The cost of waiting - Printable Version

The cost of waiting - Printable Version

+- The CardBoard (https://thecardboard.org/board)
+-- Forum: Emergency (https://thecardboard.org/board/forum-11.html)
+--- Forum: Covid-19 (https://thecardboard.org/board/forum-12.html)
+--- Thread: The cost of waiting (/thread-19758.html)

Pages: 1 2

The cost of waiting - BostonCard - 05-21-2020

https://www.nytimes.com/2020/05/20/us/coronavirus-distancing-deaths.html

According to the study, a delay of 1 week in imposing shelter in place measures may have cost as much as 36,000 lives. Normal caveats about modeled counterfactuals apply.

BC

RE: The cost of waiting - dabigv13 - 05-21-2020

I think many people in places that avoided the worst of it don't realize how close they were to big problems. California was on a very steep curve for cases and hospitalizations, the same shape as NYC or Italy. If we had another week of growth before activity clamped down (whether via SIP orders or people reading the news of NBA getting cancelled etc), we would have been in the same boat. Thankfully, just as predicted, between 2 and 3 weeks after SIP, the curve flattened. California didn't avoid NYC's outcome because of weather or density. We avoided it because of the lockdown. I'm not sure people understand that.

RE: The cost of waiting - oregontim - 05-21-2020

And one built-in irony of shelter in place is that if it works many people will use its very effectiveness to prove that it was never needed in the first place.

And FWIW That's not my original comment. I got it from some credentialed expert, and probably read it first in this forum.

RE: The cost of waiting - magnus - 05-21-2020

Channeling outsiderfan, how many lives would have been saved if the CDC had supported masks from the beginning of March.

Anyway, do any of these studies take into account the likelihood that Americans would have obeyed earlier guidelines?

For many of us, unfortunately, proof is in the pudding, not the recipe (not sure this analogy works but you get my point). Early March was still too early for many to take this seriously. Heck, even in April when things were peaking, there were still plenty of non-believers.

RE: The cost of waiting - magnus - 05-22-2020

Thanks to 76lsjumb, i found this article that similarly states my comment above about the unlikelihood we (as a critical mass) would have listened much earlier.

https://www.nationalreview.com/2020/05/how-much-sooner-could-we-have-locked-down/

RE: The cost of waiting - Mick - 05-22-2020

(05-22-2020, 01:18 AM)magnus Wrote: Thanks to 76lsjumb, i found this article that similarly states my comment above about the unlikelihood we (as a critical mass) would have listened much earlier.

https://www.nationalreview.com/2020/05/how-much-sooner-could-we-have-locked-down/

I wonder what the likelihood of American shutdown would have been had the CCP blared to the world what they knew about the coronavirus, say, on December 20, 2019; instead of 1/20/20?

RE: The cost of waiting - 2006alum - 05-22-2020

(05-22-2020, 06:25 AM)Mick Wrote:
(05-22-2020, 01:18 AM)magnus Wrote: Thanks to 76lsjumb, i found this article that similarly states my comment above about the unlikelihood we (as a critical mass) would have listened much earlier.

https://www.nationalreview.com/2020/05/how-much-sooner-could-we-have-locked-down/

I wonder what the likelihood of American shutdown would have been had the CCP blared to the world what they knew about the coronavirus, say, on December 20, 2019; instead of 1/20/20?

By all accounts, they didn't know too much. But regardless, locking down 60 million people on Jan. 22 sent a clear enough signal. For a variety of reasons, we, as well as much of the rest of the world, didn't listen.

RE: The cost of waiting - BostonCard - 05-22-2020

I think the NRO makes a very good point. Had lockdown orders been handed down earlier, a lot of people would have considered them vast overreactions given what was occurring. Humans do have trouble understanding exponential growth. And it took some time to hit a lot of people. I think basically it wasn't until the NBA cut its season short that a lot of people started taking the virus seriously.

