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San Jose: Three TSA agents test positive for Covid-19 (www.mercurynews.com) similar stories update story
212.0 points by godot | karma 2124 | avg karma 3.8 2020-03-11 04:12:37+00:00 | hide | past | favorite | 174 comments



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I hate to stoke FUD, but that's pretty much it for any semblance of containment. If those TSA agents tested positive, 1) you can be sure other TSA agents at other airports are also infected, and 2) I'd be extremely surprised if they didn't pass Covid-19 to a significant number of travelers, 3) whatever individual(s) gave it to the agents undoubtedly also gave it to other travelers.

We lost the chance at containment weeks ago. It's in the community. We need to stop all flights, close all schools, and discourage travel. Our best chance now is in flattening the curve so our healthcare system isn't overburdened.

> We lost the chance at containment weeks ago. It's in the community. We need to stop all flights, close all schools, and discourage travel. Our best chance now is in flattening the curve so our healthcare system isn't overburdened.

If it's already out, how will stopping flights and closing schools really help? How long will you stop them? At best, this will just slow the spread, not stop it.


The idea is to slow the spread, to avoid a situation like Italy where hospitals are overwhelmed: https://www.vox.com/2020/3/10/21171481/coronavirus-us-cases-...

I just made a map with state-by-state data about ICU beds and vulnerable (older) population. Some states have less than half the number of ICU beds per vulnerable population than others.

https://twitter.com/LechMazur/status/1237545167659253763


As the poster above you said said, slowing the spread so healthcare system isn't overburdened should now be the goal.

This animation helps understand the concept: https://thespinoff.co.nz/wp-content/uploads/2020/03/Covid-19...


The point is that slowing it has a huge amount of merit as well, so that the healthcare system isn’t flooded with everyone getting sick all at once.

Same areas will be able to snuff it out with luck, social distancing and contact tracing. Stopping flights prevent them from being reinfected. But quarantining incoming travelers might achieve the same thing with fewer drawbacks.

Quarantining incoming travelers from high-risk destinations will likely help, but will NOT achieve the same thing. COVID-19 is already here and circulating in the community. It has been for weeks. We just aren't testing for it (this will change in days or maybe a week, so wait for the big explosion in cases). Two weeks ago, there was capacity to administer and process 700 tests. Not 700 per day. 700 total. It has improved a little since then. But it is only now that actual significant testing capacity is being brought on board. Something S. Korea has had for about a month. We are way way behind.

If by community you mean the US as a whole, yes. But there are many areas and smaller cities in which it has not arrived. Those could be helped. And if a smaller city is infected and then gets clean, they could be helped too. That's what I was referring to. Stopping domestic flights.

There’s 60,000 icu beds in the US. We are in full flu season and a lot of those beds are being used. We need to slow down this virus till summer and hope it that inverts the curve so we have time to develop methods and drugs to minimize the risk of hospitalizations. If we don’t slow it down, we’ll see 3% mortality rates instead of sub 1%. Our path is similar to other countries, we’re just a few weeks behind.

Forgive my ignorance but I recently saw a video of two women fighting over bathroom tissue in Australia or New Zealand. If they have infections there where summer is just ending why do people think that warmer weather will some how stop the spread?

Flu and cold is seasonal. There’s a bunch different theories around it from cold air lowers our defenses to vitamin d production from sun light. Sars burned out during the summer months so hopefully we see a reduction with this virus.

Thanks that makes sense, I'm still a bit confused as to the fact it's going to be summer in the northern hemisphere but winter in the southern, does that mean things will get better in Europe and North America but worse in South America, Australia etc?

Flu seasons are usually judged by what is happening in the other hemisphere. During our summer Australia had a bad flu season which corresponded to the US having a bad flu season during our winter months.

https://en.wikipedia.org/wiki/Flu_season


90% of the people in the world live in the northern hemisphere, and a significant chunk of the people who live in the southern hemisphere live near to the equator (i.e. they have no winter). Also, it's not about to be winter in the southern hemisphere, it's about to be fall.

Even if it isn't, there will be fewer cases of other diseases so hospitals are typically emptier. Also, it's less likely to contract COVID in combination with other diseases.

Contagion is funny.

Each sick person will only, on average in unmitigated conditions, get two or three other people sick. If you consider just a single infected person that doesn't seem that infectious at all. Yet because this is an exponential process that won't slow down until a significant fraction of the population is infected or immune 2-3 is enough to go from a couple people sick to most of the world in fairly short order.

Yet if you can reduce that 2-3 down to 1 or below even with relatively half-assed measures like telling some people to stay in inside, isolating known-infected and likely-infected persons, closing down some major spreading venues, telling people to wash their hands or use surgical masks... presto chango the disease dies out and no more than a tiny percentage of the population will get infected.

If the half-assed measures reduce the exponent but don't get it below 1, eventually most people will still get infected but it will take a lot longer. That extra time means the hospitals get less overloaded and lots of additional lives are saved because many covid19 cases require serious medical intervention (forced respiration). It also potentially creates time for better treatments to be created/discovered.

