A nation that values athletics more than it values education will not fare well when a pandemic comes around. The denser the population, the more frequent the pandemics.
1
Trump is the most renowned and legendary expert on pandemics and their cures of anyone who ever lived . We are lucky to have him as our leader and chief virus fighter .
1
Probably not and everyone has been spreading fear about the Next Great Pandemic. Averaging out? men who are smokers die at the highest rate. China consumer 40% of the world's tobacco and 60% of men smoke.
If 300,000,000 that is 300 million got it and half are men and 3% die this would be 4.5 million dead.
But fear sells newspapers and fear has people glued to the TV watching ads. So can we bet that medicine has Not Advanced at all in 100 years?
Generally, well-nourished, healthy people have an extremely low rate of contraction and even lower death rates.
Now should we be talking of all the damage this will do to the tobacco companies and their profits?
With seven billion, we can lose a billion and China and India will replace those in less than a decade.
But let's be afraid of this just like every flu season where thousands die.
Buy stock in companies that sell masks, but do not short tobacco that would require people to act intelligently
1
Donald Trump has never taken responsibility for his own failures and has always taken credit for others’ achievements, including an economy he inherited that was so strong it weathered even his trade wars and tariffs and tantrums. Until now.
Of course Trump is not responsible for the coronavirus, which would make it poetic justice if (like the deus ex machina that ends a Greek tragedy), the coronavirus were to prevent his reelection and thus end our American tragedy. And if there are indications that it might, it will not be because (as the hapless Mick Mulvaney claims) the media is stoking fears in order “to bring down the president.”
Rather, it will be because anyone who has been paying attention understands that Trump is delusional, his administration is incompetent, and both are completely unprepared for a crisis of this nature. The coronavirus is his Katrina, it is deserved, and we are fortunate that it comes before and not after November.
17
More fear mongering -- unnecessary of course -- unless you are an anti-Trumpist and you want to weaponize the coronavirus for political purposes. Sure, it could be the big one.
But it's just as likely that the number of infections will remain low, that the mortality rate will be low and likely primarily affecting those with preexisting health issues.
When it warms up, the virus may go into hibernation, and existing drugs will prove effective in curing most cases -- and that at worst this maybe a nothing more than seasonal flu -- and with a vaccine it may fade from memory.
No question we need to improve global approaches to stopping/containing viruses. But let's remember that the reason we have things like coronavirus is wild meat markets in Asia and Africa. So while it's important to improve our response capabilities, prevention is even more important.
Meanwhile, let's not get out over our skis in spreading fear, ok? I know the Russia collusion thing didn't work so well for progs, nor did obstruction or the Ukraine, but using the coronavirus to attack Trump is simply childish.
2
This is it “the big one”. However, we need our pharma supply chains made in North America and not made or controlled by communist countries.
The disaster of a global economy is Communist China being the world’s manufacturers. Democratic countries then become beholden to inept, corrupt and ineffective communists. Not good.
4
Everybody is right. And everybody is wrong.
Bottom Line: A lot of people died...it's time to get serious.
1
A 2018 simulation that the Gates Foundation conducted of a flu pandemic estimated that there would be 28,000 after one month, 10 million after three months, and 33 million after six months.
2
the article says that the 1918 Spanish flu killed 2% of those infected , and that 50 million people got it . If both figures are correct, then 2 and one half billion people got it . But the total global population in 1817 was 1 and one half billion .
6
There is a cure - a beefed-up immune system.
Drugs and Doctors never cure anything, ever, only your immune system cures. At best they mitigate symptoms to give your immune system a leg up.
Quercetin has good effect against coronavirus-SARS.
https://www.ncbi.nlm.nih.gov/pubmed/22350287
Black tea also (it has tannic acid and 3-isotheaflavin-3-gallate).
High-dose D3 (like 400,000 IUs) will bulletproof you such that you'll live almost forever. Protective against cancer too, and all the autoimmune diseases because it modulates your entire immune system.
An intermittent Vitamin C IV drip will save you from a virulent virus if you achieve dynamic flow.
Each of these have strong anti-virus activity and should be a first and best defense against Ebola or any virus.
There's also an older anti-viral which has had very good safety and efficacy against Covid-19 in 10 multi-hospital clinical trials in China.
One might also drink water. The bugs like water, migrate to it and then flow out, which decreases their number and replication rate so it's easier for your immune system to deal with.
Washing hands is effective.
2
More cases everyday, more deaths being reported.
Where’s the hoax, Mr. Trump?
What new pearls of wisdom is the stable genius going to give us now?
3
The "Big One"? With a death rate of 2%, and that mostly confined to those with previous health issues, I don't think so.
1
Curious if the hospital system that charged Mr. Osmel Martinez Azcue $3,270 enjoys “not for profit” tax status. Our health system has been too busy building cardiac, orthopedic and cancer hospitals in an effort to rake in the cash — they had no interest in being able to handle a real national health crisis. We might want to reconsider what we as the taxpayers are getting in return for enriching so many healthcare executives.
11
A well-meaning article. Kristof's readers are educated and enlightened. They are socially conscious. What about the Americans, there are a lot of them, who are not? They don't read Kristof. Nearly half voted for Trump and may do so again. He lies to them because he knows they believe his lies. Will they continue to do so? Who knows? An enlightened and better educated public would demand a more enlightened response to a crisis like this one. That is where our largest problem lies. Trump and his cronies are mostly an unfortunate manifestation of that problem.
11
We will not know currently if the coronavirus is the big one. It may linger and become much worse or eventually fade away with few new cases and then none. These possibilities are 50/50. Let’s hope and pray this scourge is short and over soon. I would not wish this dreaded disease on anyone not even my worst enemy. Please be safe and take extra precautions.
4
If we know one thing it is that the coronavirus is devastating to those who have pre-existing conditions.
I'm afraid we are about to be hit very hard because of this.
The chronically ill will suffer but they are not to blame.
America is a democracy.
It is time to take a humanitarian approach to health care in the United States.
Call your elective representative. Tell them to wake up. Tell them it's their job to listen to the will of the American people.
We are facing a humanitarian crisis of unimaginable portions.
Insist. Be heard.
Then vote.
7
The ugly trends have begun to be unleashed. In Berkeley and its surroundings all pharmacies (CVS) and stores are out of hand sanitizers. I thought at first it had been a publish rush for these products (in some places it may be), but a CVS employee informed me in at least one store that a person had bought all the hand sanitizers and all products with antiseptics (including alcohol) in the story yesterday and the same occurred this morning after a new batch was put out. That was 200 hundred items put out this morning bought by a single buyer. Obviously they are going to the black market. Authorities need to investigate that. It is occurring in all kinds of stores. So the public is unable to implement simple preventive measures of disinfecting hands when soap is not immediately available. I hope the soap does not disappear from store shelves . This is getting ugly. The public good is at stake.
11
Interesting how we have heard nothing on the US trade representatives from many states that continuously traveled to and from China through December and January.
The different states are hoping no one notices, while the coronavirus continues to spread across the country.
With the span of travel around the world, it will be very interesting, to put it kindly, what happens when a real serious pandemic spreads around the world. Millions, possibly tens of millions, will die.
The coronavirus, unless it mutates into something very serious, will see few relatively few deaths.
Meanwhile flu continues to kill millions around the world.
All Americans should read Mr. Kristof's columns, including this one. They are the best anywhere. Did he write Biden's short speech after the South Carolina primary? That was the best such political speech of the primary season. It was blessed with the same spirit of honesty, forgiveness, humility, wisdom, hope. We are all doing here what Kristof says to do: "Worry less and wash your hands more." Greetings from Washington State, just down the street from one of the hospitals that treated one of these patients. Make America smart again.
15
When I was a kid, my grandpa who was in World war I used to tell me that it wasn't so bad. He used to say he wasn't afraid of getting shot, he was more afraid of getting the flu. I was an adult before I realized the implications of what he was saying. Mostly he wouldn't answer any questions about it.
10
1918 Flu death rate was closer to 20% than 2%. Right?
1
@tim woodruff
2.5%
1
Consider the following article by Elizabeth Goitein that appeared in The Atlantic a year ago (before the coronavirus outbreak):
https://www.theatlantic.com/magazine/archive/2019/01/presidential-emergency-powers/576418/
Trump is thinking long and hard about how to weaponize the coronavirus to his advantage with the upcoming election. We know he cares only about himself and his retaining power. He will throw the rest of us under the bus in a heartbeat if need be.
He has broad authority with presidential emergency powers. He wouldn't have to cancel the November election or declare martial law. He could use his powers to radically skew the election in his favor -- to rig it -- thereby avoiding both the Democratic contenders and having to challenge the results if he loses. For example, he could control the internet with a massive disinformation campaign sowing confusion with things like where polling places are located (see the article above).
Trump can't control the coronavirus. He has installed an administration of sycophantic lackeys. His precious stock market is crumbling. But he still has the Senate and the courts working in his favor.
Trump's best bet is an end run in November. Then he can continue the emergency powers he invokes after he wins the election.
Am I missing something here?
8
I always request a ballot weeks before an election so I can vote on a paper ballot and mail it in. Everyone should do that for several reasons. One, it is easy and two, no one can close or change your polling site. You can request a ballot by mail by contacting your county voting office or go online by phone or in person. You can do it 6 weeks or so before the election. Don’t let Trump stymie your right to vote.
6
@Blue Moon
It's a good strategy, along the lines of Naomi Campbell's Shock Doctrine or Disaster Capitalism.
The multinationals in cahoots with the CIA and the World Bank's "Economic Hit Men" have used this strategy for decades in Latin and South America.
Trump can suspend habeas corpus and impose martial law with a stroke of a pen. Justice, the Supreme Court, and his Congress will back him up.
Martial law has been declared multiple times in our history. One sign that it could happen is the weakening of judicial review, which we have under Trump:
https://nypost.com/2017/01/29/customs-agents-ignore-judge-enforce-trumps-travel-ban-aclu/
But he'll have to contend with Pelosi and her oldsters sending him a sharply worded letter.
1
Remember that Ellis Island (1892) processed approximately 12 million legal immigrants based on "health" and other criteria. What are we doing today Nicholas?
2
Its absurd to call the US health care system deficient. 90% of all new healthcare technology is invented in the US! Providing universal health care does not reflect the quality. Would you rather have open heart surgery in the US or Spain. PLEASE!
2
From the article, it seems to be a bad time for an anti-science POTUS, whose best plan is for a "miracle". So, he passes it to Mike Pence who is going to "pray" it away.
Many of us saw, experienced, and lived through the united front of federal and state bio/virus containment efforts that was successful during the polio epidemic of the 40's and 50's, The Presidents that were in office at that time sustained that effort from election to election.
And here we sit with some highly disturbed individual as President of the United States, likely on the cusp of an epidemic. Disgusting.
8
We need to bring up daily that Trump and his ignorant sycophants slashed the budgets of the CDC and dismantled the worldwide infectious disease surveillance program we had in place for an occurrence like this. It is the most dangerous thing Trump has done and will affect every single American. Trump, in his infinite ignorance said that he did not want people doing nothing, and we would hire more if needed. That proves out utterly ignorant he is about the work these people did. And how unfit he is to lead the country.
I used to work at the CDC in the Infectious Disease Branch. I worked on the anthrax bioterrorist attack in 2001. I worked on SARS. West Nile virus. Rift Valley Fever, Nipah virus, Hendra virus, Hanta virus. Ebola virus. The list goes on and on. We have major outbreaks every year and the only way to counter them is to have the people with the expertise in place and trained WHEN THEY HAPPEN. An outbreak does not take a break to let us get up to speed. It happens. It spreads as fast as it is able to, and it waits for no one.
Besides fighting outbreaks these same scientists constantly research new viruses, develop detection methods, make contacts in other countries, work out disease fighting scenarios. All to be ready when it happens. Trump threw all that out the window.
So, every day for the rest of this year, pound on Trump and his ignorant sycophants for their failure to understand what the real world is like.
19
GOP will call these demands to improve health care and security a "socialist" measure. They rather take the risk. Sad but true if people rather tend to believe nonsense and not science.
1
Severe death and destruction are a few decades out yet. If this virus is worse than the flu, it will still be a minor bump compared to what is to come.
