In the past week we have seen the stock market and financial markets around the world tank due to uncertainty over the severity of coronavirus. We have seen drastically downwardly revised economic forecasts. I saw one article on the fate of the airline industry—I flew on half-full planes on Friday, in a fairly empty airport, as the result of the fear and anxiety.
I have read the calculations and it’s not great in terms of public safety. The current known death rate is about 3.4 percent, but that number is almost assuredly way too high. That’s because there is likely a large volume of cases too mild to be identified.
I have read fairly robust analyses that put the true death rate closer to 1 percent. That’s still about 10 times higher than the flu. These analysts warn that there is a push-pull effect here. The unknown cases will push the death rate downward, but the current cases that will end with death will push it upward.
I have read as well a lot of well-intentioned people and public health officials with a list of do’s and don’ts. I agree with people taking precautions. But there is a fine line between caution and paranoia, and that’s what has me worried.
No one is doing the other calculation—how many people could die if the economy tanks? The vulnerable people living on the streets or on the edge of starvation around the world who could be pushed over by a major recession or depression. The impact on people’s lives by shutting down schools.
I start worrying when I read that Stanford University is cancelling in-call coursework for the rest of the quarter and that Elk Grove, one of the largest school districts around, is closing all schools and cancelling student-related activities through March 13 due to the coronavirus.
What happens on March 13? Is the expectation that this will be short-term? That we can briefly ride this out? One of the dangers of coronavirus is prolonged incubation and contagion. Thirty days is 
how long they recommend quarantine.
Reading Marcos Breton’s column makes one wonder what the officials at Elk Grove were even thinking.
As he reports, county officials were caught flat-footed by the announcement.
He writes: “If county health officials were communicating with the Elk Grove district all along then that message didn’t get out to county elected officials.”
He notes that County Supervisor Phil Serna was at a campaign event in the Arden Arcade area on Saturday when he learned of the announcement. Senator Richard Pan has spent weeks attempting to calm fears about the coronavirus. As has Sacramento Mayor Darrell Steinberg and Assemblymember Kevin McCarty.
According to Marcos Breton, “All of them learned at the same time and without warning.”
Mayor Steinberg seems to have the right tone: “We are all rightfully vigilant about what we don’t know about the spread of the virus.
“But I am very concerned about the big picture that we don’t cause a panic,” he continued. “We must organize a community discussion with the goal of developing standards and protocols for when we must shut down public events and public spaces. … Let us have a rational and balanced policy with the guidance and leadership of our public health officials that will help determine these kinds of decisions going forward.”
That has been my concern here—a lot of panic and not enough cautious planning.
The response has to be commensurate with the threat. It is instructive to compare this perhaps to Ebola, which has had some serious outbreaks mostly in Africa. On the one hand, coronavirus is more easily spread, as it can spread through the air. But Ebola has about a 50 percent fatality rate according to the World Health Organization, while coronavirus seems to be about one percent.
However, Ebola is spread at this point only through direct contact, which has made it much easier to contain.
I say this not to minimize the danger of coronavirus but rather to put things into context. The elderly and those with compromised immune systems seem to be most vulnerable to fatality, with most people getting mild flu-like infections at most.
That again leads me to wonder—should we be shutting down society and our economy over a one-percent fatality rate?
In addition, shutting down a school flies in the face, perhaps, of science. Wired two days ago reported: “In a recent analysis by a team of researchers at Johns Hopkins and in China of more than 72,000 confirmed cases from China, children under the age of 10 accounted for less than 1 percent of all infections. Of the 1,023 deaths recorded in China at the time, not a single child was among them.”
“We see relatively few cases among children,” World Health Organization director general Tedros Adhanom Gheberyesus told reporters in mid-February. “More research is needed to understand why.”
As Wired reports, “a detailed new study helps to explain what’s been going on. It turns out, it’s not that kids are somehow immune to SARS-CoV-2. They’re just not getting very sick.”
That brings us back to Marcos Breton and Elk Grove: “How could the largest school district in Northern California announce it was shutting its doors in a complete vacuum of information and leadership?”
“I can’t say it’s the best decision,” EGUSD Superintendent Chris Hoffman said Saturday.
The California Department of Health released its guidelines for schools, colleges and large public events to protect against the spread of COVID-19 on Saturday.
As Mr. Breton points out: “Nowhere in those recommendations do state officials call for the closure of a district without a single student or staff member testing positive for COVID-19.”
What I worry about is that Stanford and Elk Grove are the tip of the iceberg—an iceberg for which we cannot possibly conceive the bottom of at this time.
