Friday, March 13, 2020

Panic and the Coronavirus: Is There is Better Approach?

Our society is now transitioning into panic about the coronavirus.

Universities and schools are being shuttered, sports activities and public gatherings are being cancelled, individuals are hoarding toilet paper and supplies, travel is being severely constrained, the stock market has crashed, and business activity is nose-diving.  Major businesses are forcing their employees to work at home.

This blog will try to summarize the coronavirus threat, suggest that some of the panic-driven actions may not be well-founded, and that there may be a far better, more effective approach to deal with the virus.


Before I begin, let me note two things.   I am not a medical doctor, epidemiologist,  or viral expert. But I am a scientist with some facility with statistics and data, and my specialty, weather prediction, is all about helping people react appropriately to estimates of risk.  And I have talked to a number of doctors about this issue.  But don't read any more if my background bothers you.

How Bad is the Situation Today?

If one steps back and looks at the actual numbers, particularly against other threats we face, the situation is far less apocalyptic than some are suggesting.   As of today, the Centers for Disease Control and Prevention (CDC) notes 1215 cases and 36 deaths in the U.S. since January 1.  This is a very, very small percentage of the U.S.  population of 331 million.   The number of U.S. cases no longer appears to be going up as rapidly, as noted by the latest CDC graphic (see below).  Note the drop after the peak in early March.


In China, where the problem started, the number of cases is rapidly declining (see below).


According to Washington State's Department of Health, the state has had 457 coronavirus cases and 31 deaths.  Most (23) of the death's in Washington have been limited to one nursing facility in Kirkland with a large number of elderly, chronically ill patients.  In fact, according to the NY Times, this facility would typically lose 5 patients a month.

This facility also represents about 50 of the coronavirus cases in Washington, since several first responders and staff were sickened (with no fatalities) due to exposure at this site.    In many ways, the Kirkland facility represented an unfortunate random event--the random exposure of a group of extremely vulnerable patients.    If this random exposure had not happened, Washington State would probably not be getting headlines as a center for this virus outbreak.

An extremely important element of this coronavirus outbreak is that it hardly sickens young people, and healthy individuals of middle age or younger generally do not face a life-threatening illness.  To illustrate, here is the age distribution of cases in King County.   Few folks under 40 are sickened and none of them died.  The problem is with the sick and elderly.  This age distribution is going to be very, very important.  Similar statistics are found in China.


There are undoubtedly many, many cases of coronavirus infection in the younger, healthier members of society, many of which are not aware of their infection.  But without testing, we don't really know other than by indirect statistical approaches.  Thus, the "death rates" are clearly far too high, and highly deceptive.

Comparison to the Flu

It is important to note that the coronavirus numbers are extraordinarily smaller than those of the flu.

Below is a flu graphic I got from CDC and added the coronavirus cases (see the gray dot).  In fact, the gray dot should be much smaller.   For example, we had 36 coronavirus deaths nationally so far compared to 61,000 flu deaths in 2017-2018.  45 million cases that year compared to 1200 coronavirus cases so far this year.  In WA state, 75 have died of flu through the end of February and several years have brought 200- 300 deaths from influenza.


Coronavirus is not even in the same league as flu, which also kills the youngest among us. We did not close down universities, businesses, and more for flu.

Interestingly, many who are panicking about the coronavirus today, refused to get a flu shot in past years, or to practice reasonable hygiene when flu is around  (e.g., washing hands carefully).  Coronavirus is also not in the same league as auto accidents, which kill 1.25 millions a year (3287 deaths a day), with 25-50 million injured or disabled for the worldwide statistics, while about 38,000 die in the U.S. each year from auto wrecks. 

Are our political leaders shutting down society for the flu or stopping auto travel because of deaths on the roadway? The answer is no.  So why are they willing to close down society to deal with the coronavirus, which has represented only a small smaller risk to the general population?  Life is full of risks that must be considered, mitigated, and dealt with.  But society must continue to function.

Poor Response and Lack of Testing



 As the virus began to spread in China, the U.S. needed to develop a coherent plan for understanding and dealing with the crisis.  This did not happen.   President Trump probably made the right call about cutting off travel to China, but the lack of coherent planning beyond that is apparent.  The lack of testing is a major failure of his administration and others.