However, this is where leadership comes in. Someone willing to take what might look like an unpopular stance could have gotten people to take the virus seriously earlier. Maybe even instituting a mandatory lockdown while it still looks like an overreaction would have resulted in a lot of grumbles, and some defiance, but most people would have actually followed the advice. If you wait until the people are "ready" and voluntarily social distancing, then the actual lockdown orders are going to make much less of a difference than if they are instituted before people are ready.

Now, this was not an administration failure, per se, as instituting shelter in place orders are the responsibility of state and local leaders. Some leaders did well here and some did poorly (I'm looking at you, Bill de Blasio). But it would have been a lot easier to issue controversial orders if it could have been done in a coordinated fashion with the same message being repeated at local, state, and federal levels. Federal guidelines for how and when to close could have given local officials cover to issue shelter in place orders that the public might have been less ready for. And if the threat was high enough to impose a shutdown on travel from China, it should have been apparent that once there was community transmission, putting in a travel ban is akin to closing the barn door after the horses have left.

BC

RE: The cost of waiting - magnus - 05-22-2020

(05-22-2020, 09:13 AM)BostonCard Wrote: I think basically it wasn't until the NBA cut its season short that a lot of people started taking the virus seriously.

The NBA action was definitely a big step towards acceptance. I think Tom Hanks getting diagnosed also made it more real for many people.

RE: The cost of waiting - Nan3cy - 05-22-2020

(05-21-2020, 12:47 PM)oregontim Wrote: And one built-in irony of shelter in place is that if it works many people will use its very effectiveness to prove that it was never needed in the first place.

And FWIW That's not my original comment. I got it from some credentialed expert, and probably read it first in this forum.

I heard that on the radio from a medical person, right at the time that SIP started in the Bay Area. She said, if all goes as well as it possibly can, our best outcome is that when it's all over, people are saying, we did all that for this?? Nothing happened! So, if you do everything right, your reward is that the conspiracy types are at your throat. Great reward.

RE: The cost of waiting - Goose - 05-22-2020

(05-22-2020, 09:13 AM)BostonCard Wrote: However, this is where leadership comes in. Someone willing to take what might look like an unpopular stance could have gotten people to take the virus seriously earlier. Maybe even instituting a mandatory lockdown while it still looks like an overreaction would have resulted in a lot of grumbles, and some defiance, but most people would have actually followed the advice. If you wait until the people are "ready" and voluntarily social distancing, then the actual lockdown orders are going to make much less of a difference than if they are instituted before people are ready.

I agree that leadership can be extremely important in advancing good ideas that are not necessarily popular at the moment. However, I think that we have many examples of leaders getting "out in front" of the general populace too soon and losing their credibility. It can harden positions to the point moving ahead at all becomes impossible. FDR had this happen to him on several issues, as did Wilson. The trick for good leadership is to determine what is possible in terms of moving ahead, doing that, and NOT doing more.

The other issue is how sure the leader is of his ground. I think in this case, even if the leaders was someone other than Trump, it would have been a very difficult call to recommend SIP in February. A travel ban to/from China for non-citizens is inconvenient, but it doesn't really "bite" into the economy that much. Closing all the US borders does significantly do so. SIP is a "nuclear" option for the economy. A leader has to be damn sure it is necessary, and even more sure that he can pull it off, before he can do/suggest these things. I see no way that SIP could have been credibly suggested on January 31. March 1 is a different point, but even then I doubt it could have been done. Most states had essentially no cases. At that point, getting buy in to the idea that spread was inevitable would have been very hard.

RE: The cost of waiting - oldalum - 05-22-2020

I agree that lockdown realistically could not have been accomplished earlier, given the lack of available testing. Had testing been ramped up earlier, the evidence would have been there to lock down earlier.

RE: The cost of waiting - M T - 05-22-2020

(05-22-2020, 11:36 AM)oldalum Wrote: I agree that lockdown realistically could not have been accomplished earlier, given the lack of available testing. Had testing been ramped up earlier, the evidence would have been there to lock down earlier.