“My greatest concern about the current state of affairs is that it will breed unwarranted fear and panic,” Supervisor Serna said.
I fully support caution. But we need to temper that caution with sound reasoning.
—David M. Greenwald reporting
Politicians are telling us not to panic but historians are telling us that closing the schools pre-emptively is the best way to limit community spread. Though the kids aren’t getting sick, they, apparently, are major vecotrs:
https://www.nytimes.com/2020/03/06/opinion/coronavirus-schools-closed.html
As of Sunday morning I was convinced that the denominator was under-measured and the death rates were overstated. Apparently the WHO is paying attention to that, and I was misguided. This video is an interview by Channel 4 (UK) with the CEO of the Coalition for Epidemic Preparedness Innovations.
https://www.youtube.com/watch?v=dcJDpV-igjs
We are not getting clear guidance from the top, so there’s no good reason to criticize Elk Grove School District.
Joseph – There was some guidance, but I think more to the point, why would Elk Grove make the call without consulting the county? That’s what really caught my attention.
David – it’s a good point that I, since I’m not involved in government – don’t see as that important. (That doesn’t mean I’m right, just that I don’t see the perspective).
School districts are independent entities that do not come under county jurisdiction – I could see why a responsible and concerned authority at the school district would make the call that he/she did.
If you listen to the speaker in the video that I linked, you will see that his big concern for the US is the decentralization of the various governmental entities who have to deal with this. Your Cal Dept of Health link was the first responsible authority that gave real guidance to responsible authorities down the chain of command (CDC guidance is simply “wash your hands”).
That’s why I wrote “this should be the lede”. We (all of us) need central guidance because incompatible responses across different jurisdictions will undermine all of the responses. This Dept of Health guidance should be more widely publicized.
Not exactly true, (Co Department of Education — in some matters) but close enough…
The person “making the call” should bear responsibility, and/or credit for ‘the call’… if correct, to be praised… if wrong, over-reacting, not so much… time may tell…
I’d give the supe the benefit of the doubt at this point… children are excellent ‘vectors’… worst cold season I had was when our kids were in 3 different schools, and my spouse was a teacher in a fourth… and, their parents can equally become vectors… by engaging in daycare so they can go to work… parents of the kids being sequestered, should sequester themselves as much as possible from others, and adults should be held responsible for the prudent measures.
Atomic energy, viruses, paranoia/panic can all cause chain reactions, increasing exponentially… prudence and common sense not so much… but the latter two are crucial… a key maxim of survival training is “prepare for the worst, expect the best”… prudent actions/inactions (not going to a ‘rave’) is what is needed.
Folk should take reasonable measures, but not panic, nor minimize the need for taking reasonable/prudent actions. Not just for covid-19, but in pretty much anything.
Am waiting for the anti-vaxers to weigh in… they are the antithesis of what we need to do to get past all this.
Cal. Department of Health link is the FIRST time that I see a clear if/then scenario from an organization of authority. That should be your lede!
Clapping my hands to David Greenwald.
It’s nice to read a balanced and well thought out article about how much paranoia people are showing towards another kind of flu that has currently only 500 cases in the whole country.
I can’t believe Elk Grove shut down their schools. It’s like the whole nation has gone crazy.
Are we really going to tank the economy and shut things down over the flu?
https://www.facebook.com/photo.php?fbid=3236685026341843&set=a.3226383114038701&type=3&theater
Exponential growth. Does anybody understand how rapid exponential growth is? The vertical axis is logarithmic in this plot.
Pretty darn rapid. I took math.
Sacramento Bee, Marcus Breton opinion piece:
Closing Elk Grove schools gives a shocking lesson in how not to handle the coronavirus
I can’t imagine what all those Elk Grove parents are now going through trying to line up daycare so they can go to work. All over one unconfirmed COVID 19 case of the flu.
Bananas……………..
Of course, the daycare workers MIGHT have Corona Virus. Just sayin’
I was inelegant… meant to be part of my point… daycare workers might not have it, nor show signs of it, but they can be vectors…
Dad told me that “some folk don’t get ulcers, but they are carriers”… known a few of those folk…
Below is a quote from Dr. Fauci, the administrations foremost expert on infectious disease who has worked with the CDC through multiple administrations. He is not known as an alarmist and the current administration is, if anything, taking a very conservative approach to the virus. As quoted in the New York Times:
“The leading American expert on infectious diseases, Dr. Anthony S. Fauci, said that officials might have to order regional lockdowns in the near future.”
Another perspective, tweeted by Donald Trump this am:
The Fake News Media and their partner, the Democrat Party, is doing everything within its semi-considerable power (it used to be greater!) to inflame the CoronaVirus situation, far beyond what the facts would warrant. Surgeon General, “The risk is low to the average American.”