Americans insist on being anti-science. It is hard to have cults when the "know-it-all" scientists are interjecting facts.
Let's prop up the belief in magic people in the sky, that should fix everything. It's what got us Trump and it is working out as planned. The people wanted him to destroy the government they hate and he is doing an outstanding job of it. Praise Jesus, and white people with money.
2
All non-essential travel into the United States (including commerce and non-citizen anything) should have been stopped in January...with returning citizens allowed entry only under strict protocols...and immediately quarantined. Every...single...traveler.
Had travel restrictions been implemented asap, we would not have the virus multiplying exponentially now.
2
Do you think undocumented residents are going to seek medical care when they think they will be deported for doing so?
The corona virus is the best argument for universal coverage. Even billionaires get exposed to uninsured.
We are all in this together. And stop shaking hands.
6
The man from FL cited was "billed" 3200 but that doesn't mean he will ever pay it. He will only be forced to pay if he has assets (real estate, etc). I'm tired of this kind of disingenuous statement from those on the left.. All medical bills are dischargeable in bankruptcy and are essentially uncollectible to those with no assets. Though it's true potential pandemic testing should be free. But not medical care.
Mr. Kristoff: You write informative editorials weekly in the Times. But, please, please educate yourself! You owe it to your readers to stop using the term "Spanish Flu".
The term is based on a misattribution of the Great Influenza's origin.
It began on an army base in middle America, possibly in Kansas, USA, during The US's preparation to send troops to Europe to fight in The Great War, WW 1. Numerous soldiers got sick and many died on their transports to Europe.
American war efforts spread the flu countrywide, and in the end, Worldwide.
Perhaps we should more rightly term the disease, The American Flu. Gosh, that doesn't feel good, does it?
And maybe the present coronavirus outbreak should be termed the Chinese Disease!
On the other hand, maybe we should just Not debase nations, nor Medical Science, jingoistically, and trivialize history and science.
DidYou ever wonder where the designation originated, or investigate how A Spanish Flu outbreak went worldwide? Did it appear in, say Madrid or another city? How did it spread to the rest of the world...? And so forth.
Virology is complex and worth your study. After all, just what are these H and N?
We are all so fortunate our president understands so much!
3
I live in Canada where we know we can't change the past we can only affect the future.
In Canada the future demanded we make healthcare and access to education a right not a privilege. It also demanded that access to broadband be made a right not a privilege.
In 2008 America elected Obama to make healthcare a right and a dozen years later Americans have double reason to fear something that always afflicted our lives but now threatens our economy and threatens America's very existence.
Obama and Biden were charged with making healthcare a right not a privilege and they punted and gave you Romneycare that put off the decision till the tomorrow that will come after America is dead and gone. The America I loved decided that compromise would keep America together so principles were sacrificed and possession of the bully pulpit was squandered.
I have lived in towns and villages where the population has yet to reach the level of before the Spanish flu.
It seems to me that America has yet to recover from the Creel Committee that happened at about the same time.
The truth may be very painful but it is seldom lethal. I fear Wilson's Committee of public information will prove that denying truth to encourage patriotism will prove to be America's last words.
https://www.smithsonianmag.com/history/how-woodrow-wilsons-propaganda-machine-changed-american-journalism-180963082/
3
I think that the USA has got what it needs. Mike Pence. The coronavirus czar who makes his way from news show-to-news show emptily assuring us that Trump and the administration have things under control. Strategy? Science? Facts? Plans? Nah. Just thoughts and prayers for the family of the deceased WA state patient. Sound familiar? The czar abides!!
11
I'm trying to get excited about this.
If this outbreak is the catalyst that turns around our habit of getting over 99% of our antibiotics from one country - China - it will have done a lot for future generations here.
etween the Clintons and Bushes, we ousourced our American drug formulation business, and the globaslists have a lot of apologizing to do.
And than goodness Pres. Trump didn't wait until a thousand Americans died before getting serious about Coronavirus like Obama did with H1N1.
3
@L osservatore Interesting. Somebody from ''fair Verona'' posted the exact same comment yesterday....and the day before that too
3
We are woefully unprepared, and that is the way the Trump administration wants it. They are the ones who dismantled the offices tasked with handling a possible pandemic because it was Obama who did it and Trump doesn't believe in science. He knows more than anyone else. He wants to hide the truth. The American people are the ones to pay for his utter stupidity.
8
This is not the big one.The big one will be avian flu. It lurks in all those chicken and duck farms close to large populations in Asia. It still has not developed the ability to jump from bird to man and man to man after that. One day it will. When it does hell will freeze over. Research into vaccinations need to be encouraged. We still do not have an effective flu vaccine.
2
@SridharC ...And what makes things more interesting is that some strains of bird flu kill birds. The influenza vaccine requires eggs to grow the virus. If the virus kills the egg the standard procedure for making the vaccine would fail.
@SridharC So we shouldn't worry about this one ?
Mt great-aunt died in 1921, at 19 years of age. Her death was such a shock that her name became my middle name. So many years later (I was born in 1968) the loss of this vibrant soul rang so deeply still that my parents thought it a nice homage to my great-grandfather, her brother.
She died of the Spanish flu. Alive and healthy one week, dead 7 days later.
Almost a century later, no one is alive to remember her. No one likely remembers she existed at all, except for me.
I have a photo of her somewhere, lovely and lithe. Her figure reposed against a chaste, she looks at the camera sweetly but beguilingly, her dark doe eyes and black hair styled in the short waves of the era, her flapper dress revealing long thin arms and long legs. An absolute knockout.
12
@GWE
chaise
dang auto-correct
:-)
4
@GWE My father lost 2 cousins, a father, and a baby sister to Spanish flu that year. Those deaths mean nothing today to people more concerned with profits and politics.
4
I was part of a medical disaster team during the H1N1 pandemic and we were trained and prepared to staff airports and border crossings to screen travelers for illness. We were also re-taught how to use the Bird Respirator. These little machines can keep people alive who need mechanical ventilation and many thousands of them were stockpiled then. If the Feds still have these, they will supplement more complex ventilators and save lives. Hope Trump hasn't thrown these babies out with the Disaster Preparedness Experts bathwater.
8
When I read an AP article that includes: Trump is cautioning that “there’s no reason to panic at all.” that's when I begin to worry. Everything that comes out of his mouth is a lie. OK, I'm being a little facetious, but...
9
Suppose this virus infects every single person on this planet and kill 2% of the entire world population. This unparalleled human tragedy would only return the world population back to what it was in 2017. It would take 6.5 billion deaths to get back to where we were just two centuries ago. As a species we humans have nothing to fear, from this virus or any other.
2
@A Cynic
But will it kill the right 2%, that will hardly be missed, or will it kill randomly, taking millions of outstanding individuals far too early?
We no longer hire people based on qualifications and credentials.
Trump doesn’t qualify as a garbage collector but claims to be an expert in medicine, defense, deals, economy and a stable genius in all. A fool that manages to fool and brainwash millions of people.
Why is it illegal to scream “fire” in a crowded theatre and legal to misinform the public during a health crisis?
Why are our officials lying to us and cause delays in treatment that could save lies?
Why is Fox and Trump junior allowed to circulate lies that could dissuade people from seeking medical help or keeping their distance from others when they feel sick?
9
The Trump administration fired the U.S. pandemic response team in 2018 to cut costs. Trump also cut funding for the CDC, forcing the CDC to cancel its efforts to help countries prevent infectious-disease threats from becoming epidemics in 39 of 49 countries in 2018. Among the countries abandoned? China.
We are supposed to rest easy because Pence is the coronavirus czar? Pence has no medical training. Trump said the risk to Americans' health remained 'low,' and that the number of people diagnosed with the virus was small.
Trump said Pence would report to him.
Dr. Anthony Fauci, one of the country's leading experts on viruses and the director of the National Institute of Allergy and Infectious Diseases, told associates that the White House had instructed him not to say anything else without clearance.
The president plans to control information that we receive on a worldwide pandemic?
11
...administration response: don the con say it will miraculously be gone soon (yes he said "miracle"l and appointing mike responsible - whose last response to epidemic caused 100 new HIV cases.
admin & GOP throwing how many people off of Medicaid & eviscerating Medicare
so much for "right to life"
hypocrites all
3
Why hasn't the CDC set up a response team?
5
This may not be the "big one" but Donald Trump certainly is!
2
This is one of those frightening moments when the corrupt conman who is our president tries to look strong and capable. He is anything but. It was bad enough when he kowtowed to Putin in Helsinki, and withdrew from the Iran nuclear deal, and even began flirting with Kim Jong Un. He is the worst kind of leader -- incompetent, but thinks he can handle anything; stupid, but thinks he's brilliant; and easily manipulated, but thinks he's tough and strong. Every time I think of the people at our southern border, I cringe: how unfair to them; how cruel; how heartless.
Now, his shortcomings could be responsible for the sickness and deaths of many Americans. He lies that he cares about his followers, all while his administration is fighting pre-existing conditions. I lament that Americans are so easily conned by this pretender, this madman, this barren shell of a human being. The entire GOP is responsible for our nation's utter depravity on refugees, science, climate, reality.
Vote as if your life depended on it. Because it does.
14
But that Bernie Sanders is out of his mind. Wait till you are bailing out United Health Group.
1
I hope it is the big one. There are too many humans on the planet destroying, polluting, and fighting. Less of us is a good thing even if that means I’m one that dies.
2
I'm a frequent visitor to Cape Cod. Over the years, the seal population has swelled and the Great White Shark population likewise. At first, nearly everybody kept swimming. Then someone got bit. Then they stopped swimming only where the seals were. Then a kayak in a seal free zone was bit in half. Then the juvenile (still a formidable predator) to moving to bays and inlets to feed on striped bass. Soon enough, someone was killed by a Great White. Go to the Cape beaches now. Virtually no one is swimming. The braver souls might take a quick dip at the shoreline only. One death did it. Get ready for crowd free zones where crowds were most plentiful and necessary for the economy to work.
1
Wash your hands, keep you hands away from your mouth , eye, and nose. Eliminate unnecessary travel. Don’t panic, it’s probably not as bad as the media makes it sound.
5
@hen3ry "It's easy to cut funds when there is no obvious need. It's much harder to restart things afterwards. Trump made the classic mistake of saving money because there was no big disease out there threatening us. "
This is an excellent example of how ignorant Trump and his sycophantic cronies are. In point of fact, all those funds and people were working daily on threats that most never hear about. I have worked at CDC. We worked DAILY on outbreaks of infectious disease from all over the world. The point is that NO ONE KNOWS WHICH WILL BE A BIG OUTBREAK. We need surveillance so we are not caught unprepared, but Trump, an pseudo "businessman" at best, is one of those who, when they cannot comprehend what someones job is, decided they are "doing nothing." in this case is is literally fatal mistake. Those scientists and epidemiologists are working DAILY to develop detection, research new viruses and other microorganisms (remember, plague (yersiia pestis) is a bacteria but has killed millions. Without those people on the front lines are are blind to what is happening. Trump deserves to be pounded daily on his failure to understand how the real world works.
Trumpers, are you all paying attention to what your Dear Leader is NOT doing?
7
Close the schools. Now.
5
Of course the great trump nightmare scenario is/was if there were ever a real emergency and we needed decisive leadership. Instead this ridiculous ninny makes it all about himself once again, not caring a whit the damage he could do.
The best thing to do during a crisis like this is hold a MAGA rally - right trump?
4
In the age of Donald Trump, I expect the evangelicals will start to pray since more than any other group they are responsible for electing this corrupt liar and incompetent bumbler to the position of POTUS. He and his administration have decimated the CDC, and under John Bolton, another know-nothing nincompoop, completely disbanded the entire pandemic response team which Obama put in place in the wake of the Ebola and Zika viruses. We have other unscrupulous and debased public figures like Mulvaney and Limbaugh claiming that those raising the alarm are trying to discredit Trump. Hilarious! Trump needs no help there; he is entirely capable of discrediting himself as he done over and over again. While he squandered money on a wall, he left us totally unprepared for the virus which will surely now start to spread since we have no reliable test kits, insufficient face masks, and hospital staffs who are unprepared. The CDC already sent California test kits which did not pass validiation, sent untrained teams to deal with American evacuees from China's Wuhan province, the epicenter of the virus, and put a science refusnik, Mike Pence, to be the overall head of the response team. Perhaps this will finally share the faith of the True Believers who make up 42% of those Americans who give our POTUS a favorable rating in the polls.
