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Open letter from Italy to the international scientific community

left.it

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Re: Open letter from Italy to the international scientific community

#351
post #249

Earlier quoted context omitted.

Why even test? The decision procedure is the same: treat the ill, lock down everyone else at home, avoiding social contact at the max; enforce social isolation and/or masks in "critical" spaces (power plants, grocery stores, ...). What does a positive or negative test change?

How do we know when to initiate or let up on the lockdown if we don’t have any testing?

A decline in cases to treat would be informative, no?

Re: Open letter from Italy to the international scientific community

#352
I was downvoted here recently for sounding the alarm bells on how bad this is going to be and accused of trying to incite panic. Folks, COVID-19 is something that should be taken seriously. President Obama had great advice: "stay calm and listen to the experts". All the experts are saying this is going to be bad and we should be getting ready now for what will happen in the future.

Re: Open letter from Italy to the international scientific community

#353

"Flattening the Curve" is a deadly delusion https://medium.com/@joschabach/flattening-the-curve-is-a-dea... "Flatten the curve" scenario requires r0 to between 1.0 and a small number above 1.0, like 1.1. In other words, it's not happening, you either contain the virus or let it explode.

Flattening the curve is the only scenario a lot of countries can realistically do outside of a Wuhan style quarantine.

Re: Open letter from Italy to the international scientific community

#354

As a physicist, it still feels odd to me they are talking about statistics with such confidence here. It seems only SK has earned that right and has tested enough people to get reliable statistics. If you only measure the sick in the hospital...

If you make a bunch of assumptions about the distribution, you don't need a large sample size to make decent estimations about the population. Of course, the only way that works is with random or stratified random sampling. With reporting bias, I'm not sure any country has enough data to make statistically confident statements with any precision.

Folks with a stronger statistics background are welcome to correct me.

Re: Open letter from Italy to the international scientific community

#355

Earlier quoted context omitted.

No, not even close. Those wet markets are a fucking nightmare. There are truly optimized for pulling new diseases into the human population. Thousands of animals, hundreds of different species, many known to be reservoirs of potential human pathogens, crammed together in close proximity with each other and with humans who eat them. In his interview with Joe Rogan, Michael Osterholm called it "the perfect experiment t…

You are missing the point of my comment. A bat infecting a pig or some other two step is a pre-cursor to many Zoonotic events. Those wet markets are indeed a huge accelerator. But the pre-conditions exist in many places and all it takes is one butcher that isn't paying attention and you've got the ball rolling. Africa and Asia have a lot of this and so are a recurring theme in these very unfortunate stories. But it c…

> one butcher that isn't paying attention

What are you suggesting exactly--that a slightly inattentive butcher wouldn't notice the difference between a leg of pork and a bat?

Re: Open letter from Italy to the international scientific community

#356
post #22

My co-founder and I are really struggling with the decisions ahead of us. We feel we should act quickly, and enforce our team to work from home, but the spread in our city is quite low for now. We also wonder how long this can go on, are we going to be isolated for months? We are at a critical point where we have just closed our seed round this past week. We have both put so much energy and time into this moment and…

Here's what Paul Graham wrote on twitter: > When you're dealing with exponential growth, the time to act is when it feels too early. https://twitter.com/paulg/status/1237801364023017472

This is one of those times where it gets bad so quickly by the time you're starting to respond it's too late.

Re: Open letter from Italy to the international scientific community

#357

Earlier quoted context omitted.

What the letter means is that if your country is not there yet, you might be DAYS away from widespread panic and total lock down. I gotta say this but I don't think we should put forward the position that total lockdown is an irrational position. Total lockdown seems fully rational, not a product of mere panic at all. Total lockdown worked in Wuhan. Absolute and complete isolation inherently results in exponential de…

> "you know that promises to the largest loss of life on US soil ever" From what I'm aware, if hospitals are able to handle the patients, it shouldn't be up to that level. And the "slow it down" plan is primarily about not overwhelming hospitals.

You understand wrong and these common arguments can be easily seen to have incorrect arithmetic.

There are no countries with mass infections where the fatality rate is plausibly below 1%. Of course, when the health system is overwhelmed, the fatality rate can be 4-5%. But let's just look at a 1% fatality rate to start with.

The US population is 327,000,000. Seventy percent of that is 228,900,000. One percent of that 2,289,000; A little more than two million people if we assume 70% infection and an orderly health care system. But that horrible figure isn't plausible.

Because there's more. Claims you can avoid the overwhelming of the health care system are clearly false. Dividing, assuming, unrealistically that the event could be divided evenly through a year, that means that, that many people dying in a year (365) involves 6271 people dying per day and ten times that many people, ~62,000 people, arriving very sick at hospitals, per day throughout the year. And that is far, far more than could be handled by the US health care system.

