How Much Worse the Coronavirus Could Get, in Charts

Play with a model of coronavirus in the U.S.

Comments: 149

  1. The absolute key to slowing the spread of this virus that follows an exponential growth pattern is reducing the number of NEW infections. The number of cases will increase by a factor of 10 about every two to three weeks if the pattern from China is accurate and is reproduced here. We currently have about 1,000 cases NOW. So, in about 2 weeks, expect 10,000 cases and in about a month from now about 100,000 cases and in about 2 months, about 10 million cases. The KEY is slowing the number of NEW cases reported. The only way to do that is self-isolation and barring that rigorous hygiene and reducing person-to-person interaction, large public and private events, and early testing the minute one thinks they may have been exposed. We are unfortunately ill-equipped to handle this massive public health crisis. This president and administration have been watching this crisis unfold for months in China and has done nothing to prepare for the tsunami heading our way. This is what happens when scientists and public health experts are dismissed for political expediency.

  2. As reality begins to set in I'd think we will become much more aggressive with this thing. Trump and congress will begin fighting for their political lives.

  3. The disease is spreading so quickly. It has gone viral.

  4. My husband returned from Italy two weeks ago just before Delta’s last flight from Milan. When the immigration officer asked where he was coming from, she took a step back, grabbed the phone and inquired what to do with this man (must have been her first coming from Italy). When she was told to let him through (my husband heard the exchange) she said “what about his temp, can someone come take his temp?” Nope! Nothing. My husband was baffled. The officer was reacting appropriatly, but there was nothing in place. Knowing the danger, he self-quarantined and took his temp everyday. On day 9 he developed a low grade fever for two days, then it passed. We called his Doc, we called the CDC, we called my pulmonologist because I have CF, and NO ONE to this day has said “let’s test you.” This is beyond irresponsible. This is criminal neglect of a nation at risk.

  5. Mathematically modeled epidemiologic COVID- 19 graphs are only as good as the parameters that they rely upon at a specific space and time. The most critical parameter, which is a reliable broad-based available testing for the presence of the COVID -19 infection, is unfortunately missing in America. Moreover, there are unique human beings behind these graphs whose faces and names we will likely never know.

  6. Act early and aggressive, yes, thank you. But we already missed that train. NYC still keeps the schools open.

  7. Being reported on CBC News Network in Canada: A Canadian company called Medicago has produced a coronavirus vaccine that could be ready for human trials by July/August.

  8. @JimmySerious QUEBEC CITY, March 12, 2020 /CNW/ - Medicago, a biopharmaceutical company headquartered in Quebec City, announced today that they have successfully produced a Virus-Like Particle (VLP) of the coronavirus just 20 days after obtaining the SARS-CoV-2 (virus causing the COVID-19 disease) gene. Production of the VLP is the first step in developing a vaccine for COVID-19 which will now undergo preclinical testing for safety and efficacy. Once this is completed, Medicago expects to discuss with the appropriate health agencies to initiate human trials of the vaccine by summer (July/August) 2020.

  9. @Richard Johnston Yes. Normally it takes another 12 to 15 months to be approved for use among general population. But that's normally. Perhaps in an emergency situation more money and research can be put into the effort to speed up the approval process. As was done with the Ebola vaccine once the need became urgent.

  10. Dear New York Times, Why do your articles lack crucial contextual information and why are you burying the lead? First. I need a yardstick for a million deaths. How does that compare to other death causes? The CDC has information. In 2017, 2.8 million died in the U.S. Heart disease: 647,457 Cancer: 599,108 Accidents (unintentional injuries): 169,936 Chronic lower respiratory diseases: 160,201 Stroke (cerebrovascular diseases): 146,383 Alzheimer’s disease: 121,404 Diabetes: 83,564 Influenza and Pneumonia: 55,672 Nephritis, nephrotic syndrome and nephrosis: 50,633 Intentional self-harm (suicide): 47,173 Second, it isn't the deaths so much, it's the illnesses. There aren't enough beds and hospital equipment for all those people at once. (Don't worry, the rich will be okay. Remember: Medicare4All bad, dying in gutter good. Must stop Sanders and his crazy woo-woo talk about how healthcare is a human right. Why, I remember how hard I had to work to spend my trust fund ...) If the Times could take a minute or two to stop kicking Sanders' corpse and actually focus on communicating information to its readers (some of whom are quite rich, and thus worth preserving) ...

  11. To be fair, you should also chart the best case scenario. There are sign that China is recovering. Don't get me wrong, I am not saying this will happen, ie the best case scenario but it is much more likely than the worst case as history has proven in modern times even with a moronic president like Trump. The most likely scenario is that it will be closer to the best case scenario but the US will fair the worst of all countries because of an ego maniac demagogue at the top in the WH.

  12. In the US, it’s too late to count on “testing.” We all have to concentrate on social distancing and hand washing.

  13. "...uncertainty...shouldn’t see this model as a precise prediction." Should read "...shouldn’t see this model as an accurate prediction".

  14. ALL of this should have been mantra for our Public Health mechanism and THEY SHOULD HAVE BEEN PREPARED. Under Trump, who messes with money and votes only and spends his time lying and manipulating his image instead of governing (or appointing competent professionals to do competent jobs), everything having to do with humans has been sidelined. Trump has blamed everyone including Obama, China, the Democrats - everyone but HIM. As usual, his total incompetence and inability to govern have failed this nation. If he were really either stable or a genius (as far from reality as it gets) he never would have run for President because he is totally unqualified. ALL of his "businesses" and scams have failed, and now our country. Everything Trump touches dies.

  15. Great! Curves like these act as a kind of armature that give a rough idea of the form of the beast we face. Again, great!

  16. This is very good, but it misses the point that there are not 2 but 3 strategies: 1. Let 'Er Rip 2. #FlattenTheCurve 3. #CrushTheCurve The last, #3, appears to be vastly better than #2, much less #1, according to biodata expert "Arguably Wrong." Crushing the Curve NOW forebodes much better for than even #FlattenTheCurve. See the graphs here by biodata expert "Arguably Wrong":

  17. I just returned from Liberia and memories of Ebola are evident as you can witness Ministry of Health vehicles driving down the main boulevard in Monrovia with signs and a blasting speaker informing Liberians that "coronavirus is real" -- the same as during Ebola. Stores and hotels require everyone to wash or sanitize hands before entering. Church services are ending with announcements about hand washing and eliminating hand shake greetings in a very social culture. A shop owner up in the rural area told me the coronavirus "can't survive in the heat of Liberia" so they were "safe". Misunderstandings like this, fear of hoaxes, and poor healthcare systems will cause countries like Liberia to suffer should the virus make a stronghold there. At least their leadership isn't minimizing the seriousness of this pandemic as ours has.

