Well designed chart and clear, contained writing.
Thanks Nicholas Kristof for putting this together. The US as a whole has really stepped up to the plate by so many cancellations which are keeping the public informed--and ideally compliant in good health practices--in an effort to contain this infection.
The key factoid so alarming is this continued lack of testing kits. Something so basic--that every other modern country has done efficiently and wisely--should have been a nobrainer from the start.
It gives me a strange feeling that for reason's I can't comrehend test kits are being deliberately held back. Is it to avoid offending the president who's consistenly downplayed the dangers of Covid-19?
Or is it just simple incompetence and mismanagement? That we even have to ask such questions is just as alarming as the virus itself.
369
@ChristineMcM or, unimaginable but possible, is there a financial motive? Some insider provider plans to profit from the sales of hundreds of millions of tests and this insider provider is still manufacturing them, isn’t ready to get them out there just yet.
50
@ChristineMcM Remember that Steve Bannon, an early advisor to Trump, talk about deconstructing the state. There are elements of Trump World that may be looking at this crisis as a opportunity to move quickly to an authoritarian regime. Call be crazy, but why is it taking so long to ramp up test kits when they have drive thru facilities in South Korea. Something is not right!
81
@ChristineMcM There are only two plausible reasons, and they're not mutually exclusive:
1. No testing=no real numbers, allowing the thing in the White House to continue downplaying the potential seriousness of the virus.
2. Massively lucrative contracts for big donors are far more important than expeditious testing with WHO test kits. No matter if American lives are lost due to delays.
58
Has this model been presented to the President?
Does he understand it? Does the Vice-president understand it?
Vice-president Pence is in charge of the task force to deal with Corona-virus. If he does not understand the implication of this model, then someone should take his place.
17
The double time in the US appears to be 2 days based on number of reported cases (JHU website), not 6 days a reported in the article.
2
I was getting to think that NYT did not have the ability to use graphics honestly. Thank you! I hope THIS is contagious.
6
The scientific Johns Hopkins dashboard report is much less scary that Kristof's imagination:
https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6
13
"the president [DECISIVELY] scoffed at the coronavirus and tried to talk up the stock markets."
6
Given Donald's ("the golf playing president") past history in managing his business, notably his "Taj Mahal" casino, he will just let this one go and float down the river,
and declares "I am the best but I can't be bothered with this (and I am going to Mars_-Largo and hide out)...
Don't expect Donald to show up anywhere or touch anybody except his MAGA parties...
And let Mike Pence face the music..
and you can bet on it
5
"..no one knows, because testing has been catastrophically bungled."
How do you that it is "catastrophically" bungled when you have no clue how the distribution model looks for this virus?
Also you keep ranting: testing, testing, testing.
Testing does not equal cure.
Testing does not equal less contagion.
Testing does not equal eradication.
Care to explain your obsession over testing?
4
From a famous Italian novelist : " Dear French cousins ".
https://next.liberation.fr/livres/2020/03/12/coronavirus-chers-cousins-francais-par-cristina-comencini_1781454
And a group of French journalists based in Italy begging French authorities and the public to take it more seriously.
" So that France finally takes the measure of Danger ."
https://www.liberation.fr/planete/2020/03/12/journalistes-francais-en-italie-pour-que-la-france-prenne-enfin-la-mesure-du-danger_1781450
This will be a paradigm shift
for all of us..
many repercussions .. .still unknown and unrealized
....sensible advice ?...everybody hunker down for a bit !
when there`s trouble about..lie still...
but communicate with your neighbors
2
Since the WWII , We never saw world wide lte say a misery.
The generations who live through WWI and WWII era and time line , they were generally understand one after other the world wide catastrophic events, the life is vulnerable and be humble, Not everybody i.e. Hitler didn't get it anything what happens to human civilization if you do that level of catastrophe.
SO we should look our life and I hope we again not everybody but majority will behave responsibly and respecting this earths rules, SO do not eat pangolins, do not go deep in the heart of wild life and disturb them, We ( except scientists) should stay out of wild life encroachment.
4
verrry coool man cant wait to get it
If warmer temp can kill the virus then why do places like Florida,Southern California,South Texas have high incidences of the virus?
7
OHH MY GOSH, THE WORLD COULD BE DESTROYED BY A PASSING METEORITE AND THE WHOLE WORLD COULD FACE EXTINCTION, UNLESS WE FOLLOW THESE STEPS.....
LOOK NOW I'M A JOURNALIST TOO...
5
mmmm, i dragged the start line back before the 'today' marker and nothing changed, does this mean that there is indeed an in built safety mechanism in the fabric of spacetime that thwarts time-travel and that even if i do manage to convert my hot-tub into a time machine i will not be able to go back in time and stop Bill Clinton learning to play the saxophone? Or did the NYT not think of this flaw in the graphic, just think that if you did indeed possess a hot-tub time machine you would have possibly been made aware of this flaw, which maybe would not have stopped Bill Clinton learning to play the saxophone, but would certainly have stopped me from wasting 5 minutes of my time this morning writing this inane comment.
1
It's great to see that NYT has not lost the ability to use digital graphics for conveying information rather than manipulating opinion.
3
what is used for "large gatherings"? 250 is too much, are you using 20 or 30?
I shared these graphs with my 10th and 11th grade mathematics students in the Bronx. We also explored other statistics about COVID19. Tonight one student wrote to her teachers the following. We are at a school with high levels of poverty in the Bronx. But we have amazing students. I thought it was inspirational so want to share.
Dear Teachers,
I will not be attending school until Wednesday or even further along this month. I refuse to put my family members in risk of any health issues. My mother is hopefully getting surgery Monday and I need to be as healthy as I can be. The DOE is being completely irrational. I also value your health. If you are forced to attend school to educate students, rather the building be empty then crowded with students. I will not be subject to any health risks. I will not subject my family to any health risks. I will not subject you to any health risks! I value my education but also my life. Please share ALL work! Also, Power Points and recommend any video links that will allow me & others to stay on track with my education at home! Thank you and stay safe.
160
666,000 deaths STILL makes Corona the NUMBER ONE KILLER this year. Heart disease, the current #1 killer kills 647,000 people.
Even if we do EVERYTHING RIGHT, Corona becomes the #2 killer this year.
And IF we do everything to prevent the EIGHT MILLION deaths which are FULLY POSSIBLE. We will wreck our economy.
People are only blowing this off because they AREN'T DOING THE MATH.
It's not necessary to fight over toilet paper in Walmart, but if you aren't deeply frightened, you aren't paying attention. You aren't fully aware of the possibilities.
72
The most disturbing thing about this afternoon's Dog and Pony show was it mentioned nothing to actually help hourly gig workers.
I don't work in that world any longer but I can imagine the terror those people must feel right now. They can't afford to get sick but by continuing their job they almost can't help it.
Always looking for the angle these sleazes. Don't help anyone really but maybe they can kill Social Security and Medicare by strangling a payroll tax in the bathtub.
60
I wonder why Trump, Pence, Barr and Ivanka, all exposed recently have not had to be tested? The results should be public and none of this secret private Dr stuff....we deserve to know if they are infected and if so they should be in quarantine. Trump sounded like he had a sore throat, that is the first sign.....they all need to be tested without further delay.
36
America announces a national contingency plan to confront the Corona virus ~ We and 114 countries in which the virus has appeared are likely to announce an emergency ~ Ok good ~ And when will we get rid of the virus ~ It was said weeks and the possibility of months ~ But I imagine that if the role of the virus lives up to two weeks ~ then the solution is for those countries to stop The activity and my choice is isolated at home for the people for a period of two weeks ~ and whoever has to go out to wear the full protection clothes ~ and thus we will save hundreds of hundreds of billions and unemployment will be only two weeks and the interaction will be on the Internet ~ and I hope scientists and decision-makers quote the idea and rest from anxiety
1
Your figures show the peak occurring at the same time -- late July -- regardless of when the interventions begin. But there is much talk about slowing the spread of the virus, so that the peak is not only smaller but also occurs later in time. How does this figure into your analysis?
4
Here in Tacoma-Puyallup area, although we are in basic almost close down and social distancing, people are coping well. While they watch and stay farther from each other at the store, they are unfailingly polite as well, as if the community itself is doing the right things. A great many of us have been through similar, so we know the responses and the ways that people will compensate, presently it is a watch to see how bad symptoms get in the general populace.
As I write this I have heavier than normal congestion with sinuses being irritated and a mild couch, but that is also fairly normal for this time of year with the pollen and mold spores we get as things start to dry out a little, so the irritation is a normal thing, but makes one stop and think, just a little more. I will stay as quarantined as possible and watch for further symptoms, but life does have to go on.
As a funny note: we had snow here today, in the middle of this pandemic fright, we had snow on Friday the 13th in March, Numerous people commented on the world going crazy...and then it snows on Fri 13th.
6
Why are these scenarios so dramatically higher than the actual China and South Korea scenarios (and Singapore and Hong Kong, as discussed today in the Times), where new infections have plateaued and appear to be decreasing steadily? Why would the US situation grow to a multiple exponent of what has actually transpired in China, a much larger country, with presumably less infrastructure to combat the virus?
10
President Trump and Vice President Pence should be immediately quarantine. Many of the United States Senators and Representatives are over 60 years old and would be vulnerable to Coronavirus. The consequence of this virus permeating the senior government is terrifying. Some senior members of the government have already self quarantine and it is in the best interest of the United States Security that Trump and Pence are quarantine for 14 days immediately.
5
No reason to panic, every reason to plan.
1
I watched President Trump speak a moment ago.
He claimed that he did not know the person who was standing next to him who has tested positive for coronavirus . He claimed that he has no awareness of the pandemic response team having been dismantled by his administration. Not only did he deny any knowledge of the pandemic response team having been dismantled, but told the reporter who has asked the question that her question was a "nasty question", and that organizations change positions all the time. He said something like :"You've changed jobs", making the analogy that a reporter switch from one newspaper to another is the equivalent of eliminating a pandemic response team.
He dodged a reporter's question as to why he has not self-quarantined. rump, Vice President Pence, Dr.Fauci and others stood close to each other at a packed press conference, while experts are recommending social distancing, and when Trump had direct contact with someone who has been diagnosed with Coronavirus.
Not only is Trump standing right next others, but continues to shake hands with people.
Is there nothing that can be done to stop this sociopath who had endangered and is endangering the lives the American people, and the people who are standing right next to him ?
How can it be that the very lives of millions upon millions Americans are in the hands of this deranged sociopathic narcissist who has caused and will cause the deaths of Americans both by his actions and inactions ?
9
I find it hard to put it in perspective and accept this analysis until a sister comparison is made with respect to China to show what their drastic measures and interventions amount to; it seems that the infections and fatalities have slowed down there, and for a country with 5X population one needs comparative answers.
3
The number of deaths we can project correlates with the number of infections. What we don't know is the general number to be assigned as the underlying lethality rate for covid-19. One early estimate put it as high as 3.4% which would translate into 34,000 deaths for every one million infected. This number is believed to be higher than the actual rate, however. Dr. Anthony Fauci said this week he believes the lethality rate will be established somewhere around 1%, which, at that level, would make the virus ten times more deadly than the flu. (The rate cannot be scientifically estimated because we don't know the number of infections in the population.)
How many people will be infected now that the disease has broken out into community transfers? Also unknown. If 30% of the population were to be infected, a not unreasonable number, then there could be deaths ranging from under half a million to around one million with a projected lethality rate of 1/2 of 1%. If it turns out to be a full 1% lethality, the deaths would be around one million to up to two million.
As the charts show, all of the variables are variable in relation to each other. The only thing we know with absolute certainty is we face a growing crisis of historic proportions with the lives of millions of our citizens at great risk. Even if the disease were defeated soon, we could learn a lot by studying how the numbers played out.
3
This virus is exposing the weakness of our economic system. Many people don't have access to health care. Our health care system is lacking resources to deal with the potential of a widespread epidemic. Our workers do not have the resources to get through the loss of income for an extended period of time. Our families don't have access to quality child care when schools are no longer open. Those of us who have been saying we will pay the price for not having universal health care and strong safety net programs are being proven correct. This is feeling like 2008 all over again. And many people have still not recovered from that deep recession.
7
This is a good way to illustrate the urgent need for timely action. Your readers will probably be convinced, but your political leaders do not see rational arguments. As a public health doctor I welcome your recognition of the importance of public health action. I have just finished writing a memoir that pays tribute to the usually invisible hand of public health action. But COVID-19 might be a game- changer.
6
In statistics (my profession) and related disciplines, we adhere to the concept that: “All models are wrong. Some models are useful.” This model is useful to demonstrate the importance of actions and timing. Thanks.
9
What isn't really noted here is that with every scenario, the peak number of infections doesn't occur until June or July. That means we need to settle in to preventive actions for the long haul - at least three months.
3
If Trump has tried any of these measures 6 weeks ago or even 3-4 would the American public had been ready for it?
Trump clearly deserves blame for the lack of testing available but for enacting social distancing prior to disease being established in US seems to be Monday Morning quarterbacking.
2
In Methodology, the "R0" (R-naught) term is identified as "replication rate." That is a misnomer; it is not a rate -- there is no time component. (Miles per hour is a rate, per hour is the time component.) The proper term is "Base Infection Number" and it is an eigenvalue which is the coefficient for the geometric progression describing the spread of a disease through a susceptible population. If you do a quick search for "James Holland Jones Notes on R0" you will find a paper written by a Stanford professor in 2007 that gives some excruciating detail. And the math.
1
One factor that seems to be consistently ignored is the role of transportation. Experts please correct me, but I suspect Americans use public transportation at a far lower rate than do residents of other large countries. Nothing to be proud of, but could that be a form of social distancing that (because it is the norm) we have failed to factor into the projections?
5
Thank you for this article and I must thank the brilliant developers of the model . I studied Mathematics in the early years of my life and it wasn't till later in life ,when I utilized Mathematical models in my work, that I gained an appreciation of the power of the mathematics. The insights gained from this article are indispensable. It is too bad that most people fail to appreciate what the mathematics is telling us.
4
All of a sudden it dawned on me that this is what happened a couple of hundred years ago when the Europeans brought their diseases and what happened to the American Native Populations. Small pox was devastating. This is from PBS.
When the Europeans arrived, carrying germs which thrived in dense, semi-urban populations, the indigenous people of the Americas were effectively doomed. They had never experienced smallpox, measles or flu before, and the viruses tore through the continent, killing an estimated 90% of Native Americans.
6
This all definitely seems to be implying that the Chinese stats are all very, very skewed down to say the least. I guess that's a given. After all, no way the Chinese government would have undertaken such drastic steps if the contagiousness and mortality of the virus were "only" as bad as a seasonal flu ... !
5
There is a lot of discussion about extension of unemployment and other benefits for workers. I am 60 years old and a self-employed worker. Who is considering people like me in this emergency?
5
@JTE Elizabeth Warren
6
It seems again that Americans never read the European press.and forgot about history.
Several articles from Italian intellectuals or a group of French journalists working and living in Italy urge the French authorities and the French public to believe that it is a much serious problem than they see now.
The same could apply from the French to Americans.
Also about the warmer weather slowing the virus, please look at what happened in 1917.The Spanish Flu ( which came from the USA ) indeed paused at Spring time but came back at fall 3 or 4 times stronger and killed between 50 million and 100 million people world wide.
6
While this is informative, it is also, how to say this, surreal in a way.
Especially with aggressive intervention, that intervention needs to continue for MONTHS, not weeks. If this thing acts like seasonal flu, then come fall, we will see another wave, requiring more MONTHS of aggressive intervention.
But shutting down all large gatherings, staying home, cutting or eliminating air travel, cruises, cinemas, restaurants, museums, etc. for months means that all of those things are basically, gone. The businesses will not survive.
No sports areas, no concerts, no festivals, no races, no community gatherings, no marches or gatherings to petition the government for redress of grievances. Little or no air travel because all the airlines are gone - for business or pleasure. Much of the travel and tourism industry gone. Restaurants, bars, cinemas, and all the associated businesses that spring up around them because they draw people, gone.
These aggressive interventions are enacted to prevent overwhelming our existing critical care capacity. I hear almost no coherent discussion about ways to EXPAND our critical care capacity for infectious disease. We're going into this making every existing hospital a potential collapse point because we are mixing infectious disease treatment with everything else. The Chinese built some 10 hospitals just for COVID-19 almost overnight. Why are we not creating dedicated infectious disease treatment centers?