A key capability is to develop sufficient testing resources to determine the progression of the disease in the U.S.  This was sorely lacking, and the flawed testing developed by the CDC was one example of it.  Other countries have tested vastly greater numbers of individuals.  Importantly, the U.S. has not begun randomly test the general population to determine the extent of spread among U.S. residents.

The Extreme Cost of the Current "Social Distancing" Approach

   Currently, the "social distancing" approach is being stressed by politicians and others.   The idea is that by canceling schools and large public gatherings, coupled with workers working online from home, there will be a reduction of coronavirus community spread, reducing the peak in the number of cases and put less stress on the limited resources of the medical community.  This is illustrated by the figures below.  You notice the number of cases doesn't change (the area under the curve).  And it has another issue:  it greatly extends the period in which society is affected by the disease.



The cost of social distancing is immense, something many politicians do not seem to have thought through.  The stock market is in free fall, the economy is tanking, colleges are poorly educating their students through questionable online learning, K-12 students aren't being taught, business is contracting, and workers are losing salaries and being laid off.  The lowest income folks are hurt worst, making "social distancing" highly regressive.   I have read estimates that that the world economy could lose trillions of dollars and that recession is now becoming more likely in the U.S.   

Social distancing may be attractive for  a short period to slow the virus, but in the end it is not sustainable.  It is also inefficient.  In an attempt to prevent the virus from getting to elderly people with health problems, a huge population that does not have the disease or unlikely to get very sick from it is restrained from normal activity.  Something more effective is needed, something I would call "smart quarantine."  More on that later.

A number of the local politicians and others have been motivated to try massive social distancing based on a modeling study completed by several local researchers, suggesting only extreme social distancing can prevent a massive increase in cases and up to 400 deaths in our region.  This is a relatively simple model approach, which from my reading does not consider the variation of death rate with age, or the varying social interactions with age.  It assumes a uniform death rate of 1.6 %.   I think it would be useful to test an alternative strategy, based mainly on testing those that are not ill, and removing those people from social interaction.

Media, Politicians, and the Web:  How and why they can promote panic

The tendency for stampeding the population into panic and promoting actions that are in the end counterproductive is a real risk of the current political and media landscape.


For politicians, there is the potential for endless attention, with opportunities to give sober pronouncements and promote increasingly harsh measures.  Resources become freely available from a worried citizenry.  And the situation provides fuel to attack political foes, as is apparent with the attacks on Trump for virtually every action he takes (and some have been reasonable, like the China ban).  That said, President Trump is certainly guilty of underplaying the seriousness of the situation and providing inaccurate information.  The lack of testing is a massive failure.  There is, however, plenty of bipartisan blame to go around for ineffective responses.

For the media, the situation is a bonanza, with huge increases in attention, which promotes more "clicks" and revenue. An increasingly isolated and home-bound populace is glued to the constant media barrage, promoting fear and anxiety. 

A highly connected population, unlike any population before, is unable to escape the incessant coronavirus coverage that is constantly featuring the latest death and shut-down.

Another Way

So it there another way to deal with the coronavirus epidemic that could be more effective and far less cost to society?  I suspect there is.   This approach would take advantage of several unique and new aspects of the current situation:

  • The fact that young and healthy people, the bulwark of our nation's productive capacity, are only minimally affected by the coronavirus.
  • That most of the mortality is among the sick and elderly.
  • That the technology to test millions of individuals quickly is available.


Perhaps these facts allow us to deal with the situation in a dramatically new way.  If a rational actor was running the response, perhaps they would:

1.   Protect the most vulnerable with all available resources.  All nursing facilities, retirement homes, and the like would be essentially quarantined, with all patients and staff tested for the virus, with those testing positive isolated from the remainder.  All visitors would have to be tested.  All individuals who are over 60 and possessing serious health problems would be asked to self-quarantine, with food and other assistance provided to allow them to reduce contact with the outside community.  Governor Inslee has initiated some measures, more are needed,

2.  Extensive random testing of the general population would be initiated, with millions of tests available for this purpose.  Such general testing would allow a determination of the extent of COVID-19 spread and the isolation of affected individuals and their close associates.  This is what I call "smart quarantine"-- the use of massive testing to identify the carriers and currently sick and to take them out of circulation.

