government will need to balance all these aspects and take advice from experts across them before synthesizing that into policy.  I wouldn't expect a response to be solely governed by medical or scientific opinion.

The delay was criminal.

We did the same here, anyone with any sort of science background could see social distancing had to have started a week before it did. I was talking to my school on the Wednesday, and their view was 'what will 5 days do'. Which is a hell of a lot.

We are already seeing social distancing working, and we really should see that kick in more and more over the next week or two. Credit to the public. Even MRT's are saying people are staying off the hill, the idiots are the exception rather than the rule. It's easy to watch the news and think everyone is still acting normally and that's not the case.

Imperial group released their models on which the advice was given and some from that group complained when they felt it was misrepresented. The modelling science is simply not being hidden.  There will have been many other inputs to the government decisions including: practical management issues, political considerations, economic advice, financial advice, business advice, social advice, public health advice, logistical advice, behavioural advice etc. I still think the government scientific experts stated views on the subject of models were explainable from the (now public) scientific modelling advice (Imperial at the time were predicting hundreds of thousands of deaths).

Yes my view on behavioural science is an assumption but given all the actions we have seen (like a million mobile phone users leaving Paris before the lockdown) if anything I'm understating it. I simply don't believe Boris could have locked down much earlier (and I can't stand the man).

My impression was that it was a sort of hindsight political justification - uncharacteristically poorly thought through if it came from Vallance or Whitty (so I suspect it didn't).  However it arose it was a spectacular misstep and led to a lot of hot air about herd immunity by people who didn't know the first thing about it.

If you were dying of an acute respiratory infection would you take the medical advice or wait to see what the economists, sociologists and diplomats had to say?

Neither would I. Hence why I was interested in why Offwidth was so certain they were "following exceptionalism in the expert advisors' view on the science".

I would prefer the former. However, for example, the economists advice will have helped decide whether the medical expert was available to advise me or not.

Medical, obviously, but that would be a medical problem for me, not a wider one.  The government is dealing with the wider issues too.

That was my view. They grasped onto it and the medical experts involved seemed to struggle. 

It was also rather galling to here anti-vaxers talk about the importance of herd immunity.. We still see it here with republicans, saying don't respond so much to the virus because a vaccine will be here, a group who have largely shunned vaccines, stunted vaccine research and will have poor vaccine uptake.

Quite a lot of the scientific advice to the government has been made public - the key body is the Scientific Advisory Group for Emergencies.  Take a look, for example, at the 4th March document "SPI-B insights on combined behavioural and social interventions" .  (https://www.gov.uk/government/groups/scientific-advisory-group-for-emergenc...)  

It's interesting that there were conflicting views (e.g. about school closures), so whatever we might think in hindsight it's not entirely true to say that there was clear scientific advice that the government failed to follow.

Is there a sample size issue here?  Do those advisors know how many other sources of advice the govt sought?  Perhaps they were in a minority, or when their views were weighed against all the other contributing fields they emerged as an outlier (despite perceiving unanimity amongst their peers)?  Its easy afterall to find experts in a given field with wildly differing opinions and just as an economist will say it is ludicrous to shut down all business, ALL the relevant advice has to be weighed against the bigger picture.

I think it is far too early to question the government's approach and doing so is based on thinly available information and selective samples of experts. 

At its worst it looks like stirring up panic ("the government has it all wrong and is playing with your lives!") for political gain or increased newspaper circulation.  It's one thing to question rationales but presenting extremely one-sided arguments is pretty low at times like this.

The following was from that document was very prescient!

"Many of the strategies allow for some ambiguity. There is a danger that this may be exploited or become a source of tension."

My feeling is that there wasn’t solid agreement in the scientific advisory board, and Boris depended on Cummings to help him understand and cope with this.  Cummings is one of that last peope I would choose to do that’s.  There’s been snippets here and there hinting at this. Arguably it’s a failure equally shared on both sides.  The civil service should have been on it but Cummings open contempt for them (his batshit insane data science blog post) and other recent high profile events show how these mechanisms are also the totally subverted by the era of Personality Politicians and special advisors - the most harmful of Blair’s toxic legacies.

