Summary: The daily WHO briefings are terrifying because they show what we should be doing to fight COVID-19 but are not doing. Let’s catch up before we get a raging epidemic. It won’t happen unless we demand better and faster action.
Fight ignorance about the epidemic with numbers
The total number of cases in a nation is a factoid, useful for scary headlines and little else. The epidemic’s impact results from the affected area’s number of cases vs. its population. These numbers are rounded and from WHO’s March 9 situation report.
- China has 81 thousand cases and 1.4 billion people. A small ratio, and they have it under control.
- But that’s still misleading, since 84% of those cases are in Hubei Province – 68 thousand cases in a population of ~60 million. And they have it under control.
- Italy has 7400 cases and 60 million people – 11% of Hubei’s cases with a similar population. Not yet under control.
- S. Korea has 7400 cases and 51 million people – a similar number of cases as Italy but with only 85% of its population. Yet they’re getting it under control.
- America has 200 cases and 327 million people. We’ll have the same proportion of cases as Italy does today when we have 40 thousand cases.
But we will have 40 thousand cases if the US government does not quickly act more aggressively, as explained in yesterday’s WHO briefing. How has Trump responded? For example, see this devastating indictment from the WaPo: “Trump is breaking every rule in the CDC’s 450-page playbook for health crisis.”
Excerpt from the WHO press conference on March 9
See the full transcript. Slightly paraphrased for clarity. Red emphasis added.
In red italics are my comments about America’s failure to prepare.
Dr Tedros Adhanom Ghebreyesus, Director-General of WHO (TAG)
As you know, over the weekend, we crossed 100,000 reported cases of COVID-19, in 100 cases. …Now that the virus has a foothold in so many countries, the threat of a pandemic has become very real. But it would be the first pandemic in history that could be controlled. The bottom line is, we are not at the mercy of the virus. The great advantage we have is that the decisions we all make, as governments, businesses, communities, families, and individuals, can influence the trajectory of this epidemic. …
Of all the cases reported globally so far, 93% are from just four countries. This is uneven epidemic at the global level. Different countries are in different scenarios, requiring a tailored response. It’s not about containment or mitigation, which is a false dichotomy. It is about both. All countries must take a comprehensive, blended strategy for controlling their epidemics and pushing this deadly virus back.
Countries that continue finding and testing cases and tracing their contacts not only protect their own people, they can also affect what happens in other countries, and globally. WHO has consolidated our guidance for countries in four categories. Those with no case, those with sporadic cases, those with clusters, and those with community transmission. For all countries, the aim is the same. Stop transmission and prevent the spread of the virus.
For the first three categories, countries must focus on finding, testing, treating, and isolating individual cases. And following their contacts. In areas with community spread testing every suspected case and tracing their contacts becomes more challenging. Action must be taken to prevent transmission at the community level to reduce the epidemic to manageable clusters. Depending on their context, countries with community transmission could consider closing schools, canceling mass gatherings, and other measures to reduce exposure.
The fundamental elements of the response are the same for all countries. Emergency response mechanisms, risk communications and public engagement, case finding and contact tracing, public health measures such as hand hygiene, respiratory etiquette, and social distancing.
Laboratory testing, treating patients and hospital readiness. Infection prevention and control. And an all of society, all of government approach. …
Singapore is a good example of an all of government approach. Prime Minister Lee Hsien Loong’s regular videos are helping to explain the risks and reassure people.
Why isn’t Trump doing this? It worked for FDR.
The Republic of Korea has increased efforts to identify all cases and contacts, including drive-through temperature testing to widen the net and catch cases that might otherwise be missed.
Why is this not happening in the worst-affected areas of the US?
As you know, more funds are being made available for the response, and we’re very grateful to all countries and partners who have contributed. Just since Friday Azerbaijan, China, the Republic of Korea, and the Kingdom of Saudi Arabia have announced contributions. Almost $300 million US has now been pledged to WHO strategic preparedness and response plan. We are encouraged by these signs of global solidarity, and we continue to call on all countries to take early and aggressive action to protect their people and save lives.
Why isn’t the US on this list? If for no other reason than we should fund others to fight the epidemic in order to defend ourselves.