South Korea is trying this approach and it appears to be working (see below)



3.  A fund to provide salaries for quarantined individuals would be initiated.  This would encourage all individuals to be tested and encourage financially marginal individuals to isolate themselves.

4.  Social distancing would end and all schools reopened within a month..   It is poor public policy to cripple education and the productive capacity of individuals that are the bulwark of the U.S. economy, particularly since most of them are not at risk for serious impacts of the coronavirus.  Sustained social distancing is not a long term solution.  Social distancing is just a short-term stopgap approach.  Massive testing and isolation should be put in place within weeks.

5.  Federal grants will be initiated to support additional hospital costs, the acquisition of additional medical supplies and equipment, and the huge testing program.

This measures would help pull the nation back from the brink of economic disaster, effectively restrain the crisis, and restore normal life to most individuals.

The American people have a long history of panicking when they are threatened, at enormous financial and human cost.  After 9/11, the American people agreed to loss of privacy and civil liberties, and allowed a tragic invasion of Iraq.  And after the attack on Pearl Harbor, fears of a third column led to the internment and loss of liberty of over 100,000 Japanese Americans.   Hopefully, fears of coronavirus won't lead to the unnecessary destruction of our economy and the undermining of the prospects of many Americans.  A creative solution to this crisis may be possible, acting as  bridge to the situation a year from now when hopefully a vaccine will be available.


30 comments:

  1. Frankly, I'm far more worried about getting hit by a car crossing the street than COVID.

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    1. Maybe you'll be worried when you can't get admitted to the hospital after getting hit by that car because the hospital is already filled with COVID-19 patients. That is the risk of an uncontrolled outbreak: the breakdown of the healthcare system.

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  2. Thank you Cliff! A reasonable response to the current madness.

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  3. Interesting thoughts and suggestions, Cliff, very rational and practical. I'm glad you can think so clearly when confronted by something this threatening, when fewer and fewer people are able to sustain such focus.

    The way people respond to crises seems to have changed fundamentally over time. There are a lot of contributing factors. I don't think the current societal response to Covid-19 is due simply to irrational fear or misinformation. If you strip away the FUD and ignorance, there is a steadily increasing baseline of stress, anxiety, and unresolved trauma from countless sources.

    When something significant like this pandemic comes along now, it pushes many more people beyond their threshold or tolerance level for stress. I believe this is a big reason that authorities find themselves reacting more significantly and noticeably than basic rational thinking would suggest. Covid-19 is not a medical, scientific, economic, governance, transportation, labor, educational, religious, or technological issue. It's all of them combined, for most of the civilized world, all at once. That's a lot of collective stress.

    To me, it seems similar to climate change. Maybe people caused it unintentionally or by negligence. Regardless, the baseline temperature is rising for all of civilization. The air and sea are behaving more erratically and intensely than ever before. It seems we are not capable of calming it. We can't see it but we can feel it. Right now, it's out of our control.

    There are multiple storms like pandemics and climate change converging into a perfect storm. It might be a good idea to stay home for a while instead of trying to keep the status quo. It won't calm the storm, and it may not even really keep us safe for long, but it will probably calm us down. Calm people tend to think more rationally and make better choices. The more rational thinkers, the better the outcome for everyone.

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    1. Good post. "Globalization" is sold as a good thing in the name of "diversity". In the long term (probably very long term) it might turn out to be a good thing. But in the short term, especially if it comes on too quickly, it is the loss of a culture, a nation, the traditions and underpinnings of a society.. many of the fundamentals of a person's basic psychological stability. Case in point - I wonder of Mr Gates considered any this this when he decided that resettling so many Indians into a Western culture might be just a wee bit difficult and very disruptive and stressful on the native population? I suppose not.. after all, there was so much money to be made.:(

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  4. At last - some reasonable words. If only people would listen through their panic.

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  5. You are absolutely, 100% right.