3
Kristof is one of the best journalists, reporters, storytellers working today. I always enjoy his columns, and he's one of the dwindling reasons I've kept my NYT subscription. This column was concise and packed full of information. I very much appreciated that he included some of the pragmatic steps that should have been taken ages ago and can still be taken if our leaders act like leaders. It's only a matter of time before Trump credits the wall with helping to fight the corona virus.
7
Everybody knows this is just a plot to cause the stock market to crash in order to keep Donald J. Trump from being re-elected!
With the world's foremost expert on communicable diseases in the White House and ace scientist Dr. Mike Pence in charge on the ground the US will crush the COVID-19 virus bigly!
If someone said ten years ago that a US president would one day claim that a disease outbreak originating in China (no surprise there) and spreading across the globe was a plot to prevent his re-election, rational Americans would have considered that laughable. But that was before a minority of the American people (with considerable help) elected a "very stable genius" to become our country's first Emperor.
Sadly, no one bought this emperor any clothes. However naked he may be, he has come up with the most original plan ever to fight a communicable disease -- keep the stock market booming and the virus will fizzle. Now, if only the Democrats wouldn't interfere...
7
Imagine a man of Donald Trump's age and being in the oval office as president and he is amazed that the regular yearly flu diseases kill thousands and thousand of people. Already this year between 18 and 46 thousand dead. So definitely 18 thousand.
Our man in the white house is astounded by this. Most of us I hope know this. And they let him get up there and state his amazement! Scary stuff! He could have even quickly been briefed. Or read some things on his own! No curiosity at all; no knowledge at all; science ignorant all around. And he and Pence are running this virus show! and it is a show.
10
If there are twenty-five thousand deaths from influenza every year in the United States, and if this bat virus is ten time more lethal and ten time more contagious, then the public can expect two and a half millions dead if there is no quarantine.
3
Listen to Bill Gates.Listen to Bill Gates. Period.
3
I am more afraid of miniature size nuclear device
I would like to share my opinion on masks, having returned from Thailand on January 30th. The mindset in Asia vs. America (in particular) is demonstrated perfectly in the mask vs no mask debate. On January 23rd I was in Chiangmai after canceling my 5 week trip to Vietnam and Cambodia. That morning, our guesthouse coffee clatch centered around the upgrade in the alarming news about a serious virus in Wuhan. A few days later I flew out through HKK. From the departure in Chiangmai until we deplaned in Seattle, not one Asia nor my caucasian nurse self was unmasked, except to VERY quickly eat, heads down, no talking. About 175 people were masked, 8 were not masked. Those 8 were AMERICANS, like me, white, like me, laughing, sneezing, laughing and making certain they touched the back of every seat on their way to the toilets. I doused my hands with alcohol every hour, and I cleaned my hotel room (even door handles) and stayed almost 100% isolated once I reached my rural home for 14 days. Now we are a month on and California, Washington, and Oregon have cases and everyone is mystified about "how it was spread". I can tell you hints: It was probably the arrogant passengers on Cathay Pacific who bloviated and spittled their way across the Pacific! Don't believe me? Wear a mask for 30 minutes and see how many times you sneeze, cough, spittle, and touch your face.
7
Excellent comment! And a simple surgical or examination mask will probably accomplish this task of stopping people from touching face and releasing vapor/“spittle “ airborne.
I hope people who must fly will take to heart you comment, also, about the epidemic exposure danger of handling the back top of each aisle seat when going to the restrooms.
4
Anyone who does not have 30 days at least of 1500 calorie a day diet of canned and dried food stockpiled for an emergency is a fool. 30 pounds of white rice is a good cheap place to start. And vitamin pills.
3
Paid sick leave vs unpaid sick leave doesn’t really matter too much when you’re dealing with a virus that spreads before symptoms show up. Or one that can produce such mild symptoms for some individuals that they’re not even aware that they’re sick.
3
@J Assuming that what you say is true, it is hard to understand why the number of new cases in China is going down. Even an authoritarian regime like China cannot quarantine tens of thousands of individuals with such mild symptoms that "they’re not even aware that they’re sick".
1
In Britain, the NHS has a dedicated Coronavirus emergency phone number ( 111). The nation instructs the following people to phone the number:
■ You think you might have the virus
■ You've been to Cambodia, China, Hong Kong, northern Italy, Iran, Japan, Laos, Macau, Malaysia, Myanmar (Burma), Singapore, South Korea, Taiwan, Thailand or Vietnam in the past 14 days
■ You've been in close contact with someone with coronavirus
The NHS tells the public that callers should NOT jut go to a hospital for testing, Rather, that the 111 service will tell them where the testing will taking place:
1. A designated isolation unit used solely for such tests
2. A drive through testing facility, where the patient remains in the car and test applied through window
3. A health worker makes a house all to administer the test.
6
America's form of virulent, unregulated capitalism will not allow for adequate emergency preparedness because it is a financial loser. Only expenses that can enrich white male Republican oligarchs are acceptable.
4
“Viewed from the heights of reason, all life looks like some malignant disease and the world like a madhouse.”
Goethe
1
The Coronavirus Pandemic is a genuine worldwide disaster, and Trump has made it worse by denial and incompetence.
Trump is concerned that this looks bad for him. His natural response to any crisis is to lie, cover up his own mistakes, and blame others. VP Pence will do whatever Trumps says. We cannot trust anything they say.
Under Obama, the US government was prepared. But after Trump cut the budget of the CDC two years ago, experts predicted that this would hurt American preparedness:
“Why American could become vulnerable to the next major pandemic”
https://time.com/5177802/cdc-budget-cuts-infectious-disease/
Every American death will be on Trump’s head.
4
The Trump White House seems to be using the rational that this isn’t as bad as the flue, which is totally ridiculous. They are okay with the 60k deaths each year from the flue and use that figure as a barometer for acceptability. First of all, the Coronavirus may be 3 times as deadly and there is no vaccine or treatment, second many of the deaths from the flue could be avoided if we had a better heath care system, sick leave and medical accessibility. When you consider our success rate against the normal flue and apply that to a rouge pathogen, all of their dismissive talk about the Coronavirus is at best wishful thinking, stupid or intentionally misleading, self serving and extremely dangerous.
2
I think it should be blindingly clear by now if it isn't already, that having a policy of simply destroying the work of your predecessor wherever and whenever you find it, is no way for a president to run a country.
trump cancelled and gutted the pandemic fighting inafrustrure President Obama put in place after the Ebola outbreak, not for valid public heath reasons but just because President Obama was responsible for establishing them.
And now we will pay the price for his childish stupidity. It boggles the mind.
6
Just wait till it gets into the homeless population.
7
Bernie Sanders, healthcare for all to the rescue!
Good news, The Galilee Research Institute in Israel says they are within a few weeks to 90 days from developing a vaccine for the COVID-19.
2
That poor man, billed $3500 because he thought to get tested for COVID-19.
Our health care system is a laughingstock.
4
I hope they waived the bill! Or that the state is paying it!
3
We need to get rid of the biggest virus that has been threatening us for over 3 years. Trump needs to go!
He doesn’t believe in science or truth.
This man chose Pence another science denier to lead the Coronavirus task force. Should we laugh or cry?
The incompetence of this administration is on full display.
Wilbur Ross, commerce secretary, said that this virus in China will be good for America. Our president stated no one has died. Then of course someone did.
Yesterday he said healthy people shouldn’t worry. What about people who are obese, people who have diabetes or many other diseases that are prevalent in the US? President Trump is one sick man himself. You can all figure that out by yourselves.
People cross your fingers and you’ll be okay. That’s the Trump way!
2
The "big one" is going to be virus with the average basic reproduction number of measles and the case fatality rate of Ebola. That pathogen, if it exists, will either wipe out humanity on its own or induce a panic that will do it for us.
1
If there isn’t a pandemic, don’t offer thanks to our anti-science “global warming is a hoax” prez, who’s proposing budget cuts to the CDC and has appointed Mother Pence as his coronavirus czar...
1
Insanity, the 'big one'? Y'all want to compare this to a movie script or the 1918 pandemic, within two weeks the next story (whatever) will command your undivided attention (and speculation). Please calm down already! The common flu kills many many more EVERY YEAR than this virus will in 2020.
3
Mr. Kristof, Dr. Peter Jay Hotez is actually at Baylor College of Medicine, and not Baylor University (the two institutions are quite different).
Millions of American workers do not have paid sick days even health aides in nursing homes, hospitals and at-home agency workers. These folks do the most intimate care of the sick and disabled : bathing, toiling, etc. But we need an ad-hoc federal fund to allow all workers paid sick days, asap. Typhoid Mary 2020 will be a sub-contract worker.
Also... dump the birthday candles. Misting a cake with your microbes in order to blowout candles and then serving that to family and friends is a stupid tradition. Think of something else.
6
we were warned.
Coronavirus: how Disease X, the epidemic-in-waiting, erupted in China
Health experts warned of a future epidemic that would be ‘threatening to the world and socially disrupting’
The new coronavirus that erupted in China may fit the description
https://www.scmp.com/news/china/society/article/3052721/coronavirus-how-disease-x-epidemic-waiting-erupted-china
2
Of course it's Trump's fault. I knew that was coming the first time I ever heard of the disease.
2
Jared Diamond said hunter gatherers were bred for intelligence, civilized humans for herd immunity. We better hope are stupidity doesn't overcome our herd immunity, isn't looking good.
2
I'm waiting to see a photo of the line at the hand sanitizer station at a Trump rally.
1
The" big one"? I thought that SARS was the "big one." Or, wait, wasn't that Ebola? Or was it Zika....
4
I like mention of the sick restaurant worker scenario. Why do people who send their kids to universities that cost $60,000 a year not seem to care that the food and cleaning staff may be making minimum wage? Without paid sick leave benefits. We are very smart and we are very stupid.
3
Nice list of things we need to do as a nation. Please send to Fox news so the Prez and Repub Senate will have a clue.
The globalist diversity crowd gets its wish - if not this one then soon the "next one!"
2
Gee, I sure hope the virus doesn't get trumpo. What a tragedy that would (not) be.
1
My understanding from climate alarmists like Mr Kristof is that precisely what is needed is fewer people on the planet. Now they advise on what we all must do to stay alive? Its senseless to hope for restraint from NYT and it’s ilk, but maybe, just maybe, some accountability?
2
The Trump haters are making this political and blaming him for this catastrophe. They have done this before and will do it again and again. If President Trump, discovered a cure for coronavirus tomorrow, they would still blame him for the outbreak. He cannot do anything without the haters finding fault. He is their whipping boy.
1
This virus is, sadly, a perfect advertisement for M4A.
1
Despite our occasional bursts of technological and intellectual brilliance, humans are, in reality, the dumbest of creatures.
Is there another intelligent species that knowingly defiles, poisons, destroys its own habitat?...increases its population beyond sustainability?...maintains behaviors that are likely to sicken and decimate themselves and their progeny?
Stupid...and willfully so! Absolutely beyond comprehension.
3
Dear God,
Hit me with your best shot.
Hit Trump harder.
Your loving servant,
(your name here)
1
You bet the Corona virus is the big one. When the bodies of famous people start piling up, Incompetent President Trump’s bid for reelection will be over.
2
The key is to respect your ignorance, listen to the experts, and act appropriately. Based on our current administration, we are all doomed.
2
Good luck with wits in America. 63 million Americans voted for a nitwit.
3
I would have thought with all the scientific advances we have made since 1918, we would be better situated to fight the coronavirus. But with the morons we have running this government, I have no such illusions. The only weapons Trump has in his arsenal are lies, threats and lawsuits. Unfortunately those don’t work on germs.
5
Experts' warnings about everything go unheaded. Name one that is widely practiced with high esteem. There is untold simple evidence about the benefits of diet and exercise, yet half the population is obese. Many more are nearly so. This is not hyperbole. I consider speed limits expert advice, if not the law. At 5 MPH over, I am routinely passed like in aggressive anger. At 10 MPH over, I am challenged to a daily dual with 100s who I swear I never once crossed. This same citizenry relished the notion of handing over the executive branch of the federal government to someone with zero experience and a penchant for dishonesty.