What does testing have to do with it? Suppose it was known there were two deaths in Santa Clara County as of Feb. 17? Do you think the public would have been willing to shutdown the county? the state? Do you think NYC would have shutdown, or Washington State would have been testing their retirement centers?

The evidence was there in China. It took the unfortunate cluster of deaths in the retirement center in Washington State to make people realize that it can happen here. Maybe there are those that think actors & athletes are our models for rational behavior, but I'd like to think that is just media machines at work.

RE: The cost of waiting - Goose - 05-22-2020

(05-22-2020, 02:02 PM)M T Wrote: The evidence was there in China. It took the unfortunate cluster of deaths in the retirement center in Washington State to make people realize that it can happen here. Maybe there are those that think actors & athletes are our models for rational behavior, but I'd like to think that is just media machines at work.

The evidence was there that it could happen in China. SARS also happened in China. SARS didn't happen here, although we were repeatedly warned that it could/would. One can certainly argue that we did not have anywhere near adequate surveillance in the US to know what was going on with COVID-19. However, most people aren't going to take it on faith that it will happen here until it has at least once in recent memory, and that includes persons in authority. There are epidemics that happen elsewhere in the world all the time. They didn't impact us here. This one did. It is probably true that our lack of detailed knowledge about how this virus behaves made it difficult for the CDC, or really anybody, to say in January that it was extremely probable we would be heavily impacted unless we started SIP immediately. If we had a decent contact tracing and testing system in place in all the states, maybe we could have contained it. We didn't, and so we couldn't even attempt containment. Do we now realize we need such a thing? Let's hope so.

RE: The cost of waiting - oldalum - 05-22-2020

(05-22-2020, 02:02 PM)M T Wrote: What does testing have to do with it?

Everything. It's not number of known cases or deaths, it was community transmission that led to the lockdown. In the Bay Area it was ONE case--the FIRST case. In fact, for the counties other than SCC, it was ZERO cases (of community transmission), but they locked down simultaneously. The Public Health Officers could not lock down the Bay Area until they had evidence of community transmission, which meant there had to be thousands of infected people. They were pretty sure there was, but they were unable to prove it due to lack of testing. The very first case they discovered without a known contact, they instituted SiP. Not much outcry from the public that I can remember. If we had enough testing in February to know the prevalence in the county, SiP would have been done much earlier.

No matter how obvious the China signal was, no public health officer was going to institute SiP here based solely on what was happening in China, or Italy, without evidence that more than travelers returning here were infected.

____________________________
Suppose it was known there were two deaths in Santa Clara County as of Feb. 17? Do you think the public would have been willing to shutdown the county?
_______________________________
Deaths in SCC were irrelevant to the decision to lock down. The only thing that mattered was community transmission. In fact, the only death in SCC known at the time the lockdown was announced was on March 9--it was thought to be the first. If community transmission had been documented to be occurring in February, they would have locked down with zero deaths in SCC--just as they would have in March. You may think the public may not have gone along with it, and you are entitled to your opinion. But I disagree.

RE: The cost of waiting - Goose - 05-22-2020

(05-22-2020, 04:05 PM)oldalum Wrote: Deaths in SCC were irrelevant to the decision to lock down. The only thing that mattered was community transmission. In fact, the only death in SCC known at the time the lockdown was announced was on March 9--it was thought to be the first. If community transmission had been documented to be occurring in February, they would have locked down with zero deaths in SCC--just as they would have in March. You may think the public may not have gone along with it, and you are entitled to your opinion. But I disagree.

I think it is important to remember that in late February Italy had started their downward spiral and lockdown protocols. The initial lockdowns in Italy were on 21 February 2020. We all saw on the news how bad the problems were in Italy, and getting worse. The public went along with the lockdown on March 16 in the 7 Bay Area counties because a) we saw what was happening in Italy, and b) we knew the disease was present here to a significant extent. IMHO, that is why the Bay Area went along. Absent the debacle in Italy, people would not have been willing to believe it was going to happen here if we did nothing.