  18. And this doesn't include the other carnage...massive economic damage, which itself will cost many their lives. My livelihood, a very humble one, depends on people traveling. I'm getting cancellations literally by the hour; my income is rapidly going down to zero. What I hope is that, despite the need for "social distancing", people will actually pull together and help each other through this crisis. So many will be harmed in so many ways by this. Scary too is that tens of millions of Americans continue to listen to a lying president whose only concern is the impact on his re-election, and a TV "news" station whose only concern is propping up that president. Misinformation in these situation is deadly.

  19. @Virginia, Yes. We (may) need a “hold” on bills all around for people whose income is slashed to avoid terrible problems. If all vendors can stop paying bills, this would allow them to extend the payment date for the rest of us for a significant period (1-2 months).

  20. @Virginia How many deaths is it going to take to change the minds of all the right wing deniers? How can it be possible to let deadly disinformation (Hannity, Limbaugh and friends) circulate freely? What about accountability?

  21. @Virginia One should stop criticizing the government and administration which are doing their job as best as possible. There is no place for politics only for common sense and the enemy is not Trump but the coronavirus. On a lighter note if Trump could tweet to God he would probably tweet:“almighty God. In every speech I end with God bless America. America is me so God bless Trump 2020. Something to laugh about in these dark days.

  22. I work at a rural community college 45 miles north of Sacramento. We just decided to go online-only until April 5. I am thinking it is unlikely it will be safe to return by then, whether it's that the infection rate went down or its inevitable incline is slow enough that we could get to mid-May safely. I just don't see it. Most schools in the area are online indefinitely. These charts make it look like the entire summer, fall, and even next spring might be too unsafe, resulting in maybe a year or more of online instruction.

  23. Seattle and the state of Washington HAVE now acted aggressively and school is cancelled by order of the governor across 3 counties for six weeks; nearly everyone is working from home; restauranteurs are literally closing their businesses and laying off their entire staffs because no one will go out. But the closures are probably the right thing to do. What’s very difficult to deal with is how long do these extreme measures need to last? There’s no answers, but we can’t cancel work and school for months on end... right? If we do, I’m really concerned I won’t have a job and this will end in personal and community economic catastrophe. Nick, it would be really great if you could talk about this in a future column. I’m struggling psychologically with the isolation already when I’m normally pretty resilient, and we’re on day 2. This article is the first one I’ve seen with any suggestion of time scale. Do we need to be on virtual lockdown until.... October? Next January? How does this end?

  24. @Spike On time scale, we really don't know. I've been grilling epidemiologists about this and there is some optimism that there may be a diminution in the warm weather months (obviously only in the northern hemisphere; it'll get worse in Australia and Argentina, in their winter), as there is for the seasonal flu. But flu experts tell me that even they don't fully understand why the flu goes away in the summer. One possibility is that the virus is less persistent on surfaces in hot weather. Another is that people are inside and close together in the winter, and so it is more transmissible. But there is some chance that it will get better in the summer, and then get worse again in the fall. We may have some treatments by then that help, and hopefully we'll have a vaccine some time in 2021. At that point this coronavirus may simply be part of the background, coming and going each year. Your point about helping deal with economic issues is absolutely correct. I'm worried about a surge of homelessness because people can't pay rent.

  25. @Spike In China it is ending. People can go to work. All restaurants are closed. Supermarkets are only available by app. If you are not working you stay in your home. If you want to go into a public space, you have to show, by means of some app, that you have had no symptoms for 14 days. Then you can enter a public space with some sort of bar code on your phone. This is what they mean in China when they say they are coming out of the crisis. They mean that people can go to work. This is the only way they have been able to stop the virus. If someone has symptoms they quarantine them.

  26. @Nicholas Kristof How about people get more vitamin D from the sun in summer? The immune system functions on less than all four cylinders if there's an insufficiency of vitamin D. My level in summer is ~55ng/ml, when I run shirtless every day. In winter, when I take 3000 IU/day, it's roughly the same. (Rule of thumb: if your shadow is longer than you are, the relevant rays for catalysis of vit D production are being filtered out.)

  27. 'Ahead of the curve' never had so much meaning. The federal government is lagging in leadership and policy and, importantly, credibility. Take Trump and Pence out of the picture and let someone like Anthony Fauci lead. This is critical. There is a vacuum at the top. State and local governments and private institutions (Universities, et. al. and yes, even the NY Times as demonstrated here) seem to be leading in policy and information, but it is not enough. Until testing becomes widespread and cheap, and there are protocols in place, the risks are enormous.

  28. Not great news, but the first solid news for those of us trying to get the shape of honest expectations is the US will start to take aggressive measures nationwide in 1 week or so. Like Churchill said, we’ll do the right thing after exhausting all other possibilities. This would mean a quiet spring and getting back to normalcy by the fall.

  29. @Scott That's exactly why we did this project. We wanted to show: a.) the trajectory is scary if we don't act; b.) we can bend the curve; c.) we must act aggressively and quickly. The exact numbers are uncertain, but the trends are clear.

  30. @Nicholas Kristof I think that people in the U.S. need to realize that there is a strong possibility that they will lose a loved one to this disease, and start acting like they can prevent that. Today is my first day of working remotely. I see a lot of individuals and companies who are not waiting for direction from the federal government or the CDC before taking action. Many companies who can not telecommute employees will require loans to tide them over, on that front it's good that the Trump administration is taking proactive action. It's unfortunately that he still feels the need to downplay the severity of this crisis and ignore all other facets. I feel that his mental &e motional process simply aren't engineered to handle this type of ongoing event. For many, that's as worrying as the disease itself. Thanks for doing your part to help bring context amidst all of this unknown.

  31. I haven’t heard anyone talk about the digital signature tools used in drugstores and doctors’ offices. I am told to pick up a stylus and sign both at the drugstore for prescriptions and at the doctors’ offices for all sorts of authorizations. Touchscreens are also culprits. It seems like a no brainer to have an alternate method that does not transmit germs. Why is this not addressed in all the discussions on how to limit this virus?

  32. @Susan Yes! I’ve felt the same way. It’s just as bad as a handshake.

  33. @Susan Wear surgical gloves and then wash the gloves.

  34. The phrase 'the wise uncertainty of epidemiologists is preferable to the confident bluster of television blowhards..." says it all.

  35. @MMJ But the flaw in this article's analysis is that it uses only one estimate of the case fatality rate, assuming it is 1%, thus resulting in estimated deaths as high as 1 million. This creates an illusion of certainty with respect to a key variable, and makes for scary reading. In fact, we have no idea what the true case fatality rate is, and many public health experts are saying it could be well under 1%. The problem is that no nation has conducted systematic random testing of the general population, and as a result we are certainly missing a huge number of people who either have no symptoms or have exceedingly mild symptoms. The more testing a nation conducts, as in South Korea, the lower the case fatality rate has been.