I still don’t see understanding from government that all these models have sufficient unknowns as free parameters that they can fit to anything; they’re useful for interpreting data and for identifying the most important changes to make but they’re not meaningfully (quantitatively) predictive.  Science does have a habit of getting carried away with models because they’re super detailed and high powered.

"At its worst it looks like stirring up panic ("the government has it all wrong and is playing with your lives!")"

But they were wrong, and publicly admitted it when they changed policy twice in a week.

We went into household isolation about a week early partly because I refused to let government play with our lives in a deeply misguided strategy.

My trust in government was totally destroyed by this.  Not just the U-turn but the pitiful lack of preparation on PPE and medical device manufacture 8 weeks before it became a critical issue with a real human cost.  It’s hard to go lower than that.

I would have thought this was the perfect time to question the approach. It would be a bit irritating a year down the line for someone to go "I wrote up this approach which would have worked miracles but didnt want to challenge the government".

Where is this "one-sided argument" coming from? The government if anything is being let off lightly.

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

To go back to the OP, whilst still in trouble we are seeing social distancing working and this data will only be from the first few days of social distancing. The next week should really change. But we are seeing a consistent flattening of the curve over a number of days suggesting it's not just variation.

Now imagine if we would have started 2-3 days before. Those 2-3 days delay by the governments, everywhere, will kill thousands.

Now imagine they’d started ramping up testing capability and building contact tracing capability 8 weeks before, and started quarantine/lockdown 4 weeks sooner on travellers...  

But it is not the people dying who get to make the decision. Others have to, and so there are going to be some very hard and very horrible decisions to be made along the way - I don't envy those who have to make them one bit.

And then the systematic ones as opposed to the response issues: how often did the health service practice pandemic control in the last 5 years? When did the cabinet office last do a pandemic response simulation?

The Obama team ran a pandemic response simulation for the incoming Trump team and they basically sat there, bored and then dismantled the team once in.

Apparently 3 years ago but the results were kept secret as they plainly showed how we weren’t ready to act in time once a pandemic showed its head.

https://www.google.co.uk/amp/s/www.telegraph.co.uk/news/2020/03/28/exercise... 

I don’t even know where to begin.

At least they ran the sim! - when I was working on FMD in 2001 the MAFF handbook on what to do (actually a big A4 folder with excellent and detailed plans)  - was last revised in the early 70's - it included instructions about how to go about getting the GPO to wire in extra phone lines, what to do if th eoutbreak was in a specific place (Royal Show) and in the outbuildings at the MAFF place I was working out of there were bales of public information stuff in relation to the plan.

Of course he could, it would have just cost him some of his capital with the electorate to stand up and clearly explain why the actions were necessary, what those few extra days of hardship could buy us in the near future. That's leadership.

jk

By contrast, this analysis (p20) suggests the UK is/was the most prepared of any country in the world for a pandemic.

https://www.ghsindex.org/wp-content/uploads/2019/10/2019-Global-Health-Secu...

Of course that might more a commentary on other countries poor preparation than the UK's good preparation.

I can’t get the report to load.  I’ll try again later.

I suppose it helps if you don’t count Taiwan as a country, and the developments here vs Singapore certainly suggest different as well.  The UK certainly had the base to prepare from, and sufficient warning time we could have used to prepare in.  All of which combined with our planning simultion makes our early response even harder to fathom.

Whatever you might think, the herd immuntity idea was pretty clearly exceptionalism and I'd rather believe the senior government scientifc advisors were happy enough to go along with that, rather than have spoken strongly against it in private but backed it in public.  I'd hope, given the lives at stake, it would have been a resignation issue, if the idea wasn't partly based on those highly pessimistic initial Imperial modelling outputs and other science. As the modelling changed and deaths increased they abandoned herd immunity as a strategy and  their views firmed up on the importance of a lock-down. It's why I disagree with wintertree for once on this subject, whatever Dom's involvement, the CSA and CMO had to be enough on board.

We clearly won't agree on this but I do think it will come out in public one day.

"Of course he could, it would have just cost him some of his capital with the electorate to stand up and clearly explain why the actions were necessary, what those few extra days of hardship could buy us in the near future. That's leadership."