The best time to start seriously addressing this would have been weeks ago when it became clear that it was spreading from unknown and non-isolateable sources inside the country-- at least to the extent that it could be done without major damage... before there were thousands (likely hundreds of thousands now; given the observed spreading rates) of cases circulating in the US. But so long as the vast majority of the people who could eventually be infected are not yet infected, it's STILL a good idea.

On top of the risk we're facing from hospitals overloading, there is also a lot of potential for widespread panic once testing catches up and the numbers go from a rounding error to "big and scary looking" overnight. Beginning countermeasures earlier should help reduce the panic both by decreasing the peak infected numbers and by making it clear that the issue is being addressed.


Slowing the spread is exactly what we need to do. Around 15% of the people who get COVID-19 need ICU care in order to keep breathing. The fatality rate with care is no higher than around 2%, and maybe less. Without medical access, it is around 15%, guaranteed.

The problem is there are only so many ICU beds available. If we self-isolate and slow the spread, then we can keep the number of dangerously ill people below our capacity limits, and make sure that everyone who needs care gets it. This is what Japan and South Korea have done. Italy did not react fast enough and now the fatality rate there is approaching 8%(!!).

With very strict measures, we might even stop the epidemic in its tracks. So far, only China is on track for doing that.


> Around 15% of the people who get COVID-19 need ICU

I'm usually the doomssayer, but that's 15% of people who are diagnosed. Usually people who are asymptomatic or nearly asymptomatic don't get diagnosed.

Only a few countries have testing programs widespread enough to start estimating case vs infection rates... and certainly not the US, where there are plenty of people who have been obviously infected who are still not included in the official counts because of god-knows-what-the-CDC-is-doing.

What is clear enough is that whatever the rate of serious cases are, it's more than high enough to overload the hospitals-- just as is happening now in Italy. So I fully agree with your point, I just don't want to see if lost in the noise because some people will notice the 15% claim is almost certainly an overestimate.


CDC is keeping the numbers down, as requested.

Other countries don't have the problem with widespread testing that the US has. That number comes from China, Italy, and South Korea. 15% of people who show symptoms need intensive medical care.

Yes, but what percentage of people who get infected need intensive medical care? :)

The difference matters because it's likely that 60-70% of the population or so will eventually be infected. But it won't be 15% of that which need intensive medical care but some lesser number because some infections will be asymptomatic or nearly so.


In South Korea and China they are testing everyone who has been exposed to the virus. Obviously they're not testing everybody so some are slipping through, but these are broad tests that are capturing some of the asymptomatic cases as well.

If you want you can calibrate against the Diamond Princess numbers.


> The fatality rate with care is no higher than around 2%, and maybe less. Without medical access, it is around 15%, guaranteed.

Literally nobody is saying that. Please stop spreading misinformation.



I don’t see anything about a 15% mortality rate. Can you point to that specifically?

~15% need serious medical intervention. That's at the very beginning of the article I linked, the "severe" cases in the table.

Now under normal circumstances this intervention is not life threatening--that's the smaller "critical" category. But without access to common hospital equipment, the symptoms do become critical. Basically the patient becomes unable to breath normally, and without access to a breathing machine they'll suffocate themselves.

Most "severe" cases are treatable with access to a hospital. But if we peak at once and that equipment is all occupied by other patients... that 15% of severe cases become fatal.


Slowing the spread is the point. We have a lack of capacity for handling the urgent care cases. Once the capacity is over limit, in particular ventilation, people will die who otherwise would not die. The difference is in thousands of deaths.

Slowing things down is important in order to keep the medical system from being overwhelmed.

We already know we don’t have enough ventilators or enough staff to care for the ill if we end up with a similar growth curve to what they’ve seen in Italy.


exactly, and slowing the spread is the difference between Japan, Italy, and something far worse...

https://www.flattenthecurve.com/

Or if you want more math, here's why putting into place extreme measures even one or two days later can make outcomes significantly worse

https://medium.com/@tomaspueyo/coronavirus-act-today-or-peop...


Slowing the spread is entirely the point; the slower it spreads, the lower the peak of acute cases, which means less burden on healthcare resources.

> If it's already out, how will stopping flights and closing schools really help? How long will you stop them? At best, this will just slow the spread, not stop it.

Yes, it will.

One thing that tends to get neglected is that in a lot of diseases, most people don't pass the disease on very well (maybe infect one other person) but a small number of people (superspreaders or superinfectors) pass it on EXTREMELY effectively.

If you can block the superinfectors by quarantines, that is like putting control rods into a nuclear reactor--you slow the progress dramatically.


Yes, slowing the spread is the goal.

Slowing the spread gives vaccine and antiviral researchers a fighting chance to win the race, gets us to summer where if we’re lucky enough that this virus is seasonal it’ll go away, and, most importantly, “flattens the curve”, as your parent commentator already pointed out.


Everyone keeps hoping the virus is "seasonal." That warmer temperatures will dampen the spread. The data on that is total hokum. The flu is seasonal because everyone in the WORLD is exposed in a matter of months and either develops immunity or gets sick first and then develops immunity. The next season's flu comes from viruses incubating in animal populations and agricultural wildlife patterns are seasonal (e.g., pig/chicken raising in Asia, global bird migration patterns). Influenza circulates year around, but in the Summer months, we are mostly immune due to prior exposure. The new version of the flu starts going in Winter and we are all immune again by the Spring/Summer. IMHO, COVID-19 will only have the same pattern by happenstance.