  36. @Kevin Actually it is not crucially important fatality rate, You do not have Vaccines like flu so it is spreading and fatality rate is very high in already fragile and ailing group 70 yrs and older 15% reported at this moment. This will be a grueling scenario for hospitals next 1 year.

  37. @SU Certainly, even if the fatality rate is much lower than 1% (and it may also be quite a bit lower than 15% for the elderly), we still have a crisis. But the true characteristics of this pandemic would ensure the most appropriate response. I agree that the elderly are the most vulnerable, and we should be taking extraordinary measures to protect them. Closing colleges and schools may be counterproductive, because it will bring asymptomatic kids home where they will be more likely to infect their parents and grandparents (in many cases older relatives will be the primary caretakers, as parents who have to work will not be able to afford other options). We should also be spending more to ramp up capacity at hospitals. The Director of the Ohio Department of Health estimated yesterday that 1% of state residents have already been infected, very different than the modeling here. The virus may be far more contagious than currently known, and therefore less lethal. We must figure this out quickly with a more comprehensive testing methodology. Once we do, we will be able to weigh more accurately the costs and benefits of these disruptions to society.

  38. Apparently Mayor deBlasio, Governor Cuomo, and Chancellor Carranza are treating this simulation as more of a game to see how many public school teachers, staff, and family members can be infected. What a unique social experiment!

  39. Mr. Mayor, is it too much to expect the city of New York to have a contingency plan in place about how or when to close schools in case of a pandemic? No, we're coming up with a plan as we speak. But shouldn't you have come up with a plan years ago when SARS first made an appearance? Not really. It was very localized. Ok, what about when MERS gave us that scare? There's barely any camels here, so... Ok, understandable, what about when H1N1 appeared just south of the border, did anyone think it was a good time to come up with a plan then? Well, it was the summer, so we weren't that concerned. Right, what about a few months ago when the coronavirus appears to decimate China? Well, it wasn't a good time either, you know the election. Totally. What about when it was clear that Italy had been too slow to react and was inundated with the virus? You know, Italy, Shmitaly. Absolutely. What about when the West Coast got hit? You know, it's the West Coast... No disagreement there. What about when the first cases started to appear in NYC? Well, we thought about it, but... So now, after you have decided that all gatherings of 500 people are dangerous, after you've said we might have 1000 cases in the city next week, NOW you're coming up with a plan to close schools? Yes. I told you. We're working on it. Amateur hour.

  40. Trumps' shutdown of incoming air traffic from China is starting to look more and more prescient. (I doubt it was his idea but let's just go with that for now -- fragile ego and all...)

  41. Avoiding large gatherings makes sense, certainly if you have a weakened immune system. It is not yet clear that those who recover have antibodies that render them immune from repeat infections. But it seems likely. Since there are no vaccines likely for at least a year, some sort of limited, controlled exposure might be beneficial, if only in generating a pool of resistant individuals that can keep things running.

  42. One thing that perplexes me - China? We hear that global infection rates will be 40-60%. So in China that means about 500,000,000 people become infected. Let's say the mortality rate is 1%. That yields 5,000,000 deaths. The numbers from China today: Infections: 81,000 Deaths: 3200. Very, very, very low. So what's going on in China? And what does it mean for the numbers in this article?

  43. @Raymond O'Keefe Great point. Perhaps there's a response category even more intense than the "Aggressive" one described in the article. It seems that information sharing by China is also questionable.

  44. @Raymond O'Keefe I think this make be the point of the article. The rates in China are significantly lower due to the very fact that they have been extremely aggressive in managing the spread. Had they not, the numbers would be much higher.

  45. @Raymond O'Keefe China is conquering the illness with quarantine measures much more severe that we have now. Look at Italy, over 15,000 cases and over 1,000 deaths and no end in sight. That's where the US is headed. The important part of Kristof's article is that if we slow down the contagion we can handle it.

  46. This is a great piece. It helps us put this into perspective. It might be painful for us, especially with the lack of normal activities like sporting events and other entertainment, but seeing this helps to put it into perspective. If we can give up live TV shows, sports, and plays for a few months, we can help lots of people.

  47. @Alex Nguyen Agree. That chart and the explanation needs to be repeated and publicized as much as possible. If we don't do everything we can to lessen the spread, we'll end up like Italy, forced triage so that the people who are less likely to survive will be left to die. We all have friends who have other illnesses and we should do what we can to protect them.

  48. What do you mean by intervention? “Intervention” is a highly subjective term. It means different things to different people and different agencies. TN thinks it’s intervening by making it easier to drive around trucks of medical supplies and by limiting public access to one of its four veterans homes (yeah, I know, inexplicable). That’s different from the interventionist strategies of Seattle or Italy or China.

  49. Helpful and informative, but slightly wrong. You state that with 9m cases one third will die. That isn’t close to the fatality rate. For the majority of people the rate of death is around 2%. For over 60 it goes up to 10 and for over 70 to 15%. These stats are from the CDC. So let’s try and not make it worse than it is.

  50. Due to the fact that we have a completely incompetently run government, the COVID-19 virus will get a lot worse by the way they are handling their policies. Blocking the use of Medicaid to the States is deplorable. According to the Daily Kos, "The Trump administration is refusing to allow states the flexibility to use Medicaid in responding to the crisis..." During disasters such as Hurricane Katrina and the 2009 H1N1 outbreak, presidents have granted waivers to states so they could quickly enroll people in Medicaid or so medical providers could quickly treat people.

  51. We're pretty close to locking the barn door after the horse has escaped.

  52. We don’t need a canary to tell us what’s coming. We have the examples of China, Italy, South Korea and Iran, as the most impacted countries. Trump is doing zilch. As Yale epidemiologist Professor Gregg Gonsalves said last night on the Rachel Maddox program, it’s up to the people to organize and demand action. We’re in the midst of phase two of the immensely damaging impact the Wall Street looting that crashed the economy in 2008 is coming back to bite American families. The brilliant meritocrats have private planes now. Imagine moving from NY’s Rockaways to Park Ave. and becoming overnight billionaires.....And getting pardoned by Trump as Michael Milken was a couple of weeks ago.

  53. Excellent article! The model helps us put a "cost of delay" on interventions measured in deaths or hospitalizations. Should be very widely publicized to help decision makers and the public swallow the "aggressive interventions, now" bitter pill.

  54. I'm not hoping for much relief from warmer weather. For one thing, summer just ended in Australia and for another the flu keeps coming back seasonally.

  55. If we could summon the empathy to make this a global effort we could renew a sense of national purpose through something other than military might. This could be a global training exercise for addressing poverty, climate, education, etc.