I would suggest that this kind of mixed messaging is unhelpful for Americans trying to make good choices for their own health and safety and that of others. What would help is to let the medical experts lay out the facts and make recommendations based on the science and limited information known to date while recognizing that much of the precautions applicable to coronavirus are equally applicable to seasonal flu. Americans should be staying home when ill, not going to work or large events, but our economy does not make provisions for responsible public health actions. Anyone who has read any of my articles will know that I place individual and public health over financial considerations. The difference is I am willing to state my bias openly. Those who hope to profit in any way will rarely do so.
52.6K
Who, where? Oh, that’s right, I’m supposed to figure that out myself, with our ol’ pal Google.
Which is why they wear a size W shoe.
What a coincidence, that’s the same place I learned that the towers had fallen.
Unsuccessfully, it appears.
Next time, start the talk with – “Senator, I’m warning you, I’m about to tell you something . . . ”
Always good to be vigilant about what you don’t know.
Hopefully recent exposure to the virus at a CPAC fundraiser will provide the president and his supporters with firsthand data about its pathogenicity, virulence and mortality rate.
Unfortunately, some of the attendees have moderate and liberal friends that they socially associate with…
To clarify Elk Grove’s cancellation of classes. They had one student who was quarantined due to exposure, so they cancelled classes across the district and essentially moved Spring break up to this week. They plan to hold classes over their scheduled Spring break in a few weeks to make up for the time missed this week, so there will be little negative impact on instruction. The hardest hit seems to be athletics with teams unable to play as scheduled – some teams are in play offs. These games are being forfeited and their season is over. There is no plan on what they will do when COVID-19 spreads. I’m assuming that they are dealing with hysterical parents who are now stocking up on toilet paper.
Yet, dealing with hysterical folk, without caving to their hysteria, is EXACTLY what professionals should do. At whatever risk to their careers.
Professionals should gain information, make judgements, then ignore the hysterical vox populi… on another thread, different topic, the “know-nothings”, and/or the “henny-pennys”…
Somebody needs to be the adult in the room…
You are asking a lot.
A person’s dream should exceed their grasp, or what is hoping for?
Or something like that…
From the California Department of Public Health:
https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/School%20Guidance_ADA%20Compliant_FINAL.pdf
It doesn’t sound to me as though Elk Grove school district followed these recommendations. I think our state health agencies will be our best source for information and recommended practices at this time. I hope the school board is in contact directly with CDPH about how to proceed when a child or staff person in DJUSD tests positive.
Meanwhile, the Yolo County Board of Supervisors will be holding an emergency meeting at 11 a.m. which will be live-streaming on the county site as well as on Jim Provenza’s Facebook page.
The latest CDC flu figures:
And this is just in the U.S; not worldwide.
So tell me now how 500 cases of COVID-19 in the U.S. is a crises
Given the high rate of spread, the lack of vaccine, the apparent ease of transmission, limited treatment once sick, and the very high mortality rates in older people, I would say it qualifies as a crisis. I can’t think why one would wish to treat it otherwise.
Also this:
How testing failures allowed coronavirus to sweep the U.S.
Useful for pointing fingers backwards… useless for prudently moving forward.
We are where we are.
Don… data with no source, sample size, type of same (US? Worldwide?). [at least, not noted]
If US, you would have to look at sample size and ‘sensitivity’ of the data set… most of the US deaths have been at exactly one facility caring for aged and/or infirm… skews the data, big time…
Here is some more data about mortality rates by age in China.
ADJUSTED AGE-SPECIFIC CASE FATALITY RATIO DURING THE COVID-19 EPIDEMIC IN HUBEI, CHINA, JANUARY AND FEBRUARY 2020
https://www.medrxiv.org/content/10.1101/2020.03.04.20031104v1.full.pdf
I would encourage folks to read this paper that uses the most updated information we have about the age-specific case-fatality rates, infections, and lag-time from infection to death. They are built upon the same data from China that Don cited above.
A few points:
1) It is incorrect to say there are only 500 cases of COVID-19 in the US. There are 500 confirmed cases—confirmed by testing. By everyone’s admission testing has barely begun here. This implies we simply do not know how many cases there are. There are certainly many thousands already.
2) The age-specific case fatality rates are the real area of concern. In every age group over 60 they simply dwarf anything we have seen with seasonal flu.