For the moment, only a handful of countries have signs of sustained community transmission. Most countries still have sporadic cases or defined clusters. We must all take heart from that. As long as that’s the case those countries have the opportunity to break the chains of transmission, prevent community transmission, and reduce the burden on their health systems. Of the four countries with the most cases, China is bringing its epidemic under control, and there is now a decline in new cases being reported from the Republic of Korea. …We’re encouraged that Italy is taking aggressive measures to contain its epidemic, and we hope that those measures prove effective in the coming days.
Let hope be the antidote to fear. …Let solidarity be the antidote to blame. Let our shared humanity be the antidote to our shared threat.
Question: Is there a light at the end of the tunnel here at all? Do we see an end to this thing even now? We know that the fundamental measures that are put in place seem to work in controlling the spread, but do we see a light at the end of the tunnel?
Dr Michael Ryan
I think we’re still very much in the beginning or middle of this fight. The disease has not run its course by any means in most countries. In fact, most of the countries infected have recently imported the disease. The spread of the virus now and its impact are more in the hands of us and society than they are due to the virus itself…
And there are things that may happen with temperature change. Not that the virus will change because of the temperature, but certainly human behaviour changes according to seasons, and the way in which humans mix and distance socially changes with the season. So we may see some natural changes in the incidence of the disease. But hope is not a strategy, and therefore when we look at this as being realistic we’re still very much in the up-cycle of this epidemic, and there are still a number of miles to go. …
The Director-General has said that the window of opportunity is closing and the spectre of a pandemic is rising. At the same time, another window of opportunity may be opening. The data from and the experience of some Asian countries shows that the application of measures across all of society, a systematic, government-led approach, using all tactics and all elements available, seems to be able to turn this disease around. Maria, you may have a more precise definition of where you think we are epidemiologically.
Dr Maria Van Kerkhove
One thing we never want to do is predict what will actually happen. It is in our hands. It is in the hands of how every country deals with this. I think in many countries it will get worse before it gets better, but in many others they only have one or two cases, or they haven’t had cases yet, and that is an opportunity to stop something before it begins. We’ve talked a lot about the four Cs of transmission: no cases, cases, clusters, community transmission. It’s difficult to answer that question on a global scale.
I think that’s important for each country to do on its own. What is the risk of importation to my country? What is the risk of transmission in my country? What is our capacity to deal with this? Where do we have gaps? And how do we address those gaps? Those are really critical questions for every country to be asking themselves, if they haven’t already.
Why are Trump and Pence not getting this information to the American public?
China has shown that they’ve slowed {the epidemic} tremendously, and in some they have stopped transmission. We’ve seen Singapore take drastic action and reduce its transmission. We’ve seen some countries not have any onward transmission. So in terms of what may happen and the light at the end of the tunnel, absolutely, we can see a light at the end of the tunnel. How quickly we get there depends on what countries do.
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Useful articles about COVID-19
The methods to defeat COVID-19 have been proven by centuries of use against many kinds of epidemics. To see them in action, I recommend reading Florence Under Siege: Surviving Plague in an Early Modern City
After weeks of fear-mongering and a tsunami of guesses and trivia, some in the major news media are providing useful briefings. I recommend these two from the NYT. They are antidotes to the fear-mongering by amateur experts.
- “How Deadly Is Coronavirus? What We Know and What We Don’t.“
- “They Recovered From the Coronavirus. Were They Infected Again?“
- “Inside China’s All-Out War on the Coronavirus” – People say that “America can’t do that.” Yes, we can.
Also see a comparison of COV-19 and the flu: on page 2 of WHO’s March 6 Situation Report.
Posts about the coronavirus epidemic.
- The 2019-nCoV virus shows that we’ve built a better world.
- Hidden news about the epidemic sweeping across America! – How fake news drives out good news.
- Amazing but hidden news about coronavirus – Update about the epidemic, and why so few know the good news.
- Lessons from the coronavirus about climate change.
- Cut thru myths to see facts about COVID-19.
- Blockbuster news from China about COVID-19.
- China shows us a future of the epidemic and the world.
- A devastating epidemic spreads across America.
- COVID-19 goes global. What works against it?
- Soon we’ll see if the US can defend itself again COVID-19.
- A situation report on the hidden news about COVID-19.
- The COVID-19 story: mistakes were made.
- Important:Â Some good news about COVID-19.
- COVID-19 will hit world economy hard. Here’s how.
- WHO warns America to prepare for COVID-19.
For More Information
Ideas! For some shopping ideas, see my recommended books and films at Amazon. Also, see a powerful and disturbing story about “The Birth of a Holy War.”