Demonstrating 'strong leadership' on something that you know won't happen is stupid.....its exactly what Canute wisely demonstrated many centuries ago. Had Boris done it, I would have praised him but I'm pretty sure most of the population would have ignored it. Those million phones leaving Paris after strong leadership are evidence and I suspect we have our own numbers leaving London (evidenced in GCHQ). I do agree, that in the few days difference it took to really notice the need to lockdown was more urgent, (remember they said we were 4 weeks behind Italy on the data back then)  it will have doubled deaths, as Roadrunner6 indicated..

Well clearly the administration that ran from then and is continued now had MUCH MORE IMPORTANT business than protecting the UK population from identified risks.

It was the People's Will, much good has it done

I want the guilty punished when all this is over

it is noteworthy that it is during the period SINCE this exercise that May and her disciple Priti Patel have created the environment that rid the NHS of over 20000 unneeded and unwanted and undesirable EU citizens working in the NHS

This is a crime that will go unpunished, an attack on and neglect of our national infrastructure

and we ain't seen the Russia Report yet

7 or 8 days ago I said to my wife that we'd be over 1000 deaths by the end of the month.  I hadn't taken into account that we'd be nearly double that.

was it exeptionalism? Sweden seemed to have followed that pathway, colleagues from the netherlands say they did the same.

Exceptional doesn't mean unique.

Listening to the Governor of NY state on the BBC news channel at about 16.45 today I was amazed to hear him say there is no public and private hospital split, or inter-state regional splits, anymore. All efforts, capacity and equipment will be coordinated and shared fairly state wide. If one link of the chain breaks other links can no longer say that's nothing to do with them, as the chain is still broken. They need to be careful as it might catch on and produce a 'socialist' health system, like the NHS.

Christ wercat! What have you and the Mrs been up to???

The leadership would have been using his public speaking skill to persuade and the full weight of the law to cajole. We don't have to like it! 

The 4 weeks behind Italy thing was notably unevidenced bollocks from the moment it left his lips. Being charitable in the extreme he rounded up the biggest outlying number anyone had mentioned to him. I don't feel charitable where Johnson is concerned. 

Jk

They've had massive issues with supplies because of this (basically competing at the federal, state and private levels) so he's basically creating one system and as one over flows another one kicks in and the same with ICU wards in each hospital, likewise they can manage resources at the state level. Cuomo has come out of this looking an incredible leader.

Even his nightly family battles with his brother on CNN. He's able to make people laugh yet take it very seriously. 

I thought the stupidity of the system there was far more obvious.

So here..

Bet it takes longer than a few weeks to really ramp up PPE . More like 6 months to a year timescale for decent stuff . That’s just from my limited knowledge of fabrics and textile manufacturing in that specific area. Just to get the machinery may take 3 months. It’s not off the shelf stuff. 
 

you will get the odd company who can double up, but for feeding the whole   system it will take far longer. 

GM are making 50,000 ventilators starting at the end of April. Our peak is mid April. Anyone see an issue there??

I think you are naive and forgetting how fast this took off, if you seriously think at a stage when deaths were below 100 that Boris could have effectively applied a UK lockdown with legal penalties. I think the political and population reaction to that might even have delayed population response and made things worse than they are now. I'm speaking as someone who wanted that lockdown as fast as possible. On the first strict announcements on social distancing on March 18th there were 104 deaths, just 3 days earlier there were only 35 (roughly tripling in that short period and also tripling in the three days before that, from 10).

It was the CSA and CMO leading on 4 weeks (not Boris), consistent to the Imperial model data at that time.

Not really... or, at least, not a new issue.  They are making them for the US

He was really impressive. 

Hopefully other states can assist for a while with venitlators. They will certainly appreciate any return help later themselves.

They've re purposed (well are going to) a closed car factory, but its taking too long. Hence the issue.

The US view is a truly free market can adapt to market forces faster. That is not happening. That's the issue.

It sounds like the free market is having a field day letting 50 states and the federal government bid against each other and drive prices up.

I agree with you that it would be hard to lock the UK down sooner due to lack of population support; that didn’t limit countries that prepared their population genetically in advance.  Those counties are now in a much better place than us.  We can learn from that.  

On the other hand there is a lot out government could have done 6-7 weeks sooner.  The scrabble to start ventilator production, the scrabble to create field hospitals, the scrabble to de-retire staff, the scrabble to order PPE (see the BBC story from a few days ago about manufacturers still not having received orders).