10
@Joe Watters Perhaps though, once the vaccine is available and natural immunity has also been built up, then this virus will become more like the "seasonal flu" - i.e., manageable.
I find this a bit silly although I am sure Nick thinks it's important. We do not need this chart to convince us that intervention is needed now and needs to be aggressive. The difference between say 6 million and 9 million on a chart is awfully abstract. Even if Trump is incapable of doing anything effective, there are a plethora of people all across the country that have swung into action and they are the ones who will make the difference. Governors, mayors, congressmen, even Republicans, are reacting. As a very small example, the mayor of San Francisco and the head of public health held a conference yesterday with private schools in San Francisco and asked them to shut down. They did. Schools throughout Marin County are closed. Look at the NCAA and major professional sports. All shut down, as in, no March Madness. I think Trump and his cohorts were they only ones who weren't taking this seriously and they aren't smart enough to understand these charts.
5
I pulled my kids out of school 2 weeks ago and have been practicing social distancing with the fam for 2 weeks. I'm not a prepper. But anyone with an ounce of foresight could have seen this thing coming a mile away. This article and one like it should have been published every day for a month.
7
I am 67 my husband is 70, We have no health problems and are on no meds. I would like to know if it is safe and advisable to go to yoga class where size has been reduced to 16 people, four in each row, that is the only place we would go to exercise, to our local family owned studio, we will go grocery shopping and to two classes of yoga, walks and see our grandson otherwise stay home no other socializing.
2
@Juliana James stay sage at home
3
This is a great illustration of how badly this event could affect us. Besides minimizing the BAD, maybe we should also try to maximize its potential for GOOD. IMO, we can learn a lot from this about trade-offs inherent to globalization, for example.
Corporate profits are clearly a major benefit and driving factor in globalization. But pandemics like this one and the many sure to follow also need to be factored into the equations, along with climate change and environmental destruction. Dangerous viral, fungal and antibiotic-resistant bacterial epidemics are sure to occur if globalization remains unfettered.
4
@carl bumba It doesn't take a lot of global trade to have enough people crossing borders to spread virulent diseases like Covid-19 or the flu. And while the USA could perhaps isolate ourselves, the rest of the world doesn't have 2 large oceans between them and the rest of the world. I don't think that trade has particularly been the main reason of cases spreading, a bit of tourism and visits to family members would probably have been enough.
Trade has made the world much more prosperous and efficient. Transfers of medical information will help find a cure for Covid and then maybe other diseases that kill millions. The immigration you also likely find dreadful has led to a lot of the researchers and developers and entrepreneurs that we now count as part of our GDP.
1
Great analysis. A constant consideration seems to be Hospitals being overwhelmed. This makes sense to me, yet I have not yet heard of stopping all elective surgery so Doctors, staff and administrators can focus on this pandemic priority. As more Doctors and staff are exposed, it appears the defense will collapse. Thank you for this work!
3
The admission "Any disease model is only as good as the assumptions" is very true here but it is an irresponsible understatement to merely say that the model is not precise. It is more accurate to say that the model has key assumptions with wide parameters that wildly skew the results.
3
There is a growing body of evidence which suggests that warmer weather helps decrease the spread of viruses due to increased sun exposure, which in turn, helps raise our Vitamin D levels. Many medical researchers now believe that low Vitamin D levels are associated with weakened immune systems and can exacerbate the spread of viral diseases. So, in addition to social distancing, washing your hands, eating properly, and exercising, it is a good idea to check with your doctor and make sure your Vitamin D levels are not deficient. Mr. Kristof's article offers critical insight into how we should proceed to lessen the severity of the Covid-19 disease. Success in winning this war depends on a team effort where federal, state and local governance intersects with the efforts of ordinary citizens who must make wise choices on behalf of the common good.
3
This model assumes a single wave of infections, presumably followed by herd immunity. But that's not what happened with the Spanish Influenza in 1918,. It was a smaller wave at first, followed by a much large one. I haven't read anything that suggests SARS-CoV-2 will be different.
It might well be that this Spring is the dress rehearsal. This Winter is the big event.
4
@Joe W Spot on! While this pandemic may not be the worst, it may well be the one that changes current world order. It is an example of how "order through fluctuations" emerges in complex systems. These perturbations can emerge away from centers of activity/power or attention as rise of Genghis Kahn or the murder of the Archduke Ferdinand (WW I) demonstrate. The higher the connectivity and complexity, the greater the amplitude of possible outcomes. I read about this in Erich Jantsch et al in 70s in General Systems Theory. It is ironic that a microscopic semi alive parasite can devastate and humiliate the smug arrogant current Orwellian oligarchical world order.
1
I'm at Dallas Fort Worth Airport as I type. I went through customs, baggage claim, back into the airport, through a security checkpoint, on the skylink train, walked through two terminals - all told, I saw 5 public hand sanitizers. I ate a meal, got a cup of coffee - none of the wait staff used sanitizers. Feels like just another day at the airport.
8
Thank you for providing these models that explain the purpose of social distancing and other disease interventions. Unfortunately, these models are incomplete and flawed, because they assume the interventions are permanent. In fact, these interventions can and will only be of limited duration, with the most extreme capable of being maintained only for the shortest time. Once the intervention fails or is ended, the disease cases will again surge. If the intervention begins and ends too early, it will not "flatten the curve", but rather will simply delay the peak by duration time of the intervention. The degree of the post-intervention surge depends on the prevalence of acquited immunity in the population at the time (i.e. the number of recovered cases before and during the intervention). For this reason, it is important the intervention be timed to occur around the time of infection peak - with interventions more difficult to sustain started later - to maximize the number of recovered cases that occur during the intervention. Of course, it is difficult in practice to determine when the peak will occur or how long an intervention can be sustained, but there is a substantial risk of prematurely initiating the more stringent interventions that we are not capable of maintaining long enough.
4
@Jym Please look at the simulation again, you have missed the point.
And some interventions we might just be able to live with. The technology for tele-working exists now. Flextime will avoid rush hour and all the wasted time in traffic and we can then not be so close together at work. We can wash our hands (how gross how many people never did after using the bathroom) and we can stop shaking hands and touching strangers. A bit of distance is fine, why are we breathing into others faces while standing in line anyway. If we are lucky, some of these things will help us avoid other infections, like flu or norovirus or Hepatitis .. Industry will adapt, people like takeout, so maybe that will be our primary way of eating food not cooked at home. We can cook some meals ourselves. We can see if delivery services for groceries make sense. Pharmacy deliveries for older people are a great idea. We can socialize with neighbors or with a smaller group of close friends or even with strangers in the park, keeping a decent distance.
2
Nicholas, excellent way to illustrate visually, which is so much more effective than 1000 words. Please replicate this concept in future columns regarding climate change and the result in delaying actions: impact on human lives, livelihoods, property value, communities and economy. I am sure there must be many researchers with existing models to leverage. Please please please make these available to the larger public. Perhaps then people will realize that urgent action now is the "ounce of prevention is worth a pound of cure."
3
Thanks Nicholas for always writing an informative and factual column. I am aghast at the inaction of the US with a 'response' more like a poor third world nation. I am proud of my birth country, Australia, for their aggressive response and always widely available medical access for all. I cannot understand why this country does not embrace preventive medicine, long a pillar of progressive medical systems in other countries. The coronavirus will highlighting in a very obvious way why money MUST be funneled into preventive medicine and preventiveness in general. The lack of available testing kits for this virus is just unconscionable, and Trumps reaction to this pandemic worthy of another round of impeachment, if you ask me. As a small business, like thousands of others, the risk of going under because of cancelled contracts and inability to work is real. Who will compensate us for lost revenue? The fallout from this will be much greater than anyone contemplates.
6
@Cat Preventative medicine is not profitable in our dysfunctional health system. People change insurers often because of their company changing providers or changing jobs, so no point in keeping Joe's blood pressure low or helping Sally lose weight, you might get Fred and Jane next year. Providers are only paid for billable services, which are only for existing conditions, not what you might get next year.
Not clear how coronavirus will be handled by our health care system either.
2
Nicholas, this is very helpful analysis and modeling. Could interstate commerce (truck, rail, and private) act as an accelerator of the spread of the virus? The US has a large geographic area traversed daily by millions of truckers and indivduals refueling at highway stops. This includes using fuel pumps, eating meals, and using facilities. With the delay in testing, could this factor have been overlooked?
4
Trump has assembled a fabulous team to test and fight the spread of the virus. The President and his team composed of government and private sector leaders, have done a wonderful job in reassuring the American people that the leadership is and will be in control to minimize the impact of the coronavirus pandemic.
4
@lieberma He may have but is it too late. This potential epidemic started with headwinds on February 28. Trump did nothing to ease the public fears instead he spoke to the investment community as opposed to real Americans. He (Trump) needs to get out his turbo actions and assure the country that we are making progress and to assuage the citizens' concerns economically.
5
@lieberma
What are you talking about?
Just because the team is capable does not mean that Trump will pay any attention to it.
5
@lieberma Wow! It seems description is at least too kind and, at worst, written by RT. Recall this is the genius who destroyed the pandemic response infrastructure coordinated by Ron Klain for Obama. Racism destroyed that infrastructure and his dismissive inaction delays mean that all misery and death that results are on him. Secondly, the Chinese Communist Party should apologize to the world for their criminal coverups and lies. If I lose a loved one or a friend I will sue them through class action in international venues.
1
What's missing are the costs. We could permanently reduce the rate of infectious disease by prohibiting social contact, but we wouldn't have much of a society then.
We are already depriving much of our student population of a quarter to a third of a year's education. Economic activity is slowing and workers by the million will soon be jobless. The prescriptions for flattening the infection curve all extend the curve into the future, prolonging the economic misery.
Against the costs, measure the benefits not just in the number of lives saved but in the more important measure, the number of YEARS of life saved. Many of the lives being saved are elderly, so fewer years of life are being saved than if the disease targeted children. In fact, children might be better off in the long run by gaining exposure and acquiring immunity to this novel coronavirus.
We have great expertise in public health, but public health is more than rates of infection and fatality, and public policy needs to weigh public health alongside other measures of the public good.
5
Can we get more data like this about past disasters? Hurricane Katrina's "You’re doing a heckofajob Brownie" FEMA response failure. Hurricane Maria’s Puerto Rico "unsung success" response failure. Let’s get solid data on how the Less government / No government movement has worked out.
By the way, many towns in N Illinois - S Wisconsin haven’t had a serious fire in 10 years. Time to get rid of the fire department?
5
What's frightening is the next influenza season starting when this COVID-19 season declines - is that going to make for a worse flu season as the healthcare "system" will probably not have recovered and many people would still be recovering from COVID-19 infection? All the more reason to take more intense versus mild measures.
3
Outstanding modeling revealing the terrible price paid for delay of the past 2 months.
Can't say we weren't educated but we must remain concerned with Trump and Pence still in denial of the severity of CoV2 continuing to reject science and engaging in risky and needless hand to hand contact and delay which if imitated nationwide will lead to lives lost, maybe their own or their families and friends. As if they have a death wish.
A stitch in time saves 9 a concept so simple but lost on those politicians who think they know it all or that denial is a sound strategy for pandemics.
Thanks to the free press, scientists speaking truth to power and state and local authorities who have taken over the fight after the Ex. and Legislative branches abandoned America.
I see most Americans sacrificing, without complaint, and doing their part which give us old folks some hope for us and our families.
9
The case fatality rate is way underestimated in the model. Currently WHO lists the mortality rate as 3.25%. John Hopkin's estimates it closer to 6%. If you consider the current number of deaths indicates the the number of unknown cases at the time those people dying got infected, a mortality rate below 5% of the cases is simply not believable. So that means not 1 million dead, 6 million. Also the under reporting is at least a factor of 10. So we are already 10 days further into this curve.
At this point there is no way to avoid overwhelming the US healthcare capacity, short of taking the same type of drastic actions China did, immediately!
1
You're in effect saying that regardless of what the U.S. does now, a little less than 0.1% (320,000/327,000,000) of the people living in the United States will have died from Covid-19 by this time next year. That's approximately 25% of the people killed in car accidents, or eight times the number of people killed by guns. That's an awful statistic.
I understand the methodology you describe at the end of the article. How certain are health professionals that the RO is 2.3, and the fatality rate is 1%? I remember Anthony Fauci recently testified to the latter. Still, are those figures firm, or still subject to change pending further study?
Also, your timeline parallels the 1918 flu epidemic. Some appearance in the late-winter/early-spring, an explosive resurgence in early-fall. Do we know if the onset of warm weather will stall the spread of Covid-19? I worry, because it would quite likely lull this Administration into complacency. Trump will often rush to proclaim success, however premature. I fear his complacency almost as much as the virus itself.
5
Sorry if this is obvious, but can you please explain the graph? What's the difference between the red and purple lines?
@Candace Smith The red represents people infected with the virus. The purple represents people infected with the virus and who die as a result.
Yet more fear mongering by the media, trying to generate clicks for their ads. How will the US get to even 10,000 deaths, let alone 1,000,000, when China, a nation 4 times our size, only produced 3,000? Even if we hit 15,000 deaths, the flu killed more Americans this past winter. Yes, we need a response, but panic is not the right one. But, hey, it gets people in a frenzy reading this paper, right?
5
@QED .According to the CDC: Covid 19 like all Pandemic influenza is different from other outbreaks we have faced because of the characteristics of influenza viruses – their propensity to change, the ability to spread easily among people, and the routes of transmission – make the disease challenging to
contain. Throughout history, influenza pandemics have led to widespread illness and
death. Pandemic influenza is not a theoretical threat; rather, it is a recurring threat. That is what you are missing from your argument is the recurring threat.
4
Sobering
2
Great article and a very useful tool, thank you. I've worked with plenty of ROI calculators but never one where your return is measured in death! Truly scary to see the path Trump was on of doing nothing before he gave into Congressional pressure. Still, the prospects are grim at this point, even with a quick intervention. I hope it's not as bad as some of these models predict. But, in any event, you certainly persuaded me to lay low and not go visit my elderly parents over the Spring Break!
9
So my workplace went from work remotely for a couple weeks, to work remotely until further notice. This is all this week. Students will not return, events are cancelled, but I actually feel better now that we took this step. I am lucky to be able to do this. Despite missteps from the Federal Government, we are also lucky to have access to good information (unfortunately, also bad), societal knowledge of how the virus spreads, scientific knowledge re: genetic sequencing for research. I worry about those who refuse to take it seriously and am angry at those media figures who promote this as a political issue as opposed to public health. And I am ever thankful for Anthony Fauci. Stay healthy, all. Wash those hands yet again.
6
Why doesn't the chart show what would have happened if we intervened in February?
7
Aggressive interventions today would result in ~50k deaths per this thing.
Yet, China's death rate has stopped growing fast and is at 3k now.
With 3x the population of the US, I'd expect a similar chart to show 150k deaths.
What am I missing?
2
The asymptomatic and mildly symptomatic people who develop immunity are not in the remaining population available to become ill. Takes ? around 2 weeks to develop immunity.
1
nice work....2 thoughts...
1) forward this to Congress (Republicans, too...make 'em stand up and be counted...before they (hopefully) drop (metaphorically, of course)
2) stay home...think of Rip Van Winkle
4
Nicholas Kristof is an island of sanity, in dark and stormy waters. Every American should be reading him right now.
11
I would rather have news like this in black and white terms than mindless babble and tax cuts.
10
Warm weather may not abate the spread of the virus. Other countries near the tropics have seen continuous increases in infections.
4
The graph is a really useful tool, albeit telling a very scary story. As long as the Trump administration's focus is much more on the economy and less on curbing the spread, the more extreme forecasts are more likely than not. To the commander in chief all that matters is reelection. Congress threw caution to the wind by cutting the budgets intended to arm America to combat pandemic like outbreaks. As always, Congress' foolhardiness impacts the lives of everyday people. I say this not to lay blame, rather point out that no big spend now can compensate for past errors. Time is not on the side of the people. For me the most important message of the graph is moving the aggressive action axis out to early May. So sad.
2
In Quebec, with 19 cases of coronavirus, schools universities and daycares will be closing on Monday. Libraries and public sports venues are already closed. Gatherings of more than 250 persons are banned.
This province, with all its idiosyncrasies, can be so incredibly forward-thinking at times. And this is one of them.