Please like us on Facebook and follow us on Twitter. Also, see these posts about epidemics…
- See the ugly cost of the next big flu pandemic. We can do more to prepare.
- Stratfor: The superbugs are coming. We have time to prepare.
- Posts debunking the hysteria about the 2009 swine flu in America.
- Posts debunking the hysteria about the 2015 ebola epidemic in America.
- Important: A vaccine against the fears that make us weak.
Books about epidemics
The Hot Zone
Pandemic: Tracking Contagions, from Cholera to Ebola and Beyond
You are so far ahead of the curve, a voice of rationality and humanity. I am grateful. I have a darker take on the inaction and motivated stupidity evidenced by our leadership, for what it’s worth, https://shrinkpage.com/masks-unmasked/
Leland,
I’ll read your post later (I’m rushing out to work). But remember Hanlon’s razor.
I prefer a psychoanalytic dictum which might be paraphrased “Always attribute to malice that which is not adequately explained by stupidity.”
Leland,
“I prefer a psychoanalytic dictum”
I don’t know what that means.
“Always attribute to malice that which is not adequately explained by stupidity.”
While that sounds fun, but I suggest you read this: “The COVID-19 story: mistakes were made.” Mistakes are the norm in wars and epidemics because they are unique and extraordinary events and so cannot be practiced. The norm is that amateurs look at those mistakes and draw big bogus conclusions from them, often under the illusion that they could have done better.
I could not find a reply to reply to your reply. Again, I deeply appreciate the depth and care of your analysis, and you are doing a great service. I read the “Mistakes were Made” blog, and hindsight and ex cathedra perspectives are always superior to the on-the-ground realities. What I meant by the psychoanalytic dictum is that unconscious motives may influence behavior contrary to conscious intentions. This is commonplace enough among individuals and groups. Sometimes, behavior flows from defensive avoidance. Denial fits into this category, “It’s only the flu, etc.” At my son’s school, one of the teachers told the class that the adolescents they didn’t need to worry at all. The scare is bogus. They will not be affected. So they could just go about life as usual, and need not be concerned and could go about life as usual, take trips, etc.. I understand that the teacher’s soliloquy may have been meant to reassure, but where was he coming from? Even if he were correct about little risk to this age group, what about the adolescent’s parents and family? You could argue he was ignorant, and yes ignorance is at the root of all evil, but I detect narcissism as well, the narcissism of endemic exceptionalism. Is this malice? Perhaps not, but it is only a step away from malice –at the least, an absence of empathy for persons outside his narrow perspective.
Well one piece of good news is that the idiots out there comparing it to the flu have mostly shut up. But the complacency they engendered still lingers, as if the most important thing is to “stay calm and not panic.” No, it’s quite the opposite. People need a fire lit under their asses, now. Social distancing, now. The U.S., with it’s lack of testing is operating in total la la land.
There are 3 main strategies at the moment:
1. Nuke the curve, get the R0 below 1 through testing, tracing and social distancing (successfully implemented by China, S. Korea, Singapore, Taiwain, so far).
2. Flatten the curve, get the R0 low enough that most of the population gets the disease, just slowly enough that the hospitals don’t get overwhelmed. This appears to be the plan for most of the Western countries
3. Hold my beer. This was the Iranian approach, and is the current American approach.
Am I being unfair? Yes but hardly relevant. Life isn’t fair and death even less so. This outbreak is a great global IQ / responsibility test for governments everywhere and outside of Asia most are failing pretty badly. On the other hand, Asian governments tend to be staffed with engineers, who understand exponential functions, whereas Western governments tend to be staffed with humanities majors, who understand . . . something . . . it must be something, right? Four years of chanting “White Man Bad!” appears to be poor preparation for the real world.
Other good news:
* The temperature-humidity hypothesis still seems tenable so we may catch the seasonality break yet, though Singapore remains worrisome.
* It looks like the effort needed to effectively flatten the curve low enough to prevent health care overload is not very different from the effort needed to nuke the curve and wipe it out locally. So we might as well try for nuking if we’re going to flatten.
Scipio,
This post describes the official answers of WHO to those questions. I am unclear what you are adding to their analysis and recommendations.
What would the payroll tax affect? I saw your retweet on social media, but don’t know what it means. Could you explain?
Isaac,
A payroll tax cut benefits those working. The economically worst hit people by the disease are those whose income vanishes – self-employed and hourly, of businesses that close or reduce activity. A tax cuts doe nothing for them.