  56. Just finished a very interesting article in mainstream UK newspaper about a couple in TN. One of the two has had significant Covid symptoms and has had contact with a recent traveler to China, but the state refused to test. A quote from the partner: "Despite all this, and the ER staff’s extreme caution when interacting with us in an isolation room – like a scene from the movie Contagion – after nearly six hours of back and forth, the state of Tennessee’s public health department declined to approve a Covid-19 test."

  57. There are multiple reasons to think that U.S. medical system can handle the COVID-19 crisis in a much more effective way than countries that have gone before it. First, American frontline healthcare workers will be much better protected. Just diverting those suspected of infection away from Emergency Rooms and protecting healthcare workers will make a huge difference. Second, in a real emergency, the awesome capacity of U.S. national guard and military would be marshaled and we would be able to dramatically increase medical capacity into local hotspots. Huge military bases are everywhere in the United States and military transport could move tens of thousands of people in a day. Third, U.S. has deep experience with viral infections and diseases. From HIV to hepatitis, we have become very good at driving down death rates. We’ll benefit from the learning curve and, minimally, cocktail of medications will dramatically lower death rates. Forth, since H1N1 or SARS, there has been revolutionary improvements in understanding fundamentals of DNA and RNA. Technologies like CRISPR have brought huge amounts of new understandings on fundamental biology, and it’ll accelerate the development of vaccines and cures. Of course, none of this matters if our officials have their heads in the sand or the lack of testing so we can’t even know the scale of the infection. Hopefully, the sheer disruption of our society has broken this barrier. Now we can mobilize and use all our tools.

  58. This is a situation that exposes the risk of having a private, insurance based health care system. I am very happy to live in a country again with a government run, single payer health care system. 100% of focus is on care and testing and proactively managing the curve so that there is sufficient health care for those in need, 0% on who is going to pay. The other factor which will be important to contain the contagion is to be able to drive social distancing, e.g. get a large number of people to work from home, and take the decision to slow down the economy to get people to stay home to flatten the curve. This is a lot easier to do if you have the will to support small businesses and provide a robust safety net for employees at all salary levels, e.g. obligatory paid sick leave, and fair laws on how you can hire and fire people. I am afraid that in the US, the most vulnerable will bear the brunt of the cost as they loose revenue, working hours or even their jobs. Denial, tax cuts and travel bans is not going to solve this one.

  59. My mother fits the profile of persons who develop severe complications from Covid-19. She is 67 years old with chronic respiratory and cardiac conditions mostly stemming from the lingering results of rheumatic fever in her adolescence. Even the seasonal flu will often send her to the hospital, where she will be put on a respirator. Thankfully, she is a retired nurse that lives in rural Wisconsin, and thus knows how to maintain hygiene and can take reasonably effective social distancing measures. But, nevertheless, I am truly scared for her well-being. My father passed away four years ago from a heart condition. She is alone. Since I work remotely, I would drop everything and go out there to take care of her, but I am also nervous that doing so would expose her to the virus. I've been manifesting flu-like symptoms for weeks, and have been unable to get tested. Seeing that number at the end of the chart - the total deaths from the pandemic in the US - is harrowing when you have a loved one that is at risk. And knowing that the collective cynicism of our government and of many citizens might endanger her life fills me with such anger.

  60. My husband and I live outside of Seattle and are taking all precautions. I am constantly second guessing our decision to remain virtually isolated. Once you make the decision to step back from society, you have invested time and energy to keep yourself safe. Then if you introduce just one or two people into your circle, you are potentially breaking the safety net you have created. This seems plausible for a few weeks, maybe a month, but for months on end seems both impractical and not sustainable. My biggest fear is not being able to get medical care when needed. From your charts, it seems that this time period will be in the summer no matter what scenario. Perhaps we made our decision to remove ourselves from society prematurely. Additionally, testing is critical and I believe the government has finally gotten the message. What we really need to see is a ramp up on hospital beds and medical devices that will save critical patients. If the medical industry and government can’t get testing correct, how will they ever be prepared for the onslaught of severely ill patients?

  61. The benefits of screening for infection are probably higher than estimated here. Screening means testing everyone, symptoms or not. Positive tests mean stay home until test negative, perhaps under penalty of imprisonment but definitely with guaranteed pay. Negative can work. This would flatten the curve and reverse the trend. Widespread screening of the public could be deployed in a week and ramped up over a month but it would likely reveal >1M infected in U.S. already. Thus, don't expect it any time soon.

  62. This model makes very big assumptions. That the disease won't spread, eventually, to the same number of people. And/or that the number of lives that could be saved would be greatly improved if they can all be taken care of in hospitals that aren't overloaded. I'd take issue with both of those ideas as being overly optimistic.

  63. THANK YOU Nicholas Kristof, Stuart Thompson and NYT. I hope leadership will heed this modeling and take aggressive action.

  64. Awesome visualization. But I would be more likely to share with colleagues if it didn't have "trump-response" in the link. Bending the curve requires everyone to act. Education helps that end, and great visualization like this is a great way to educate people. I would recommend making these features as non-polarizing as possible in order to reach the greatest number of people. It could actually save lives.

  65. All of this implies that numbers produced by China were fake, because also being a large country, they would have seen at least tens of thousands of deaths. It appears to me that, as a society, we are almost two months behind in developing and broadly sharing the conceptual harness to understand how this epidemic unfolds. Had we had these tools early, the world would have been better prepared.

  66. The charts are helpful, and bracing, thank you. The glass half full takeaway is that ninety percent in all scenarios will survive. Not as bad as the flu, the president says. It is now painfully obvious that this pandemic was just not convenient for him, downplaying it's danger. How many more will now die because of his (intentional) inaction?

  67. Italy's stats are frightening. Almost 7% dead. But you playing statistical games here. Is this what is done in political polls? Slide the bar and Hillary wins. Or climate change? Slide the bar and we're 100 meters under water. We really don't know how many people have it. The virus doesn't show in test when no symptoms a showing. Even then there aren't enough test to go around. Take a good look at it. This is science and at the moment it needs more data.

  68. Fascinating and informative. One thing not shown - and I am unsure how one might show it -- is the unevenness of the effects of the virus. Hot spots with higher infection rates would appear in areas that are crowded, with populations that are older and (as to lethality rate) less well resourced with tertiary care hospitals. Also, prisons and - horrifyingly - detention centers (north and south of the border) managed or created by the federal government for undocumented immigrants. But other places, like middle and upper middle class suburbs might do much better - single family homes, parents in white collar professions that more frequently can be managed remotely than are blue collar jobs, etc.