Many parents can’t take time off if we close school. Children aren’t at risk here, reason why still unknown. That’s a terrible idea.

The issue with schools is that they're daily large gatherings where the virus can be transmitted. Children can be carriers with schools providing the network effect for spreading covid-19.

Garmine's recommendation is in line with expert opinions I've been reading for the last couple of days. There is at least one really great case study from the Spanish Flu: St Louis proactively closed schools and reduced deaths by 50%, compared to Pittsburg who closed schools relatively. It seems a decidedly good idea to get ahead of these things.

1. Just because kids aren't dying, doesn't mean they aren't carriers.

2. When it gets bad, schools will be closed anyways, and parents will need to figure out how to handle childsitting.

3. The longer we delay closure, the worse off everyone else will be.


Children aren't at risk, but can still act as vectors of infection. And it's not just kids, many adults work in the school system.

Shutting down schools is almost assuredly an effective measure to slow the spread of the disease. And slowing the spread is the overriding public health imperative. Even if the same number of people get infected, fast transmission means the healthcare system gets overloaded with all the patients at once.

A 5% reduction in the rate of transmission could plausibly reduce the number of fatalities by 50% or more. We need to do everything possible to institute "social distancing" to slow the process done.


But you need to provide daycare at least for some children. Otherwise police, fire departments and hospitals will cease to work. Doctors can't work long shifts if there's no one at home taking care of children. You could make school voluntary and encourage everyone to stay home who can take care of their children. But closing all schools sounds dangerous.

I agree completely. But I think the status quo of just continuing normal school procedures is a potential epidemiological nightmare. We could still provide childcare to those who need it, but in a format that drastically reduces transmission potential.

First, like you very astutely pointed out, stop making school mandatory. Even encourage families to keep kids home if they have childcare available. That probably entails ceasing any academics, since parents will otherwise feel pressured to keep their kids in school lest they fall behind.

Second, we can keep kids isolated in small groups, so they're not intermingling as is typical during a school day. A child should be assigned to a single pod, and only interact with his assigned pod for the remainder of the epidemic. Obviously childcare workers should be assigned a single pod, and stay in that pod. The smaller we can sub-divide pods, the better.

Finally big common activities, like lunch or recess should be staggered so that kids aren't ever exposed to anyone else outside their pods. Other than that pods should stay confined to the same classroom for the duration of the epidemic. Pods should probably be assigned based on busing routes, so that kids only bus with their pod.


Part of the worry is that even for completely non-essential jobs, managers will say "you can still send your child to school so I expect you to come in and work". "Schools are closed" is a much simpler message, and I imagine the vast majority of doctor parents can arrange for a non-doctor parent (from another family) to provide their childcare.

> But you need to provide daycare at least for some children.

Here's a problem: what's the difference between state-provided daycare and school, from an infectious disease standpoint?

Both are a bunch of kids in one building, attended to by adults. Both will require busing kids to said building, with buses driven by adults.

Might as well just leave the schools open.

I don't have a solution, just pointing out that daycare == school for this situation, so closing schools but providing daycare in it's stead won't make a difference.


> Children aren’t at risk here, reason why still unknown.

Isn't this the underlying plot of Maze Runner, and a bunch of other books/movies?

A decade of young adult fiction dystopian worlds of only young adults, followed by an actual decade of dystopian world of only young adults.


TSA agents likely are having direct contact with a much more diverse crowd than the average person, with maybe exceptions for folks in super urban areas, regularly using NYC's subway, etc.

Also they infrequently change their gloves, as if the gloves' only purpose is protecting the TSA agents from the things they're touching.

Going through SFO on Sunday, the TSA agent working the controls behind the X-ray screen sneezed into his hands. A colleague looked up at him, and then he sheepishly ceded his seat to the other agent and put on new gloves. As I was packing up my things on the other side of the metal detector, I saw him chatting with a more managerial looking TSA agent. Not sure what conclusion to draw from the brief observations, but it did leave an impression.

Super nitpick: SFO doesn't employ TSA agents. Those were CAS contractors.

https://en.wikipedia.org/wiki/Covenant_Aviation_Security

Thanks! Never knew that this role was sometimes contracted out.


Wow, I never knew such thing existed. Do you have any idea what makes an airport use CAS over TSA?

I'm sure someone can answer better than I, but SFO picked CAS before TSA was mandatory.

I dimly remember that it's up to each individual airport.

Yeah, it's pretty clear by this point that the virus has been spreading widely in the States for some time. Such is life.

Just wait until they actually start testing people in earnest; the infected numbers will skyrocket in a very short period of time, causing another stock crash and more mass panic.

It'll probably be at least another few weeks before it's time to buy with both fists, imo.


Are people not aware at this point that the US will look like Italy/South Korea in a few weeks time? Hence, the hoarding of goods that has already begun..

