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Sunday, March 08, 2020

COVID 19 and ISA

Posted March 25: On March 8, I wrote the following note to a colleague who wondered why I was thinking about withdrawing from the ISA conference in Honolulu, scheduled for March 25-28. S/he was comparing the virus to the flu and noted Hawaii's lack of cases at the time. I have slighted edited it to fix typos, add links, and assure anonymity of individuals.
I understand the flu risk argument and Hawaii’s lack of cases. However, the lack of cases is likely because of lack of testing. The US really dropped the ball on this with delays in preparation, a flawed first test, and an illogical containment strategy. Many experts are now saying containment obviously failed in many communities and it is time to consider mitigation of community spread.

The logic: The doubling rate for known cases outside China is every 4 days. Given the number of deaths in the US (20 now, I think), between 450 and 2000 people likely have the disease already. Nearly 500 have tested positive. The NYT reported yesterday that nearly 2800 New Yorkers are in self-quarantine. There are 76 in Hawaii. The Atlantic Monthly reports that fewer than 2000 people have been tested in the entire US – only 16 tested as of yesterday in Hawaii. If the true number of current cases is merely 500 people right now, we could still have 1 million US cases in 6 to 8 weeks time if the status quo prevails. There are serious concerns the virus could quickly outstrip the health system’s ability to function. This thread is from someone who used to work at CDC as an Epidemic Intelligence Service Officer:
With testing just about to ramp up, many experts say the number of US cases is about to “explode” as the CDC guy wrote.

I actually have a personal story that illustrates the poor planning** in the US so far:  I had a colleague return from a research trip to Wuhan on December 14. We had beers together a week later at a popular local bar and socialized again together on New Year’s eve. By late January, however, the news coming from China was of such concern that the University required recent returnees from China to spend 14 days at home in quarantine. Of course, for people in my friend's social circle, the horse would have already been out of the barn if he was infected. 

Until this week, no one in Kentucky had been tested for the virus. They’ve tested 14 across the entire state and identified only 1 person with the virus. What scientists don’t really know with certainty is if asymptomatic people could be carrying and spreading the disease. 

That’s really the problem. Who knows?

And the risks are worrisome.

The evidence not only seems to suggest that that virus spreads much more quickly and readily than the flu (because of airborne droplets) – but that it is perhaps 20 times as lethal. I had the flu vaccine in the fall, but there is no vaccine against this virus. Even though the lethality is greater for the elderly, people in my age bracket are still dying at a 10-fold rate. With flu, about 1% of people end up in the hospital with a serious respiratory problem. With COVID 19 it is more like 15 to 20%. That’s largely why the health systems could be broken with a huge outbreak (to flu-like levels of cases).

Mitigation measures are going to become fairly draconian for the US:

Fauci of the National Institute of Allergy and Infectious Diseases said today on Meet the Press that “You don't want to go to a massive gathering, particularly if you're a vulnerable individual. If we continue to see the community spread go up I think you need to seriously look at anything that's a large gathering.”

Austin, Texas, canceled its annual South by Southwest event. Numerous universities are ending travel outside the CONUS. The Physics people canceled their large meeting in Denver. A friend who works in Department of Energy in DC told me that all work travel has been suspended. Someone tested positive who had just attended the CPAC (Conservative Political Action Committee) conference, where both Trump and Pence spoke.  

The Trump administration is still insisting that we are in containment mode, which means 14 day quarantines. Thus, if anyone at the ISA conference develops symptoms and tests positive, attendees could end up spending weeks in quarantine [Hawaii subsequently ordered all arrivals to the island to quarantine]. Even healthy people from the first cruise ship were quarantined for about a month (2 weeks offshore or in Japan and 2 weeks in the US).

I don’t think I’m especially alarmist.

** "Poor planning" compared to Taiwan, for example, a democratic partner of the US, which learned about the disease in December and began its countermeasures at that time: "As early as the beginning of December, Taiwanese health officers started boarding flights arriving from Wuhan to check passengers for symptoms before they could leave the plane."

"Poor planning" also in that US public health officials could have immediately starting investigating recent arrivals from Wuhan, China, and finding out if those people, family members, or contacts in their social circle had unusual illnesses in December, January, or February. Top policymakers and members of Congress certainly received briefings about the dangers that early and some were worried: From Senator Richard Blumental (D-CT) after the January 24 briefing the Senate received: “We are far from having this potential epidemic under control. We should be worried and concerned about this potential epidemic as a nation” 

Sadly, it appears the negligence started at the top: "President Donald Trump ignored reports from US intelligence agencies starting in January that warned of the scale and intensity of the coronavirus outbreak in China, The Washington Post reported Friday."

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