I don't mean to say it's a comeuppance or even poetic justice that we have incompetent leadership when we need clarity and insight. It's not that the national IQ is well below where it should be for the many challenges of our age, it's that heading experts' warnings about anything is hard, much less a virus that didn't exist until a few weeks ago.
So, we fail. How do we learn from this failure? For one, we need to focus on what's important. I can say for certain it is not the status of the stock market. It is not whether Donald Trump is doing anything right. It is whether we are connected to our neighbors and family because they will need us or we will need them.
16
"While figures are uncertain, the coronavirus may kill 2 percent of those infected; if correct, that would be similar to the lethality of the 1918 flu ." Not according to what I've read. It is estimated that over 500 million people contracted Spanish flu. Even if 50 million died (and some estimates are lower), that would be a 10% mortality rate. If coronavirus kills 2% that would be five times LESS lethal than Spanish flu, and closer to a "normally" bad flu.
2
The Trump administration is doing all in their power to treat this pandemic. They are having frequent press conferences and keeping us up to date with the latest outcomes. They have put together an excellent team comprised of some of the best medical personnel in the world. We have up to the latest medical facilities and personnel who who are working tirelessly to remedy and keep under control the coronavirus. They are doing all that they can to keep us safe. We shoukd not panic and go about our lives. We must use due diligence and just be careful.
3
There are many people in this country with coronavirus symptoms. There are likely many other asymptomatic carriers out there as well. Thanks to the Trump administration only a few hundred have been tested. We know almost nothing three months into this thing. If you think his is good management tell me the name of the company you run so I can short the stock.
21
You mean like the way science-denier Trump insisted that the virus is entirely under control in the US and the 15 or so infected would all be released from hospital within a day or so? Or how he blamed the stock market nosedive not on fears of a pandemic but rather on the alarmist media and the field of unworthy Democratic candidates for the presidential election?
16
@KMW Trump did not put that team together, and in his time in office he has tried to kill it. The CDC was there long before Trump and his administration and even earlier do their best to prevent it from doing its work.
5
I hate to share this thought, but if, as it seems likely, that transmission can't be controlled, and most of the mortality is among the elderly (an age which I am approaching), how much attention and resource will really end up being devoted?
2
Great article , obviously we have many experts on pandemics and zoonotic viral outbreaks. The plan was to cut the CDC budget in 2021. Our leadership prior to the outbreak was refusing to increase this essential budget. Aft it is gone no doubt they will try to cut it back. We have authorized $2.5 billion and we really should go to the needed $30 billion dollar level. Common sense is a motivator during time of panic but health science is crucial in the new world order. Zoonotic outbreaks will accelerate in frequency. Our virologists know this and have predicted this. Our "anti" science, tax cut governance had planned otherwise. Face facts the people in the front lines who vote need to put their foot down. Higher education and health science IS national defense. I can't believe this is even a debate. Look at the history in this well written article.
1
In his editorial, Nicholas Kristof gives his take on what the rulers should do if they want to end communicable diseases, but the question facing each of us is what we can do to protect ourselves and our families.
Since the government has credibility issues -- for example, it claimed the air in NY was safe after the collapse of the World Trade Center, or that people were safe from nuclear testing now believed to have cost the lives of many, including some making the movie "The Conqueror" -- we can't rationally trust those associated with it with our family's lives. Thus,
choosing the correct experts to listen to for your family's well-being is a challenge you face.
Furthermore, when the government quarantined the Diamond Princess, many became infected as a result. Hence, ignoring evil government actions is vital to protect your family and community from communicable diseases. Do your utmost to avoid becoming another of its victims.
Kristof's blaming government is de riguer in journalism, but isn't likely to change anything in the next few months, nor is one vote likely to do anything, especially if you don't live in a battleground state where a mere vote changes the outcome. You would be better advised to focus on what is under your control. For example, the astronauts on Apollo 13 did not worry about a possibly damaged heat-shield since they couldn't fix it anyway.
Kristof's advice about things not under your control is wasting your time.
5
Everyone including politicians should read Carl Sagan’s last book, The Demon Haunted World. He wrote it after contracting cancer knowing he was dying. The book basically poses the question by a very concerned dying scientist, of what becomes of a society that is increasingly dependent upon science and technology but wherein the average citizens are entirely uneducated and indeed disdainful of science preferring instead pseudoscience, mythology (religion) and banal pop culture? It’s a good read and a scary reality.
2
Here I see the obvious treatment of antibiotics to prevent meliorate opportunistic bacterial pneumonia which victims typically get. The U.S. is acting like a third world country: China is much better once it acknowledged the disease.
1
You can prepare for pandemics. Or, you can have empty tax coffers due to the fact that multi-millionaires like Donald Trump and Jared Kushner, and multi-billion dollar companies like Apple and FedEx get checks from the IRS every year instead of a tax bill. But, you can't have both. And for decades now the GOP has been utterly determined to ensure that it's the latter.
It would be real justice if the people who decimated funding for the CDC, and the viral response teams at the NSA and the White House were the only ones to get infected. Or, perhaps, if off-shore tax-shelters were the only vectors for infection.
That aside, I think we can all agree that the only thing that really matters in all of this, is that Donald Trump, himself, doesn't get infected. Well, at least we all know that he would agree that that's all that matters.
It's too bad we can't just fly Trump over Wuhan and drop him into a wet market.
2
Who knows if the voting can continue for primaries or if this will effect our voting for the Presidential election.
1
To start with I think China needs to be more forthcoming about the origins of this virus. I've heard stories ranging from the eating of wild bat meat to the source being an accidental release from a laboratory. I've been to China a number of time and while the Chinese do eat a number of foods that we would seem strange ( chicken feet come to mind) I've never seen or heard that they eat bat meat.
If it's a biological weapon that was in development I suppose we will never know that, but to effectively produce a vaccine you need to know as much about the origin as possible. International pressure needs to be applied to China forcing them to produce all the pertinent facts that they can in regards to this virus as soon as possible.
4
@VMG
China published the genetic code of the virus extremely quickly, making it accessible to researchers throughout the world (I believe in early January). Researchers in UT Austin are already working on a vaccine based on that information, but it will still take over a year to develop one.
1
Yes Sir. Having a good and affordable health care system is an essential part of the American Dream. Now when doctors are needed more than ever, they would not come because they are also needed in the countries where they were born. We believe in God, and for that reason we are praying for the scientists, doctors, nurses, and government officials in charge of finding a remedy to coronavirus.
It's always best to leave the numbers to the experts. Still it sometimes hard to believe the numbers I remember people saying it killed nearly everyone who got it in 1918. Numbers on the internet say between 18 and 100 million were killed. Millions of refugees and soldiers were moving around because of WW1 which explains how fast it spread.Today people travel for vacation and business which leads me believe the models for Corona virus are conservative. So far the death rate of people with Corona virus is 2 to 4 percent for confirmed cases.
I also remember claims that WW1 killed 140 million and 120 million for WW2. Over the past 50 years those numbers have been drastically reduced.
Last week a science story on these pages stated factory shut downs in China due to virus means less CO2. Good for the planet. Since Covid-19 affects mostly elderly perhaps a story could be done on the financial saving with fewer elderly around. Sorry about that. It's just my way of reminding some these are people we are talking about not numbers.
Alex Azar said there is no cure or vaccine ready in the short term. I understand there is a meeting of Big Pharma representatives at the White House. Hopefully Azar is proven wrong. It's a start anyway.
Floridian Osmel Martinez Azcue went to a hospital to test himself for COVID-19. He didn't have it, but his bill was $3,270.
Am betting Osmel Martinez Azcue is open to the idea of Medicare For All, but he knows that we can't afford it. Sorry, Osmel. Look at the bright side, though: You don't have COVID-19 yet. Is ours a great medical system or what!
1
I would classify Corona as a medium level threat. The plague in the Middle Ages was much worse.
This coronavirus pandemic IS a big one because of the attention it has gotten, its probable lethality at 2-3%, and the fact that it has caused turmoil in the financial markets. But a more lethal pandemic is probably just down the road and will make Covid19 seem like ordinary flu by comparison. It is time we invest in real the science of how to instantaneously respond to every new infectious disease as it arises. It is theoretically possible to develop synthetic antibiotics to thwart any microorganism as soon its genome is deciphered. That is only a matter of time if we invest in real threats to our population instead of silly walls and other 19th Century ideas from the likes of Trump and his Republican intellectual throwbacks.
1
Nicholas Kristof reliably makes my day with the intelligence and deep humanity that illuminate each of his essays -- so much so that, particularly in the wake of all the readerly picking over the number of millions of dead left in the wake of the 1918 'Spanish' flu pandemic, I can hardly believe the nit I am about to pick.
Yet here it is: in the early 20th century, mourning families draped ribbons of crepe fabric, not crepe paper, around the doors of their homes. The black fabric, also known as 'crape,' was usually black (sometimes white) silk with a crinkled surface, much like that of crepe paper.
2
It's "COVID-19". Be professional by referring to it as COVID-19. Stop using the ambiguous term "corona virus". When another corona virus emerges with different behavior, impact and preventative measires, we will be unable to differentiate between them, and people will fall ill and die needlessly. Be clear: This is COVID-19.
As a dedicated Republican, I say: better to have people-killing diseases run rampant, than to wreck our economy with job-killing regulations.
But disease run rampant will slam many businesses to a crawl or halt. And there go revenues.
1
He says..."we will get through better if we make preparations while relying on science and evidence rather than on muddled political leaders trying to talk up markets or score political points." and then he goes on to try and score some political Anti Trump points. Trump did not cause an epidemic and NO amount of preparation can handle the load of another pandemic. More ventilators? great... and where will they be used? Wow will run them? Silliness!
1
The "Big One?" Let's not forget HIV. By 1984, 4200 were dead and an estimated 300,000 were infected by the virus. The Reagan Administration's response? Laughter and apathy.
2
The cost issue is huge. More than 40% of Americans are already afraid to go to the doctor or hospital because of cost and punitive medical debt collection. The average deductible of $2,000 is more than most can afford. If they can't afford their bills, bankruptcy is just the tip of the iceberg. There's ruined credit records crippling patients' ability to get credit, housing, and even jobs. There's rampant wage garnishment, driving people further into poverty. And in states like Kansas there's getting thrown into jail for failing to show up for medical debt hearings.
They say we are well-situated to deal with an epidemic with top rate scientists and medical institutions, but with Americans afraid to go to the doctor or hospital because of cost, and punitive billing if they do dare to go, this epidemic will be worse than in any other industrialized nation.
https://features.propublica.org/medical-debt/when-medical-debt-collectors-decide-who-gets-arrested-coffeyville-kansas/
Excellent piece, Nicholas. This is more about America's current leadership than this virus - though not to minimize the serious risks here. We have the most incompetent and ineffective government leaders imaginable for the massive 21st century challenges facing America and the world, facing all life and the natural world.
Trump is our worst presidential nightmare. Rejecting scientific FACTS in favor of his own politics of ignorance and cruelty and his self-aggrandizement is insane. Rejecting the science behind the climate crisis in favor of fossil fuel profits and personal greed is genocidal. Rejecting this coronavirus pandemic science as a Democratic party hoax is insane, genocidal and shows complete incompetence, ignorance and disregard for life itself. This is our current president. This cannot stand. Where are those who call themselves leaders?
Where are the voices with the courage shown by Lt. Col Vindman, Fiona Hill, Marie Yovanovitch and the others who stood tall , stand together and told the truth? Trump and the Republican Senate must be crushed or we and our kids are done. Wake up, America.
Proposal for the NY Times: choose 1-200 recognized leaders from all key sectors of society and devote the entire Sunday Magazine to truth, trust and the realities of this administration. Leaders ready to stand up to this cruel bully and his sycophants and tell the truth about him and his cronies and sign a declaration of Truth, Trust, Transparency in our government.
2
Timely read: "The Patron Saint of Plagues" by Barth Anderson.
The 1918 Spanish flu which started during WW1 killed about 800,000 people in the USA and persisted many years after that.