Last reports I saw had us 11 days behind Italy based on known cases. We are probably even closer with unknown cases. I think tomorrow is the day to ensure you have a couple weeks of food and incidental supplies in your home if you haven't done so already. I don't think there is any hope of us slowing things down as successfully as they have in South Korea with their widespread testing.

This disease is fatal for people that are very old or otherwise ill. In Italy the average age of fatal infection is 81, which is older than the life expectancy for an Italian man. For 80% of people infected it's a mild cold or flu, not requiring hospitalization.

I realize HN is full of Zero Hedge gold bugs, but this doesn't strike me as the apocalypse.


You’re getting downvoted, but none of your facts are inaccurate.

That's absolutely true, but the problem with this virus is not mortality but hospitalization. I read numbers yesterday that in Bergamo, up to 30% of ICU patients are under 60. Those are very likely to survive but need ICU treatment for up to 2 weeks.

Most European countries have already accepted that most will get infected at some point (see Merkel's statement yesterday). It's all about flattening the curve to make sure hospitals have capacity. If we manage that, mortality could stay at reasonable levels. But we have no idea how high mortality rates could go if people with severe symptoms would need to stay at home.


median age of hospitalization in Italy is 65

https://twitter.com/Dr_FarrisD/status/1237499092835676162


And median age of death >80. Which exactly proves the point, younger people (as in not seniors) also need hospital treatment but recover much more likely.

I wasn't arguing against your point. I think that the median is a better data point for your argument

See, there's the mass panic I was talking about. We're not expecting an asteroid or a tsunami, people can still buy groceries in South Korea / Italy / Wuhan / etc...

Sure you should stock up on essential medicines that you might need if you have to stay in for awhile, but I wish people would knock off the chicken little attitudes. It doesn't help, and it makes people stop listening to reasonable precautions when the sky consistently fails to fall.

Thank you for the example; please don't go spouting this stuff to your friends and family. Just tell them to wash their hands and keep their distance from others instead of advocating full-scale panic.


The point of stocking up on food is to avoid the need to go to the grocery store during the highly infectious phase of the pandemic.

The best way to minimize the chance is to not leave the house. The best way to avoid leaving the house is to have enough supplies in for a few weeks.


I'm surprised that the comment like this even had to be posted.

That's exactly why you do it


I don't think his issue is with lack of food in stores. I think his issue is that you would definitely not want to go to do your daily grocery in a city with such large outbreak as Wuhan. Better stock up and when the high infection ratio hits in your town, (if ever (?) then at least you don't have to expose yourself by going outside.

Just because you can leave your home doesn't mean you should. I don't say this just for personal precaution. I saw this so people can act selflessly and self-quarantine at the first sign of problems. Most of the people reading this are probably healthy people in their 20s-50s. The virus doesn't pose too much of a threat to us. But these people can also be prime carriers of the disease and increase its spread. If you or someone in your house gets sick, you really shouldn't be going out in public to buy groceries even if it is technically still possible to do it.

And for the record here is a 12 day old article that says Italy has had 650 cases and 17 deaths[1]. The CDC website currently has us at 647 cases and 25 deaths [2] and plenty of other places are reporting higher numbers[3]. I don't think I am raising a false alarm here.

[1] - https://www.npr.org/sections/goatsandsoda/2020/02/27/8099845...

[2] - https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html

[3] - https://www.nbcnews.com/health/health-news/live-blog/coronav...


For reference, relatively live updates of stats worldwide https://www.worldometers.info/coronavirus/#countries

Thanks for posting that site. I hadn't seen it before. Comparing Italy and the US we appear to be roughly 9-12 days behind Italy depending on which specific metrics you look at like total cases, total death, new cases, or new deaths.

It's 2020, you don't need to leave your house to buy groceries...

Until the VC money runs out.

Or the shoppers get better at math.

Or I have some personal pride. That one usually wins.


While panic buying isn't advisable, buying larger amounts certainly is. I guess most of us have gotten used to being able to go shopping every day. Reducing that to once a week can greatly help reducing the spread of the virus. If everyone starts that at once it will cause shortages for a few days but not much longer.

Those in the Bay Area should already have that: it’s called earthquake preparedness.

People really need to calm down. This isn’t Ebola but people are acting like it is.


Ebola would be easier to manage. Yes it’s much more deadly if you get it but it’s also a hell of a lot harder to get.

It's safe to say that the US will likely look worse than Italy or South Korea since additionally the US also has:

- Inconvenient labour laws regarding sickness, people are and will be afraid to take sick leave

- A lack of public healthcare, the US system does not seem designed for a collective approach.

- A higher rate of diabetes compared to the rest of the developed world which seems to be affecting quite a lot the impact of the virus.


Also a stronger aversion to control orders. Can you even imagine telling someone they cannot buy as many X as they want? Or locking down a city?

I find it fascinating that authoritarian regimes have an advantage in that they can rapidly implement lockdown.

Freedom has a price.


I would not say that authoritarian regimes necessary have advantages, Taiwan and Japan seems to handle this crisis much better than Iran for example.

Culture does play a big role into that indeed though, if you can manage to close off events & cities and having your citizens obey all the health precautions, it has a big impact on how it spread.