  69. Great article. Beyond increased testing, what is being done to expand capacity to support the surge in hospitalizations? I've heard nothing from government officials about what is going to be done proactively. Set up triage facilities by the defense department as would be done during wartime? Build new hospitals in 10 days as China did? Reopen closed military facilities to quarantine infected individuals? What is the plan?? I'm not feeling confident Trump and his sycophants have a plan.

  70. The Trump and FOX fans did not take this seriously. I know many conservatives who still think this is a media driven crisis and it’s not that bad. It looks like local and state governments will be leading the precautions. But only the federal government has the money to really kick this crisis.

  71. $1000 a month would go a long way to helping millions of Americans who will lose their jobs in the coming months from an economy grinding to a halt. Just a few months ago, people thought the Freedom Dividend was a crazy radical idea, and yet here we are. Let's hope we bail out people this time, instead of banks, airlines, cruise lines, and, of course, Trump hotels.

  72. Thank you for this model. Even if it’s not fully accurate it gives all of us so understanding. We’re in the desert and seems that the warm, dry weather staves off transmission. But who knows for sure.

  73. Yet the schools are still open. Just the kind of leadership and vision that we've come to expect.

  74. While I applaud the model idea, doesn't showing 324,000 deaths per 3.1 million cases imply a 10.4% mortality rate? And isn't the mortality rate currently discussed, somewhere closer to 3%? Given that all deaths are accurately counted but the denominator is likely much higher as many people won't be tested, the model seem aggressive.

  75. @CL That's 3.1 million cases at one time- in other words, the peak of the epidemic. The total number of cases (and total deaths) would be higher.

  76. @Sarah Thank you for the clarification. This means that as the cases progress, the death rate rises? Still not sure why, because peak to peak it's still 10%? Or am I Brian Williamsing this thing somehow? I think a clearer graphic might have show cases and cumulative cases so we can absorb both numbers

  77. The U.S. obsession with 'being exceptional' has again revealed the deep flaw in that thinking. That only 'we' can create the best virus test, and thus we wasted weeks of time, clogging up the system with poor and dangerously inept testing protocols, and sluggish regulations. If we had simply used the S. Korean tests and reviewed what was working best in international waters and adapted those as best practices we would now be in a much different and better place, in wrapping our head around this issue.

  78. Thank you Nick Kristof and Dr, Thomson for your optimistic outlook on the Coronavirus in America, and how quickly we must act aggressively now to avert thousands of deaths . Will we be "hunkered down" for the duration of this pandemic (as we were during the Spanish Flu of 1918-20) and WWII (1940-46)? Or will "normalcy" be recreated within a year or so?

  79. Excellent article. Forwarding this to family and friends. The key takeaway is to act early and act aggressively: precisely what China did and what the US did not do. My Republican family members have been posting on social media that this is all media hype and overreaction. Clearly they are very wrong. This is why I am thankful that others have been swiftly rising to the challenge. I have seen more initiatives and leaderships by cities, counties, and even states versus Trump's incompetent and ineffective federal government.

  80. Mr. Kristof, you'll get no argument from those of us who are Democrats about the severity of this situation. But if you've talked to any Republicans in "flyover country" recently, most are still clinging to the myth that this virus is a "hoax" and not worse than the common flu. As we know now, nothing could be further from the truth. I've spoken with very educated Trump voters recently (those with degrees, and in a few cases, even advanced degrees) and even they still tell me this is all a "Democratic plot". My concern is that if nearly half of us (ie, Trump voters and their families) do not believe this virus is real - and serious - then they will not take even the most basic of precautions, like social distancing. They will continue to mingle among all of us, so we are all at risk. They will, essentially, become walking disease vectors, infecting us all. And of course, they'll claim that sensible precautions "take away their freedoms".

  81. @Charles Dodgson I predict that 'problem' will solve itself in time.... I also believe that the number of people who genuinely believe this is all a hoax is pretty small. It's hard to argue global conspiracy when nearly every country in the world is taking steps and global media is reporting on those steps.

  82. I was glad to see some time lines associated with all of these predictions I’ve read about. The temporal aspect is useful in reflecting about all of these “two week” shutdowns and such. In truth, they may have to be applied for longer periods. It was also interesting to toggle the options while imagining the results applied to China. Granted, the populations are way different. But, I hear chatter about fewer and fewer cases being reported there each day. Their total number of cases is close to 80,000 now. It’s a long way to a million. The model could get you in that ballpark with aggressive measures started very early.

  83. Thank you for this medical science-based analysis, and for the interactive graph which helps in comprehending numbers/percentages/timelines. My husband and I are in our upper 70s. If we decide to stop volunteering at the Food Pantry, stop delivering deli food to IRIS, are we self-serving narcissists, or prudent seniors? The people we serve will still be hungry, and there will be more hungry people as the economy shreds It's a moral as well as a medical dilemma. Sally

  84. Thanks for this article/interactive tool. It is very well done. From my understanding, the pandemic in 1918 worsened in the fall, hitting younger people much harder than it did earlier in the year. I wonder how the covid 19 virus is being monitored for mutations and whether we will be prepared for those adaptations if and when they may occur. It seems that up to this point, the US response has been mostly reactive rather than forward looking. Your interactive tool helps to demonstrate how our actions today can be helpful or worsen the effects for tomorrow.

  85. Besides social distancing, what are the community responses that will help get us through this, as it goes on for months? Some cities are turning back on water that has been shut off. But how do we support vulnerable people -- the older population with health conditions, young poor single parent and other families at risk for losing housing, those who have problems getting food? Can't county governments, large health systems, Medicare and Medicaid health plans, community based organizations have a role here? Meals on Wheels? Home Health? Shouldnt we also be talking about the community response to support the vulnerable? Who pulls it together; where do we focus, how we do it safely? Are there emerging models?

  86. Great visual and follow up to your 12 step program. Follow up Katie Porter's questioning of CDC Director Redfield about his authority under 42CFR71.30 to waive all cost for corona virus testing. Without free and widely available testing, the intervention will come late. In the congressional hearing, Redfield did commit to making testing free and available. The catastrophic bungling of the CDC and healthcare leaders in responding to the corona virus might not originate from the scientists, who seem to understand how to arrest the disease outbreak and have displayed a compassionate side. It seems that a hidden layer of bureaucrats has thwarted the public health effort, so that it can't deploy effectively any measures or even contemplate getting test kits from China. CDC acted promptly and effectively to curb the Zika and Ebola health threats. What happen with the response to the corona virus? I suspect Trump has appointed incompetent lackeys to gum up the process. Given the Trump administration's record, this should not come as a surprise. I hope reporters will reduce their interest in human side of a story and focus on what has led to such a health response debacle and provide insight on how to fix it. I hope Nicholas will follow up his analyses with other tough questions. American lives depend on it.

  87. So if I am reading this correctly, even if AGRESSIVE measures started today, March 13 (Friday the 13th BTW), we still we have 377,000 people dead from the virus Holy crap!