3) Do your own math on this data: there are c49 million Americans over 65 in the US. Let’s say only 5% of them ever get infected (estimates of potential infection range from 20-60% at this time though encouraging data from Korea suggests it is possible to bring the R naught measure of infectivity down quickly with super aggressive testing and isolating cases—something the US is NOT doing—we are more like early Wuhan than Seoul), and then let’s say that all of them have a case fatality rate of just 5% (highly unlikely in the age groups over 70 and 80 but try it out). Compare your result to the reported number of deaths from flu…
4. We are in the early days of this epidemic in the US so we still can take actions to “flatten the epidemic curve” and, perhaps rapidly bring the R naught below one. What this will allow is for cases to be treated appropriately in hospital and keep our healthcare system from being overwhelmed (as it most certainly is in Italy—Italy’s deaths are clustered in older ages of a significantly older population than the US overall).
5. Today the County Medical Officer will offer some of the social distancing actions we can and must take to flatten the curve. Others we already know and they involve personal hygiene, personal isolation in the case of illness, and careful attention to surface hygiene in public places. I am happy to provide further information on these practices for any an all who are interested.
6. One additional correction: children are not “vectors”. They get the disease like everyone else and indications are they spread it like everyone else. However, they do not tend to get sick from it for reasons that are not understood. They MAY be less infectious but they still shed virus.
7. Finally, as you have likely read, the virus causing COVID-19 is here to stay. Taking actions now to reduce its spread will provide necessary time to develop treatments and vaccines. Your best sources of information are Drs Fauci and Messonier from NIH and CDC. Listen to them carefully.
Presentation by Dr. Chapman, Public Health Officer, before the Yolo County Board of Supervisors on March 9 2020:
https://yolocountyca.swagit.com/play/03092020-1208
One correction: I said that children get the disease like anyone else. That appears not to be the case though children do get it. We will not know the extent to which children get it until age-stratified population-based serological tests are done to check for antibody response. Those are not happening yet but I assume with the development of blood tests (they are being used in China now from what I understand but check me on that), we will need and get such tests. This will give us a picture of the disease across ages. The outcome that many expect is that this will mean that “infection fatality rates” (IFR) will go down. The CFR too may go down as we better understand mild disease. For now the data presented seems useful (and is given with intervals).
So, I assume UCD will go ahead and cancel Picnic Day?
Based on everything I have understood about the timeline of the spread, I cannot picture a scenario that would allow Picnic Day to go forward. On the one hand, if we do not all take aggressive enough action now the health impacts will be enormous and more significant restrictions might be in place. On the other hand, if we are successful in “flattening the curve” then we will need to stretch our social distancing actions out over a longer period of time—perhaps well into May.
I have NO inside knowledge about how the University is making decisions on this and blanket cancellations up to a certain date are not something we have yet really attuned ourselves to do (notice, for example, that some UCs are saying they will start the Spring Quarter online). This is not a criticism but I believe these decisions will come soon and will need to be made.
They are already prohibiting events with 150 people, so I agree
Excellent article that you posted on Facebook: https://www.fast.ai/2020/03/09/coronavirus/?fbclid=IwAR3jJ5iF08DiGT1VplXuJyNk8CjdjLqP66Cb8w-klJBvu7dzm2YQG5uXXMI
Shut it all down. Picnic Day, sporting events, church, restaurants, council meetings, all businesses unless they work from home, all airports, trains, Disneyland, etc.
Everyone needs to stay home and duct tape their windows and doors and stay at least 6 feet away from each other.
Because killing off the economies of the world is much better than chancing a slightly higher death rate for this flu
in older people even though more people die from the common flu already.
This is not flu
The death rates are not slightly higher.
We can have a serious conversation about what should be shut down and how to respond economically if we all start from facts.
I don’t understand, if things like Picnic Day and sporting events are being considered for cancellation (or empty stadiums) then why not the other things I’ve mentioned? How are they safer than Picnic Day? How is it okay to have a 1000 person event but not a bigger one? How is it safer to have 100 people crammed into council chambers who are sitting right next to each other?
I totally agree with what David wrote here:
Are we doing more harm ruining the world economies than any good from the drastic measures being taken?
I think we are going to see more and more of this stuff being canceled. In a way it sounds silly, but when they shutdown the NBA season, that really hit home for me about where things are and more importantly where they are going.
We’re getting a daily dose of how many people are getting sick or dying from COVID-19 but how many people got sick or died from the common flu yesterday? You know the common flu numbers are much greater and it kills people of all ages, not just the elderly that already had health issues to begin with. But somehow the common flu never tanked our economy.
I a big sports fan, several players often will have the flu but they would still play. Where was the panic then?
I think the key is not how many people died from the common flu yesterday, the key is the rate of increase and our inability to stop that rate of increase and probability that the number of cases will overwhelm the system.