RE: The cost of waiting - dabigv13 - 05-22-2020

Imagine how much better our situation would be if we had a competent CDC with testing that showed community transmission in February, and a President who would've seen what was happening in Italy in late February and shut us down then. We'd be in the same boat as South Korea or NZ by now.

RE: The cost of waiting - Goose - 05-22-2020

(05-22-2020, 09:13 PM)dabigv13 Wrote: Imagine how much better our situation would be if we had a competent CDC with testing that showed community transmission in February, and a President who would've seen what was happening in Italy in late February and shut us down then. We'd be in the same boat as South Korea or NZ by now.

Maybe. We have a much larger population that is not nearly as compliant with government requests. We have many more points of entry that would need screening. It is also important to remember that the President can't shut down the individual states. He can close the borders. The important thing we are missing is contact tracing and quarantine. We didn't have that going in and we don't have that now. Showing community transmission indicates you have failed to contain the disease. Korea, Taiwan, and Singapore contained the disease. We didn't, because we had no organization at the county and state level to do it. The CDC can scream all it wanted, but without "boots on the ground", it doesn't matter.

RE: The cost of waiting - chrisk - 05-22-2020

(05-22-2020, 09:13 PM)dabigv13 Wrote: Imagine how much better our situation would be if we had a competent CDC with testing that showed community transmission in February, and a President who would've seen what was happening in Italy in late February and shut us down then. We'd be in the same boat as South Korea or NZ by now.

The CDC should also have been looking at what Taiwan was doing. Because they acted in January before the virus was widespread, they were essentially able to stamp out the virus before it gained traction. As a result, they were able to reopen schools quickly (and with very tight protocols) in February, well before the US seriously considered closing schools. Today, people wear masks but there are few restrictions. Baseball and basketball games began in April and this month, up to 1000 fans are allowed to attend games.

Everyone who is allowed to come into the country is isolated for 14 days, regardless of testing status, even if a resident.

RE: The cost of waiting - Genuine Realist - 05-22-2020

(05-22-2020, 09:13 AM)BostonCard Wrote: I think the NRO makes a very good point. Had lockdown orders been handed down earlier, a lot of people would have considered them vast overreactions given what was occurring. Humans do have trouble understanding exponential growth. And it took some time to hit a lot of people. I think basically it wasn't until the NBA cut its season short that a lot of people started taking the virus seriously.

However, this is where leadership comes in. Someone willing to take what might look like an unpopular stance could have gotten people to take the virus seriously earlier. Maybe even instituting a mandatory lockdown while it still looks like an overreaction would have resulted in a lot of grumbles, and some defiance, but most people would have actually followed the advice. If you wait until the people are "ready" and voluntarily social distancing, then the actual lockdown orders are going to make much less of a difference than if they are instituted before people are ready.

Now, this was not an administration failure, per se, as instituting shelter in place orders are the responsibility of state and local leaders. Some leaders did well here and some did poorly (I'm looking at you, Bill de Blasio). But it would have been a lot easier to issue controversial orders if it could have been done in a coordinated fashion with the same message being repeated at local, state, and federal levels. Federal guidelines for how and when to close could have given local officials cover to issue shelter in place orders that the public might have been less ready for. And if the threat was high enough to impose a shutdown on travel from China, it should have been apparent that once there was community transmission, putting in a travel ban is akin to closing the barn door after the horses have left.

BC

Not a 'lot of people', just about everybody, including probably the majority of health professionals. (I have mentioned my ultra cautious PCP, at the physical she dragged me to on 2/29, was dismissive - 'just wash your hands'.) Not just Trump, but most Democratic politicians were in the same camp. Op-eds in the NYT and Post emphasized the dangers of xenophobia and were dismissive of the virus - this well into February.

There was no political consensus for these drastic measures until the second week of March. I believe it was the clinical experience in Italy and the cluster sites in the US that changed opinions radically and quickly.