  88. The number of new COVID-19 cases in China has been declining—not growing— for about three weeks. Over the five-month period since the virus emerged, China has had 80,815 cases, 3,177 deaths and 64,151 recoveries. It now has 13,487 cases, of which 4,020 are serious or critical. To reach one million deaths in the United States, the COVID-19 pandemic would have to be hundreds of times worse in America than it is in China. 2020/03/03/809904660/why-the-death-rate-from-coronavirus-is-plunging-in-china

  89. Nice job NYT.

  90. Hey @nytimes -- high-five to your data science team.

  91. "Play" with a model? Really, NYT, you could do better at choosing your words.

  92. This is where America pays the bill for having elected a transgressive, narcissistic, sociopathic two year old to run its affairs. Pays in full.

  93. "Play with a model of coronavirus in the United States." Really? That's the sub-headline you came up with? When it comes to coronavirus "play" is a four-letter word.

  94. The republicans had an opportunity to end this tragedy and did nothing. Instead they are dancing around the fire engulfing our country screaming and chanting like the savages they are. And our president, Donald J. Trump, who appears to have the intellect of an enraged beast in a cage manufactured from his own dark ignorance and destructive values, continues to lie to the American people, many of whom will surely die due to his ignorance and a GOP vendetta.

  95. Would someone please strap Sean Hannity into a chair and explain all this to him? Every night his captive Fox audience hears nothing but his spewing on that H1N1 killed more people and how many months it took to be declared an emergency. That was SPECIFICALLY because of the flatter curve.

  96. As a physician, I am appalled at the delivery system for valid coronavirus tests. Compared to competent medical systems like South Korea who have rapid-result, drive-through testing, we have a cumbersome, red tape-strangled plan to restrict testing to those with contact with foreign nationals, etc. and those who have already tested positive. To top it off, so far our potential patients have to show symptoms when we know that, because of the two week incubation period, asymptomatic carriers exist and can transmit the virus. And finally, our populace must go to their primary care doctor, which millions do not have, to plead for a test which is then sent to the CDC with a 3-4 day turnaround before results are received. A more antiquated, bureaucratic mumbojumbo mess could hardly be designed. Millions will get sick and about 3% or more of those will die. Thanks for stripping us of our safety net, Trump. We are all victims of your stupidity.

  97. So the UK is not taking aggressive measures but Trump thinks travel back and forth from there is ok, while it's not ok from the EU. His xenophobic white nationalism rears its ugly head again. If this country is stupid enough to re-elect him and his congressional enablers in November, I'm going to rethink remaining here, even though I'm 70.

  98. When Trump and McConnell both need ventilators, watch what happens on a national level ... The predictions, in my opinion, presume we have the common sense, and the wherewithal, to get in front of this thing. Corporate America is about to become painfully aware that the people, the American people control the corporate purses; perhaps we will hear them beg before this is over, and Trump, in my opinion, is the greatest example of the definition of "idiot" currently alive. Time to sideline him, and his idiot partner Pence, so intelligent leadership can step up.

  99. To meet worst case scenarios, COVID-19 would have to be many times deadlier in the United States than in China, the epicenter of the epidemic. The number of new COVID-19 cases in China has been declining—not growing— for about three weeks. Over the five-month period since the virus emerged, China has had 80,815 cases, 3,177 deaths and 64,151 recoveries. It now has 13,487 cases, of which 4,020 are serious or critical. China is now reporting about 8 new COVID-19 deaths per day, If the rate is sustained, this would be 2,920 deaths over the next 12 months in a country with three times the population of the United States, but the death rate will probably continue to fall. 2020/03/03/809904660/why-the-death-rate-from-coronavirus-is-plunging-in-china

  100. The NYT is on the path of Hysteria.the Editorial and the front page article on the Worst case do nothing but promote anxiety and fear. Our President can’t give us confidence and this kind of reporting doesn’t either.

  101. Any chance you can change "interventions" to "interventions Obama was not man enough to do" and send this chart to the commander and chief? Maybe that will get him off his rump enough to do his constitutional duty.

  102. Anyone who says not to politicize this crisis is probably a Republican. Trump's speech and Pence's CNN interview place them and their supporters below contempt. They have phlegm on their hands. We're on our own. Prepare supplies as best you can and be there for each other. Godspeed.

  103. Arguably the support for the Vietnam War was lost with one photograph--the young girl in flames running naked from a napalm attack. One photograph could do the same for the unwillingness of our government and the population it represents to take this pandemic seriously--our president in a hazmat suit visiting Ivanka lying in hospital on a respirator from COVID-19. I wish none harm but wish all intelligence and the courage to use it.

  104. “The figures are for America, but the lessons are broadly applicable to any country.” LOL LOL LOL

  105. Nothing to worry about since Jared is now leading the effort!

  106. A drag bar should be placed in the graph that shows virus outbreak outcomes if Trump is removed from office -- if removed in May? If removed in June? If removed in July?

  107. Great article. I think that if we don’t flatten the curve, the USA part of the Coronavirus outbreak will forever be called the Republican Epidemic. After all, you can’t name a catastrophe of great magnitude after someone with such a low IQ. That would be like naming the Chicago Fire after Mrs. O’Leary’s cow.

  108. Testing, testing testing. Follow the South Korean model. This is a must starting today. Everything else is a prediction. We need to start at the heart of the virus. Without testing worst-case scenario looms.

  109. Thank you for this article.

  110. Not to be grim, but this is the time to prepare, and encourage older relatives to prepare, ADVANCE CARE DIRECTIVES, aka Living Will. If you are 82 and wish, for whatever reason, to die at home in your own bed, how cruel and ironic to be in total isolation on a ventilator - stealing your wishes away from you, and stealing life from someone who got into respiratory distress AFTER all the ventilators were in use.

  111. Could you modify the model so we can see how many fewer deaths there will be if Trump immediately resigns?

  112. This NYT information … and news from LA Times "Trump administration blocks states from using Medicaid to respond to coronavirus crisis" - should really make us all worry...and furious about Trump's administration lack of on-time management of this pandemic. LA school district - second largest in the nation- still open. The School Board should read this article!

  113. I enjoyed the line "But the wise uncertainty of epidemiologists is preferable to the confident bluster of television blowhards"

  114. I choose to act aggressively now. I am staying home and told others they can't visit me. I am Facetiming friends and family and going about my usual business all from home. I am doing my part in this war.

  115. Brilliant graphics. There should be a prize for brilliant graphics. Maybe there is. Thanks NYT

  116. Trump has been exposed to the virus, but in a dramatic failure of leadership, has refused to self quarantine, or even get tested. I’d love to see this graph, or a similar one, with Trump at the center. It could show him infecting thousands, who go on to infect many more thousands. Or it could show him self quarantined, and limiting the transmission of the disease. Move the line, and it is a dramatic representation of how the behavior of our President is affecting the country. This does seem to be a metaphor for his leadership. He attracts malignancies like greed, racism and viruses, then disperses them everywhere.