9
Thanks very much for the articles and models. It will be interesting to see how well we cope vs. countries with universal healthcare, sick leave, better testing, etc. Bloomberg recently ranked the US 54th in the world for healthcare efficiency with mediocre results despite or because we spend twice as much on healthcare than other Western countries. We will need a Universal Wage to look after the poor and sick.
9
@F Walker I don't like what you write. I don't want what you write about. But, in this crisis, I really don't have a good response to what you suggest.
2
A very helpful and informative article. Of course, I would have preferred a more robust and intense response from the CDC. The failure on the testing front is baffling beyond belief. The ROK and PRC can test rapidly - what is it about their testing that leaves us in the dust? It's just baffling. Is this nothing more than "not invented here"? Or is there something that I'm missing?
7
For once American's innate paranoia may yet mitigate this latest virus. Everywhere I go it is the subject of conversation.
Perhaps all those apocalyptic zombie movies we watched, while scaring and entertaining us also prepared us to stock up, move to the hills (or isolate ourselves) change out habits, stock up and collectively being afraid of the same things.
3
“But the wise uncertainty of epidemiologists is preferable to the confident bluster of television blowhards.”
Substitute “television” with “administration”. Americans are getting a front row seat to mismanagement when a novel virus first appears, especially with a President who’s overriding concern is his own political fortunes. I wish there was an independent “expert group” website that served as a clearinghouse/alert center for all national data. I don’t trust anything coming out of 1600 Pennsylvania Ave.
14
What happened to: "The government is not the solution to the problem, the government IS the problem"?!
5
Two questions:
1. If no on is immune becuase this is a novel virus, won't everyone eventually get it?
2. Is the area under the curve, the total number of infections, equal for all scenarios?
@MRod
Everyone doesn't need to get it. At some point "herd immunity" helps protect those still uninfected, especially if folks continue smart hygiene practices. I'm not sure about under the curve. I found the graphs a bit confusing. From what I understand, it's likely one-third, at least, will become infected. That's about 100 million in the US, and that equals 500,000 dead (assuming .5% mortality, which seems more likely than 1%). This is just spitballing though; the next few weeks, with large-scale testing, will give us a much better picture.
1
Unnecessarily scary article. What Kristof is saying is that the US will fare exceedingly poorly compared to China, where the number of cases appears already has peaked with only 80,000 total cases and more than 50,000 already recovered.
Kristof's statistics show that the US will experience 50X to 1000X times the cases at peak than China (which has 5X the US population), and at least 50X the number of deaths than China.
Is Kristof saying that China has pulled off a miracle, and that the US cannot come close to China's success in combatting the virus?
5
@Wolff
Um, kinda.
China can control its citizens much better than we ever will. Also, it's not necessarily over in China. Until a certain portion of the country's people have it, it will spread. They can't stay locked down forever. But I hope you are right.
5
@Wolff Well at least temporarily. We don't really see a way for China to maintain its current miracle. None of these models are, what if we take China extreme measures today. If we did best guess is the real number of cases in the US are around 20,000. Maybe we could get that to peak below 40,000. But for every ten days at that becomes a 400,000 peak even with Chinese like measures. Delay 20 day, and it is simply way to late to implement even Chinese like measures and expect them to have an effect.
4
@Wolff How can we be sure we know what the REAL numbers are in China? Think about it.
2
Is it reasonable to consider domestic travel restrictions for leisure travel at this point? I'm supposed to go to California in two weeks for a two week vacation. I feel fine, but am I increasing my chances of being a vector if I go through multiple airports, planes, and interact with many different people? If I hear someone like Fauci say that we should postpone all vacation travel for the next few months, I am happy to comply. But I don't see any clear direction about this.
2
@Eric
It's common sense to avoid travel, particularly to a hot spot of infection, as parts of CA are at present. If I were you, I would cancel. Better to lose your vacation than your health.
5
This is very interesting and helpful. But the model makes a lot of assumptions. You let us play around with the timing of interventions and aggresiveness of the interventions, but what if the R0 is higher? Or the mortality is lower or higher? Where did the assumption of 1% come from? Ultimately, the decision on interventions is more than just a scientific decision. It has to be balanced against the economic and social impact of the interventions. Is there any way to incorporate into the model the cost of the interventions, not just direct, but indirect (e.g. lost work days because a parent has to stay home to care for children who are not in school). Finally, I hope politicians like Trump and DeBlasio are getting properly briefed using models like this.
2
The curve shows the number of infections peaking sometime in July. Is this a certainty, regardless of the eventual number?
2
Thanks. But all schools should be closed.
2
If we still had labor unions, there would be paid sick leave. If we had universal health care, we would not be at the mercy of what corporations decide is in their best interests. If we had free local college, more people would be likely to train for the medical profession. A few greedy, selfish oligarchs run this country to the detriment of all but themselves, and I am tired of it.
28
One important "corrective" will be to defeat Trump in November. I'm a Bernie guy, and Liz, too.... but whomever it is, here's my suggestion: Let either Joe or Bernie announce that Liz will be their VP choice.... and that they will only run for one term. Both of them are too old to consider for two terms.... and if Liz will be VP, that will set her up to run in 2024.... a great candidate!
4
Sorry, am sure others have already commented on this. First chart says 310 deaths. Assume that’s supposed to read 310,000?
Hey Nick,
Thank you for this work.
Help me understand the projections, please, a little more.
China stands at roughly 81,000 infections and 3,200 fatalities. Why are the U.S. projections 100 times or more worse? Am I reading that correctly?
Kevin
1
Strikingly similar issues on a longer time scale with regards to climate change....and US inaction.
3
Thank you.
This is the most effective summary I have found. Powerful tool.
Please tell me how to print this so that I can share it with others.
Okay if this ends up being really bad I WILL partly blame the news media for a boy-who-cried-wolf effect. Because, yes, a lot of people are still thinking, "Well they said Swine Flu would be huge, Avian flu, anthrax..."
3
@bess
A. Biology/epidemiology is not like math.
B. "The news media" is not a homogeneous monolith.
4
Whoa, am I scared. What are you basing your estimates on? How can you make any estimates when R isn't known and the fatality rate isn't known and we don't know how many will get seriously sick.
And whatever your estimates are based on, you need to rethink because we now have a situation where virtually all publicly gatherings are shut down. Everyone who can work at home is doing so, people are voluntarily social distancing and unless you live in a cave with no internet, you know you need to religiously wash your hands.
R is (per a NY Times article by a stats guy) calculated by taking how long a person is contagious x the number of people you come into x the likelihood of transmission x the vulnerability of those who interact with someone sick. Now, if we do nothing about corona, then all of these numbers should remain high and the number of infections and fatalities high. But, if people self quarantine and we close borders, the number of carriers should decline. If we close schools, public events, churches etc., then the number of people a carrier will contact will fall. If people wash their hands, the likelihood of transmission will fall. And if people at high risk self isolate to as great an extent as possible -- then the overall susceptibility will fall.
So why not produce numbers that reflect how people are responding. If those who are sick/vulnerable take them out of circulation, everyone is social distancing and washing hands -- what happens?
1
While Mr. Kristof admits the possible fallibility of all of this guesswork - and it is totally guesswork, informed or otherwise - what always strikes me about such reports is that if they come true, the writers can say, "See, I told you so.", and if they prove unfounded or totally at odds with the subsequent situation, they can just forget they ever wrote the report and no one will be the wiser. It's a win-win situation for them, but in all honesty, I'd rather have their informed guesswork than none at all, so I can live with it. If only they'd keep the politics out of it. (Elsewhere in today's paper, Ms. Rice makes it a point to say that Mr. Trump should not have termed this a 'foreign virus' because no virus is foreign and calling it so only insults another nation, but I cannot help noting that, even after 102 years, we still call the pandemic of 1918/19 "the Spanish flu". I wonder when we'll have to post apologies for that and what the reparations costs will entail?)
2
@Joe Pearce
A. Better to buy too much food than have hungry guests.
B. The Spanish Flu was named a century ago; no one names their baby Gladys anymore either.
5
thank you thank for this illustration
as a physician i am hopeful that collective action will save the vulnerable
i hope Americans have the patience for this
take care
4
I see the last sentence under methodology states that warmer weather isn’t factored into the models. These charts show that the worst part of this occurs in the dead of summer. I’d like to see someone familiar with data regarding temperature and viral spread apply their best guess for us.
Is there anyway the model parameters produce fewer than 10,000 US deaths? Because if that is the outcome and scientific assumptions precluded model parameters to produce that outcome then we have a bigger problem, one that enables uninformed people to dismiss scientific modeling on any number of critical issues.
As always, Mr. Kristof, your writing is well thought out and very informative. BTW, I just finished reading your book Tightrope. It echoed in a very compelling manner what I have observed in the American Midwest and Southeast.
1
Here’s why social distancing works: if 10% of the population distances itself then there remains (roughly) 90% of the population interacting with only 90% of the population. So you have only 90%*90% = 81% as many interactions (and opportunities to transmit disease) as you normally would. This is a reduction in infectious interactions of 19% from baseline.
- 10% social distancing results in 19% fewer opportunities for transmission.
- 20% social distancing results in 36% fewer opportunities for transmission.
- 30% social distancing results in 51% fewer opportunities for transmissions.
If you have the ability to stay away from other people, please do so. It is not being selfish, it is an act of generosity.
7
It could get this bad, but at this point, aggressive intervention is starting and data from other countries, like China, suggest much lower infection rates and bell curves of 8-12 weeks, not 6 months. Not to mention, there are cases in warm counties but the disease isn't spreading as rapidly. My county is shut down for 2 weeks with only 22 infections. I am in favor of this intervention and I think it will get bad, but the CDC's predictions seem more like a scare tactic than based on current dynamics.
2
If we had real justice, we'd be able to send Trump the bill for all of the excess hospitalizations that he caused for payment. He's bragged numerous times that he's worth $10 billion, so he'd have an easy time paying all the millions of dollars to cover these costs.
6
Economic damage feeds on itself and snowballs. Much of the value of a business is the procedures and connections with vendors and customers that have been built up. When the business losers customers and fails, this value vanishes; if the business owner starts a new business, the value must be recreated step by step.
When the market for people is gutted, the market response is to reduce the number of people. Deaths from the virus are the instrument the Invisible Hand uses to adjust supply and demand.
2
In Italy--which many experts say is a model for our immediate future--almost all the fatalities are in people over 75. But The at-risk population in the U.S. will skew younger.
The life expectancy of an Italian who has reached the age of 60 is 85. The life expectancy of an American who has reached 60 is 83.
That difference may not seem like much, but anyone who's been to Italy has seen 75 year-olds cycling to the market to buy fresh vegetables; healthier than Americans that are years younger in simple chronological terms.
We're about to learn the real costs of associated with spending twice as much on health care as the Italians do (per capita, or as a share of GDP; they're both about the same ratio) to buy our status as the #37 country for population health. Where's Italy, you ask, considering they spend half what we spend? They're #2.
I guess they try harder.
6
At some time point it will be crucial to have some standard test to identify those recovered from the disease: they will then become key elements in making countries keep functioning while previously uninfected subjects must maintain distancing etc during future waves of the epidemics. Any news of research work on this?
1
Thanks for sharing these charts; they really exemplify the need for early intervention. Do you know what the recommended duration is for each of these intervention measures? For example, how long would we need to take 'aggressive' measures? Would they need to remain in place until the virus shows signs of diminishing?
Just to be pedantic and to complicate things perhaps in terms of Ro. Surely if some people are immune because they already have had the virus the formula should be something like Rom = (1-m)Ro. (Where m is the proportion who are immune). You want that or whatever other formula you use to get to 1 or below presumably.
From that admittedly simple formula and with an infection rate of 2.3 my calculation gives:
m = 1-1/Ro
=1- 1/2.3
=1-0.43
= 0.57
or 57% of the population have to be infected before the illnesses infection rate is 1 and it is under control. Obviously back of the envelope calculation and I'm sure your calculations were more sophisticated. However, as I said, just to be pedantic.
Aggressive measures are important. But so is income. Instead of tax cuts, how about a basic income of $1000/mo for adults for a few months? Not sure this administration ever takes into consideration those who work the gig economy; musicians; cooks, waiters, and other restaurant workers; individuals who staff events that are cancelled, etc. Just put the money directly into the hands of the individuals.
5
I am trying to reconcile the chart with the earliest interventions with what has been reported in Hubei, the worst hit province in China. Hubei has 60 million people, so one fifth the size of the US. They have had about 70,000 confirned cases and 3000 deaths. Their interventions are pretty strong and according to China, has put them past the peak.
If we scale that up to the US, there would be 15,000 deaths, far lower than the 300,000 deaths the chart indicates. Is China fudging the numbers or is the chart making some assumptions? Do we really know how R0 is affected by interventions and mitigations such as what we are seeing today in the US (canceled social events, reduced travel, closed schools, etc)? It seems far too early to me to know how those things will affect R0.
I think I would prefer reading peer-reviewed analysis although I appreciate the effort.
1
@Scott Werden
You cannot impose Chinese type of measures here, This country has guns, people will literally start civil war.
4
According to the CIA World Factbook, the median age in China
in 2018 was 37.4 years. The median age in the U.S, was
38.1 years. So technically, the article is correct. The U.S. has
an older population than China. But the margin is not
great enough to believe that it would make a significant
difference in the relative death rate of the two countries, all
other things being equal.
Nicholas - thank you for this, and even more, thank you for your responses to reader questions. I find it invaluable and an amazing source of generosity on your part.
1
There are 3 important steps right now needs to be agrresively work on it.
1- Testing must become very widespread , cost must be taken over by government, or no advantage what we can use with modern medicine.
2- Aggressive containment procedures ( as you see in Italy). It is clear that these measures have devastating effects on economy, pain is inevitable.
3- We need ICU type medical care who fell life threatening level of sickness, Which is known the most expensive type of medical treatment and care. even more demanding, you need respirator device, it is an expensive device ( relatively ) and we have officially 65000 in US at the moment, we may need triple or quadruple of that number at some moment.
These 3 is our big issues like all other countries, Brace for impact follow advises , no fooling around , do not believe fake remedy's.
1
I had H1N1 10 years ago and it was nasty. I coughed for months, sick as a dog. Even though there was a vaccine, only the most vulnerable were able to get it at the time I was sick. H1N1 was not a new virus, types of this virus had been around before, so they could could create a vaccine early. H1N1 fizzled out in the summer and came back in the fall. I think things may start to get back to normal by June or July and all heck will break loose in the fall again. Hopefully, they will have enough vaccine by then to go around. But, I doubt it.
3
It is folly to expect the Trump Administration to possess the leadership and expertise to rally the American people in this time of crisis. Trump is no FDR and his administration is poorly staffed with the necessary scientific expertise to cope with this emergency.
This is what happens when you place an unqualified showman in office and his first & only priority is getting re-elected. He has hollowed out the federal bureaucracy to such an extent that the necessary expertise to overcome a serious pandemic may be absent. He cares more for loyal sycophants, than doctors or scientists that will treat this pandemic for what it is, a grievous threat to American life.
This was something totally unforeseen by the electorate in 2016 and it is the reason why we usually choose presidents from a small group of qualified individuals with the intelligence & temperament to provide the necessary leadership in times of crisis. Let us hope that we can get through this even handicapped by a leaderless administration.
5
My primary concern is that the ineptitude exhibited this far by the administration is so conflicted politically that things will not be implemented as rapidly as necessary.
It makes me wonder if the reason for such a lack of testing is because they don't want the public to actually understand how much the infections have spread.
And if course the complete lunacy of Trump and Pence both neglecting a test themselves.
Imagine the CEO of a major corporation refusing to do so.
2
Beautiful plots, but ...
"Prediction is very difficult, especially if it's about the future."
Niels Bohr
3
@C
Two things is certain
1- This is contagious disease.
2- We have no data showing this is waning.
3
My friend sent an email saying drink ginger tea because it bolsters the immune system. I said for me the top priority is to avoid being tested. If I tested positive I might be forced to quarantine. I'm not afraid of the virus but I'm sure I wouldn't like the quarantine.
I'm aware that my thinking is antisocial. That's all right with me. I identify as an antihumanist.
3
My biggest question: Why is this an Opinion piece and not a news piece?