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  6. Do a little conservative calculation. Only 50% of the nation becomes infected. The death rate is he same for every one as 10-40 year olds in China = 0.2%.
    How many people die?
    When ever you see a country like China, who has rapid implementation of decisions, rush to build a big hospital in 3 days in the face of a respiratory tract infection, you know you have a huge problem in this interconnected world.

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  7. Thank you Cliff! Fyi an excerpt from
    https://www.bloomberg.com/news/articles/2020-03-04/south-korea-tests-hundreds-of-thousands-to-fight-virus-outbreak

    Detailing why and how South Korea was able to get testing started so quickly


    An outbreak of Middle East Respiratory Syndrome in 2015 killed 38 people in South Korea, with a lack of kits to test for the MERS pathogen meaning infected patients went from hospital to hospital seeking help, spreading the virus widely. Afterward, the country created a system to allow rapid approval of testing kits for viruses which have the potential to cause pandemics.

    When the novel coronavirus emerged, that system allowed regulators to collaborate quickly with local biotech companies and researchers to develop testing kits based on a genetic sequence of the virus released by China in mid-January. Firms were then granted accreditation to make and sell the kits within weeks --a process that usually takes a year.

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  8. Interesting summary, it seems clear there are two paths to follow 1) Mass testing and selective, full, quarantine (South Korea) 2) Extreme social distancing (China). We have seen both play out in different countries - and be effective. We have also seen actin taken too late cause a higher death rate and sever strain on a regions health care system (Italy)

    All of this comes down to testing, because unless you can test at scale you can't make evidence based decisions or effectively find and quarantine the infected. The failure to consider or prepare for mass testing and to have taken so long to do it will have cost lives and possibly billions of dollars.

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  9. Thanks for the voice of reason, but I question one thing: With the limited testing in the U.S., do you think we really have enough data to justify your statement that "The number of U.S. cases no longer appears to be going up rapidly"?

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  10. well done! I do like the other way.

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  11. I agree with most of your analysis, and appreciate the call to not overreact. The only wrinkle I can think of, with regards to operating k-12, is school districts that have a "high" percentage of staff in high risk categories. I do not have the numbers to quantify the tipping point percentage, but it is something that needs to be considered.

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  12. I think you forgot about our homeless folks. They are being threatened by a virus spread by the wealthy travelers. The homeless deserve better.

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  13. In the absence of the resources and infastructure needed for your plan it seems social distancing is the best current solution. Secondly we cannot yet look at the decrease in the rate of new cases because we have such a lack of usable data. I work with older folks who live at home on Medicaid. They cannot self quarantine, bc the require caregivers from outside their homes to survive.

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  14. Meanwhile, on a lighter topic, it is snowing in Olympia, in the neighborhood known as Upper Eastside--just about a mile from downtown.

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  15. Cliff - the approach that you are suggesting is essentially exactly what South Korea is doing at the present time - and it is clear that it is an effective approach. Unfortunately it seems our horses are so far out of the barn that we are beyond the stage where this would work..thoughts?

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    1. South Korea has effective testing. We are essentially flying blind and have been for weeks. That is the first thing we have to come to grips with, which is why the wider quarantines are going into effect. If we can get effective testing rolled out, then you can consider smarter, tighter quarantines. In Italy they are already at the point where they are having to ration ventilators. Do you remember that last flu season? Of course not, this is much worse than the flu for vulnerable populations. And our healthcare infrastructure is just not set up for this. It's lean and meant to produce the green. Nationally, we have around 900,000 hospital beds. It's once the healthcare infrastructure is stressed that deaths spike.

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  16. The problem with this virus isn’t that it’s lethal, the problem is that it spreads quickly and our healthcare systems are easily overwhelmed and 20% of those who get sick require hospitalization. When scientists are talking about 20-40% of the population getting sick, that is a massive number of people needing hospital services.

    The more we can slow down the spread, the better chance our hospitals have to keep up. Even if young people generally don’t get very sick, people who are not practicing social distancing will catch the virus and spread it to others, including those who are more vulnerable.

    I found this article on notes from the UCSF expert panel useful: https://www.linkedin.com/content-guest/article/notes-from-ucsf-expert-panel-march-10-dr-jordan-shlain-m-d-/

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  17. Until there's mass testing available, the only choice is mass social distancing. You can't call that an over-reaction at this point, by your own logic. If we had mass testing, then maybe cancelling stuff wouldn't make sense, but we don't, therefore it's the only choice.