My local Costco is already telling people they can only buy 2 waters, paper towels, and disinfecting wipes. No one is rioting.

Maybe Costco is an authoritarian regime!

As almost all business, it is.

They already made you carry identity cards. "Show us your papers!"

It's a business, they're free to do whatever they want. I'm not sure how well people would react if the government tells them they're not allowed to leave the city anymore. In Italy, apart from riots in prisons, the population accepts that pretty well, I'm not sure it'd be the same in the US.

* rampant thoughtless individualism has a price.

the greatest weaknesses in the u.s. is a sense of self-entitlement, selfishness, and an inability to stay calm in any sort of "panic" situation. the u.s. government and general public have no idea how to sanely handle emergencies on its own soil.

I’d argue that the greatest weakness in the US is the lack of ability of its political/administrative system.

When either the authoritarian leader of China, or the elected government of Italy decide that the country needs to quarantine, they do it. Meanwhile nobody even believes it’s possible in the US because the system is set up not to allow any even mildly controversial law to pass without months of bickering (see Obamacare which would have been considered a relatively moderate reform in any European parliamentary system)


I assume you haven’t had that much exposure to other countries? The US is no more prone to panic than any other country I’ve lived in.

it's a wrong assumption. i've had enough exposure to know that the u.s. government is not equipped, logistically at a minimum, to deal with these things. and people are not equipped either.

Please don't take HN threads into nationalistic flamewar, regardless of which country it's about.

https://news.ycombinator.com/newsguidelines.html


i didn't. i didn't mention a single other country. it's an historic fact that the u.s. has not dealt with the same level of disturbances other countries have dealt with. and the u.s. quite clearly struggles with these emotional issues.

any "nationalistic flamewar" is an interpretation by others.


On the other hand, the US has a lower population density and less use of mass transit.

It's also not clear what advantage "public healthcare" is supposed to have in this context. The CDC has the authority to test and quarantine people. For the majority of people infected the "treatment" is to stay at home and recover. A minority of people will require hospitalization, but most of those people will have health insurance. The vast majority of those requiring hospitalization will be elderly and eligible for Medicare. The large majority of the remaining minority of a minority will have private insurance. And the remaining minority of a minority of a minority who require hospitalization, aren't eligible for Medicare and don't have private insurance will presumably still get treatment and then have a bad day when the bill comes, which is a financial problem rather than a medical one.


> It's also not clear what advantage "public healthcare" is supposed to have in this context.

In place and redeployable infrastructure.


Is that a real difference or a hypothetical one? Private healthcare providers can lend each other staff and equipment if one is overwhelmed and another is idle.

What you'd want from a government is to have a surplus of portable infrastructure able to be deployed in an emergency, but that's the CDC and FEMA.


> The CDC has the authority to test and quarantine people

And what of that when the President doesn’t like the numbers he sees, stokes the many conspiracists among his supporters with distortions and outright falsehoods, and that segment of (likely well-armed) population that think the “deep state” is executing a coup, start resisting?


Actual militias living out in the woods are among the least likely to become infected (and thus quarantined). Milquetoast anti-vaxxers who live in cities and buy coffee at Starbucks are not going to try to take down the CDC in large numbers, and the four of them who do try will just get themselves arrested.

> It's also not clear what advantage "public healthcare" is supposed to have in this

More people going to a doctor because they aren't scared of the bills means more people being properly tested, properly quarantined, contact-traced, and most importantly properly reported and reflected in the statistics, leading to better countermeasures and responses.


The obvious solution to this would be to offer free testing to anybody without insurance who a doctor thinks should be tested. It's somewhat stupefying that neither the insurance companies nor the government are already doing this (assuming they're actually not).

> still get treatment

Everyone always seems to forget about this. According to the Emergency Medical Treatment and Active Labor Act[0], any hospital that accepts Medicare must "provide an appropriate medical screening examination (MSE) to anyone seeking treatment for a medical condition, regardless of citizenship, legal status, or ability to pay." And if it's determined that treatment is required, or the patient's health may be in serious jeopardy, the hospital is required to treat them until they're stable.

In other words, if you show up at the ER, they're required to run tests to see if you have a life-threatening condition. If you do, they're required to treat you until you're stable.

Everyone makes it out like US hospitals will simply turn people away at the door; in fact, they can't (assuming they accept Medicare, which most do). They'll at least find out your status, and treat if necessary.

If you've ever been in an ER waiting room, you've seen this posted.

[0] https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_an...


I hate to break it to you, but when society starts to unravel because there are 1,000 dying people lined up outside the hospital and no free space on the floor for them to be treated, the Emergency Medical Treatment and Active Labor Act won't be worth the paper it is printed on. Words and laws can't make 0 hospital beds fit 1,000 untreated patients...

Not getting treated because there are no resources available is a completely separate problem from not getting treated because you don't have insurance. At that point you're down to solutions like converting the nearest hotel into a temporary hospital.

> Inconvenient labour laws regarding sickness, people are and will be afraid to take sick leave

Are you familiar with sick leave policies in Korea?