A second class of afflicted are those without medical insurance, or who lose their insurance, or who have low-quality insurance – and get destroyed by medical bills. A tax cut does nothing for them.
We are seeing the effects of electing an unqualified clown to the White House.
Larry,
I’m still going to maintain that the fear of COVID19 far outweighs its actual threat when measured against other disease related deaths around the world. COVID19 is not the most contagious, not the most deadly, not the most widespread, and not the most damaging pathogen out there and yet it gets billions of mentions in world-wide media.
Take a look at this website that compares COVID19 to other pathogenic diseases and tell me that the world response to COVID19 is warranted.
https://informationisbeautiful.net/visualizations/covid-19-coronavirus-infographic-datapack/
Worldwide daily deaths from COVID19 are dwarfed by typhoid, AIDS, malaria, tuberculosis, hepatitis B, norovirus, seasonal flu, whooping cough, and a bunch of other diseases that nobody cares about any more. And yet the mentions in the media surpasses 1 billion which is at least two orders of magnitude more than all the other diseases combined.
Now everyone is scared because everyone else is scared.
The only thing about COVID19 that makes it more dangerous than any other sickness is the fear that has been whipped up over it.
This one ranks right up there with the Y2K virus and Climate Change for over-hyped, media generated, society-ending phantoms.
Every disease you mentioned either has a vaccine / cure, is easily preventable, or both. COVID19 falls into none of those categories. Is panic warranted at this stage? Probably not. But the same goes for doing nothing. Why must it be a binary choice? A year from now we’ll get that vaccine, but until then, preparing for the worst is prudent.
Rando,
Thank you for pointing that out.
That we see such comments as by Kris in the third month of the epidemic demonstrates another aspect of America’s dysfunctional response – poor communication by our leaders, so the public gets either ignorance or misinformation.
Kris, start by reading this account of what the epidemic looks like from inside an Italian hospital: https://news.sky.com/story/coronavirus-italian-doctor-says-fighting-covid-19-outbreak-is-like-war-11954229
Their problem is all the sick people needing emergency care at the same time. Northern Italy has a relatively well-developed healthcare system, and it’s breaking down. Containment can flatten the peak and make it manageable.
JP,
“Northern Italy has a relatively well-developed healthcare system, and it’s breaking down. ”
A bit more about that. Americans have little contact with illnesses except thru our vast medical system and TV shows. Many people believe that without intensive care, everybody with COVID-19 dies. But even in Hubei Privince, core of the global epidemic – a poor province in which the health care system broke down – only aprox 4% of those afflicted died. Almost everybody recovers after a few weeks.
Something like 80% of the people dying in Italy are over 80 years old, most of whom have pre-existing conditions.
This isn’t the Black Death.
That’s true Larry. Still, we want to avoid elderly people getting into intensive care units and not having a respirator available, as Italian healthcare staff is reporting right now. So, as I see it (and as my government puts it), we’re trying to contain the epidemic to protect our most vulnerable people and to keep our national healthcare system working properly.
By the way, I’m not American.
JP-
I apologize, I wasn’t clear. My comment wasn’t directed at you. I was providing additional color to your comment for our American audience.
The fact that people are infectious before they get sick means every infected is exposing hundreds before they are caught. Everyone will get this at some level. I cant see them stopping it.
The point is not to ‘stop’ it. That’s impossible for any airborne disease, unless you want to make breathing illegal. The point is to buy enough time until a vaccine makes it through clinical trials.
Randolorian,
“The point is not to ‘stop’ it. That’s impossible for any airborne disease,”
Define “stop.” As WHO’s experts have been saying for the past month, COVID-19 differs from the flu in one critical respect: it can be contained. Quarantines, contact tracing, and cordons sanitaire work – because it is less infectious than the flu. That’s how China, Singapore, and (now, slowly) S. Korea contained the spread of COVID-19.
Not all airborne diseases are the same.
Sven,
“I cant see them stopping it.”
Then open your eyes. As WHO has been saying for a month, China has “stopped” its spread without sophisticated medical tech using only the age-old tools of quarantines, contact tracing, and cordons sanitaire.
I am amazed that in the third month of this epidemic – with it the top subject of every media – most of the comments repeat falseshood. The information superhighway does not work well in America.
An excellent video explaining how epidemics typically work.