  117. Where do you get a six day doubling number? It looks more like four days.

  118. Interesting and insightful article, but one correction - the US does not have a materially older population than China. The median age between the two countries is about the same. The US does have a larger population of 65+ year olds but that is offest by a much larger (as a percentage) young population (the consequence of China's One Child policy and its connected very low birth rate)

  119. Helpful in understanding the facts not fiction; gives me a sense of least of trends and plausible outcomes. My head still spins with Trump's ignorance and indifference -the "semi" European travel ban to the U.S. feels more vindictive than vindicating.Is it fortuitous that the 2 exempted counties speak English,predominantly Anglo and the leaders have solid relationships with Trump?

  120. To calibrate this you could point out that Siri says 7500 people die every day in the US, of natural causes (2.7 M/y).

  121. Every employer (including mine), event-holder, conference-planner, and local or state official who has seen the necessity of social distancing has far more right to be in the Oval Office than the square peg who is currently there. These intrepid men and women have paid close attention to the medical and scientific experts and acted to protect the public and “flatten the curve.” By contrast, the person we elected to make wise decisions on our behalf has not only downplayed the seriousness of the COVID-19 pandemic but also ensured its spread by opposing increasing the number of test kits because they would cause a jump in the number of reported cases, thus decreasing his chances for re-election. Certainly, American life has been disrupted by cancellations, postponements, and orders to work from home, but nothing disrupts life more than dire illness or the ultimate disrupter, death. A sincere thanks to everyone who has done what trump is morally and ethically incapable of doing—promoting “the general welfare.”

  122. thanks for the epidemiology lesson, I wish this was presented to the President (maybe it was but he wasn't listening, dangerous)

  123. I can't help imagining Trump's eyes glazing over at about the first glance at this chart. We have a mentally impaired individual at the helm of the government, and inept family members advising him who have no qualifications to be involved whatsoever. The demented speech was written by Jared and Stephen Miller ("foreign virus" certain sounds like vintage Miller, doesn't it - this is someone who wasn't even elected, and he creates havoc among our allies), and "supported" by Ivanka. Excuse me? I thought she was in the handbag business. If I say I'm disgusted at how all this is handled, it doesn't begin to cover it. I'm actually out of words until I can find my thesaurus. In the meantime, in an interview with Terry Gross yesterday, her guest Dan Diamond detailed the mismanagement of the administration, including that Trump himself told Azar "Don't test." This, in my humble, is impeachable right there. This is costing American lives, possibly even myself. I have a preexisting condition, but even if I started to show symptoms, I wouldn't be able to get tested. So, yeah, it's personal, baby.

  124. @Margaret I am 76 yrs old and hope you and all of us elders get through this. In the interest of justice/accountability I suggest teaming up with fellow citizens especially those who lose loved ones to sue via class action means under international law the PRC regime and this regime. "Woe to the man whom scandal comes", St Matthew 18:7.

  125. By interventions, do you mean universal? “Intervention” in and of itself is highly subjective. TN thinks it’s intervening to make it easier to drive around trucks of medical supplies. That’s different from the interventionist strategies of Seattle or Italy.

  126. The R0 is probably understated. Don Burke has been saying the R0 during the undetected period is probably closer to 5 or 6. It won't stay at that rate but it does mean that there is a much larger initial pool than we are currently modeling.

  127. The actual value of R0 is much higher than around 2.5. Currently, the number of cases in the USA, and also in western Europe, is doubling every 3 days or so, not every week or so. That's consistent with a value of R0 between 5 and 10. On the other hand, there's strong evidence from Asia that aggressive measures CAN bend the curve substantially. Shutting down sporting events, schools, and other public events is a good first step. The next step will be when we stop going to restaurants and bars. The final step will be when we adopt some of the personal habits of the Koreans and Taiwanese. (Of course that depends on having much better supplies of things like masks than we currently have. Right now healthy people should NOT wear masks, since those are needed for health professionals and the sick.) Since our testing is so bad, it will take a couple of weeks for our efforts to show up in the statistics. We'll have a much better sense of where things stand around the end of March.

  128. Thank you for this initial information spread. The current WH administration seems to think that as the spring season starts in the US, things will improve. We cannot and must not remain on this path! We will not know (or know how to tackle) the pandemic unless we begin seeing how many are infected. To me, we are seeing just the tip of the iceberg. Without testing on a massive scale, more infected individuals will infect others, a much worse scenario. But how does mandatory testing occur? Kickback could be widespread. In any event, knowledge is power—if you do not occupy the WH.

  129. Sobering article. The math behind the models I'm sure is accurate, but as has been pointed out, the models are only as good as the available data that is fed into them and to me one possibly key missing factor is how many (what %) of people are infected but asymptomatic. If that number is large, then we might quickly get to the point of herd immunity assuming once a person is infected, they become immune to reinfection after a few weeks. Is this what is actually happening in China (in addition to the massive lock-down effort)? If numbers from China are accurate, and they are resuming at least some normal daily routine without return of rapid spread, then maybe herd immunity has been achieved there. Alternatively, if the % of asymptomatic infections is small, we could very well be in for what the models in the article present. Hopefully somewhere in the world there are researchers determining exactly what the asymptomatic % is.

  130. Good work. Kudos! I recommend a follow-up article about the effects of herd immunity and the importance of vaccination. We need to know if recovered patients have developed immunity and if growing herd immunity further slows the virus “burn” through our immunity-naive population. We need to have a crash effort toward immunization and vaccination and this is where the federal government has a key role.

  131. The biggest problem with this analysis is that it assumes the case fatality rate is 1%, thus resulting in estimated deaths as high as 1 million. In fact, we have no idea what the true case fatality rate, and many public health experts are saying it could be well under 1%. For weeks the NY Times was reporting it was 2%. The data just isn't there yet. The problem is that no nation has conducted systematic random testing of the general population, and as a result we are certainly missing a huge number of people who either have no symptoms or have exceedingly mild symptoms. The more testing a nation conducts, as in South Korea, the lower the case fatality rate has been. Amy Acton, the Director of the Ohio Department of Health, estimated yesterday that 1 percent of state residents, or over 100,00 people, have already been infected. If that's even close to true, and if the case fatality rate were 1%, there would be a massive surge in serious cases at hospitals by now.