1
Hats of to the epidemiologists at the University of Toronto, along with their colleagues at Sunnybrook Health Network (Toronto) and McMaster University (Hamilton, Ontario) who have succeeded in isolating the Covid-19 virus, which is crucial information that they will share worldwide to develop treatments including a vaccine.
https://sunnybrook.ca/research/media/item.asp?c=2&i=2069&f=covid-19-isolated-2020&fbclid=IwAR3KPoBr8X33jz84VJNF8pkLEl5K31TFCgSLqcipvN9U75LEK8nFmBz7cKU
3
The President and Vice President of United States, both exposed to the virus in recent days, arrogantly refuse to get testing and Trump keeps shaking hands with everyone he meets.
Thus increasing the chances of spread, to people in his immediate environment who are, you know, not doing anything too important....just running a country.
This is the "model" behavior we are getting from the very top.
No Words.
I sincerely wish all of us the very best of luck over the next several months. We are going to need it. Lets do everything we can at a community level to fight this, despite the egregious, sickening, criminal lack of professional leadership at the top.
6
I don't understand the math. The case fatality rate is 1%. How does 9.4 million infections result in 1 million deaths?
@Peter I had the same thought, then I reread the text that accompanies that part of the graphic. 100 million are infected in total (the area under the curve). The peak represents that 9.4 million would be infected at the same time.
@Peter The label is "at peak" which to me means the maximum at one time but is not an integral of all infections. At each data point the assumed 1% would be dying, which I expect would give the total of 1 million deaths.
These graphs are very helpful, Nick. At this point in the US, we must "take care" of each other - though not physically! Social distancing, and for some self-quarantining, is one of the best practices. Of note, I read an article on twitter about South Korea now bouncing back after a 2-week long siege of steadily growing cases - the past 3 days have shown significant drops in new cases. Their intensive drive-through testing made all the difference. IF this egregious administration had taken the WHO's offer of millions of cheap test kits, and not decided to allow two companies to benefit from making them now, we would have enough test kits NOW. Colorado is the first state to implement drive-through, and NY is starting theirs soon. The people need to speak up to their legislators. Otherwise we will get to the numbers you describe. I'm self-quarantining - transplant recipient.
1
Looking at the charts again, I feel like Ebenezer Scrooge asking the ghost of Christmas future. "Are these the shadows of the things that Will be, or are they shadows of the things that May be only?" The prospect of so many deaths in even the best case scenario is heartbreaking.
1
Helpful graph, thank you. I hope it impacts policy.
There's a regional aspect to the spread (https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html). That interacts with the timing of successful intervention. Especially if we fly less, it'll hit communities at different times. Closing schools might make sense in parts of the Bay Area and Boston now, but it wouldn't make sense, yet, in Helena, Montana.
Also, we could spread the distribution in time and still "destroy" one community hospital after the next. Infected, and now-immunized, health care workers could even move around and help in the next region where they're needed.
It would be helpful to have the regional aspect more explicitly in the model. Even better, it would be helpful to predict when is the best time for each community to time their intervention.
When is the best time for people in your neighborhood to work from home and to shut down schools? With modest levels of randomized testing everywhere, and a model like you've shared here, the answer should be a direct function of the population density and the current (random-tested) infection rate.
That would make it more calm/controlled, like predicting a rain storm. That could lead to more efficient responses. That could calm people and markets. And that could help the most financially imperilled.
1
If the government starts attacking the testing issue and we shut down public gathering, we can probably reduce the scope of infection and death. The caveat is the numbers of people that do not have the separation capability because of jobs and children.
2
"Situation improving" - it is cheerfully stated by Mr. President, and echoed in this report - this with coming higher ambient temperatures (spring,summer). But doesn´t that apply only to colder regions (like State of Alaska, Toronto, and to my current homecountry)?
But a majority of americans live in States where people mostly stay in AC-cooled crowded rooms and cars all through the warmer seasons, lasting for most months of the year.
1
"Try it yourself...?"
That is a form of self-indulgence that we don't need
.
You are both serious enough to know that we shouldn't be treating what we are facing as a board game.
In essence, we don't need to "try it ourselves," we should listening to the science experts.
1
@rw Yes, I agree. Kind of feels kind of macabre to "try it ourselves" and figure out how many deaths can occur.
2
@rw The point is to demonstrate how varying the timing and severity of actions changes the effect on the situation, using models from epidemiologists. An interactive graph is a good way of getting that across. The important thing is not the actual numbers; it's the trend.
1
Ohio’s Governor DeWine and the dozen scientists he has worked most closely with use exactly the same modeling as you do.
That is why yesterday was the date DeWine ordered schools to close for at least the next three weeks, visits to nursing homes and state hospitals to cease immediately, and a statewide limit of 100 in any crowd.
His goal is to flatten the number of infected citizens when we hit peak of the epidemic inside the state, and to have us beyond the worst Number of hospitalizations by July.
He emphasized that although only 5 Ohioans are confirmed to have COR 9 as of 2 pm yesterday, if he waits even a week, that dynamic chart gets much worse. With cases doubling every 6 days for this virus, he wants to drag down the speed of spread starting now.
He keeps emphasizing that most people are asymptomatic for days But still spread the virus.
5
Outstanding article. This makes the model easily understandable and illustrates the impact of practical changes in our behavior on the peak severity and cumulative fatalities,
The good news is that an aggressive approach can save thousands of lives.
Lets get underway today!
1
Clearly, the GOP has gotten its wish and has decimated "Big government" to the point where we have to rely on the states and cities to run the country. Even athletic associations have done more than the federal government.
7
@Anthony I agree! Notice how Socialist/Liberal giveaways come in handy for this 🍌republican regime to score political points just as unity of the American People is used when the ruling circles need cannon fodder for their wars. The Big Government is the physical structure of our Constitution and those who attack it are the real enemies of our people!
1
Thank you for this great piece, especially the interactive model!
I'll say again: this is why I subscribe to the Times.
2
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.
2
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.
1
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
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.
3
Thanks for the informative article. I have a question regarding interventions...in 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.
1
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.
1
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 ..."
7
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.
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.
3
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.
2
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.
1
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.
6
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.
1
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!!
3
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.
1
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.
2
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.
4
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.
2
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.
1
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.
1
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.
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.
7
@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.
2
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.
Helpful in understanding the facts not fiction; gives me a sense of control..at 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?
1
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).
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.”
3
thanks for the epidemiology lesson, I wish this was presented to the President (maybe it was but he wasn't listening, dangerous)
1
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.
2
Where do you get a six day doubling number? It looks more like four days.
1
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)
2
Could you modify the model so we can see how many fewer deaths there will be if Trump immediately resigns?
10
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!
1
I enjoyed the line "But the wise uncertainty of epidemiologists is preferable to the confident bluster of television blowhards"
1
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.
3
Brilliant graphics. There should be a prize for brilliant graphics. Maybe there is. Thanks NYT
1
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.
3
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.
2
Thank you for this article.
1
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.
4
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.
2
For an even more comprehensive set of model results, read this excellent article: https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca
1
“The figures are for America, but the lessons are broadly applicable to any country.” LOL LOL LOL
1
Nothing to worry about since Jared is now leading the effort!
3
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?
4
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.
2
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.
2
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.
1
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.
3
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.
1
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.
4
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.
3
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.
2
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.
https://www.npr.org/sections/goatsandsoda/
2020/03/03/809904660/why-the-death-rate-from-coronavirus-is-plunging-in-china
https://www.worldometers.info/coronavirus/
2
"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.
2
Infections in Singapore and Northern Australia suggest that summer weather will not dampen the infection. It is not the flu.
Please send this link (below) to all that question aggressive social distancing measures.
https://www.theatlantic.com/ideas/archive/2020/03/who-gets-hospital-bed/607807/
2
Nice job NYT.
1
Hey @nytimes -- high-five to your data science team.
1
"Play" with a model? Really, NYT, you could do better at choosing your words.
This is where America pays the bill for having elected a transgressive, narcissistic, sociopathic two year old to run its affairs.
Pays in full.
2
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!
1
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.
https://www.npr.org/sections/goatsandsoda/
2020/03/03/809904660/why-the-death-rate-from-coronavirus-is-plunging-in-china
1
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.
1
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?
1
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.
1
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
3
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.
2
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".
3
@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.
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.
3
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?
1
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.
3
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.
1
@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.
1
@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
Yet the schools are still open. Just the kind of leadership and vision that we've come to expect.
3
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.
$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.
3
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.
3
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.
2
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.
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.
2
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?
3
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.
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.
2
THANK YOU Nicholas Kristof, Stuart Thompson and NYT. I hope leadership will heed this modeling and take aggressive action.
2
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.
1
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.
1
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?
3
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.
5
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.
8
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.
1
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."
3
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.
2
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.
2
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.
2
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.
1
We're pretty close to locking the barn door after the horse has escaped.
2
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.
4
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.
1
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.
1
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.
4
@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.
1
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?
2
@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.
@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.
1
@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.
1
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.
4
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...)
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.
3
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!
1
The phrase 'the wise uncertainty of epidemiologists is preferable to the confident bluster of television blowhards..." says it all.
321
@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.
4
@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.
5
@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.
5
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?
3
@Susan Yes! I’ve felt the same way. It’s just as bad as a handshake.
1
@Susan Wear surgical gloves and then wash the gloves.
1
Not great news, but the first solid news for those of us trying to get the shape of things...my 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.
634
@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.
786
@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.
110
@Nicholas Kristof The link below makes the same points you do but in more detail and using actual data from different countries. He argues for even more aggressive action from all of us.
Please read the essay at this link: https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca
42
'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.
4
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?
452
@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.
450
@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.
102
@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.)
35
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.
2
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.
884
@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).
21
@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?
116
@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.
4
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.
4
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":
https://www.unz.com/isteve/arguably-wrong-ballparks-3-different-strageties/
1
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.
2
@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.
2
@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.
1
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) ...
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.
4
In the US, it’s too late to count on “testing.” We all have to concentrate on social distancing and hand washing.
2
"...uncertainty...shouldn’t see this model as a precise prediction."
Should read "...shouldn’t see this model as an accurate prediction".
1
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.
3
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!
2
Act early and aggressive, yes, thank you. But we already missed that train. NYC still keeps the schools open.
2
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.
4
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.
2
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.
111
Only yesterday, I think, I read comments about chancellor Merkel´s warnings, which she issued in Germany. Comments to the extend of "How can she scare everybody like that? If this was true it could mean 0,5 mio dead." Well,...
Already yesterday I felt she was (involuntarily) raising awareness about the seriousness of our problem not only in Germany but also in the rest of the world, while other so-called leaders are gone golfing.
I am glad to see this article and simulation by the NYT - and to see that commentators do not consider this alarmistic any more.
What a difference a day makes.
7
What’s really frustrating is that America had a few weeks to see what was happening in Asia (both with the virus spread, & countermeasures being taken) and to prepare, but little was done except lies about how it’s nothing to worry about, just like the seasonal flu.
3
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.
4
If Trump's current behavior and the distorted blathering of conservative media is any indication of what is to come - we are headed towards the worst case scenario. Where are our true leaders who will make a difference? It's not just one person trying to boost the Dow. It's all of us who take appropriate precautions now.
3
What's interesting with the models is they will not be applied equally. In real time you will get to see if the aggressive measures in, say, New York work better in states that don't adopt them. We will get to see the 'overreacting' perspective play out. This pandemic is just a worse (Not necessarily worst) episode. More will follow. Some less severe, perhaps some more. How we handle this one will determine how we handle the next. My biggest fear is human arrogance. Trump will have you believe we are better than viruses simply because we are human. And Americans, being the 'best' humans on the planet, are better at defeating this than, say, the Germans. Isn't it so ironic the biggest threat to Americans aren't 'invaders' at the border? It's the ones sitting right in front of your mucous membranes. The ones you can't see. And Trump wants to Pooh, Pooh the experts who suggest building a 'social distance' wall to keep them out.
4
Trump, FOX, and Republican "leadership" believe the real threat is to Donald Trump's re-election prospects. That is clear from their rhetoric.
3
"We’ll be honest: We worried that the clean lines in the graphics here risk suggesting a false precision. None of us know what lies ahead. But the wise uncertainty of epidemiologists is preferable to the confident bluster of television blowhards. The one thing we can be confident of is that enormous risks lie ahead — including a huge loss of life — if we don’t take aggressive action."
This paragraph should have been the lead. Not everyone reads a long article through to the end, even a good one such as this. Peace.
BBC this AM reporting India's caseload has begun, and China begins to propagandize that there is no proof the virus began in their wet markets—the world should thank them for their unprecedented response. So. They won't look into these markets, then?
A little early for the brand of self-congratulation China is beginning to promote.
We don't know if people can be re-infected, and if India flares incredibly, the West of China may be re-infected.
And while it is generally true viruses fare better in the cold—half the globe is always in winter. Our virus needs only winter over in the Southern hemisphere, as the Spanish flu did—and return again in the fall.
A Journal of the Coronavirus Years—we need a volume to match Samuel Pepys, or Gabriel Garcia Marquez.
Simply seems so surreal.
2
The fact remains that we do not have an adequate ability to test people, as well as "leadership" that is utterly incompetent. So by that qualification alone we are in for a serious epidemic.
5
US has not tracked and traced infections - massive case of under reporting. Washington state had a serious problem and no effort to contain. You guys have a serious problem and the government is not taking it seriously. China has shown that lock down works and it a model you need to start thinking about. Watch Italy with interest and see how long it take to contain. Spain/Germany and France may need local or country wide lock down by mid April. UK may follow by mid-may. If you don't prepare for that then you will have people dying at home because hospital system cant cope with 1m to 2m cases.
6
Trump will NEVER acknowledge the seriousness of the virus because he is incapable of admitting that he was wrong. Furthermore in his mind the flu kills more people annually than does the virus making it less dangerous. Also social distancing is for him an abstract concept that he does not understand.Particularly since it interferes with the adrenaline charging mass rallies of his fervent supporters.
2
Any ... model is only as good as [its] assumptions and the way it’s designed to work.
2
Thanks for this article. Well done. One minor correction: some of your red lines are labeled as "infections", which makes sense when you are pointing out that the US could experience 100 million potential infections. Others of the red lines should be labeled "hospitalizations", eg when you say we could have 9.4M or 533,000 infections (should be hospitalization) at peak.
2
Excellent article, informative and non inflammatory, just well presented facts and facts are what are missing in much of the media coverage at the moment.
Your average person just wants to know what is this bug and how do I avoid it, what are the signs to look for and what happens to me if I get it or someone I know gets it.
There is an absolutely essential article in the SMH which readers here should take a minute to peruse. It covers even more than this article and when the two are read in conjunction and the information taken on board...your fairly well on board of what can happen, what to look for and how to behave.
https://www.smh.com.au/national/what-does-covid-19-do-to-the-body-and-what-s-it-like-to-have-the-illness-20200302-p5465a.html
It has a chart titled:
The risk of dying if infected with COVID-19 (by age group)
Based on more than 72,000 cases in China until February 11.
I can't reproduce it here but it is in that link and it will allay some fears for sure for many people worried about this. It is indeed the elderly who are most at risk here. It explains how they tried to save the life of the young doctor in China who first alerted the world to the virus and also shows why medical staff are most at risk.
Would love to see the article published in the NYT as well.
3
BBC this AM reporting India's caseload has begun, and China begins to propagandize that there is no proof the virus began in their wet markets—the world should thank them for their unprecedented response. So. They won't look into these markets, then?
A little early for the brand of self-congratulation China is beginning to promote.
We don't know if people can be re-infected, and if India flares incredibly, the West of China may be re-infected.
And while it is generally true viruses fare better in the cold—half the globe is always in winter. Our virus needs only winter over in the Southern hemisphere, as the Spanish flu did—and return again in the fall.
A Journal of the Coronavirus Years—we need a volume to match Samuel Pepys, or Gabriel Garcia Marquez.
Simply seems so surreal.
1
Now if 'Fox News' would ever produce and air a similar tract, would that audience understand, accept and integrate the premises and results?
That is the failing of news that does not educate its audience but attempts to herd lemmings.
3
Michael Osterholm, MD, Epidemiologist, explaining why the US is ill-prepared for this pandemic...in part because the majority of the simple everyday medications we use and many of the acute care medications we depend on are manufactured in China and India...these supply chains are broken right now. Video released on Tuesday.
https://www.youtube.com/watch?v=E3URhJx0NSw&t=2540s
3
The ignorance running through the general public is discouraging and the fact that it is being validated by right wing talk radio is just amazing. Turn on your AM radio and listen to people minimizing this disease, complaining people are over reacting and otherwise down playing the potential impact. The folks who get their news from Fox really are way under informed on the facts of Covid-19 also. Ironically their prime demographic is the most vulnerable.