The problem with the Spanish flu of 1918 was the overwhelming and unexpected reaction of the human immune system, that injected fluid in the lungs and caused death. The first step towards prevention besides the normal cautions of keeping far away from crowds and from suspected infected persons, not shaking hands, washing your hands often (and throughly) and not touching eyes, nose or mouth. Boosting immune system by proper diet and ingestion of 1 gram vitamin C and other vitamins. Wearing a N95 rated face mask tightly fitted, (watch on youtube) if traveling on buses, trains and airplanes. And most important be afraid and not complacent by disregarding the health warnings. This is a very serious disease that's has not been researched widely, and a lot is unknown, so we must be prepared for the worse without panicking.
2
Alex Azr--HHS chief on Sunday News this morning saying it's important to treat Americans as adults. Really? Then why modulate your voice as if talking to little kids saying
We don't know where this will go.
We will see more cases.
We will see more community spreading.
How big that gets-we do not know.
We are actively working on vaccine.
Basically HHS knows nothing.
Hope for the Best, Brace for the Worse?
1
Relax, President Dunning-Kruger and Pastor Pence are in charge.
Hopefully, much brighter minds will rise above their proud incompetence, incuriosity, ignorance and worship of the God of Mammon and help steer us through this crisis.
Perhaps Americans will finally learn the hard way that rejecting science, expertise, Medicare For All and good government is a recipe for manmade Republican disaster.
4
but Italy, S Koree, etc. can test on the spot...makes you wonder who we have become....
3
3700 die in car accidents everyday world wide. 2700 have died of corona virus in 10 weeks. Humans perception of probability is very weak, to say the least. We live in the age of exagerration on almost everything.
World wide 0 deaths with those under age 10. Zero. .2 percent in all decades from 10 to 50. 50-60 its .8. 60-70 3.2, 70-80 7.2 percent, 80+ 18.7 percent.
But they close schools? Wash your hands 6 times a day, if over 65 then stay home for 8-10 weeks and order pizza. The over reaction says more about us than the virus. It kills old people, it doesnt kill the very young.
@Mortimer
It doesn't kill the very young... yet. If this is like 1918, there were three waves. The first, like now, started in the spring and didn't kill too many. The second wave returned in the fall and killed millions, particularly the young and healthy. The third lingered on into 1919 and 1920 and decimated certain countries, like Samoa.
1
@Mortimer
It kills people and old people are our families and humans.
Sadly, people worry more about the stock market than the elderly. Are you suggesting that the virus is useful in getting rid of the elderly?
4
"[W]hen you have 15 people, and the 15 within a couple of days is going to be down to close to zero, that's a pretty good job we've done."
-Donald J. Trump, February 26, 2020
2
with more testing positive by the hour its time to get those test kits to the ERs on west coast and for sure get the pts in ICU with URIs tested and every ER pt with symptoms...Lets be prepared and proactive...... from a former home health RN in Oregon
@ose
This is a Lower Respiratory infection, not URI.
This isn’t the big one, but in this age of disinformation, destruction of rational discourse, and loss of critical thinking ability, it might as well be the End Times.
1
I have nothing against prayer, but if Trump thinks this is a hoax there is no need to appoint Pence to co-ordinate our response.
We desperately need leaders who believe in science!
3
Reading through many of the astonishing comments below, I began to distinctly hear the sound of a fiddle playing in the background.
1
Question about the coronavirus, what about those held in detention south our borders if it hits them?
At this point in the course of this viral outbreak an attempt to draw a parallel with the 1918 pandemic is simply fear-mongering.
What follows is condensed from a CDC report on the 1918 pandemic in order to put our current situation in appropriate context.
Besides the properties of the virus itself, many factors contributed to the virulence of the 1918 pandemic. The world was still engaged in World War I. Movement and mobilization of troops placed large numbers of people in close contact; living spaces were overcrowded. Health services were limited, and 30% of U.S. physicians were deployed to the military.
Medical technology and countermeasures were limited or non-existent. No diagnostic tests existed that could test for influenza infection. Doctors didn’t know influenza viruses existed. Many health experts thought the 1918 pandemic was caused by a bacterium.
Influenza vaccines did not exist, and antibiotics had not been developed. No flu antiviral drugs were available. Intensive care support and mechanical ventilation were not available. Doctors were left with few treatment options other than supportive care.
No coordinated pandemic plans existed. Some cities managed to implement community mitigation measures, such as closing schools, banning public gatherings, and issuing isolation or quarantine orders, but the federal government had no centralized role in helping to plan or initiate these interventions during the 1918 pandemic.
1
@JFB
Yes... but the world's population is four times greater now and we fly around at jet speed, so let's not get too carried away with the reassurance.
2
Trump claimed cutting the staff at the CDC was not a problem because they could bring people in when a crisis occurs and respond to it. This is being reactive instead of proactive. The CDC should be preparing for things that could happen instead of waiting until they occur and responding after much of the damage has been done, and bringing people in and trying to quickly get them up to speed on what is happening.
3
As with any threat to public health and safety there will be a range of reactions among the population. There will be those who willfully disregard all warnings and intentionally flout any recommended precautions. Then there will be those who react in the opposite extreme and hoard food, medicine, fuel, building materials, and cash. The former will be responsible for acting as the factor that will spread the disease in our society. The latter will be the element that disrupts economic activity. I do not see this ending well or soon.
4
Trump’s response to this crisis is an egregious example of using the power of the presidency against the American people to suppress information and promote falsehoods to further his own interests. It is evidence that he is desperately (and ineffectively) attempting to prevent freefall of the stock market and discredit legitimate concerns about the potential harm of the novel Coronavirus. After all, in his view, ignorance is bliss; what we don’t know won’t hurt us. If there are few reliable tests, and obtaining and using them requires lengthy negotiations, how will health officials know how serious the consequences to delayed and feeble responses may be? This stalling, hemming and hawing, and lying is criminal, willful dereliction of duty and may have disastrous consequences.
2
Are you fear mongering? Yes, but I sense you don't know any better than to ask the opinion of a Harvard College dropout whose credentials are billions of dollars and a high opinion of himself. The fact is that there was little science to counter the 1918 pandemic. We have learned a great deal over the past century about mitigating flu viruses. There will continue to be suffering and loss of life but not of the magnitude of the 1918 pandemic.
2
That anecdote about the $3,200 “flu test” is distressing. It’s part & parcel of the general opacity of medical costs in the US. Similar to tales of the $75 aspirin pill or $200 band aid in hospitals. Here’s an idea for an Executive Order from President Trump... $50 max flat fee for a flu test; waivers for uninsured/under-insured. Use one of those War Powers laws as the basis. But take away the “gotcha” factor for cost. Keep the test affordable. Heck, this week’s stock market losses cost the economy far more than testing all 330 million people in the country.
2
The last place I would want to be if I'd been exposed to this virus is the United States. We'll talk about it's vaunted health care system once this is over. In the meantime, I plan on returning to Canada, where I know I will be looked after, no matter what.
7
"The White House and Congress should immediately establish a system to ensure that patients need not pay for coronavirus testing and treatment. We should also ensure paid sick leave. Do we really want to go to a restaurant where a coughing, sneezing food preparer still goes to work out of financial need?"
Great idea. And here's the good thing about having a megalomaniac narcissist for a president: he won't waste time trying to get Congress on board. He declared a "national emergency," bypassing Congress, to divert almost $4 billion dollars from military spending for his inane wall. He could do the same thing here with regard to testing, treatment, and paid leave and he would be on much firmer "national emergency" ground doing so. Here's hoping that Trump's ego turns out to be one of our best defenses against this virus. His ego knows his legacy may be at stake.
2
Nicholas,
You said,"“If we see a situation in the U.S. like we saw in Wuhan — more than 1,000 cases among hospital workers and five or six deaths — it’s game over,” he said. “Health workers lose confidence, and things start to fall apart.”
Hotez said that one crucial step is simply ensuring that all health workers have enough personal protective equipment."
We have already lost that battle.
My wife a 40+ year Big City ICU Nurse tells me that the Hospital Administrators preparations are a joke. They are living in a world of magical thinking. The Nursing Staff actively, but quietly, discussing do they stay or do they refuse to work.
They are well aware of the situation of the Wuhan Nurses and then do not want to become a statistic.
If you could hear what she is being told and her response in detail as to why it will not work...you would be scared to death.
3
There will never be enough masks, hospital beds or ventilators to take care of everyone, when The Big One comes. What really needs to happen is for Third World countries to adopt better hygiene, both personal and with regards to what they eat and how it's prepared. Then, they won't unleash these horrible viruses on the rest of us. Why do we have to pay the price
1
@Roberta
Wait... the so-called "Spanish" flu started in Kansas, from pigs. Should we stop eating pigs?
Glass houses, throwing stones, etc.
1
No.
This is not the Big One.
We already know that it is far less lethal than SARS, much less MERS.
Donald Trump almost destroyed our ability to respond to a lethal pandemic. But this is apparently merely a pandemic, not a lethal one, so we will dodge the worst. Trump won't learn anything, so we have to hope that the next President will believe in science and rebuild our defenses.
Dan Kravitz
2
“Sports events were canceled. Theaters closed. Shaking hands was made illegal in Prescott, Ariz. Philadelphia hurriedly set up six more morgues. Families put crepe paper on doorways to signal a death inside — and crepe was everywhere.”
The calamity here is not just biologic, as in death. Although many thousands may die because of this pandemic and this Administration’s inept response therein, an equally viable threat is the financial.
For starters, how many people will file bankruptcy when their medical bills come due?
How much will it cost this nation to stem and prevent the spread of the virus?
And, as we have seen, Wall Street has already tanked. Supply chains will be decimated.
The economy as we know may be heading for a crash. A serious crash.
I’m glad I’m not in the market anymore. Cash under the mattress, food in the pantry, doesn’t seem all that outlandish any more.
Before things get unmanageable, it’s time to vote Elizabeth in, and this Administration out!
3
Great article. Sick leave is one of the most important factor now that could reduce the spread of the coronavirus. Yes employees are sick due to the stress at work and the lack of sleep due to the commute, besides employees share the same air-conditionning as the guests therefore the threat is real. In China the working conditions are also horrid and cause a tremendous stress to employees to supply the world thus it is logical and normal that the world would get the coronavirus. We need also to review our air-conditionning system, to my knowledge only on country France ever did an audit in the 90's on the flaws of the modern air-coniditioning system.
2
The 1918 Influenza killed primarily young fur healthy people. There is medical speculation that this virulent virus caused a cytokine storm where the patients immune system actually caused the pneumonia and death. When you have an asthma attack it is your immune system that causes the symptoms and makes you ill.
The Presidents responsibility is defense. Public health is defense. Trump is a colossal failure at defense. Not only will this pandemic kill many Americans but it will stymie the economy. The collapse of Wall Street's overbought stock is a reminder of further disaster. I kept looking at the negatively sloped yield curve for the last few months and it too was a sign of price collapse. And his inability slitty to act like mensch and disclose exacerbates the stock price collapse. Not until the VIX goes back to normal and now it is around 40, will the market bottom out.
2
This bit from your column shows why the USA will not handled "The Big One," even if this virus is not it. We have the worst-run healthcare in the developed world. Note:
"Osmel Martinez Azcue, who returned from China and found himself becoming sick. . . .he did the responsible thing and sought medical attention: He went to a hospital for testing. In the end, it turned out not to be coronavirus — but he was billed $3,270."
This is not care. It's managed for-profit cruelty. It's time for a public option, and making these insurers all non-profits.
5
No way. The death rate is far too low. It's nothing compared to Ebola or similar viral infections. As usual, the very young and very old are the most vulnerable.
@Easy Goer Young people are not getting it because their immune system is already on War footing from the natural environment.As we get older our immune system sort of just waits for the next invader and isn't on high function.Thats why legality rate for old people is based on the viral load they receive or if have compromised immune already.So if your sleeping next to your mate who is carrier for 2 weeks breathing in his germs, you might be in trouble from huge viral load.I know, it's Gross!