> Higher rate of diabetes

Korea has 8% with Type-2 diabetes and 23% are pre-diabetic. The US does have a higher rate, but not by much: 10.5%

> lack of public healthcare

Just 8.5% of Americans are uninsured. So about 9 people out of 100. There may be capacity concerns, but no more than most other countries. If a surge of British citizens suddenly went to the hospital, they’d be overwhelmed as well.


8% versus 10.5% of 325 million us residents is a difference of 8,125,000. The U.S. healthcare system is not equipped to treat that additional 8MM people because our citizenry is much sicker than other countries.

I believe the concern about uninsured is not the numbers but who'd be affected. Office workers, which can quarantine rather easily, are likely to be insured. But those in contact with most people on a daily basis (e.g. fast food workers, retail employees) are more likely to be uninsured and also have a lower allowance for sick days or PTO.

My concern would therefore be that the people that cannot afford health care or quarantine are also the ones most likely to act as multiplier as they come in contact with hundreds of people a day. That's not a purely US problem, e.g. delivery drivers or Uber drivers also tend to be low wage and self employed in Europe.

But in the US the combination with the lack of health insurance could make this worse.


Kaiser Family Foundation puts the rate at over 10% of people under 65 years old. They also don't discuss underinsured folks. This is becoming a thing again now that our idiot president relaxed regulations.

https://www.kff.org/uninsured/issue-brief/key-facts-about-th...

https://khn.org/news/underinsured-explainer/


This is truly interesting because obviously virus does not prejudice. So what is so special about Italy than other countries like Germany or France or Spain doesn't not have same size of an outbreak?

Initially I was thinking its the testing part. If you test nobody then nobody is sick. But that's not the case because with such high level of mortality, we would know that people are dying from COVID-19.

So my take is - what I read via WHO, is that this virus has two or more strains, one more deadly than another. So its quite possible that one or more passengers from China traveled to Italy with that more deadly type in them.

Of course next logical question would be - is it only in Italy or we have those in other countries and perhaps incubation period is longer? That's probably a billion dollar question...


Nothing is special about Italy; they were just unlucky enough that the spread started there earlier than elsewhere.

According to current trends, France and Spain will be where Italy is now in about week.


Exactly, joering is entirely wrong in his bizarre analysis. Outbreaks have a stochastic quality to them. If a certain individual doesn't hit a certain country first, you are likely to see false evidence that that country hit later has some sort of inborn advantage in fighting the virus. This is nonsense until proven otherwise. Italy has a huge trade with China in textiles, leathergoods, and machine tools. There is a significantly more cross-border travel between the two countries than say France. It is likely only a matter of a week or two before France and Germany and Spain and then the UK experience similar numbers as Italy. That is, unless those later developing countries prepare by implementing social distancing and robust testing early. It looks like they are, so hopefully the growth rate will be a lot slower and health care systems will not be overwhelmed. In the U.S., we are a bit behind and it may go quite badly or our isolation and lower density may provide the needed slowing to implement effective systems. We shall see.

I'd the virus is that widespread then there really isn't that much to fear. Consider we know most of the days caused by the virus. If the virus is much more widespread than we think, the number of deaths is so the same.

It can take up to 2 weeks for people to start showing symptoms. Also it can affect different people in very different ways.

Yes, for most people it isn't much to fear. Even children seem to fare well.

But since it is very contagious and dangerous to the elderly, it's still a good idea to distance yourself from at-risk groups. The panicked overreaction probably won't see the backlash that it deserves, because there is a kernel of truth that social distancing can help to protect a small number of the most vulnerable people.

Also, it's easy to point fingers in hindsight. A lot of the decision-making up to this point has been based on extrapolations from very incomplete information.


> Just wait until they actually start testing people in earnest; the infected numbers will skyrocket in a very short period of time

The President, while visiting the CDC, said that he would prefer not to let the Oakland cruise ship passengers disembark, because it would bring the numbers up. He'd rather keep the numbers down.

Based on that, I doubt that there will be testing in earnest, so that "the numbers" don't skyrocket.


literally the exact same bullshit happened in japan. LITERALLY the exact same.

If I wanted to quell panic I would institute random testing to drive the numbers UP. That would lower the perceived fatality rate and assuage fears.

I think that's been the case for a long while. It's super contagious and produces no to mild symptoms in up to 80% of the most active age-segment of the population? You are contagious even when you don't have symptoms, even if you are going to eventually get them? One day the west coast epicenter is a nursing home in Seattle but the next day the head of the NY and NJ port authority tests positive?

Reported case =/= actual cases and pretty much everything I've read/heard from doctors and virologists says the numbers of reported cases attributed to the actual CFR has been bunk the whole time.

I would not be surprised if hundreds of thousands of people in the US have it right now.


I just flew through Seattle, Spokane, Orange County and Salt Lake City this weekend.

TSA agents physically touched my passport and boarding pass at each one. I wonder what are the chances they've given it to me?


You probably should self quarantine for at least a month. Have a family member carefully purchase at least 86 rolls of toilet paper because apparently that boosts immunity.

You didn’t actually fly through San Jose, but are asking what your chances are?