We also seem to be handicapped by the group in charge on the Federal level. The president has spent all the early preparation time down playing the threat. Pence is outright lying about the availability of testing. All the other political officials follow their lead because they've seen what happens when they contradict Trump ("you're fired!"). They now seem to be coming around but will need to perform much better in order to be effective. We need more medical supplies, respirators, ICU beds, many more tests, anti virals and a vaccine. We need a war effort as Sanders said. We need someone to rally every medical scientist in the country to shorten the time to develop a vaccine. We have the resources we need someone to marshal them to the cause. So far our Federal officials have let us down but that does not have to continue.
5
The virus was here before your graph, and real data needs to be modeled from prior conditions. Your graph is bad and will only increase pandemonium.
1
By refusing to listen to the best available (or even the 10th best....) expert scientific advice FROM THE BEGINNING, Mr. Trump is personally responsible for each and every excess death that occurs because of his cavalier attitude towards what was a "clear and imminant" threat from this new virus. Its a pity he can't be tried and convicted for criminal negligence causing death - or is that criminal narcisssim, since until the fat REALLY started hitting the fire around the world, all he was worried about was his election campaign being damaged by the economic fallout. VERY sad. VERY criminal.
5
We have currently about 3,500 death from Corona Virus in China (over 1 billion people). How can a model be trusted that assumes 50,000 death for the US as best case scenario? I agree, very irresponsible.
1
Nope. Your numbers are wildly inflated. Follow the South Korean data in particular closely. Once the ramp started in South Korea, it has declined to very few new cases in about 5 weeks. Four weeks from now the US will have very low lumbers of new cases. My estimate: 10,000 cases with 600 deaths...That is %0.6 death rate.
1
@TJ Wow. Have you paid no attention to how South Korea has responded vs how the U.S. has responded? It is not a matter of raw numbers, it is a question of the public-health response once the virus has been detected.
2
@TJ The reason to follow South Korea's numbers and not Italy's numbers?
This is important and far better graphically than what I was seeing on TV, where the infection curve was a little above hospital capacity.
We can only hope Dr. Fauci continues to be in the forefront, but he is at high risk himself. Dr. Redfield appears to not be very competent, judging by his performance with Rep. Katie Porter yesterday.
The Cleveland Clinic and the 11 other hospitals who have rapid testing with results in 8 hours would do us all a favor by sharing the technology nationwide. It's time for all of us in the rest of the country to pul together, because help may not be coming from DC.
I can't help but wonder what a highly functioning CDC would have done by now. Elections matter.
4
You are playing mathematical models with very hypothetical parameters. Are you really being responsible by writing that up to two thirds of the US population "could" become infected? Later you do relativise the statement. But, that simple sentence is what the reader will take away from your article. At a time when panic is taking hold and reason is in short supply, I would have expected less sensationalism.
1
If nothing else hopefully this will prove to ALL Americans that the current administration is incompetent and the worldview that free markets will take care of things will finally see its death knell before the body count becomes unbearable.
2
This clear and concise call to action is precisely what the president should have, could have, presented to the country. Instead we get word salad and self-congratulation.
The House should vote articles of impeachment today for criminal negligence. Trump's abject incompetence and willful misdirection would be actionable in any sane society He is literally causing death through intentional obfuscation and malfeasance.
The Senate could convict in a 15 minute trial.
I am not being lighthearted. This action might save hundreds of thousands of lives.
3
Wonderful, if scary article.
Truth is, at this point, I am taking it all personally, wishing I could just go to some central point and get tested.
If no one knows if they are sick, and since we all need to shop and travel, sooner or later we will be around someone who has coronavirus, or we will make someone else sick.
This debacle reminds me of some other stupidities my government muddled into, including the Vietnam and Iraq wars. We like to think we elect competent people, but geez...
Hugh
2
In the face of this crisis the executive branch has launched an all-out effort--to maintain Donald Trump's self-image.
7
South Korea and Singapore have been very successful with this approach. Kind of hard to believe that America can't come up with cotton swabs at the end of little sticks for testing. Trump deliberately discouraged testing for political reasons. He needs to resign and take Pence with him.
5
I was just telling someone 12 hours ago that this was the sort of analysis that was needed to explain what and when things needed to be done. Thanks NYT.
2
Trump's and the Republican's grossly inadequate response only reinforces my view that the formerly grand old party has become genocidal. This wasn't sudden: back during the AIDS epidemic they refused at first to check the blood supply for that virus, and then some "people of faith" claimed that "AIDS is [G]od's judgment on gays."
Today's Republicans' mantra seems to be Make America White Again, and the victim groups of choice now include not only the poor, elderly (privatize Medicare! or lure people into "advantage" plans they can't easily switch out of--all for corporate donor profits), people of color, Muslims, and LGBTQ people. When that's the strategy, NO group of Americans is safe. And epidemics are far cheaper than actually creating jobs (and using resources and money) in an traditional genocide scheme, which involves rounding up victims, building and staffing murder facilities, and transporting the victims there. In other words, mass murder by malign neglect.
Call them out on it...and vote them out on it.
1
Fantastic chart, very informative and succinct, the kind that even almost the White House could understand.
Would like to bring one sobering-scary fact to mind: this model is based on a 1% mortality rate.
So far, the rate has fluctuated at around 3%...
Hope you're right, very much so.
5
A lot of attention in this article is focused on "flattening the curve". And, of course, I think this is right.
However, when I look at the idea “flattening in the curve”, I think of two curves:
The first curve, and the one identified here in this article has to do with keeping caseloads beneath our capacity for treatment.
But, importantly from an epidemiological perspective, we should think about this curve as it relates to our capacity for testing. If we cannot test, we cannot understand who to quarantine, and therefore cannot control this outbreak.
Current epidemiological data supports the assertion that mortality rates are greatly impacted by preparation and preparedness.
We are woefully unprepared from a diagnostic testing standpoint.
Using a "foreign" WHO testing kit was deemed un-American by someone in the current administration.
Sadly, we had at minimum six weeks to prepare for this.
Soon, I fear, this will be more than sad, it will be tragic.
9
Thank you for printing this. Here's the problem though. This information should be coming, not in an opinion column for the NYT, but as an announcement from the CDC.
Fortunately, I live in Oregon. Yesterday in their news conference state officials made clear that, without interventions, more less 75,000 Oregonians would become infected. Farther, although 21 cases had been confirmed (at the time of the press conference), the officials stated that the real number was closer to 150 to 200.
In the abject failure of the federal government to respond to this crisis, I am glad to see that the states (some of them at least) are stepping up.
4
I have seen this equal-area curve with the horizontal “care capacity“ line in a number of contexts now, and it is a great concept visualization that helps frame how our individual choices affect us as a society. Missing is a conceptual vertical line far off to the right that represents the development of an effective vaccine that will cut off the flattened curve and actually make its area = number of infections less.
2
Dr Anthony Fauci said on tv this morning that the peak will be "at least a matter of several weeks...a few weeks up to eight weeks." So I am confused, or maybe skeptical, of the much longer time scales of many months in these graphs.
3
Here's my best guess: mild interventions beginning now, ramping up to moderate by late April or early May (remember, "president" Trump thinks the pandemic will, like the flu, subside during warmer weather - but it's not the flu), then in mid to late June, aggressive measures will be taken.
Alternatively, perhaps this will behave like the flu pandemic of 1918-1919 and we'll see a tapering of the pandemic in early May. Because of the "dynamo", /s, in the White House and his "crackerjack crew", /s, "running" everything, things taper off for the summer and then come roaring back with gusto and greater and more potency. We will be caught unaware, flat-footed (much like now) and things will be dire.
Other countries will have developed vaccines and treatments; however, the US will have nothing. Why? Because of what we have for a government led by a narcissist who believes he knows everything.
6
I am dreading the inevitable economic impact this will have, and the fallout we will all experience with inconvenience and shortages. A lot of businesses and individuals are going to be terribly hurt; this will have consequences for all of us. Some of the damage will not be apparent for awhile, maybe many months.
6
Italy did it like Trump: deny that corona is anything to be taken serious. So it is doubtful that the lower estimates proposed here are still realistic.
2
I don’t find articles like these helpful; it just accelerates anxiety and panic, which is high enough already. Yeah, we know it’s bad and going to get worse. We understand that.
1
@Brad Disagree. I have friends who are freaking out, assuming 200m infected and 1.5m deaths. This makes it clear that taking action makes a huge difference and will help us avoid that worst-case model's outcome. If we take it to heart, that is.
5
@Brad That was not the point of the article. It was to show that active measures on all levels: individual, community, state and federal can be effective in responding to a novel virus. It is hard to feel empowered by that amid the worries of economic fallout that can be more front and center for many of us, but if we can flatten out the curve, we will all be better off, not only in terms of our health but it will also be better economically.
2
I see the dash/blue line peaks on about Election Day 2020.
Everyone is aware that Trump wants an excuse to call off the election and this will provide him with all the cover he needs.
2
Something seems off on the model.
The time of peak infection count seems insensitive to the degree of intervention. Surely more aggressive intervention shifts the peak farther into the future (along with decreasing it somewhat).
Can you explain the model in detail somewhere?
2
Excellent points made here regarding Korea. Using the most recent data that I can find, the mortality rate in Korea is 0.9%
It is important to note, however, that Korea has taken an entirely different position than many of the other countries have been able to take. They have been aggressive with testing, biosurveillance, and transparency -- above and beyond the “social distancing” efforts that we've been seeing here in the US or some other countries.
The Koreans have ready access to World Health Organization testing kits and are deploying 10,000 tests, roughly, per day.
They have high-efficiency drive-through testing system set up throughout the country to minimize spread to healthcare workers and other individuals. Patients do not get out of their car for a pharyngeal swab.
They have adopted a position of amazing transparency and have used SMS technology to their advantage.
As I understand it, when a COVID-19 test is positive, other individuals in the country of Korea receive SMS Messages with the location of the positive test while withholding the name of the patient for privacy purposes. These texts are quite detailed however indicating *possible locations* that the COVID-positive patient visited. There are obvious downsides to this approach, but one is not unrecognized spread of illness.
I believe the data supports my assertion that mortality rates are greatly impacted by preparation and preparedness.
Are we in the US more like Korea or more like Italy?
8
Unfortunately not every citizen reads the NYT. In a related article, people are divided on the severity of the outbreak and the likelihood of effective mitigation, along party lines. With our “illustrious leader” stepping on his own words, contradicting health professionals, all outcomes are uncertain and trend towards the dire, towards the non flattened curve on your chart. My husband and I are both in our seventies. We’re not panicking, but are definitely afraid.
10
The virus cannot be controlled without data. No tests no way.
14
"Any disease model is only as good as the assumptions programmed into it, and there’s so much uncertainty about the coronavirus that we shouldn’t see this model as a precise prediction."
Why not use the algorithms used to exactly predict climate change. It is scientific.
1
This article is enormously helpful as well as hopeful, since it tells us that the best experts see a way to vastly minimize the destruction and death this virus will cause, IF our government acts quickly and responsibly, which means that WE the people need to make our voices heard. We don't want this to turn into a political football - we don't want to hear different sectors of government pointing fingers and assigning blame. That helps no one. We want all sides to work together, quickly,intelligently and effectively. This means that we need to listen very very carefully to the scientists, epidemiologists, doctors and other health experts who are at the forefront of the research, and we need to exert all the pressure we can muster to compel our elected officials to do the same. Moreover, we should be willing and grateful to accept any kind of assistance that foreign governments, especially those who have successfully managed the spread of the virus in their respective countries. China, South Korea and Singapore have shown us what works and what doesn't. This gives us a great advantage since we are not facing the same unknowns that our friends in Asia faced when their battle began. The real question becomes: Is our government prepared and willing to take advantage of that advantage.
I would love to see a committee of 100 non-partisan leading scientists, doctor and other experts, issue a joint plan of action, and then challenge our government to enact the plan.
17
This is inaccurate. The case fatality rate of documented infections may be around 1% or higher *of people testing positive*, but no country has 30% of their population testing positive for the virus. The highest percentage is Italy with 25/100000 = .025%. The fatality rate for documented positive cases only applies to people testing positive, not to estimates of the number of people be carrying the disease, especially since the latter estimates are wildly high and not backed up by actual data.
If you apply the 1% fatality rate for cases that have tested positive to the highest percent of positive cases any country has found, you get 1% of .025%. With the US population that would be 80,000 deaths, not millions.
I hope the fatality rate is not even this high, but claims that millions will die do not seem to be justified by the data from other countries based on what is actually happening as opposed to models or unproven theories. I am not trying to minimize the danger of this pandemic. I'm happy that we're taking precautions. I'm just trying to avoid panic based on bad math.
Applying the fatality rate for confirmed positive cases to unproven estimates on the number carrying the disease, is not mathematically valid and gives a false picture of the danger. The truth is bad enough. Can we stick to that?
4
@Hdb But other countries have taken early, aggressive steps to deal with the virus. We've done nothing in a month. If China still weren't testing anyone, or isolating anyone their numbers would be huge. And no, despite the constant misinformation spouted by our president, we are not testing people coming into US airports. None at all. I just flew in. Not even a sign of testing. Considering the size of our population, we aren't testing anybody.
6
@Hdb
Unfortunately, the math is pretty correct.
Similarly, in Europe, there are estimates which raise the percentage of the virus carriers to climb to even 70% of the population if measures are not taken "yesterday".
To prove those estimates wrong we all need to be responsible citizens, follow the advice of the experts and hope that our governments will take the appropriate measures neglecting any political cost.
I wish you the best of health.
The transmission rate based on the experience of the two cruise ships put in quarantine seems much, much lower than projected here.
Given the time, exposure and delay in separation, one might have expected infection rates nearing 100%...
Assumptions matter and not adjusting the RO to demonstrate the impact on the projections is malpractice.
2
I'm startled that the predicted best-case scenario is 51,000 deaths. And it appears that if we begin aggressive intervention today vs modest intervention today (it seems to have already begun), the result is 269,000 fewer deaths. Thanks for this revealing tool.
6
It won’t be long before testing won’t matter, as too many will have the Covid 19 virus, but social distancing will matter greatly to avoid the peak happening too quickly and severely for hospitals to manage the patients within that 15-20 percent who gain more than a mild case. Let’s do all we can to flatten the curve, to care for the high risk and our medical professionals. We can slow the progression down and alleviate 2/3 if the death toll. We can ‘treat others the way we wish to be treated’. God have mercy on us, if we don’t.
9
Yikes! From the graphs it looks like we'll all be staying home for the summer - maybe not even to attend local funerals. What's scary now is the continued lack of enough coronavirus test kits (not to mention a lack of smarts, compassion and truth telling in the Oval Office).
225
@nestmaster The model doesn't count on warm weather, which may help; in that case there would be improvement in the summer and a worsening in the fall. No one knows.
Funerals are a really big issue. There may be a lot of them, mostly of old people who have elderly friends and are themselves vulnerable.
144
@Nicholas Kristof
Precisely why Italy has banned large funerals.
12
@Nicholas Kristof
As difficult as it is to suffer a death in the family, the silver lining has always been the way family and friends take the opportunity to come together not only to honor those who have passed but to provide physical manifestations of love and support to their immediate survivors—showing up to the wake, the funeral, the repast; hugging one another; bringing food to the bereaved and promising to stay in touch.
In many large and far-flung families this can be the only time they see one another.
Then there's the necessity of going through all their belongings and distributing things of financial and/or sentimental value.
With social distancing, the dangers of traveling in enclosed spaces, and a reluctance to stop at rest areas on long trips, I fear all of that will be lost.
People will stay home and I'm sure that's wise for their biological health, but I worry about our psychological and emotional health and the social toll not being there for one another when we're not only losing our loved ones but losing them in the middle of a global pandemic and throwing away all their mementos will have on us as a society.
29
I know this is just one facet (and may not be important to some), but restaurants in New York are New Yorkers' "go to". I was just at a restaurant picking up a "to-go" order. I was stunned at the lack of response by management: Servers re-folding used napkins, picking up used glassware & flatware. Why is the restaurant industry/association not responding??? Servers should be wearing gloves, perhaps switch from glassware to paper cups. The restaurant business without this epidemic is difficult enough. We've already seen an implosion in retail here. Now, we're going to see shuddered restaurants, the "heartbeat" of what makes New York tick. How is the government (local, state, federal) going to respond????