  132. With antibody testing, we might be able to find out who is immune. And if immunity has some longevity (this is a big "if"), then we would have a supply of people that could function without much restriction. So a push for antibody testing might be helpful. Farther out idea: If the army were to allow infection to spread within quarantined ranks, and if there is immunity conferred from this, then we would eventually have a supply of personnel that could help out in the general population. The reward for those military personnel: Excellent medical care at a non peak period, freedom of movement afterwards. Youth would confer a lot of protection for them, and the risks would be much lower. Sounds harsh, but it could be voluntary.

  133. Italy took the right decision in quarantining the entire country. Similar measures are needed in other countries including the U.S. Spread of infection is determined by becomes a game of statistics. Younger people can serve as carriers even though they may not be affected in the same way as people above sixty. Similar to the process of nuclear fission, the transfer of contagion can spread rapidly. Unlike nuclear fission, the transfer largely depends on human behavior. Lack of sense of urgency on the part of the administration coupled with the lack of understanding on the part of people can lead us down the path of absolute catastrophe. Please listen to the epidemiologists!!

  134. Thank you. This is so helpful. It makes me feel better about being "overly" cautious and canceling travel plans. I hope that the work of many dedicated scientists and health professionals, along with aggressive, proactive decisions by state and local officials, will lessen the suffering and loss of lives caused by this pandemic. One wishes, of course, that there was better coordination and leadership on the national level, but one sign of the strength of our democracy is our ability as a nation to work around the damage done by the obstruction and misinformation coming from our president and his Whitehouse administration. in contrast, Nancy Pelosi, Katie Porter, and others are pushing ahead for real action to protect our lives. Academic centers like Johns Hopkins are also doing remarkable work developing testing kits and keeping us informed. And of course, the Times (including the people responsible for this article), and other effective media sources, could not be more important in keeping us informed. It is sad that the Whitehouse and CDC leaders are working more to control the message than to control the spread of the virus, but at least those of us who embrace science, information and rational actions are able to access information crucial to our safety.

  135. For perspective, it would be useful if the model started a month or six weeks earlier -- showing how much less severe this crisis would have been, if our nation had actual leadership who took this seriously and took action when it was clear it would be a problem.

  136. Today is my 20th birthday. It feels weird trying to celebrate with my friends while also knowing the state of the world. Things seem like they are on the path of getting worse before getting better. But this model is really helping put things into perspective, so thank you.

  137. How many infections is the model assuming we have right now? Yesterday, Ohio estimated it had 20,000 actual infections for every one confirmed infection. If their reasoning is correct, then the number of infections nationally must already be enormous. In that case, it seems like the spike could be coming far sooner than this model is predicting.

  138. It's a prelude, in miniature, to climate change response. Except all the numbers will be much larger and the time frame hundreds of years.

  139. The model seems to extrapolate the behavior of infections and deaths based on the current strain of the virus. As it mutates the model might become obsolete. I wonder if looking into current influenza models could provide better insight and accuracy for this model.

  140. I've done this kind of modeling myself, in other areas. Mathematically, it is quite interesting. Behind the graphs are sets of simultaneous differential equations. Sometimes those sets can be solved exactly but for the most part they must be solved with numerical approximations. The statistics (that is, the error bars) are difficult or even impossible to calculate. All in all, these models are a powerful tool for managing the pandemic. All of that is, so to speak, on the intellectual side of the wall. On the other side of the wall is where each of us now finds ourselves individually. I travelled home from Berkeley a day or two ago. San Francisco airport was spooky, with more workers than passengers. Everybody was on edge. Now that I am home again the prospect of being stuck in my house for weeks if not months is daunting, especially for somebody like me for whom movement and being out and about are vital parts of who I am. I am just one tiny part of this massive data set. If the vast majority of these tiny parts do the right thing, we can minimize the damage. It goes without saying that I have little faith in our present administration about which Kristof writes: "At this point we may already have tens of thousands of infections in the United States — no one knows, because testing has been catastrophically bungled ... We have already squandered weeks in which the president scoffed at the coronavirus ..."

  141. Great article, truly helpful. I'm hoping you and others at the Times will next take on the question of how to support the many, many workers who will lose their income when their workplaces close temporarily or just go out of business. What happens to the waiters, the ticket-takers, the cafeteria workers, the hairdressers, the camp counselors, etc etc? We need some brainstorming regarding ways government can help and ways private citizens and organizations can.

  142. Thanks for the informative article. I have a question regarding Montgomery County, PA, the schools, day cares, government offices etc are closed for 2 weeks. For retail establishments is is "recommended" that they close, not mandated. However, honestly it is business as usual at most of the retail (not only pharmacies and grocery stores but gift shops, clothing stors and restaurant businesses). How do epidemiologists respond to that? Are those business behaving in an irresponsible fashion or is it "ok"? Will this make the other measures in the area ineffectual? Thank you so much for providing accurate information.

  143. Did the models account for how appropriate the interventions are? I am not trying to call into question the modeling itself. I have been looking for a chart like this, and it provides a good informational starting point when talking with people who have little information about COVID-19. Adding the wrinkles of time frame and severity of measures was excellent! My concern is one you shared at the bottom of the piece: Mr. Trump has bungled early interventions and is talking about draconian measures that are unlikely to actually do much, like total travel bans. An aggressive but ineffective measure can be relatively useless, and also prevent implementation of a less aggressive but more effective solution.

  144. I thank you and congratulate you for this valuable venture into a new form of journalism. It is bold and responsible. It has informed me. And I will likely go back a few more times and re-jiggle the variable elements and regret so many of the outcomes. I thank you also for the note you entitle "Methodology." Here I would propose a small addendum, maybe in two straightforward, if large, tables. It would be conceptually simple: just something like "proportion of total impact on positive effect of positive intervention contributed by...." and then each of the elements you list. Of course, this proportion would vary given the OVERALL SUM intensity of the variables, so you might want a second table with the same but at, say, three levels of intervention. And, of course, the interactions of the impact of each intervention with one another would make the third table that you might supply even more complicated, but maybe you can find a middle level. The question that such a table would help a very involved reader (like me, at this moment) to begin to answer is "should I spend my efforts campaigning for widespread drive-through testing, an end to large gatherings, etc, etc, etc?" THANKS! John, Pittsburgh

  145. This is a watershed moment. As citizens, the well among us will answer the call to take care of the sick. We will not ask each other who the other voted for. If you have anything (and we all have something) you will need to share it. And I would like to think that somewhere, Bezos and Gates are having a conversation regarding the best way to get a testing kit into the home of every American.

  146. The reference to the Spanish flu pandemic is striking, and it maybe to early to model, or not. Based on our current leadership model we can only expect this to get worse in the short term. When it passes into dormancy our very stable genius will believe the problem is over and that he saved us from much worse. An effective vaccine will not be ready by next year's flu season, lets hope the market leaders and others will begin taking action for next year because POTUS will be golfing at his private resort this summer.