Moreover, spreading the deaths evenly is inherently unrealistic, the situation of "flattening the curve" (a good thing in itself), can't stop exponential growth as such. If you decrease the doubling time of a exponential curve, you still have a situation where most of the area, most of the deaths in this case, is in the last double. So the even supposedly flattened curve won't let things go smoothly IF we assume "everyone will get this". And that promises not just 2 million but 10 millions (at the 5% death rate). If assume the US current has 10,000 infections, we approximately 12 "doublings" away from 228,900,000 infections (70% of the population). If we slow the progression to year, half the infection will still happen in the last month, with 10% of those "serious", that 763,000 needing attention per day. We're now talking corpses in the streets levels of horror. And we'd have further deaths from this breakdown situation.

And back to the lockdown scenario. My answer is that Lockdowns are absolutely necessary and thankfully it seems likely in most situations they are coming. The figures above should show that alternative is effectively going to be complete breakdown of the health care system and effectively society.

Re: Open letter from Italy to the international scientific community

#358

Earlier quoted context omitted.

I fear that the situation is already at that state in the USA. There are 1600 confirmed cases but the lack of tests hides how many real infections there are.

This is the interesting case where anecdote really does become data. If there are truly only 1,600 confirmed cases then hearing a few stories from a friend of a friend that they know people are sick should still be very unlikely. The fact that many people here and around the web are sharing stories of sick friends is are a set of anecdotes that would be nearly impossible if the reported numbers were correct. I suspec…

I think some napkin math with the number of celebrities and professional sports players, who presumably have far better access to testing than the US public (which has essentially zero access), would show that we are at least at 150k-200k infections, if not more. At least, immediately before Tom Hanks announced his infection, I saw some napkin math that showed that since no politicians, movie stars, or professional athletes were positive, the rate was less than 1/2000 in the US. Now that we have multiple infections in that group, we are in the > 1/2000 == 150k infection regime.

Re: Open letter from Italy to the international scientific community

#359

Earlier quoted context omitted.

There is really no excuse for this happening in Europe. There was ample warning and no, not just from China. The math was very clear by early/mid February. We have to face the truth that the quality of people we vote for government is not where it needs to be and that science has too long been discredited and ignored. Some of asia learned from SARS but that's it. Madrid was hosting marches, political rallies and socc…

Human beings do not intuitively understand exponential growth. It's just too fast for our primitive brains. In some sense, we are standing in the middle of the road, frozen like deer in the headlights. Science is supposed to mitigate the shortcomings of our natural intuitions and cognitive biases. The problem is that most people are not scientists. When a non-scientist is asked to trust a scientist, he or she is subj…

by intuitively I suppose you mean feel it, which I guess is true, but it does not take a genius to actually understand the concept, especially if it is explained as right now you will get this many people per day, in a week you will get this many, in a month this many. That is pretty easy, a politician should be able to follow it.

But as has been pointed out before most people think if you do something big and dramatic to fix an oncoming problem, and it does fix it, lots of people will stupidly assume that you did not need to do the big, dramatic thing because it wasn't really a problem. So any politician who reacted appropriately would run the risk of fixing the problem and losing power in doing so, I would prefer to fix a problem like this even if it meant I would not have the power to fix later problems as my calculation would be if I do not fix this problem now I probably won't have the power to fix later problems anyway.

Re: Open letter from Italy to the international scientific community

#360

Earlier quoted context omitted.

You are missing the point of my comment. A bat infecting a pig or some other two step is a pre-cursor to many Zoonotic events. Those wet markets are indeed a huge accelerator. But the pre-conditions exist in many places and all it takes is one butcher that isn't paying attention and you've got the ball rolling. Africa and Asia have a lot of this and so are a recurring theme in these very unfortunate stories. But it c…

What you're saying doesn't make any sense. You said, "A bat infecting a pig could easily happen in Italy". How is a careless Italian butcher in any way comparable to a seething, filthy wet market where live pigs and bats are crammed into stacked cages? How much bat do you think they eat in Italy? Do Dutch butchers serve bat or pangolin or dog meat, or keep wild birds in cages on top of ferrets, which are good animal…

The world is a lot larger than Europe, and there are documented cases of Zoonosis from all over the planet (in fact, a good 2/3rds or so of our pathogens are of Zoonotic origin). Also, this particular virus likely did not cross over in a wet market, there is no evidence for that.

As for how much better the EU is:

https://en.wikipedia.org/wiki/2009_flu_pandemic_in_Europe

Is a good example of what can happen here.

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