@Easy Goer Young people are not getting it because their immune system is already on War footing from the natural environment.As we get older our immune system sort of just waits for the next invader and isn't on high function.Thats why legality rate for old people is based on the viral load they receive or if have compromised immune already.So if your sleeping next to your mate who is carrier for 2 weeks breathing in his germs, you might be in trouble from huge viral load.I know, it's Gross!
@jervissr Good point-thx. What do I know? For decades, I planted gardens on rooftops in NYC for a living...
The big will really arrive in 2043, this is just so small in comparison. Coronavirus is really culling the weak unfortunately, nature tends to so this when there is over crowding. I do not believe it anything to worry about but it is something to wax philisophically.
When writing about the 1918 pandemic it would be prudent to mention that this particular strain of flu in a world that was war- torn and generally much less healthy than we are today was a strain that was particularly to deadly to adolescents. This coronavirus seems to be dangerous mostly to people with respiratory conditions or otherwise weakened immune systems.. and yes people will die sooner in some cases but no one lives for ever.
And writing negative articles is useless. All the CDC can do is track the disease and deaths... We could quarantine everyone -- but we have no idea as to how this virus will play out in a relatively healthy population with clean water and too much food in many cases.
Please stop making people worry. Common sense-- keep your hands away from your face, wash your hands frequently..and in the absence of hand sanitizer-- there's rubbing alcohol and or vodka -- possibly to be preferred. Lots of tissues for wiping things down and I frankly think plastic shields like the ones dentists wear would be much more effective than mask but I could be wrong. If you can't get mask, tie a scarf around your face. Stay hydrated and properly nourished. You should be fine.. Probably, some people are genetically more disposed to get certain diseases than are others, and which other coronaviruses you have had aka colds may also affect your immunity status.
Frankly, I think anything that makes us think is a good thing.
2
According to published comments by experts, the coronavirus may kill up to 2% of those infected and those will be the elderly and/or individuals already suffering from another illness. It is a bit worrying BUT the NY Times reporting make it seem like inevitable doom. Take the precautions as recommended by health care professionals and 98%+ of the public who get infected will suffer only a mild illness. Everyone is not doomed to catching and dying from the coronavirus.
This is an important article for pointing how just how sick our health system is and how much sicker is our current administration.
1
No one alive today remembers going through the 1918 Spanish Flu pandemic. When you speak of 'The Big One', Nick Kristof, we in America today think of the big one as being the high magnitude earthquake we've been waiting for in California, not a flu like the Coronavirus, Covid-19 pandemic that will steal our lives. How can we avoid climate change and unknown viral diseases? We can't. Hoping, praying, won't turn away catastrophic events from our lives on Earth. But washing our hands often may well help us to avoid the influenza virus fire this time
"Dangerously shortsighted" about describes Trump and his administration and the Republicans in Congress who do fealty.
I am more amazed that President after President, congress person after congress person has made the US amazingly unprepared. But I am not amazed how uneducated and gullible the American electorate is.
The leaders elected are much more concerned of maintaining their positions than making any tough choices that would benefit the American public. This is why Trump was elected. The uneducated and gullible thought they would get something different. And they did. A leader of the greatest incompetence in the history of America. Reduce taxes, build a wall, trade tariffs, acting cabinet members who have little skill and lots of loyalty; these characteristics do not bode well for most of America.
America, you elected a germaphobe with no experience in crisis management who thinks he is always the smartest person in the room. Wake up and realize that a man who argues weather patterns with a sharpie, spends 25% of his time on a golf course and uses his office to improve his private business is not your advocate in this possible health crisis. As much as he will try, you cannot tweet your way to a healthy society.
5
Why are people expecting a cure and a vaccine within the next twelve months? Where's the SARS vaccine? That was seventeen years ago, and today there's no cure for SARS.
The for-profit Healthcare system in America will ensure this outbreak will silently spread while infected people self medicate with supermarket medicines.
The USA's inept administration should listen to the experts, instead of pretending to know what they will never know.
This sort of alarmism, in the absence of facts and knowledge, is irresponsible. There is no way to "prepare" for an epidemic that sweeps the planet, if the virus in question is extremely contagious and has an incubation period such that folks don't even know they're sick even as they're spreading the contagion.
People need to calm down, the media especially. We have no idea what's going to happen, and looking for folks to blame in a situation like this isn't productive.
2
Two percent dead and somewhat isolated to elderly and weak people. Is that big? Actually they don't really know the death rate but it probably does depend on health and age and smoking.
Anyway, generally speaking, the war mongers don't kill as many people as this will likely kill because that would affect the economy too much. They like killing but not too many. The market thinks this will kill more people than the war mongers. That's a lot. While I generally think the people who gamble on the market are clueless, and there is some evidence for that, they collectively appear to believe this is serious. But then, they are not concerned with lives, but money, and they may be assuming losses due to panic rather than just simply fewer sheep to shear.
In a decade or so, the big one will be climate change. This one is just the one that worries the greedy for a bit. It will pass, and not be a threat to humankind at all really.
We can cry every time the natural happens or we can stop pretending that we are a special animal in the eyes of the imaginary beings in the sky. If all death is a tragedy then all births are too.
The ridiculous Bushian/Republican response to the aftermath of Hurricane Katrina certainly cleared the way for the Democratic Congressional victories in 2016 and for the eventual election of a Democratic President.
We may be seeing a return set up--if the coronavirus spreads far and wide, even without a high morbidity or mortality rate, the economic and lifestyle disruptions are not anything that the current administration has shown it can handle (whether on agrees Pence is being set up as the fall guy or not).
These random-act crises are the ones that truly test a government's mettle. Does anyone out there really think that the current administration has any?
The sad truth is, it may take such an obvious incompetent response to turn members of the cult of Orange away from their god and his facilitators. It may be the one thing that brings a Democrat back to the Oval Office. But I despair for the lives that will be disrupted, and even lost, in the process. And I wonder why it seems to have to be this way, and why we can't just be smarter.
2
If Trump was a real leader he would establish immediate and free testing for those sensing that they might have the virus. This would be leadership. And also good politics. Is this likely with Trump? Nope.
1
I´ve heard a virologist in a German TV discussion who was involved in developing the test for the virus and he said the panic is ridiculous and in no relation to the danger.
They just try to limit the outbreak not to stay as a constant disease and limit it to areas to die out there, and thats why the measure seem so intense, not bc the disease is so dangerous.
But if people go on freaking out like that , all kinds of things can happen and economy is already infected in a really dangerous way as it seem. Also endangers lives and well being of people esp the poorer ones - and poorer countries. And medication, that cannot be provided and imported like anti-biotics, which are already missing.
That said, in the US it is more likely to become really bad, due to the lack of insurance and all that is mentioned in the article. Here we have free testing and a hotline, where people can call doctors who will visit people at their homes and take tests , so the sick ones dont go to the doctors office and infect other patient ad staff there. And that s payed by the insurance of course and doesnt cost anything extra for the patient. So people have just to face quarantine -preferably at home, if they arent so bad- in case , but no high bills at that.
So time for the US to join developed Western countries and get general health care finally. Nothing to be scared of ( "socialism" !!!) , quite in the opposite. IMHO. You will love it.
1
Haven't seen or heard much aout Pence in the past years. Why now?
Usually Trump doesn't like to share the limelight with others.
2
We have a very stable genius leading us.
What, me worry?
1
But on the bright side, after the Big One finally does happen we will be well-prepared for the Next Big One After That.
Our crooked business leaders are always talking about best practices. For them it means ensuring that employees have no medical coverage, benefits, pension plans and the shareholders are making money hand over fist.
Unfortunately when it comes to public health we have half the country underinsured or not insured at all.
People would be less anxious if everyone had access to health care and we allowed people to stay home when they are sick. Sadly that wont work for everyone because they wont get paid. Don't get paid we already have an administration that is cutting food stamps
Right now we have people who maybe sick but cant afford to take time off and they cant afford the crushing medical bill that will arrive in the mail.
Vote Blue in November so everyone has health care because as long as you are part of the world you are exposed to a virus that no one seems to understand how it is transmitted nor does this Trump administration care. Trump didn't even know who passed away today. He doesn't even know how to understand the stock market and the impact on American lives,
3
If it comes down to our wits versus their genes, we are going to fail on a monumental scale. The messaging from President Trump is that this is a hoax by the Democrats. Instead of trying to contain this virus, he appoints Mike Pence, the consummate yes-man, as the Coronavirus Czar to hide the truth and downplay the gravity of this moment. This is a crisis in the making and one that must be fought with scientists and healthcare professionals. Unlike his other crises, which were self-made, this one will have deadly consequences. This is exactly what happens when incompetence and ignorance come together.
4
A quick scan of Wikipedia for a refresher r.e. Decision & Game Theory, we see the assumptions are “rational actors” and “consistent rules”.
When it comes to the Trump Administration, rationality and anything dealing with rules have been thrown out the window long ago.
Hold on tight.
1
Our nightmare today is that a century from now, historians will write about the breakout of a flu-like epidemic in China which grew into a worldwide pandemic and killed a million Americans because we had the bad luck of having a president who neither understood nor trusted science.
The president had spent two years before the China breakout dismantling American government centers at home and abroad, which were designed to give early warning of dangerous health environments.
That president, as he began to realize that the Chinese disease was showing up in other countries and could affect America, continued to play down the advice of experts and to delay preparations to protect the public, because he faced a tough re-election campaign and worried about the stock market panicking.
So, although the president did assemble a White House group to study the situation, each time an American government virologist or infectious disease expert warned of the need for testing kits, equipment and other preparations, the president downplayed the remarks or even contradicted them.
The president in the nightmare about what people will be reading about a century from now also announced that dire predictions of anything worse than seasonal flu, which would disappear with warm weather, were simply a hoax being spread by his political opponents. Initially, some Americans became very angered at the president’s critics for demanding better preparations.
Then the American deaths began.
1
Yeah, let’s consider the man from Florida, Mr. Azcue. He can afford to travel to China but he cannot afford health insurance? Give me a break; like the lamentations over student debt, much of the problem probably results from misplaced priorities by the individual, not because of a lack of available health coverage.
My son is a frontline RN in the ICU of our major hospital. On friday night I had a revelation after extensive readings on this virus.
He and I had a long talk about what was about to happen to him and this country. We made plans to self quarantine for at least a month should it be required.
We will send his mom (who has some medical problems that could make her more vulnerable) to live elsewhere while we create an isolation room for him should it be needed. I will attend to him until it's over.
My revelation came to me at 4pm on Feb. 28 after learning that HHS had (against advice from the CDC) let employees work unprotected with evacuees from China brought to Travis Airforce Base and then let them disperse across the country to begin this pandemic. The " first case" happened 10 miles away in Vacaville Calif within days. This disaster falls on the head of Alex Azar, head of HHS and utter the incompetence of the Trump administration.
7
In many ways I think the world was better prepared to deal with consequences of a pandemic inflicting 50 million dead world wide in 1918 than we are today.
1
Just as clean air, food, and water are not their concern, there are probably people in this country, who by virtue of their wealth, believe they are immune to such dire scenarios; these are just afflictions of the "little people". Perhaps they'll all gather together on one of their estates to wait this out. I suggest they read Poe's "Masque of the Red Death" to snap them out of their complacency.
2
With Trump at the helm, our wits have already lost.
5
One of my biggest concerns around the spread of this virus and the broken healthcare system in the US is the large homeless populations in many US cities. What’s going to happen when the Corona virus arrives in these encampments, many of which are quite large, and tightly populated? I believe we are are looking at the start of a humanitarian disaster.....
1
My daughter informed us last evening that the world conference for Physcist in Denver was cancelled yesterday leaving her, her husband and thousands of others worldwide in limbo.
1
This is affirming and reassuring for anyone in doubt:
Australian Financial Review published yesterday:
Professor Nigel McMillan, the Director of Infectious Diseases and immunology at Menzies Health Institute Queensland, Australia, Griffith University states:
“COVID-19 will eventually become just another virus which, for 95 to 99 per cent of the population, will mean no more than a mild cold”.
Professor Peter Collignon, professor of microbiology at ANU estimates the real death rate will settle at around 0.3%.
The current deaths (statistics out of China) are almost entirely those with existing health conditions (99.1%) (known as co-morbidities) and in the elderly age groups.
We do not currently have a treatment for COVID-19 so the best prevention strategy is a healthy immune system.