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  18. The elderly should be quarantined, since they don't have to go to work its alot easier to quarantine them. If an older person lives with younger people and one of the young people gets sick there should be a safe place for the elderly person to go. Shutting down K-12 schools is a good idea because the virus could spread to alot of kids and then their parents and the economy can function without K-12 schools. Colleges should remain open because college students don't live with their parents as much and colleges effect the economy more than K-12. If someone shows symptoms they should stay home until they feel better and there needs to be a government program to replace their pay because a large percentage of workers cannot afford to miss a paycheck. The economy is collapsing fast, if young healthy people who aren't showing symptoms don't continue to do what they normally do we could see a recession as bad or worse than 2008. For most people this disease is only a mild cold, are preventing the spread of cold/mild flu symptoms worth losing you're job, house? Will a recession harm more people than the disease?

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  19. I totally agree. This is what we should have done. But it is too late for that solution now. We don't have the tests and the cat is out of the bag. The only thing that can keep us from becoming Italy is social distancing, possibly slowing things down so that our hospitals (which generally run close to full, lean and mean, doncha know?) can keep up with what will be a big demand for breathing support. Of the 15% who get more seriously ill, those that survive do so because of ventilators and oxygen machines.

    I'm not sure of your motivation as a respected thinker in the Seattle area to imply that the currently recommended social distancing is inappropriate. Until we get widespread testing as you describe, I think suggesting that folks stay home is good common sense.

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  20. Cliff, I am disappointed. The numbers of CURRENT cases you present here is like saying "Look, everyone, the weather is sunny. No need to prepare for the predicted hurricane barreling toward you." Of all people, you should understand how modelling can be applied to prepare for future risks. You do not mention the limited healthcare resources for those who get very ill. Do you know how many ventilators we have available in the US? Not enough, unless we implement social distancing. You also cite China's reduction in cases. Yes, but you you didn't mention that they have been under very strict quarantine to reduce the spread and still are. At the peak, Hubei Province experienced extreme overload of their healthcare system. And what of Italy? I agree that panic buying is ridiculous and that testing MUST be significantly increased. Social distancing should be targeted to places where the virus is spreading and we can't do that if we don't know where it is. BUT your message is disappointingly short sighted and ill informed. This virus spreads MUCH faster and has a higher fatality rate than flu. -SK

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  21. Excellent perspective, thank you.

    Note it's Fifth Column, not Third Column:

    https://en.m.wikipedia.org/wiki/Fifth_column

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  22. It is always good to question institutional consensus, but I may be with it here. There is a very good explanation of the current approach here.
    https://www.knkx.org/post/episode-1-flattening-curve?fbclid=IwAR0OQ2DuVPQYtNln_hEdrc-an0VHgoTKpS5CmIkXk_TiDE_YufqOFqEfenY

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  23. Well said.We should not forget that the media is all about attracting eyeballs which translates into advertising revenue. Raising alarms gathers views and readers. Your rational approach does not. This is this will not change.
    might
    The CDC lost their way long before Trump. A rational person might believe the CDC's primary mission would be the control of communicable diseases, but seemingly it is not. Pandemics are a certainty and yet they were not prepared. That needs to change. Bigly.

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  24. In an alternative universe testing would have been readily available, accurate and quick. Our fearless leader repeatedly announced it was so. It wasn't. The UW medical labs evidently will be able to do 4000 a day by next week. Had that been available 6 weeks ago we could do something as suggested on this site.

    I understand the UW did 1300 tests two days ago, that is almost as many as the rest of the country had done to date.

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  25. Here is a another study that might reassure you a bit as well:
    https://slate.com/technology/2020/03/coronavirus-mortality-rate-lower-than-we-think.html?fbclid=IwAR2qi5AUn74RnfeGxwshDMv9GvpOU9jUWuBYwjOWuXCXrBOTOlI8mXcrCdU

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  26. In the same time frame coronavirus has killed 40 people, approx 4000 people have died from firearms, and 8000 from alcohol.

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