We were past the point of containment about a month ago

This part has always bothered me. The TSA agents wear gloves. They handle your ID and your possessions. Whatever one passenger may have, that the gloves protected the agent from, is going to be smeared on to subsequent passengers' ID and possessions.

Most major institutions probably don't even want to know whether their staff is sick.

That doesn't sound good...


Please don't post duplicate comments.

I am slowly coming to the realization that a quarter to a half of a percent of people who are alive on Earth today may not be in one year.

Please send the following links to your employers, especially if you work with the public:

https://medium.com/@tomaspueyo/coronavirus-act-today-or-peop...

https://www.theatlantic.com/ideas/archive/2020/03/coronaviru...

The only way we will avoid swamping the healthcare system in the US is by enacting widespread measures before it seems necessary/imminent. NOW is the time to act, not later.


A bold prediction, given that around 2% of people die every year.

It's gonna be bad. It's gonna be /really/ bad in the US I fear. Not even sure we have the social cohesion or political will to do what we will need to do (furlough workers with pay, free childcare for quarantine, weeks spent mostly at home, etc) when we realize it. May just let it burn through population and keep people working. Gonna be ugly.

I am especially worried about people in US prisons or detention centers, where density is high, sanitation is low, and medical treatment woefully substandard.

Tens of thousands of prisoners may well die in the next 60-90 days if this spreads as much as it seems it’s going to.


I'm more concerned with mass prison riots and escapees. Couple prison riots have been reported abroad.

Then again, though we have one of the highest per capital prison rates in the world, most are non violent drug offenders so there may not be much to worry about.


The average US citizen probably thinks they deserve it.

[citation needed]

> free childcare for quarantine

?? Who is going to be doing the childcare?

This sort of doomsday nonsense is ridiculous. We went through the exact same “panic” every election year for the past 15 years. H1N1, SARS, MERS, Ebola. If you are old or immunocompromised, take precautions, but this thread is starting to sound like some prepper hysteria.


And before that the Spanish flu, the flu of 1918, the bubonic plague, smallpox, measels...

This has already infected 10x more people than SARS and is spreading uncontrolled in many countries.

Given life expectancies, this is true every year. For people under age 50 the stats look much better; for people over 80 yearly death rates are already in the double digits. Whether coronavirus deaths are additive for the 80+ crowd is yet to be seen.

Ultimately no death rates are additive. There’s a death for every birth, sooner or later.

> I am slowly coming to the realization that a quarter to a half of a percent of people who are alive on Earth today may not be in one year.

More than that percentage of the world's population die every year regardless (about 0.8% each year it seems like[1]).

[1] https://en.wikipedia.org/wiki/Mortality_rate


Of course I meant in addition to those. My estimate is also conservative, because I believe there will be a vaccine before the year is out. Without one, we could see as high as 1.5-2%.

It isn't really additive though, since those that die from the virus are generally more likely to die of the flu and many other age-related diseases.

COVID-19 accelerates mortality rates and certainly is additive in low risk groups. It's disingenuous to normalize risk as "non-additive" to fit your narrative.

A useful number is that the deaths today represent the disease burden 3 weeks ago. Propagating that multiplier forward, the deaths today represent 500-1000 infected individuals today. So the US has 16 deaths. You're looking at 8000-16000 infected individuals in the US today.

The US seems like it's pretty screwed at this point. All the recent cases here in Australia have been people returning from the US.

Just look at the exponential growth on this plot: https://en.wikipedia.org/wiki/2020_coronavirus_outbreak_in_t...

That's not a trend that's going to reverse quickly.


Yep, this looks completely out of control. I imagine in 2 weeks the entire country will have pretty much shut down like how china did a few months ago.

It looks that way because it's almost certainly been circulating in the US since January [1], and testing was hardly available until recently (and is still ramping).

Despite the long, largely unchecked circulation period, there's no hospitalization crisis here.

And another record-hot Spring/Summer are on the way... take heart!

[1] https://www.latimes.com/science/story/2020-03-10/us-coronavi...


"there's no hospitalization crisis here."

Yeah, there wasn't a crisis in Italy 3 weeks ago either.


Why Australia is blocking South Korean travelers and not US travelers is mind boggling at this point. The smallest amount of intel sharing can stop the infected from traveling. Virtually every case to date in SK has been caught by now, their testing regime is incredibly comprehensive and free for everyone person in the country, even illegal immigrants.

By comparison the US is willfully not testing people presenting symptoms coming back from infected areas, even insurance covered citizens will pay absurd amounts for an on-demand test and it's clear to anyone watching the government is putting it's head in the sand.


That graph is sure sobering, and alarming to think of the slow rate of testing and quarantine so far. Here's to hoping that they get "over the hill" during this month or April..

Are they wearing masks at the airports yet? I am still surprised at the lack of deployment of temperature sensors and masks in the US.

Masks do not help prevent spread when worn by someone who is not infected (except by reducing hand to face contact to some degree). They help prevent infected from spreading to others. [1]

[1] https://www.cnet.com/how-to/which-face-masks-protect-against...


Well, since we seem to have woefully inadequate testing capability right now, we don't know who is infected.

If everyone wore masks, then the would be one way of making sure that infected people wore masks.