As Robb Davis pointed out to me – people don’t just die, they consume very valuable resources for a period of time before they die and that risks overwhelming the system.
Because it is silly.
And people that die from the flu don’t consume valuable resources? Over 20,000 so far this flu season.
From NY Times: “In the current season, there have been at least 34 million cases of flu in the United States, 350,000 hospitalizations and 20,000 flu deaths, according to the C.D.C. Hospitalization rates among children and young adults this year have been unusually high.”
But now consider this…
The death rate from the flue is about .1 percent. And you’ll notice that the numbers above come to a death rate of .05 percent.
The current death rate from Coronavirus is about 3.4 percent and expert thing it’s probably more accurately at 1 percent. That is ten times the death rate of flu and 20 times the death rate of flue this season.
So now factor in the rate of increase. The fact that there is no treatment or vaccines for it. And you start to imagine why the concern.
You can look at current cases and deaths as the very start of a very large curve if that helps put it into perspective.
So in two short days you’ve already backed off this statement?
Yes. Shall we go over what has occurred since Monday? The side by side comparison to Italy hit home pretty hard.
As a friend of mine posted, Pathogens adhered to a y=e^x domain. Here is a representation of where we are with COVID-19 – we are at the No.2 two point.
So this no longer matters?
It matters. We are going to have to mitigate that. It’s not going to be easy. Allowing it to go unchecked would be worse.
I did not suggest those other things should NOT be discussed. They absolutely should. The key here is a relatively short period of disruption to assure that health systems are not overwhelmed. This is not a permanent ban. Our national government has economic tools (which, BTW, the president’s team has already broached with congress) to deal with the economic fallout. Most are about supporting demand but they will be important.
Social distancing is to flatten the epidemic curve not to establish a permanent social modus operandi.
True story… we must be prudent, but NOT panicked… in the short term, postponing, cancelling some mass public events is prudent… stripping stores of isopropyl alcohol, toilet tissue (huh?, this is a respiratory thing!) sure smells more of panic, “to stock up before the hoarders get it!” type of thing… not helpful… ineffective…
Denying and/or minimizing the risk is stupid… panic is equally so. Reasoned/informed prudence is a good choice. Smart.
Robb
I really want to thank you for weighing in on this issue with your public health background and expertise. I would like to expand a bit on your last comment.
” ..not to establish a permanent social modus operandi”
I also agree that we should not have permanent social distancing as a goal. However, the same individual protective behaviors pertinent to Covid-19 are also applicable to the seasonal flu. We would do well as individuals to practice self-isolation during the flu season when we are ill and as a society to implement policies that allow individuals, particularly those at the lower end of the economic spectrum to stay home without fear of loss of income or job.
Keith
It seems as though you think some of us are only looking at one side of the equation and not considering two other aspects, the seasonal flu and the economy.
In medicine, I was an anomaly. While most of my colleagues were very numbers and statistics-driven and only secondarily considered the softer, more subjective side of medicine, I always started with the personal and worked outwards. Others here have covered the statistics so I am going to present the personal to give you an idea of some of the hidden impacts.
About 3-4 days ago I read a personal account of an Italian nurse as their ER, their respiratory units, and their ICU became overwhelmed from the overlay of their typical needs during this season + the needs of multiple Covid-19 patients. It was the cumulative effect that had them overwhelmed. Overnight units devoted to other medical disciplines were converted, orthopedists and other unlikely subspecialists were overnight converted to GPs and respiratory specialists with everyone working extended shifts.
To get a feel for what they experienced, and we may be seeing in the not so distant future, I recommend Googling “Italian nurse Covid-19” and choose from a variety of articles, some with more objective and some with more subjective appeal.
https://www.merriam-webster.com/dictionary/vector
Sounds to me like they’re “vectors”, bless their little hearts. 😉
As W.C. Fields said, “get away from me kid, ya bother me”. (Something like that.)
Robb has a doctorate in public health, but my understanding is a vector transmits the disease but doesn’t get it (i.e. an insect), children get the disease, just in a milder form. That’s the distinction.
Thanks. I dug a little deeper, and found another definition that confirms your explanation.
https://www.thefreedictionary.com/vector
For some reason, I still like to think of them as “little vectors”. (Actually, I had to look up that definition in the first place.)
To think, this all started with one person in Wuhan China eating a wild animal that was likely infected by a bat. Crazy, one person and the ensuing sensationalism has possibly wiped out the world economy as we know it.
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From the WSJ:
Pretty interesting article: https://www.wsj.com/articles/how-it-all-started-chinas-early-coronavirus-missteps-11583508932