In other words, whilst they could not easily press the “panic” button in January or February, they should have pressed the “prepare” button back then.

Granted - but the narrative is typically that the UK response is unique - in fact it looks like euroland average to me.

what hoo doo is this?!!!

Auto-correct hoodoo perhaps?

Ah, took me a while to spot that.  “Generically” - the population was more aware of a non specific pandemic risk and of what would be required from them.

Although the genetic approach is probably better! It sounds like ACE is up regulated when ACE2 is knocked down.  What can possibly go wrong?

Certainly. There's going to be few winners from all this, and many losers. 

Senators and congressman were selling shares on the quiet when they got news of this before they announced how bad it was.

A contact of mine in the US said there's a theory going round that it was started by the US with a view that US manufacturers would be best placed to pick up the pieces afterwards - a bit like Halliburton etc. getting the contracts for rebuilding Iraq.  If so, I think they underestimated the Chinese who are no longer behind the rest of the world in technology - I suspect China will come out of this better than anywhere else in the world.

please don't report us ...

the cooking here isn't That bad

The cooking? Now I'm imagining a Sawny Bean type situation

I do agree the lack of preparation, whilst dishonestly reassuring the population that they were doing everything they could, is the real scandal. 

I mentioned the management system problems above, and how some management try to block what they see as bad news, which is in fact important information in a crisis  (like Mid-Staffs did)... it's what a lot of senior management have got used to, to cover up their own failings. It's starting to happen now on PPE.

https://www.theguardian.com/society/2020/mar/31/nhs-staff-gagged-over-coron...

Loving the freudian slip given herd immunuty was the initial government idea to prepare a population.

I immediately wondered whether any of your bog standard ace2 inhibitors would compete for binding. Must have been tested by someone right away!

CB

It seems to be a recent trend to excuse incompetence as part of a cunning masterplan. See it a fair amount in yanks in particular when trying to excuse Trump stupidity. I guess its one way to deal with having that idiot in charge.

not really. Have you read up on the reports of them shipping PPE equipment to places like Spain, and for that equipment then to be rejected as not upto scratch?

I'd agree if we were the first nation to experience this, if we weren't weeks behind others already in dire straits. It didn't take off fast, it arrived months after we'd clearly seen it develop and spread in China then it grew exponentially within our community after containment failed. If anyone in charge considers that unexpected given the control measures we chose not to impose they should be sacked on the spot, it was utterly inevitable. Instead of appealing to our exceptionalist instincts, glossing over our poor preparedness he could have levelled with us, drawn on those examples abroad as a leader to explain the value of the painful measures we needed to impose and why they had to happen before this problem became a crisis. As is he was lead by the public and business every step of the way, ultimately protecting neither our productivity nor our health. I'm not daft, I know it wouldn't have been popular and we have obvious trust issues with a man who lies for sport. It would have cost him but a price he could afford to pay with his majority in a crisis. As a nation we obey rules, we maintain trust in our institutions, radical early social change was both possible and necessary. Had he done his job we would by now be well on our way to having this under control and he'd soon be hailed the Churchillian hero he dreams of being not the lassaiz faire dilettante he quite predictably turned out to be.

jk

Just watching The Donald do his White House update. 7 of them all stood at the podium, almost touching shoulders and breathing all over each other.

First up is some bloke telling them that drug gangs are taking advantage of the theory that the governments attention is elsewhere. Apparently it's all the fault of the Venezuelan government.

This is very very important, very important.

It's incredible, he's shaking peoples hands, up close and personal with people. I understand they now check for fever of anyone he meets but they can be contagious before the fever - or even be asymptomatic.

One of them literally just now stated on that podium that all levels up the chain of command are practicing social distancing. He said that with 6 other top ranking men stood right next to him. I just can't believe it.

Killian is lying to you.

youtube.com/watch?v=DmJmRwDGk60&

I was confused by that, before clicking I thought the video would be this Cillian (but remembered the spelling difference)

youtube.com/watch?v=pvEWOBAzHf4&

- a bit sweary, NSFW might be a bit redundant for most of us currently - but if you have little kids about, turn the sound down!  

I read somewhere that god gave him to America, therefore god wouldn't pass it on to the faithful!