In this instance the infected person was the airport worker. So wouldn't that help limit transmission?

And you also agree already that it reduces hand to face contact, further helping limit transmission.

Also, it's not as clear-cut to say they do not help prevent spread. Doing a quick search and picking the very first article from https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=face... says this:

> Hand hygiene and facemasks [vs just hand hygiene, or nothing] seemed to prevent household transmission of influenza virus when implemented within 36 hours of index patient symptom onset. These findings suggest that nonpharmaceutical interventions are important for mitigation of pandemic and interpandemic influenza.


I hear this a lot but the whole message isn’t consistent to me. Masks (mostly n95 respirators) aren’t effective for the general population but they are needed by healthcare workers? How is it they are at the same time effective and ineffective?

Yeah, it's disingenuous the way the media saying handwashing is the only important thing. Studies have shown surgical masks are actually pretty much just as good at mitigating virus spread (reduced virus exposure helps, even if you don't avoid it 100%) - https://jamanetwork.com/journals/jama/article-abstract/18481...

This is false you should stop repeating it. The public shouldn't horde masks but that doesn't make it ok to go around saying they don't work.

If you have to put yourself in a high risk situation like flying on a plane where you are going to be in a crowd where someone is potentially sick I would absolutely wear one. CDC's own guidance for preventing infections on commercial aircraft says as much.

[0] https://www.cdc.gov/quarantine/air/managing-sick-travelers/c...


Can you back this claim up with a peer-reviewed study? (i.e. not a C|NET article, and not a link to the totally discredited CDC)

Who are you going to trust, random US journalists or Lancet? https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

Even CNN which has been publishing “masks useless” articles every day for like at least two weeks published a piece a few days ago saying that while wearing masks may not be effective in the U.S., it could be effective in high population density countries with busy public transit (can’t find the link now). I’d say the crowded airport security lanes are definitely among the places where masks are warranted, even in the U.S.

Temperature sensors are theater. You can be asymptomatic and still spread it. You can have a fever and not have the disease.

Mitigation is not a binary thing. If a temperature sensor is somewhat inaccurate, but can still identify outliers (even with false positives, or even false negatives), there's value to it.

Then just have the sensor always read high. If it's theatre, get out the jazz hands.

Widespread temperature sensors in Singapore, even if security theater, have been great for one important reason: If you suspect you have a fever, you naturally self-quarantine since you can't go anywhere anyway.

Even the gentle nudge to self quarantine can bend the R0 curve down. Every little bit helps.


It seems extremely irresponsible to not give more details on where the TSA agents were working. Did they handle or inspect baggage? Were they working a checkpoint? Which terminal?

They just threw a fear grenade out into the general public and now anyone who went through that airport in the last week going to wonder if they need to get tested or self-quarantine.


This piece of news is scarier:

Sacramento County Gives Up On Automatic 14-Day Quarantines

https://www.npr.org/sections/health-shots/2020/03/10/8139909...


> Effective immediately, people in Sacramento County should not quarantine themselves if they've been exposed to the COVID-19. Instead, they should go into isolation only if they begin to show symptoms of the respiratory virus, the county's health department says.

> Sacramento County has at least 10 coronavirus cases, including one person who recovered.

10 cases and they already gave up on quarantines? The decision maker either knows more about unpublished cases or don’t understand infectious diseases at all... What a great way to make sure more people “show symptoms” two weeks down the road.


That article was full of equivocations and misdirection, with CDC Director Nancy Messonnier wriggling out of any leadership on establishing federal guidelines for containment and mitigation and hapless (?) Dr. Peter Beilenson, head of Sacramento County's Department of Health Services, rhetorically throwing up his arms and embracing mitigation because Sacramento County failed to track infections.

All the while, the author of the piece is clearly trying to convince the reader that mitigation (which in Sacramento County means “self-quarantine only in cases showing symptoms”) is adequate if not superior to containment.


Serious question, even if dc drops the ball why can't states do something about it? USA is a federation after all and states are responsible for the welfare of individual citizens too?

You see a lot of individual states acting - Washington State has banned gatherings of more than 250 people, NY has placed a town under lockdown and the National Guard is distributing food, California has given up on quarantine and headed to mitigation... As you can see, without direction it's a bit of a mess.

> headed to mitigation

Not for long, as this approach will clearly appear to be a disaster when mortality rates exceed 5% because of a lack of ICU care to handle the thousands of severe cases. The response will be swift, but two weeks too late.


California is bigger and richer than most countries - why would they need direction?

Of course it'd be good if the CDC released some general guidance, and was doing better on providing stats, etc. But the States really need to handle things.


I flew out and back to SJC this weekend on a trip to Disneyland, so this doesn’t bode well.

Upside, my company has mandatory work from home this month so I’m self quarantined already.


I was going to attend Tensorflow Dev Summit. We dropped $350 on flights + airbnb for this week. But even after Google canceled the summit, it was still tempting to fly out anyway and go enjoy a week in Sunnyvale.

Our plane took off at 3:30pm today without us. This article is pretty vindicating.

Thank you to Google for making tough decisions early, like canceling the summit.


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