Eat well (high protein), sleep well, avoid stress (including stress-inducing family members) and use common-sense hygiene measures.
The specter of a virus that may yet prove it's lethality remains intact...until it doesn't, an unknown figure complicated by a 'brutus ignoramus' in-chief, trying to censure health information according to his capricious needs...and political expediency. So, what could possibly go wrong? Especially when an unhinged bully has been cutting down the resources needed for control, and research?
1
As always, wise and additional insight from Nicholas Kristof. I had not thought of medical costs stopping people from seeking medical attention, and the inevitable effect that will have on propelling this epidemic forward. Oh dear, again.
1
Isn´t it a strong argument for universal free health care...
1
This is superb Nicholas. Thank you. I am pleased to see that Mike Bloomberg is, so far, the only presidential candidate with a spelled out plan for Coronavirus. That’s called leadership. Our current “leader” is a totally inept and tragic mess.
4
do americans truly realize how primitive their health care system is compared to other developed countries?
and in the next eight months we'll be hearing hysterical screams about the horror of socialized medicine and democratic socialism in general while the military soaks up money all over the place.
4
We were prepared. Then the failed Electoral College took that away.
At approximately >2% fatality rate, this virus seems to be at least as bad as the Spanish Flu, and, although we've come far in terms of medical knowledge and healthcare options, we fumbled the ball on test kits, especially embarrassing compared to Ital, South Korea and Iran (!).
With out the ability to test anyone who could have come into contact with newly discovered coronavirus patients, we cannot hope to contain the rapid spread of infection, as in the WA nursing home, where employees are beginning to show symptoms.
That the inept person in the WH fired the Pandemic Response team, should be remembered in the coming months (hopefully fewer new patients in a few weeks).
His ignorance and science denial will have cost lives.
3
This is just ironic.
Trump wants A WALL but there is no WALL that keeps a pandemic out. He cuts funding to the CDC and over 1000 real scientists leave their jobs because Trump doesn't believe in science, only he, himself & the slavish GOP. He alone can fix it. But because he can't "fix" it, it becomes a "hoax." He prevents real physicians and scientists to talk about the virus publicly, because that would mean someone shining light on the truth. He puts Pence in charge of said hoax, and blames the Democrats for it. Trump Junior claims Democrats just want people to die, making his father a failure and compromising the NSADAC.
In Trump's world, it is always someones fault (never his) and someone to be blamed. Not a solution, no working the problem, just denial, deflection and fingers pointed outward.
I crave a return to a Head of State that is calm, collected, believes in science and conducts himself like an adult. A POTUS who wishes to protect his citizens instead of just himself and therefore everyones 401K. I tire of those who think only of the economy and themselves but forget the larger human picture.
The virus forces us back to basics. If your country won't protect you from larger health issues due to politics, does your 401K really matter?
4
Good to see that Bloomberg will flood the airwaves Sunday with his message about being a leader in a time of crisis.
Maybe it will help embarrass and shame Trump and Company into stepping up and doing the right thing.
1
Trump and his Republican enablers have already established denial as their preferred remedy for climate change . Depend upon them to rely upon it as long as they can for the coronavirus.
3
One question for Mr. Kristoff: In the NYT today, I saw that Italy is second only to China in the number of confirmed cases. Most of the Italian cases are located in northern Italy. Why are so many cases located in Italy?
1
Iran's new numbers bring the total deaths in the country to 43 among 593 cases.
Iran's health ministry has said 205 new cases of coronavirus have been confirmed in the country in the last 24 hours, with nine more deaths reported.
Iran's new numbers bring the total deaths in the country to 43 among 593 cases.
1
I’m hoping this virus will run it’s course rather like a seasonal flu but let’s use this opportunity to get some preventive measures in place, like pushing on China to curtail wildlife trade, and upping preparedness generally. For those interested in a deeper dive on the topic of animal-human virus transmission (SATS, HIV, MERS, etc) I highly recommend David Quammen’s excellent book “Spillover.”
While this corona virus may be the first of many big ones to thaw from our earth, it doesn't matter whether it is "the" big one. Why? Because we have an administration headed by a greedy nincompoop who would rather lie to protect the Dow Jones than deal with a situation that is liable to be the death of millions who are uninsured, unable to afford care, and unable to protect themselves.
To Trump, his fellow oligarchs, and a bought GOP, money and power come first, and it doesn't matter if the power ends up being over a decimated population. As long as authority and resources are under the GOP's control for as far as the eye can see, they're all good. Planet warming? No problem. Many of these billionaires have the resources to build themselves the ultimate play bunker or brand new islands off of our coasts. That must be the plan, right? Where else will they and their offspring go when a lot of our land becomes unlivable due to weather or disease?
This is where we are. H.G. Wells and other dystopian book authors have become the model the oligarchy aspires to.
Madness!
2
Clearly our government is not going to protect our healthcare system from crashing. Will you be able to have an operation and not spend your recovery with COVID-19? Will you be able to go to the cath lab for your heart attack or will the ER wait time be 4 hours? I don't want people to freak out, but only we the people have the control. If we can keep our infections per day down, our healthcare system can function. Stop flying around for vacation. Don't send your kids to Grandma's house. Stay on your couch if you have a cold. Call your legislatures and demand expanded food stamps access for people who can't work.
2
Let us pray that this is not the 'big one'. With a president who is ignorant, anti-science, ego driven, intolerant of criticism, in constant need of affirmation, and who put personal loyalty ahead of expertise in his appointments that would be truly disastrous. I cannot imagine a worse leader to have during a medical crisis or during any crisis at all.
3
Reading this op-ed I realized that if we have an epidemic it might just break our dysfunctional health care system.
2
It's not the Big One, but it's showing us how inadequate the preparations and response would be for the Big One with such an incompetent administration. A mild epidemic could easily become a Big One with Trump and Pence in charge.
1
Face facts. Few people, very few, effectively contain the germs they spew. Every day I watch adults, who should know better, sneeze and cough into the air. Telling anyone to use the elbow is ridiculous. I've never seen anyone do it correctly, their noses are never covered and the schmootz flies right past.
As a teacher I insisted my students sneeze and cough into their own shirts. From little to large, I taught them to pull the collar away, tip their heads and keep their germs to themselves. And it worked. I explained the logic to the children and they always understood. At worst, the shirt had to be washed. Had they correctly used the elbow method, the shirt would also need to be washed.
2
Mr. Kristof is right to be very concerned about our level of preparedness for a major epidemic. When people’s ignorant fears drive behavior, we all suffer.
At the end of the Ebola epidemic in Liberia, one of the last families to get infected had relied on a faith healer minister to cure them. Only after they put the congregation at risk did they seek competent medical attention.
Let we think those were just ignorant Africans, in the 1990s, even after we understood the methods of transmission of HIV, we saw teachers and parents refuse to attend schools when there was an HIV-positive student in a classroom as though mere proximity were a threat.
Our people’s general scientific knowledge is appalling. In that, our president sets the example with a persistent immunity from information.
2
I'm glad we started preparing for the earthquake "Big One" here, since two weeks' worth of supplies is recommended for that, as well. If you are on meds, try to get them refilled soon. Many of them are made in China. Camping stores are great places to get things one will need. My barber, who hiked the PCT, uses the knuckle bump instead of shaking hands. Don't reach into boxes for food if many others are doing the same, pour it out. Improve hand washing technique. Start practicing keeping your fingers away from your face.
It is ironic how the Republicans, who have run on "be afraid, be very afraid" after 9/11, somehow think that the coronavirus is just a cold. Maybe they need to see an episode of Dirty Harry and ask themselves just how lucky do they feel.
Right now, I don't feel very lucky at all, between cyber viruses and corona ones. Having Pence be the corona czar is really bizarre.
2
None of us has a crystal ball, or a direct line to God. We can’t know exactly what will happen, or when. But I do know this : Having Trump and his Regime Of slobbering sycophants in charge is distressing, disturbing and ultimately catastrophic. Imagine a Plumber performing Neurosurgery. Or a Grade School Kid designing your Aircraft. What could possibly go Wrong ?
Within a couple of Months, if not sooner, the entire Trump Extended Family and a selected cadre of lackeys will be self-quarantined at Mar-A-Lago. Behind Barricades, under Intensive Marine Guards, with heavy weapons. The rest of us ? We’re on our own. A real life version of The Hunger Games, with actual hunger, woefully inadequate Medical Care and Medications, suffering and widespread Deaths.
An unintended consequence of “ electing “ a simpleton, and Collaborators that will do anything to maintain Power.
Good Luck.
4
The Trump administration is receiving scathing reviews from Democrats over the handling of COVID-19. Lack of preparedness, mixed messaging, CDC testing criteria, role of DHS/HHS among others. Even Republicans are beginning to question the administration.
Even though these are valid areas of concern, I think the Democrats need to stop criticizing the administration. They have to overlook Trump putting his fingers on the scale, making erroneous statements. Democrats, if they're smart, will ignore anything Trump or his family says and concentrate on oversight of DHS/HHS, and CDC.
The CDC has some explaining to do. The frustration with 1980's HIV was with the testing. Patients hesitated to give consent to be tested because they were afraid of hearing the diagnosis. Physicians had to regard ALL patients as if they were infected. CDC had a strict protocol, now loosened, with COVID-19. It entailed symptoms plus travel history from ground zero or other affected areas, or contact with people from those areas. The case in California was community spread so COVID-19 testing was not done. I'm sure the hospital staff didn't take any extra precautions and they are at risk.
This isn't the first administration to be caught unprepared for a disaster and it won't be the last. If it becomes a food fight over every single thing Trump says or does, the focus will be shifted from the important to the infinitely stupid.
1
"Yes, but preparation costs money", said the GOP.
4
You're absolutely right: we must ensure that no one is deterred from seeking help by the costs... but this is the Trump administration we're talking about. The only way we're going to do that is by getting rid of him and his Healthcare-destroying cronies (who all have excellent healthcare of their own) in the GOP. So, in other words, there is no hope until 2021 at the earliest. Let's just hope this isn't the big one, and enough people wake up to the menace that is this reckless, ignorant, Conspiracy-theory spreading, science-denying, dishonest Administration. Otherwise, yes, we could really see tens of millions of people die again. And we can't let that happen.
1
The United States will never join the civilized world regarding having a universal health care system until the ignorant members of its society stop labeling such a system as socialistic. And, of course, getting rid of the Republican majority in the Senate.
1
While politicians are waving their hands, and scientists are wringing their hands, citizens will be washing their hands.
1
"The United States is also vulnerable because of longstanding deficiencies in our health care system. We are the only major rich country without universal health insurance and paid sick leave, and we have fewer doctors per capita than peer countries."
First of all, I am a nurse. While being altruistic is wonderful, free medical care is unrealistic in this country. If Sanders is elected there is no way that the current U. S. Senate would ever agree to his outrageous claims that we should have universal healthcare. They would never approve the taxes. Sanders is pandering to millennials and all those who want a hand-out when he says that there will be 'no co-pay, no out of pocket expenses and free medical care.' Yes we "fewer doctors per capita than peer countries" but we would have even fewer people entering medical schools if the U.S. ever instituted universal care. People would have to wait extraordinary amounts of time to get that care. People in Canada and the UK will tell you this is what they have to deal with. Nothing is free.While it all sounds good, our capitalist society will never accept it. You get what you pay for.
As for the current large-scale epidemic, it was only a matter of time. The Spanish flu spread around the world in 1917-1918 after WWI. Imagine how quickly this COVID-19 will go around the world with the help of air travel! No amount of free care will cure it.
@Rose Healthcare in this country is not unrealistic, you just have to remove the American plunder of capitalism for profit healthcare. We are most expensive in the world and ranked #38 in outcome! Way to go america!
1
If this is the big one we're in big trouble. Vaccines, our best hope, are grown in chicken eggs. It takes six months to grow a vaccine, minimum. That doesn't include development, distribution, etc. Most vaccine producers are in SE Asia, which needs them far more than we do, at present. We're stuck with a profiteering, substandard health-care system which many victims will avoid for fear of being bankrupted. Their understandable response will result in wider community transmission. Oh, those masks that stop your cough from showering everyone near you? Also made in China. Fasten your seat belts.