13
Regarding the impact of warmer weather, an article in this newspaper this morning pointed out that the infection is currently active in summertime Australia, as well as in Singapore which is warm and muggy year round.
143
@RMS That's true, but many cases in both countries have involved infections picked up elsewhere. It's not clear how much community transmission there is in each place, and there's some reason to hope (based partly on southern China vs. northern China) that warm weather may help.
166
@Nicholas Kristof You can disregard my earlier response. I just read on and found my answer
@RMS
Trump doesn't understand climate change, much less the science of Northern and Southern Hemispheres...
Donald Dear....when it's winter here, it's summer there. Got it?
Confirm with your man of science, Pastor Pence.
36
China has many millions more people than the US and the number of infected at the same time never exceeded 60000. Total deaths are around 3000. So the numbers in this article seem pretty high by comparison.
I would like to see this model applied to China to see if it can predict those results.
10
@danarlington
China took drastic measures to prevent infection. Cities were locked down, transportation was halted. People were not allowed to leave their apartments - except perhaps for short trips to acquire food. Everybody was being monitored for fevers. They took extreme measures of "social distancing". If we don't want to see many number of infected people in US at the same time, similar social distancing measures have to be adopted. That is the point of this article.
7
@danarlington China is a dictatorship that can demand people stay inside under threat of being shot or arrested. That will not work in the US.
3
@danarlington Per The Daily podcast (Thursday March 12) China has recently been very aggressive setting up fever/testing stations all over and if one tests positive they are instantly quarantined. They have buildings and beds set up. 75-80 % of cases come from family clusters) thus China’s number of cases is decreasing. Maybe they realize this type of quarantine won’t happen in the US.
2
Excellent. A real public service.
11
This is very interesting and very helpful. I was quite surprised to see that regardless of the choice of when interventions start, this model is projecting the peak of cases in July. That is far later than I think many of us would have expected. It would be helpful for the authors to expound further on that. For many of us - managing home and work lives - that time line is actually very important.
22
We have never developed immunity to Coronaviruses (colds) before this one, because they tend to mutate. I would love to know if we have seen a lot of that happening with this virus in the genomic testing. If it is mutating, that does not portend well for reinfection and a second virus season and more beyond.
13
@Office manager There was a news item from Politico this morning that a tour bus driver in Japan has been re-infected...it appears that reinfection and mutation is occurring already.
This is responsible reporting.
This public health professional thanks you.
96
This is scary, listening to the media one gets the impression that the worst will be in the next 2-3 weeks. If these charts are correct we are facing massive increases in infections over the next 3+ MONTHS!
13
As to whether it will abate with summer, cannot we look now to the Southern Hemisphere, where it’s late summer, as a gauge ?
20
@Boyd
Trump doesn't understand Northern and Southern Hemisphere.
A stable genious like him can't be bothered.
5
@Boyd
Yes, and it's apparently not clear from the data. I think Kristof wrote that in response to another commenter. However, whoever it was said that comparing northern to southern China, it looks like there may be a decline in summer.
As for why that happens with the regular flu, and colds, I suspect it's because people get more vitamin D in summer-- as without supplements, the main source of vitamin D is sunlight, and when the sun gets too low in the sky, the relevant rays are filtered out.
Without sufficient vitamin D in the blood, the immune system is not functioning on all four cylinders. Sufficient D is 40-60ng/ml. In the darker months, I need 2500-3000 IU/day to get to that level.
Rule of thumb: if your shadow is longer than you are, the D-catalyzing rays are being filtered out.
2
Insightful presentation of potential scenarios. I strongly encourage you to develop more features of this type. The plots presented are quantitative, however, and it would be helpful (and strengthen the presentation) to have more information on the nature of the modeling--an expanded Methodology section--with links to sites and papers describing more mathematical details of the modeling.
10
The FDA has announced a new test that is 10 time faster than the old one.In the mean time the USA has ordered 300 million of the old test and gotten an unbelievably good price with delivery sometime this month or early next month. The new tests will be available in time for the next pandemic and we'll likely only need half as many.
4
@kirk ?satire
@kirk What is your source for this information?
@Elizabeth /Leonie
My bad. didn't mean to scare you. The first part about the ten times faster was news this morning. When they would be available was not clear.
I am a professor of medical genetics. It is my opinion that given the number of people infected with C-Virus grows exponentially across the Globe, it is likely that millions are already C-virus carriers. Professor Lipsitch a Harvard epidemiologist says that within a year, 40-70 % of people world wide will be infected, and emerging consensus among epidemiologists is that most likely outcome will be a new seasonal disease. So probably there is no escape everybody eventually will be infected. Efforts should be concentrated on protecting the most vulnerable-ages 70 & up & practice social distancing so not to overwhelm the health care system. Children <9 are asymptomatic to C-Virus and incidence of severe Covid-19 in young people < 50 is very low ~0.1% Thus, analyzing why children & young adults are protected should dramatically accelerate availability of antidots.
77
@lieberma
This is a more rational response relative to the "we're all going to die" hysteria that this article is promoting.
4
Thanks! A great tool for visual learners, and, perhaps, for the otherwise hard headed. Well done.
22
What we dont know
1. was this floating around 6-12 months before it was identified. most people had mild cases. now a sever strain has surfaced. which is more deadly
2. If exposed do you become immune or can you get it again? If there is immunity is it only temporary like if you just got it you can fight it off but if it dies off in the summer it can resurface and you dont have immunity. Or is it like Chicken Pox where you get it , survive, you have immunity.
3. My concern everyone goes in isolation , disease goes down. then people congregate again then it goes up again.
4. In a test will there be a difference between currently have it vs you had it and are now done.
For people who are wondering. You dont know what the next outbreak is in so there is no way you can plan and store cures for unknowns.
7
The world has changed for all who are alive today. The freedoms that we knew to congregate and travel freely will be over for the remainder of the lives of all that are alive now. The virus and other viruses are here to stay. There is no way to eradicate them. They will likely gain strength and virulence. Other viruses will surface. The emotional scarring is developing now and will remain forever. Everybody will be afraid to engage in sports, travel and even work. Socialization is forever changed. Look at he TV shows without audiences. We don't realize how important these things are until we do not have them. Flesh and blood needs flesh and blood. Now they will be taboo. Sexual interactions will be heavily curtailed, even with spouses. The day has come for the apocalyptical naysayers in their bunkers. Life as we know has been dramatically diminished forever.
2
@rich williams Yesterday a viral expert explained that this particular virus is not evolving, so he doesn't believe it'll become more deadly. And a vaccine is in development.
People said things "changed forever" with HIV (a far deadlier virus), Pearl Harbor and 9/11.
We adapted and got back to a recognizable "normal" after those catastrophes. We'll adapt and become complacent after Covid-19, too.
28
@rich williams
Seriously? - You are not, by any chance, running an online-shop for "Doomsday-paraphernalia" or trying to start a new church, are you?
Of course, viruses will be around. They always have been. New ones will surface. So? We´ll deal with it. Either by vaccination, or by self-developed immunity in our bodies.
Please yourself and dig your own hole to hide in, if you like. But stop scaring others. (and f your comment was meant as satire, I apologise I did not get it.)
1
@Randy
sure right about 9/11
1
We need more testing, many thousands every day. This should also include rapid point of care testing. Rapid testing can be antibody or antigen testing, not RT-PCR. Years ago, FDA approved rapid testing for HIV which you can by at pharmacies and test yourself.
We need a much better handle on who has the disease and we have the technologies to do this. Hopefully, it will begin very soon.
That a country like ours is the worst advanced nation at tracking this pandemic is the culmination of years of gross misinformation.
17
As shown on the graphs very early intervention is absolutely essential. Everything possible to do must be done if that means closing schools, public gatherings, etc.
11
Why should we see infection numbers different from Germany whose Chancellor predicted two thirds of the population would become infected? That would equal 200 million people contracting the corona virus here. With a 1% death rate, that would mean 2 million deaths. I would agree with your worst case scenario if we were taking aggressive action now. But given that we don't see Trump, Ivanka, AG Barr and other self-perceived GOP toughs who were in close contact with infected people self-isolating to protect others like the Canadian Prime Minister is doing because his wife tested positive and we also have the leading cable news and talk radio programs telling its automatons that it's a hoax perpetrated by the Dems or no more deadly than the flu, I think my numbers will turn out to be more accurate. They might even be half as many deaths as might occur in the U.S.
15
Thiis is a good article. I'm an old geezer, but when I was much younger I taught courses on differential equations in a small university.
The students found differential equations boring, so I tried to liven the course up by applying toy models to diseases and epidemics. As an example, I would point to "the Plague" by Albert Camus.
The students weren't impressed. I was an unpopular lecturer. However, one implication of the models sometimes generated a modicum of interest.
The model showed that if a ship of sailors arrived in the port of a fictional city, let's call it Oran, infected with bubonic plague, two scenarios would unfold.
If the city was too highly populated the number of interactions between sick and susceptible would be high and there would be an explosion of cases.
On the other hand, if the city were more sparsely populated and interactions occurred less frequently the plague would die out.
I wonder if the same principle might hold for COVID-19. Perhaps those who live in farms outside Bison, Kansas, and go into town only once a week for animal feed are better off than those in New York City, whose look out their windows at apartments which stretch to infinity.
In other words, the lethal nature of COVID-19 is just one more example of the downside of too much population growth.
It started in the highly congested city of Wuhan, and will continue wiping out people around the world, but somewhat selectively, sparing the left-behind areas of the Midwest.
38
Great analysis and graphics, but the peak occurs in July, and there's quite a bit of evidence this is a seasonal virus. Time will tell.
3
@Robert Could you elaborate on this? From what I've heard virologists say, this is not the case.
6
@Robert
There is no evidence, yet, that this is the case. It's a possibility - not something to count on.
1
Science and technology can not solve almost any problem if the people in charge don't understand or refuse to accept the issue in the first place and whom to solve it for.
It's also the responsibility of the scientists, the real ones, not those phony guys with a PhD in STEM or a job with scientist designation, but without those 'core values' that make people aware of the society and the world they live in. Two basic qualities of a scientist must be 1) honesty to talk straight, and 2) the courage to stand up for truth and honesty, particularly when those "core values" are challenged.
Yes, democracy is not about elections or majority opinion to decide or evaluate truth, but about what to do with that. But that would fail miserably if we fail to understand what is *Truth* in the first place. And it's the scientists that actually define what is truth. Philosophers and other original thinkers later can add to that.
Forget about communism and other forms of autocracy, even democracy would not work if we fail to define *Truth*.
11
Sadly, these worst case scenarios are too optimistic.
When the health-care system is overwhelmed, more people die.
Take Hubei as comparison: 4.6% case fatality rate.
Thus, I'm counting with 5 million deaths if uncontrolled.
The US health care system is spotty… how worse can it get? dunno.
8
@Volutes But in the province, the fatality rate is about 0.4%, so maybe...
1
@Volutes
IMHO the focus of the article is not so much about numbers here but on the dynamics of time with regard to interventions and there possible impact
@OneView
Maybe not.
The epidemy was stopped in Wuhan.
Uncontrolled in the US it would...
Really? China just made it through the coronavirus epidemic that it started with less than 4,000 deaths, and Nicholas Kristoff is leading us to believe that the best case scenario for the US is 324,000 deaths, although a million dead is also reasonable in his simulation.
It's so absurd one has to wonder what the angle is here.
3
@Chuck French China was able to lock down an entire city. We have not done that so it will continue to spread unabated. The best we can do as citizens is to lock ourselves down.
35
@Chuck French I more or less agree with you about China. The thing is, can the US do anything on the order of magnitude of intervention that China did and in the same quick time frame. I don't see people realizing the need for extreme draconian measures like massive quarantines and so on for at least 2 months. Maybe the stock market crash will ring the bell, I don't know. In China, the leader says it and it happened. How much pain will the US need to experience before it will be acceptable to go that far. Also, I have a student in China and I spoke with him 3 days ago. Every movement is monitored now to make sure that sick people are not in the public. Still, all restaurants are closed as well as supermarkets according to him. I think it is necessary to go that far but I doubt it will happen. ON THE OTHER HAND, there is this article today in the NYT: https://www.nytimes.com/2020/03/13/opinion/coronavirus-best-response.html
7
@Bill think of this comparison: China is able to build 1,000 bed hospital in 10 days to confine and treat patients. Does anyone believe we could do the same? My response is not a chance as permits, public hearings and federal approval would have to come first. Even though we have bungled testing thus far, all projections predict cases in the millions so perhaps we should get started!
4
I unfortunately work for an outpatient healthcare practice that has balked at rolling out updated measures to protect staff and patients, despite multiple pleas from myself and other doctors to update front desk screening questions and provide more protective equipment. Like Trump, my practice's administration can't seem to wrap its head around the concept of good prevention paying off dividends later, even if there is some short-term loss. If there are other healthcare and general workplace settings like mine that are dragging their feet, I worry that we will see the worst-case curves depicted in this article. As a physician, it is upsetting when my inbox is flooded with emails from various non-medical businesses and services explaining how they plan to limit exposure, yet I am a physician and am hearing crickets from the (non-physician) "leaders" of my practice.
79
@anonymous you are not alone. it's happening in my city, too. it doesn't help that the official guideline are weak. look at the cdc guidelines for outpatient clinics. they say "explore telemedicine options" or "consider" rescheduling non-urgent appointments. it is all very wishy-washy and optional sounding. The only thing I can say is keep speaking up, or threaten to leave if they don't change their tune and get others to speak up with you (doctors have power only in numbers when going against administrators). I imagine there will be lots of locums jobs for telemedicine in the coming weeks and months.
9
Trump's shoddy leadership of the feds coronavirus pandemic response has resulted in actions and messaging that fall far short, probably dangerously so, of what is needed to protect Americans and aggressively treat those who become seriously ill. America's response to the public health crisis is not wholly dependent on the response out of Washington, D.C.
The states possess considerable power and messaging capability, too, especially if they work together.
Politics must be minimized. The manufacture and distribution of coronavirus test kits, masks, and other protective gear; having experienced public health leadership, including virologists and epidemiologists, with the authority to manage resources, and equipping and supporting nurses, physicians, and other medical staff adequately, are priorities.
America has a great many people qualified and dedicated to protecting our citizens and caring for those who need it. Stop focusing on those who should be leading the fight, but are not doing so. Let the professionals lead the fight. Let them do their jobs.
16
Irresponsible. Even the most credible scientists are sharing "death rate" numbers that are based on such limited and flawed data that they are worthless. Most people now believe that 2 or 3 of every 100 people who get infected will die. Look at the country with perhaps the most comprehensive testing program, South Korea. Out of several thousand cases, how many people under 30 have died? Zero. How many people under 40? One. How many under 50? One. Even these numbers probably overstate the mortality rate because there will be many people who only experience mild cold symptoms and are never get tested. People die in America every day from preventable causes and we carry on without any concern. The greatest public health emergency we face is obesity and the corresponding complications, but this is nothing to people. The same goes for distracted driving. Many thousands of innocent, healthy people are maimed and killed every year but try to pass red light camera or automated traffic enforcement laws and watch people howl about the unfairness of it. This new virus is a serious issue but there is a lack of perspective in our response. And BTW, scientists who quote a 0.1% mortality rate for seasonal flu are using an educated guess that estimates the total number of infections (this brings the mortality rate down) and they are ignoring the fact that in less developed countries the flu mortality rate can be closer to 1%.
8
@Teal I agree this is really bad data science:
1. The current case number in the US is likely much higher than the base line assumed in the model since we are testing very sparsely. In that regard the mortality rate is probably much lower.
2. The testing is also not statistical representative because it is not random but along people who show symptoms and their contacts. Severe cases are much over-represented in the data we have.
3. At least for the next weeks we will not be able to distinguish between an actual increase in cases and the results of improved testing (both will happen in parallel).
4. Current death numbers in China (3,500) don't seem support a best case scenario of 51,000 death in the US.
5. Sad that people are uncritical if well-meant bad science confirms their believes.
4
@Falk Schuetzenmeister I would trust the numbers coming out of Italy as they evolve, although even there the quick action of the government to lock down northern Italy is likely a very different response than would be tolerated here by many
1
@Teal the greatest threat to our future with the Coronavirus is people who think like you who pretend there is some conspiracy behind these projections or regular people like you know better. Give me a break!
1
Visuals and sliders graphically depict the storyline. Can someone pass this on to our “very stable genius”?
24
@Tabula Rasa Done. Tweet sent to POTUS with link to Times article.