...has arrived

https://www.bbc.co.uk/news/world-us-canada-52137160

Sadly it's only just started. What we are seeing now is nothing to what it will be like in two weeks.

The 'good' (less bad maybe) news is in MA we have had 5 days in a row where cases have risen by only 15%, but it hasn't dropped any further. Hopefully that will drop further this week as we see the affects of social distancing come in.

New York State has continued to drop and is now only seeing a 10% rise per day. Again though that's been stable for 2-3 days. Not great but far better than the 30-40% rises we were seeing a week ago.

But if you take the data and plot % change against the date there's a fairly continuous decline over the last two weeks. If we hadn't have started social distancing two weeks ago it would have been even more horrific.

https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_New_York_(state)

A good article on the situation in the US

https://medium.com/@tomaspueyo/coronavirus-out-of-many-one-36b886af37e9

(Thanks to mrjonathonr on the other channel for linking it)

Yes.  I should change the thread title to the "The current US Shitstorm"

Thanks, the bipartisan bit at the end is very true. If you look at phone data on who is traveling on a map of the US it's basically split with Red V blue states.

But he goes too far with the governor thing, MA has a republican governor but it's a very democrat state (we're a state of 7 million with 10,000 cases, and a 2% fatality rate). And two of the worst hit states are very blue states in NY and CA.

I'm not convinced by his 'share of positive tests' section. Because testing is not standardized between countries, even states, even hospitals. My wife's hospital just could not test, Dr's couldn't even test patients without going up the chain of command, other states or other hospitals test on different criteria.

BBC has just run an article on New Orleans.  A perfect case study of the problem.

Preceded, deliberately or not, by a clip of the President considering himself a God.

Mardi Gras timing was terribly bad luck, compounded by poor federal advice.

https://www.washingtonpost.com/national/coronavirus-new-orleans-mardi-gras/...

Don't worry though, Jared will be on the case:

https://www.theguardian.com/world/2020/apr/05/jared-kushner-coronavirus-aid...

US projections

https://covid19.healthdata.org/projections

That's conservative and come down a lot. But is in line with CDC estimates.

It's also based on deaths so has shown a lot of variation however we are seeing Social Distancing working. Slowly. The problem is we have a big lag from infection to symptoms to positive tests.

The daily increase in cases has dropped from 30% a week ago to a consistent 15% for a week and only 7% yesterday in MA. It's in the next few days we will really see hospitals get hit.

https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Massachusetts

In the US as a whole this is also the pattern. https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_the_United_State...

If you plot the data on a logarithmic axis you can see it flattening. 

Still a 10 days to 2 weeks to go.

Those projects look pretty dire.  

The new case numbers are a bit misleading though as they released a big backlog on saturday of about twice as many test results as normal, and they always have lower numbers on sunday because there aren't as many officials at work. Added to that they are getting to the stage that the number of tests limits the number of new official new cases, essentially their numbers are capped by the amount of testing they do. We'll see what happens when they get their 15 minute tests up and running.

https://covidtracking.com/data/us-daily

If you look at historic data I don’t see the Sunday blip. I’ve been tracking the data. In Mass, for the last 5 Sunday’s only yesterdays % change was lower than the preceding Saturdays and following mondays, but even today’s only rose to 10%. The graph of % change over time for new cases is a negative correlation going back for 2 weeks.

NY has shows similar data. They are further a head than us but they have started to actually see a decline in the number of new cases.

i certainly seemed your view about testing capping data but we’ve been socially distancing for a 3-4 weeks now and we should start to see change. Time will tell. It’s hard to imagine it hasn’t worked to some degree.

I'd be interested in what you make of this.

https://www.theatlantic.com/politics/archive/2020/04/coronavirus-unique-thr...

I’ll read later but is it a confluence of a pandemic and an obesity epidemic?

Again I would urge caution. The data is currently dominated by NY and it is NY where things are likely flattening. It is also at the same time increasing in many more metropolitan areas across the US. There must be a significant risk that things get worse overall after NY shows clear recovery.

Partly. Also related to fiscal, educational and cultural poverty, with concomitant poor health across a much larger swathe of the population relative to the rest of the US.

It doesn’t make much sense to view the US as one. State but state (as in Europe country by country) makes more sense. The stock markets seems to think the worst will be over soon.