2
@Tabula Rasa You can't convince a person who doesn't want to listen, and frankly doesn't care about anyone else (save, perhaps, his oldest daughter).
2
Question? If, as they likely are, the infection cases are MORE than we have currently reported because we are currently behind the curve on testing, how does that affect the model? Wouldn't it mean that the predicted peak is a lot closer to us than where your model has it in July?
8
@Sharon Sheppard I’m also wondering about this: and then I’d like to know how fast cases can increase in a locality that doesn’t have an early head start from overseas travelers or (alas) a nursing home.
2
I generally am not a fan of Ohio’s Governor Mike DeWine, but he has done the right thing by proactively closing our schools and prohibiting gatherings and workplaces of more than 100, except for groceries and the like.
20
@J.
Stay well, Ohio.
1
This article again makes me fantasize that our President was named Nicholas Kristof.
What I have not heard about are any plans to back up the clinicians who might be called upon to devote themselves to the care of seriously sick hospitalized patients.
As a retired generalist who volunteers in a free clinic, I would be a logical doctor to take over the care of stable patients with chronic conditions if their usual specialist was unable to see outpatients.
But, I am unaware of concrete plans to “preposition” and “activate” backup clinicians if the size of the coronavirus case load approaches a point of stressing our disease care (non)system.
I looked yesterday at the websites of my state and local health department, my local medical society and the nearest Medical Reserve Corps group.
Hopefully this is being worked on and potential backup clinicians will be asked to sign on.
Stephen Rinsler, MD
113
I grew up in the forties and fifties when hospital floors were always washed up by older women who were down on their hands and knees behind tin buckets utilizing scrub brushes and bars of hard yellow Octagon soap made of lye.
My own mother was devoted to this soap, and I personally knew a few of these women who were, to put it mildly, fanatically good hospital-floor-washer-uppers.
I believe this soap is still commercially available, but I greatly regret to say that these good women are not.
I made a personal vow to myself a long time ago to stay out of hospitals unless and until some adequate substitute is found for these women, and it again becomes safe to eat off of hospital floors, which currently and for the last 30 years it has not been.
I leave it to Vice President Pence, who recently was placed in charge of this matter, to give urgent attention to it before our hospitals death rates skyrocket.
10
@A. Stanton While I generally agree that we as a society are indebted to “older women” for many things, and I applaud you for noticing these good women while they scrubbed, we might be ready for a coed scrub team among some other more radical approaches to dealing with an unprecedented public health emergency. Informed leadership acting quickly comes to mind.
6
@A. Stanton A small correction made "with" lye as an ingredient, not made from lye, which could cause serious burns.
@Warren Courtney
Thank you!
1
My second post on this-we need really good leadership at this time-local, county, statewide, national. First aim is to flatten the curve-but then what? How do we not permanently ruin people’s livelihoods and hollow out towns and cities of businesses? We have hopefully 12-18 months to get a vaccine or better treatments in place. That should be the expectation right now for everyone. Though China has flattened their curve, how well are they sustaining it and how can we do it for America? We need ubiquitous testing so that we know where the hot spots are and quarantine quickly. So where the disease is more controlled or not at epidemic levels, we can go about our daily lives (with smaller gatherings) and not ruin the local economies. On a separate note, do we have to do year-round schooling for a couple of years to make up for lost school time? Can we find ways to reduce school density so that staff, students and parents are not so stressed to be in class?
5
Very well done. So illustrative, I admire the analysis and graphics. What a great team effort.
I also appreciate the frank assessment. Testing was indeed completely bungled (as it was in many European countries... the US is not alone).
Hopefully aggressive measures will be taken, including by the public, and we will flatten the curve. Now, thanks to you, we can really visualise that.
14
Given that many universities and high schools are being closed and instructors are scrambling to provide courses on line, a short module available from CDC should be developed on the material presented in this article. People would understand how the decisions that affect our lives should be made via an all too real case study. A few university students with a background in epidemiology could collaborate to develop the interactive module (with input from Kristoff and Thompson and other faculty with relevant expertise) in the next few days. It is a teachable moment for all of the students who are out of their classrooms and we would have a more informed public. When the next outbreak occurs, CDC would be adequately supported so fewer people would be infected with less serious disease and less economic impact.
19
@Alice Imperial College already has a free online course: https://www.imperial.ac.uk/news/195455/covid19-imperial-launches-free-online-course/
The mortality rate in this model is far above those known for every country to date and those are overestimates for a variety of reasons.
3
@Jim G. As of this writing, Italy has 15,113 cases and 1,016 deaths, or 6.7% mortality rate.
Source: (https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6).
The practice of medicine in northern Italy is more like Switzerland than China where the case-fatality rate is ~3% according to the same data.
So much of the early experience around this epidemic suggests that mortality rate is very much about the ability to prepare for the surge.
25
@Jim G. Look at Diamond Princes: 696 cases, 7 deaths, 364 active cases with 32 in serious or critical condition, 325 recovered so far. The death rate is already 1% (hope it stays that way). Of course, demographics differ from the general population.
4
@AL
Another fancy graphic, but isn't it odd that your reference leaves out South Korea, the country that has one of the most reliable figures for number of infections. The more accurate this number the more meaningful the mortality rate calculation. For South Korea this is well under 1% with the elderly making up the vast majority of deaths.
2
Under-reporting is the issue. Many people have no access to health care or even if they do, they can't get an appointment. Think Naples Florida in season when the health care system is normally maxed out without the Corona impact. A one month wait to see a person's primary care physician is normal. How about the spare capacity of hospital beds? Doesn't exist. As for urgent care walk-in clinics, they will be hot spots for catching the virus. Cleanliness is not a hallmark of the U.S. Look at many restaurant toilets and sinks and those along interstate highways. This illness will run it's course and it's doubtful that politicians will learn form it. Hopefully a vaccine will be developed that will minimize the next recurrence of it.
17
For those who recover we have no testing for antibodies or insight into how long they might last. This is a second level of testing that would be useful as those who exhibit some immunity would curb the infection but also predict a second wave if the antibodies wear off.
I would like to see the impact of antibodies on the flattening of the curve.
9
@poslug
The question is understandable but the knowledge as to persistent community immunity is a long way off: https://onlinelibrary.wiley.com/doi/abs/10.1002/jmv.25685 ("Coronavirus infections and immune responses," 2020)
As for use of antibodies as a therapeutic tool to treat the virus, that is likely even further away, both in terms of discovery/testing and affordability: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5627241/ ("Antibody therapies for the prevention and treatment of viral infections," 2017).
I am at a loss to understand why the Mayor of NYC has not closed the public schools. He must know that this will inevitably happen. He must understand the basic point of this article. Because of his inaction, more people will die in NYC. More people than those victimized by police misconduct. More people those killed in motor vehicle accidents. What is he waiting for?
4
@David A.
The issue is the mayor has not figured out a plan for the homeless kids in particular, and those who count on school for meals and even clean clothes. Many working parents who cannot take time off to take care of kids, or may lose their etc.
24
@Oh My Time is of the essence here. Every little helps bend the curve. Telling people who *can* keep their kids home from school to do it *now* reduces the risk of cross-infection (which is the name of the game for the next few months). It's a no-brainer. It reduces population density & risk of cross-infection. It also keeps teachers safer. Those that have to come to school for food/clothing can still do so until we figure out how to supply stuff for individual families, wherever they are.
We need to move fast on this.
9
@David A. Not single child has died from the virus. Not a single adult under the age of 50 (parents of school aged children).
How many degrees of separation do you go?
When does the cure become worse than the disease?
1
Our country too often displays a bizarre reluctance to use its great wealth for public goods. Mr. Kristof and Thompson show us how rapid deployment of testing facilities, ventilators, and support for quarantines will save many thousands of lives and allow economic recovery much sooner. Dithering and refusal to spend for the public good is the path to disaster. Thank you Mr. Kristof and Thompson.
70
@Charles Knight
Using our power for the public good and to help people is socialism and the surest way to hurt our country.
The only good Socialism is Corporate Socialism, where the rich benefit, and those benefits Tickle Down.
10
@gratis
Watching CNBC, the host actually said it would (and I'm paraphrasing here, but accurately) be better if everybody got it and we were then done with it. Then markets would recover faster. In other words, better to kill off a million or two people rather than have the markets suffer a long drawn out period of uncertainty. He later was forced to apologize but it was striking the thinking of these types. Neither of his two co-host pushed back or disagreed, but that typical of corporate media, especially the business shows.
25
@gratis...
Dead man walking.
2
We the people still are in the dark. Though there is only early data, the information transmitted seems to be woefully incomplete. Your graphics, if a true representation of the spread, is more compelling than any Administration depiction. First we know that cases are increasing in the US, but in China, they are falling, and in other places they are not increasing geometrically. Flu also moves quickly and cases increase rapidly, but we are not given comparisons. The ID and Epidemiologists are in offices at NIH and CDC, and for this brief moment they get to be the stars, but the science at this point seems to be modeling worst case scenarios that may not come about. For instance, in China, perhaps they should have a million cases, and the cases would be going up according to your graph, but they are reporting cases going down, so the data is contradictory. I don't disagree with the current strategies, but I would like to hear CDC epidemiologists give modelling updates frequently and not just tell us what to do, but keep explaining why.
7
@William Trainor The difficulty in both the US and China is a large population without access to affordable medical care; anyone working for low wages will tend to go to work even if sick. I suspect the number of US cases is in the tens of thousands but since there is no capability to determine if a sick person has the new virus no one can be sure. I also assume that many recent deaths have been attributed to "natural causes" rather than the new virus. The current government seems very happy to keep it all secret and pretend anyone reacting (like the NBA, cancelling games) is panicking. Whereas the real centre of panic seems to be in the White House.
17
I appreciate much of what Mr. Kristoff and Mr. Thompson are trying to do. They understand the problems with attempting too much precision. Some of their discussion might help to calm nerves, but no amount of science, at this stage, will stem some of the coronavirus panic that is occurring. There is little doubt that this administration's initial tendency to minimize problems and withhold information made matters worse: https://www.foreignaffairs.com/articles/2020-03-10/science-cant-save-us-coronavirus-panic?utm_medium=newsletters&utm_source=twofa&utm_campaign=Science%20Can%E2%80%99t%20Save%20Us%20From%20Coronavirus%20Panic%20&utm_content=20200313&utm_term=FA%20This%20Week%20-%20112017 .
3
Thanks for this excellent column. It is especially welcome in this atmosphere of fear and uncertainty.
If we all comply with social distancing, more of us will stay healthy and those of us who get the virus willl have a greater chance of survival if we need medical care.
Alas, iIf only more tests had been available, earlier!
25
As I understand it most, if not all, countries are claiming to be following the "best medical/scientific advice".
However, that advice seems to vary from country to country. Some countries are pursuing a much more aggressive response than others. Some countries are trying to be more proactive than others.
The UK government's approach is to slow the spread of the virus with the peak infection rate being as much as 3 months away.
However, no closing of universities or schools, museums & libraries, no closing of cinemas & theatres, no closing of restaurants, pubs or clubs & no cancelations of sporting events & care homes remaining open to visitors
If your approach is to slow the spread of the virus, why provide it with opportunities ideal for infecting a large number of the population?
I'm in a high risk group (age, asthma, scarring on my lungs, compromised immune system). The advice to people like me is to avoid crowds & wash my hands repeatedly. I'm fortunate that I have family who make it possible for me to remain comparatively safe. That doesn't sit easily for me as I dread my wife, children & sister becoming infected.
Finally, what of those who don't enjoy the support I have?
31
@VambomadeSAHB
Thanks for your info from Scotland. I have to decide to pay the last installment on a much anticipated trip to Orkney in July. Having the curve move to July is not good news for me at 73. I will hope I can postpone a year.
2
Very insightful. This helps the American people (read Republicans - lawmakers and voters alike) understand that even in the best of scenarios envisioned, 10k's of Americans may die; and in worst case scenarios, an unthinkable 1M dead. This event is unlike any we have seen in a lifetime, and must be treated that way -- with a robust, public health response that extensively tests, quarantines, and treats -- to keep the American people as safe as possible. We are NOT on that path now.
32
dear gentlemen, as i am Italian and i do business with China, i am under pressure for virus and I have gathered many information on this virus problem and , therefore, i can underline that usually spring season ends the impact of flu, generally speaking, and that will help the temporary solution. BUT, WHAT ABOUT NEXT WINTER FLU SEASON WHEN THE VIRUS, AS ALL VIRUS, COULD COME AGAIN WITH DIFFERENT STRUCTURE AND STARTING FROM OCTOBER, WHEN THE IMPACT WILL HAVE SO MANY MONTHS FOR HIS SPREADING?
26
@ROBERTO
Dear "concittadino", spring season is here (and we never had winter in Northern Italy during 2020) and the virus is spreading like Australian fires, so dont bet on this temporary solution
5
Excellent analysis that helps bring the sometimes confusing but vital concept of curve flattening into perspective.
One factor that it would have been nice to explicitly consider is the impact of aggressive testing as a tool for contact tracking and containment. In much of the country, it is not too late to contain local outbreaks. The key to doing so, however, is to test widely and early. Rather than waiting until a patient has fallen so ill as to be hospitalized, every patient showing even the earliest sights of CoVid-19 should be tested, monitored, and quarantined while contact tracking begins. By the time the patient is very ill, he/she may have passed the illness to countless others in the community.
Aggressive testing and contact tracking might not lower the total number of cases, but it can flatten the curve significantly, particularly in America's rural heartland where relatively few cases have been reported thus far and where medical facilities to deal with a spike in cases are in short supply.
15
What's missing here to me is a note to say that to keep a sustained peak under or near the capacity for a while, you have to ensure your measures are not too restrictive. In other words, you still need people to keep passing the virus on. If not, we'll experience a resurgence in cases and have periodic-like bumps in the curve (and the resumption of damaging measures).
6
China, with a much larger population and less time to prepare, appears to have peaked with under 100,000 infections. And your best case scenario for the US is 3 million?
No. Just, no.
The idea that the United States of America is prepared to tolerate an outcome thirty times worse than in China is unacceptable. How do we defend our system against China's if it leads to such a disproportionate outcome?
20
@Leonard Flier,
Ascertainment of the number of total cases is tough, I would think. I don’t know if there has been a random sample in non sick individuals from China to estimate the incidence of asymptomatic infection.
3
@Leonard Flier after the smoke clears, we will collectively need to re-assess our reliance on Chinese-made products and supply chains. The risks they pose to the health of our society and industry have been glaringly revealed by this situation.
3
@Leonard Flier China had effective testing and quarrenting measures in place rather quickly. We are not mobilizing at the same speed, so it is predicted that the disease will be worse here.
6
Great article. Remember we are still hoping that warmer weather will also flatten the curve and buy us some time to prepare for the fall rebound of the virus.
2
@Tom German Virologists have found that the virus is not temperature sensitive. In fact it loves temperatures of ca. 27 Celsius the most
@Tom Hmmm....this didn't seem to work for Australia, New Zealand, Brazil or South Africa.
However, maybe the warmer weather has kept their Confirmed, Infected and Death Rates low(ish).
Excellent scientific analysis.
Now if this could be coupled with a model of the Stock Market, Trump might pay attention!
A million deaths are not good for the economy.
20
@AKJersey Or, his chances of being reelected.
6
Ok, I get worst case...but can we also project a best case? Perhaps a bit of optimism?
@sadjoepafan
I think the assumptions underlying the model presented in this article could actually be called a "best case" scenario because the case fatality rate is estimated at 1 percent. On the basis of actual current data, estimates of the case fatality rate are well over 3 percent. The lower case fatality rate estimate in this model is plausible because the current data are probably skewed by a failure to detect many mild cases, but we cannot be sure that it is as low as 1 percent.
10
@R. Rodgers They assume a very high transmission rate and do not test their hypothesis if the transmission rate is more like the flu. in fact, it could be much lower than the flu (which is highly contagious).
If the transmission rate is half what they assume, the spread will be much slower and much easier to contain.
@R. Rodgers
You are a victim of the poor reporting on this subject. If you dig deep into credible literature you will see scientists acknowledge that the death rate is likely much lower than current reports suggest. It is quite possible that the majority of cases in China were never identified and resolved on their own. How would a person with a cold go and get a test for a virus that no one knew existed? Old people with health conditions are certainly at risk, but look to South Korean data for a better estimate of the impact this has on healthy people. We have flu seasons where close to 50,000 people die. Do you get a flu shot? Do you avoid the public from November to March?
Excellent, if sobering charts. But I have one big question after reading this: the various models show peak infections in the July-November range, depending on the aggressiveness of the interventions. Should we take this at face value; i.e., things will almost certainly get worse through at least July before they get better under *any* scenario?
Second question: Has the current administration (and members of congress, and our governors, and mayors) seen these charts? If in doubt, it would be a great public service if the Times could email this article to *every* elected official it has knowledge of, and *follow up* with their staff to confirm it has been read--and understood. This is actionable knowledge. The goal must be to flatten the curve. There is still time, but time is of the essence.
35
There is a chance a treatment can be found utilizing new biologic-ACE modulating drugs to reduce the viability of the angiotensin conversion enzyme that the COVID19 virus invades.
While not preventative, it could save those in the most danger.
3
What strikes me about the graph(s) is that it shows the peak happening around July. Most of the more aggressive actions, e.g., banning gatherings of 1000+ here in Illinois, are currently slated for 30 days. While it could be extended, it seems that timing will be important not only in initiating actions, but also in maintaining them, perhaps for longer than most of us currently imagine. That is also difficult as folks who are not ill will get restive as the time with "nothing to do" begins to drag on. It will take strong, forceful leadership to keep whole communities cooperating over a longer term.
Then, too, if the virus takes a hiatus until fall it will be challenging (emotionally as well as financially) to gear up the public health measures for round two.
10
The WHO estimates 60% of the world population will become infected. In the US with 380 million, that means 220 million will become infected. With a 3.5% mortality rate over 7 million will die. The WHO also estimates that 20% of the infected will be severe cases requiring hospitalization or other health care treatments; that means 44 million people will need help. With 7 million deceased, 37 million are left to the current health care system to help. We have 1 million beds in hospitals and at any point 700 thousand are occupied. Do the math, the health care system will not be able to keep up. That is why China built hospitals in 10 days. Health care workers will get sick too, so who will staff the hospitals just when the 37 million need help? The answer is to flatten the curve and impose draconian policies and force people to stay home. For how long? Who knows, but if we don’t do something quickly, the curve will be too great and even more people will die.
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@Ski bum Mortality rate for those those under 40 is approximately 0%, so you have to adjust to the population age distribution when calculating the number.
the mortality rate is very high now because we are only counting the people that show up at the emergency room with severe symptoms. If you calculated the mortality rate for the flu based on that same criteria, you'd have something like 10-15%
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@Ski bum
The US population is not 380 million, it's ~330 million. Rounding out, 60% of that is 200 million.
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@Ski bum
"In the US with 380 million, that means 220 million will become infected."
The current US population is about 330 million.
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There are dogs that have been trained to detect the odor of some kinds of cancer. I wonder if bloodhounds or other especially odor-sensitive breeds could be trained to detect the virus, given that it spreads via aerosol-borne transmission. While the virus may not have an odor, it is at least possible that the aerosol from an infected person would typically have saliva that does have a unique odor.
Separately, it would be of value to mass test several sharply defined geographical areas simultaneously. Then compare subsequent doctor visits, hospitalizations and deaths 30 and 60 days later to the original percentages of positive test results. That data would lead to development of the model parameters unique to this virus. DPD
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Your model assumes a 1% mortality rate. This 3/12/20 article in The Lancet, Infectious Diseases, suggests the # of confirmed Covid19 cases, or the denominator used in mortality calculations, is artificially low, and thus the current estimates of mortality are artificially low. This study suggests that a more accurate rendering of the mortality rate outside China is 15.2%
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30195-X/fulltext
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@Alex “the denominator used in mortality calculations, is artificially low, and thus the current estimates of mortality are artificially low”
That’s not what the article says, and that’s not how math works. If the denominator is artificially low, then the real number is higher. A higher denominator gives a lower mortality rate.
1/10 vs 1/100. See how that works.
In the article they actually lower the denominator by comparing only cases that were confirmed 14 days before the death. Which makes sense for the death rate to be higher in the beginning, as testing would not be common.
Source: math
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@Mark
Yes, but the model estimates mortality rates above 5%! That's the point.
@Mark Another way to put it: The point of the lancet article is that dividing “people who died today” by “people who are sick today” is mixing apples and oranges. The thing we really want to know is more like “people who died today” divided by “people who got sick at the same time as the people who died”. Otherwise you are in fact dividing by a denominator that is too high, because it includes recently infected people who haven’t had a “chance” to die yet. But probably poor Alex just mistyped. He did link an important article.
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Very educational piece. It’s important for the public to be able to visually capture the potential impact of the pandemic and the consequences of different levels of containment.
Please note, however: In aggregate the age of the US population is little different from than that of China. The median age of the US population is 38.1 yrs and that of China is 37.4 yrs. European populations are older. The reason for the relatively young US population (compared with other developed countries) is - you guessed it - immigration and that’s good.
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Thank you Nicholas Kristof and the New York Times. The information you are gathering and presenting is clear and accurate, with uncertainty acknowledged. It is a life raft thrown into dark times. I have used information read in these pages to successfully argue for the cancellation of events within the control of groups I work with and to inform decisions about social distancing by my family. We are all on the front lines. Flatten the curve!
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Thankfully, leaders in sports, education & entertainment are heeding these warnings and executing temporary shutdowns. Disney has closed its parks, NBA & NHL have shut down for a while, and the governor of my state has ordered all K-12 schools closed until the end of March.
The problem is, the leaders of these entities cannot do what can only be done by the US president: primarily, offer the leadership, psychological assurance and genuine calls for unity that this crisis demands. Even if Trump were to suddenly metamorphose into the sort of leader who guided us past the attacks of September 11 or the financial crisis of 2008, which is extraordinarily unlikely, too many opportunities have already been missed.
What we're seeing now is too little, too late, and of course constant, major miscalculations in regard to focus. While thinking, caring Americans are concerned with the safety of the American public, Trump is concerned with how this makes him look and how it will affect his reelection chances.
A major portion of the electorate has been riding this Trump carnival train for a while now, and they bear responsibility for the major mishandling of this crisis. Unfortunately, we will all end up paying the price.
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@TLMischler TL, actually all Mich schools are closed until April 6.
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What I haven't seen in any of the epidemiological models are estimates of how long the interventions and social distancing need to go on. Right now there are sporadic approaches with some schools closing for one to several weeks, and others for the rest of the year. With models of U.S. infection peaking in July, does a couple of weeks' closure accomplish anything?
Also the prediction that 1/3 of the population will eventually contract the virus is not very encouraging. It would seem from that that distancing should be a long term thing over the next year.
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@Robbi
The length of time for social distancing measures is inherently temporally correlated with data about the rate of infection, and outcome, and geographical data. In other words, a clearer picture will probably emerge over time. However, what is critical for any type accuracy in both model prediction, and public health recommendations is that we have testing procedures and widespread availability in order to predict, and behave according to data and information, and not from hunches, conjecture, or faith.
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Our public health criteria for testing is fundamentally flawed and needs to change. Currently if you have not been exposed to someone with the virus you will not be tested even if you have symptoms. Given the fact that less than 10,000 Americans have been tested to date few people will know if they have been exposed therefore few will be tested. To fix this we need to test everyone who has symptoms period. We need test kits that work period. Until this intervention is implemented we will fail. Not sure why South Korea can test 10,000 people everyday and we have had nearly 3 months and can't seem to make it happen -- maybe we need people in charge of this who can do the job right.
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@Julie We still aren't testing because Trump doesn't want "the numbers".
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@Julie It seems like with aggressive widespread testing starting today, we could keep the death rate down to about what H1N1 was, but without that, (just moderate intervention) it could be hundreds of thousands of deaths. We really need to test.
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As an educator who teaches systems dynamics modeling in my courses I would *love* some technical details or a reference for the model employed here.
I have used similar models in my course and I would love to use (steal) this one.
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@Paul Fisher me too! This was already going to be Monday’s first online lesson.
@Paul Fisher Robert Schiller's book, Narrative Economics, includes an appendix that describes the mathematics of epidemiology.
@Paul Fisher
Apply for a API key.
https://developer.nytimes.com/
I wish I shared your optimism expressed in the last line. The right is blaming the left for spreading a hoax. If the tech companies could could preempt Fox with the doctor in San Mateo's communiques, maybe there would be chance of taking rational action.
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Any theories out there to explain Italy's nearly equal death and recovery numbers? It must take longer to declare someone recovered than it does for a victim of the disease to die, so the ratio will eventually go down some, but Italy's numbers have been running consistently from day to day, and we're beginning to see similar numbers in other western countries.
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One of the aspects cooked in to the model is the rate or serious infection and resulting mortality rates. However, sciencenews.org's summary of the "Diamond Princess" cruise line experience, probably the closest thing to a controlled model we have, suggests a much lower rate than what's apparently in the NYT model. I understand that's arguable, and we need to understand how to compare that with, say, Italy, but the presentation of the NYT model reinforces certain conceptions in readers about what ICU and mortality rates are going to be and that affecting transmission rates is the only thing variable. Transmission rates may be the only thing in our *control*, through cancellations, hygiene practices etc, but I think the article tends to foster a bleaker and perhaps more frightening picture of what's coming down the pike than we really know at this point. I wish that'd be more thoroughly highlighted. I'm not saying things are rosy and that this is not a serious health care challenge, but we really do want people to keep things in perspective, to understand that there's aspects of this illness and its transmission and outcomes that we understand well and others that we don't and are still learning. The modeling exercise makes the article more fun, but I do believe it also lends a certainty to outcomes that are still not fully understood.
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I read an more than one article that stated the 2017-2018 flu season broke all records and that the vaccinations developed for that year were highly ineffective. 60,000 died in the US with the majority being in the 65+ range. I don't remember this being front page news back then. It's been implied that there is some control over the flu, that is until there isn't. It seems to me the only thing that's certain here is uncertainty. I'm not implying that the situation is not serious but more facts are needed. While these models can be helpful, there is a degree of conjecture that I find worrisome. Blasting the public with worst case scenarios and inducing panic is the last thing we need. Calmly stated, good orderly direction is a must.
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@Rob Actually the virus is mutating as we write these words. The Hunan virus exploded in Italy because it became a stronger version (Source: a friend who is a Dean of an Italian Medical School & working in hospitals in Northern Italy). Management and containment are crucial because things could go from worse to catastrophic by July.
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@Rob -- "I think the article tends to foster a bleaker and perhaps more frightening picture of what's coming down the pike than we really know at this point."
So here's the ethical dilemma people in positions of leadership are currently facing: Human beings have a natural propensity to disregard and minimize depictions of upcoming realities which they are not experiencing personally. I see people all over my city not observing sanitary protocols. In 16 weeks, a bunch of us may all be dead. How worthwhile is it to overestimate the danger now and scare people a little into practicing social isolation and sanitation properly in order to save people from excess deaths 16 weeks later. You be the judge. But that's the dilemma. It's already too late to prevent the pandemic, because we didn't act 8 weeks ago (like Taiwan). How much longer should we wait to act?
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It is increasingly clear that we have a president who only looks one step ahead, and only acts out of selfishness regarding his re-election concerns. I’m not sure how you model for that, but it’s certainly not very reassuring for a major crises. Frankly he can’t lose soon enough.
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@Thomas Wright - there is, however, 8 months to go before the election. A lot can change, and by that time events may spin the narrative in such a way that many will vote for his victory.
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@Thomas Wright who would want to be president of a country where the market is wrecked and 250 million people are grieving?
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@Thomas Wright play with the model and set the bar all the way to the right.
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Fascinating. Here in NYC, the closures have begun, and my sense of confidence that our elected officials are doing the right thing has grown stronger. There is, though, the subject of the public school system. Mr. Mayor, is it time to close them?
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@dc
In the Boston area, schools are closing. My kids will be home for two weeks. We have not a single known infection in our community of 115,000, but it is important that we reduce our public activity to flatten the curve.
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So why do we not have mass testing already? It seems like mass testing, combined with banning large gatherings and cruises (one of the largest gatherings of them all!), and strictly limiting air travel could dramatically flatten the curve.
With the time we buy, we could be expanding our supply of ventilators and other medical equipment by a WWII style shift in domestic factories, which could operate 24/7, supplying jobs to those who need them.
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@Rose
What? Didn't you hear President Trump announce several times that "anyone who wants a test gets a test." ?
It would help immensely if our President, who has actual facts at his disposal, would speak accurately about this health crisis. Of course, it also would have helped if Trump hadn't fired our ENTIRE pandemic response team, including the White House management infrastructure in 2018.
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@Rose
You can’t treat what you don’t know, and we can’t know the extent of the problem without testing. It is criminal that we are so far behind other countries both in timing and in availability of test kits. That is the real scandal of our generation
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@downeast60 The current admin DOES give us the chance to study our bizarre American version of autocratic politics--the transparently fearful egotism, the incomprehensible circles of complicity, the incompetence! This then is an opportunity to build alternative systems for level headed strategic planning and operations. Thank you NYTimes for your excellent coverage. Thank you commenters for reminding me of our collective sanity. And thanks could be due, I'd say, if we deployed them, to a critical mass of underutilized professionals --how can we hire back members of Trump's fired pandemic response team?; I myself, as adjunct in the higher ed labor force, am ready to be a soldier for strategic thinking. And then there's the potential army of autodidacts--I googled "aerosol transmission" and the first link up: https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-019-3707-y
That to me is reason to stay calm and hopeful.
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This is scientifically correct. Also, the models do not require panic buying of staple items. Supermarkets and essential stores can stay open. The key is distancing from other people as a means to avoid aerosol-borne transmission.
One should also note that we have more ICU beds in the US than seem the case by a simple tally. Remember that most hospitals have operating rooms, which will not be used as such, aside from emergency surgery, during a pandemic. OR's have the equipment, configuration, ventilators, and monitoring equipment equivalent to ICU's. Pre- and post-acute care (PACU) areas can also be converted to the equivalent of ICU space. The limitation is ventilators and staff.
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I hope the Times will give this excellent piece more prominent play. It should be read by as many people as possible.
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Great article and the model helps to explain what is going on. We have all been drafted to fight this war, and we should have that mentality. Stay home as much as reasonable possible. Work from home if you can, so that there are less people around to infect each other. Clean your hands-a lot. Go out just once a day, if needed, to get supplies. It’s gonna be a long wait and we have to be patient and buy enough time to slow the epidemic.
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@Louis I have limited stamina and no car. Sometimes I need to go out come back to my apartment, take a nap, and run the other errands later. I also have a galley kitchen with only a mini fridge. I may have to stock up 2x a week for 3or 4 days rather than purchase enough for 2 weeks with limited fridge space.
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@Louis
People who work in grocery stores where they come into contact w/ hundreds of people a day are likely to become infected. Does anyone have any idea how we can protect those people? They can't wash their hands between customers--the skin of their hands eventually will be injured by the process. Wear and change gloves between customers? Disinfect check out lanes between customers? Does any have any ideas?
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@JJ Soap & water or purell at entrance to every store. You must wash your hands before going in (enforced). Space all customers 3feet apart at checkout lines (put tape on the floor). Purell or soap & water at check-out. Gloves &/or masks for folks on tills.
We can beat this--we just need to be clever & quick about adapting. Our enemy is simple & can't think for itself.
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Awesome! In addition, delaying infections and flattening the curve give us time to develop, manufacture and distribute drugs which reduce the severity of the illness (not just vaccines which experts think will take 6-18+ months).
Also, flattening the curve helps non-hospital logistics. For example, instead of huge sudden losses in truck drivers, food service workers etc we can maintain a steady flow of food and other essentials.
Finally, flattening the curve reduces panic, which needlessly stresses everything from toilet paper to traffic to staffing to guns. You can't shoot a virus.
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This is why I subscribe to The Times. Thank you for your detailed coverage and analysis. Having accurate information, that isn't filtered through a partisan lens (and focused on the stock market), is invaluable to us at this point in time.
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@Dan I fully agree. This information is much better than currently available on line in the UK (I am a British citizen living in France.) I also commend the latest measures by the French government to close all schools and educational places, from infant creches to universities "until further notice".
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@Dan This is not accurate it just confirms your believe.
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@Dan
You also need governments that will seek our and act on information provided by scientists and doctors. This means Democrats, and Republicans who are not drinking Trump's Kool-aid. Considering Christie's handling of Hudson River rail tunnel replacement, how would he have balanced the welfare of New Jersey citizens against his political ambitions in the Republican Party?
3