1
It's bad enough to worry constantly about the virus and ramifications, but now we have (thank you SNL) "Trump Slump)" to experience in the economic world!
As DT has said "Hows your 401k?"
1
I write from Universal Health Care Sweden, and read in my morning newspaper that a new coronavirus case arrived yesterday from Iran - Iranians are an important part of the 1,000,000 of us born somewhere else.
I now read Kristof:
"We are the only major rich country without universal health insurance and paid sick leave, and we have fewer doctors per capita than peer countries."
"He (Osmel Martinez Azcue) went to a hospital for testing. In the end, it turned out not to be coronavirus — but he was billed $3,270."
Only In America, Never in UHC Sweden. Had Martinez Azcue been here as citizen/permanent resident he might have paid about $20 to check in at his local Vårdcentral (neighborhood clinic). If I, soon to be 88, did the same I would have paid zero - after 85 UHC totally free.
Happy to be here rather in my USA even though I have Medicare + Aetna complementary - not free. Here we have scientifically informed leadership, in my USA a man who believes in eternal life, waiting for him should he die from coronavirus, is in charge of information.
Special thanks Nicholas for your replies to readers.
Only-NeverInSweden.blogspot.com
Citizen US SE
3
Thanks, Mr. Kristof, for walking back much of what you wrote in response to observations from commenters, many of them physicians.
We should have free universal health coverage, but to suggest that anyone who has a cough or the sniffles should report to a hospital for a test seems unwise. I've had a walking cold for the better part of a month, which is common in the Midwest. If everyone who has a cough like mine went to a hospital for a test, lines would stretch around the block, and then some. We don't know what the incubation period is. From what we know so far, folks with the virus can spread it to others without experiencing symptoms themselves. And so the mortality rate is all over the map. We don't know whether one percent will die or five percent. And that is no one's fault but Mother Nature's. She often works in mysterious ways.
To raise the spectre of 1918, at this point, seems alarmist. We will, of course, know eventually. But for now, it seems to me, all we can do is strap on our seatbelts and see how this plays out. To expect that humans can, inexorably, overcome what Mother Nature throws at us is to ignore the power of Mother Nature.
I do not wish you ill, Mr. Kristof, but it is quite possible that a year or so from now, you'll read this column and cringe. On the other hand, if a modern-day black death descends, you will be able to crow.
I know I would not want to be in your position right now.
3
Overlooked in all this is that the planet and the human race look nothing like it did 100 years ago. We now have 8 billion people, 1000s or international flights, mega cities and interconnectedness in business and families that span the planet, that no one could have predicted, or frankly prepared for. Our random, poorly thought out, short sighted “civilization” has left us unprepared and vulnerable to many potential threats and pandemics and climate change are just the tip of the iceberg. As we plunder what is left of the natural world to grow, house and feed ever more billions of people, this will only get worse.
1
As an author of Sci-Fi stories mostly told verbally, I have been interested in the world for decades. Pandemics are the stuff of many novels/movies/short stories. The facts are that humans though taught harsh lessons haven't gotten much better at this since 1918. Some nations in Asia are better at this than here in the USA. We are woefully lax and it will bite us, now or on the next go through.
That this POTUS treats science like an Evil, when it's clear that God vs Science isn't a real thing as some are oft to make the fight. God showed us Science so we'd see things better.
We will see a lot of patients not show signs yet pass the virus to others, the 14 day window has been shown to not be the case here, this virus has a longer and stronger period of viral load. Fever not be a good way of tracking it.
As China is in the stages that in order to keep it's economy from tanking some folks will have to go back to work, the spread will still continue. How long can the world go offline and people still get fed? As growing season approaches we will still have to have farmers doing that job, food still needs to be moved. It's not going to be easy as we haven't really prepared for this much.
1
I strongly doubt that we're going to see more deaths in the U.S. than from a severe flu (which still could mean tens of thousands), but we may well see very, very large numbers of people sick at the same time. It's this problem that I don't think we're at all ready for. And it's going to be made worse than it needs to be not only by our failure to maintain our medical system properly, but by employer attitudes that expect everyone to come to work while sick.
3
People appear to think the coronavirus is the big one judging by their behavior. My sister is a school nurse and she is getting information on this daily. She is not an alarmist but called me and told me to go out and buy hand sanitizer and household disinfectants and wipe down surfaces in the home. Unfortunately, every store was sold out of the hand sanitizer but my local supermarket has ordered 60 cases. People are taking this very seriously and are concerned because of the unknown origin. There is always fear when we have little knowledge about an illness.
Hopefully we will know soon more but until then we must be on the alert and take precautions. People who are sick should stay home and we should wash our hands regularly. Hopefully the experts will find out more and inform of us any new information. We just have to be on our guard.
1
Mr. Kristof complains that Trump has been overplaying threats like those to the border, rather than focusing on real threats. Yeah, and Dems for two years overplayed the threat of "Russian collusion." Gee I wonder if some of the resources that went into an investigation finding no evidence of Russian collusion could have been better spent on flu preparation? The politics run both ways on this, you know.
5
Really? Are you aware that the Trump administration made major funding cuts to CDC in the past year or so? Where was their voice of concern that the “witch hunt” against Trump was detracting from pandemic preparation. The logic of Trump supporters is laughable.
4
I forget—is it Robert Mueller, Adam Schiff, Nancy Pelosi or Chuch Schumer who’s been attacking science, purging researchers, cutting epidemiology funding, and giving bizarre, ramblng addresses and press conferences from the White House that just happen to be stuffed with lies, fundamental ignorances, and braying political attacks?
2
And the Russians are again hacking our democracy, though Trump refuses to believe it. That is indeed a dire threat to our nation and way of life. Just because Fox News supports Trump lies regarding national intelligence as a hoax doesn’t make it one.
3
Hard decisions need to be made soon if we are still thinking about containment. Nobody likes to try and shut down an area of the country for a quarantine, but early is better than late.
It's like hurricane evacuation. When do you send out the notice and which area do you evacuate? By the time the path of the hurricane is dependable, it more likely that significant numbers of people won't be able to leave in time. We also know that Americans aren't universally rule followers so there are always people who think they can ride out the storm.
I find it interesting that the government is controlling entry of people from China and Iran but not Italy or South Korea. Our allies must be infected with a less deadly version of the virus.
3
..‘our wits versus their genes.’ I’m putting that quote in context when i see the brain power and scientific mind of our creationist VP Pence as he attempts to spearhead the Administration’s response to a rapidly evolving potential crisis. Trump and his minions sure know how to inspire confidence. The CDC should have been given complete control and unlimited funds to fast track everything needed. But of course, that would mean Americans getting real time truthful information from a reputable source. Trump can’t have that.
9
Reading about the unexplained cases of coronavirus in the US and elsewhere raises the possibility that the Coronavirus was for a long time indigenous to humans where only recently a pathogenic variant or unknown co-factor. result in a flu. If true, asymptomatic carriers were for a long time present in the human population. I suspect that population wide screening will show that in every country a certain % of the population are corona virus carriers. The test kit just enables to quantitate indigenous coronavirus carriers that have been there long ago. In other words, it may well be that the hundred of thousands of people that are known to come down with the flu each year in spite of the flu vaccine, actually were infected with the Coronavirus instead to the 4 variants of the common types of influenza viruses: A, B, C and D. The bottomline-Covid-19 is essentially a flu with low mortality rates like the common flu that may have went molecularly undiagnosed for a long time. Caution & 14 days quarantine of carriers are a good approach until a vaccine is at hand, but all the hype and economical panic may have much more dangerous consequences than the virus itself.
3
One item of interest I heard is that satellite images show a noticeable reduction in pollution over China since this began.
Silver lining?
Certainly there is a lesson to be learned from that.
2
I have a couple of thoughts on this. First, testing MUST be free. The government has a far bigger interest in knowing who is sick with what than the people do. There is no cure, only the same treatments anyone with a respiratory illness would get. Rest, stay hydrated, Tylenol to bring down fever, and if breathing becomes too comprimised, medical intervention. And given the circumstances, if I'm sick, I'm going to stay home and isolate. I'm not personally going to pay a single dollar for a test that would change nothing for me, much less a test equal in cost to two months' rent
My second thought is in terms of preparation. I've been reading that due to the particular economic shocks that a pandemic can deliver, the government's hands are somewhat tied in mitigating the economic cost. But that is only true if one's definition of "the economy" extends no farther than the stock market and GDP. The economies the government needs to be worried about preserving are those of each individual household.
For instance, they could force employers over a certain size to provide not just sick pay but quarantine pay (for those unable to work from home) and cover the same for smaller employers. They could either guarantee payment of rents and mortgages themselves or simply ban eviction actions and mandate that landlords and banks allow payments over time once this runs its course. Certainly they should have already banned ANY price gouging.
6
Thank you, Mr. Kristof. Healthcare tied to employment restricts freedoms. It restricts freedom of speech and freedom to do the right thing (staying home when sick) because of fear of losing one's job. Why can't voters see that? Yes, the system can and should be changed.
8
Judging by the record of this administration's officials, all their pronouncements and decisions will be dominated by political considerations, emphasizing all the "great" things they have done and attacking all critics of their efforts. To expect these officials to implement the recommendations of the scientific/medical community regardless of political consequences is unrealistic. Examining the words of Trump and Pence so far in this crisis is enough to confirm this pessimism.
2
I’m always fascinated about the things that developed societies obsessively fear. Maybe first among them are incipient epidemics/pandemics when we as of yet know little about them and thus do not know if they justify outsized fear that itself can have unintended consequences.
In the meantime, a disease that we do know much about - malaria - and cost a pittance to remediate, carries on simply for the lack of political will to address it, because they are prevalent in poor countries.
Strides have in fact been made over recent years to reduce infections and mortality rates. Nevertheless, in 2018, there were still an estimated 228,000,000 cases of malaria worldwide. The estimated number of malaria deaths stood at 405,000 in 2018. Children aged under 5 years are the most vulnerable group affected by malaria; in 2018, they accounted for 67% (272,000) of all malaria deaths.
7
Quote: "It may mean avoiding sports events, school assemblies, parties and even unnecessary visits to crowded doctor’s offices". It may also mean avoiding political rallies, political conventions and, if the pandemic lasts until November, polling places. It would be one of history's greatest ironies if low turnout attributable to Corona Virus were the key to President Trump's reelection.
7
In Oregon, voting is by mail. Perhaps other states should consider that.
2
@David Friedlander - Dude, you just said the quiet part out loud. Don't give him any ideas.
2
As usual, excellent column, sir! Clear, logical and based on facts! Thanks for your columns, which are a major contribution to SANITY.
9
Dear Mr. Kristof—thank you for another excellent article on public health. I also wanted to thank you for your recent articles about your hometown—they gave me several new thoughts to research and educate myself further. But especially for your brilliant article on gun control as a public health issue. Everyone of your articles has challenged and educated me and encouraged me to further educate myself
3
@Sue Ann Dobson.
Ms Dobson, make sure you also read HALF THE SKY by Kristof and S. wuDunn
Mr. Kristof’s suggestion that we offer free testing for people who think they might have COVID-19 makes sense. Certainly this measure would be expensive, but it would be far cheaper than an epidemic, as China’s experience with the virus has already proven. Why are there no people with good ideas in the trump administration? Instead, from it we get advice to buy stocks because shares are currently cheap, claims that the virus is a hoax, assurances we probably won’t die if we get the disease, and Mike Pence—whose fundamentalism and folly contributed to the spread of HIV in Indiana—as COVID-19 tsar. If our citizens are panicking, they have good reason.
9
There are accusations that Trump is "suppressing" information about coronavirus and making us more at risk. But this is not true and if you will forgive me, I will classify it as the usual anti-Trump talk. Here are some headlines from the Wall Street Journal:
"More Countries Report Virus Deaths"
"Coronavirus Is Different. Almost No Company Is Safe."
"Deepening Rout in Commodities Stokes Fears About World Economy"
"Colleges Prepare for Coronavirus Outbreaks on Campus"
Clearly the WSJ is not unaware of the danger.
But there has to be a balance between panicking and being careless. No two people will draw the line in the same way. Don't be too vigorous in your criticism merely because you think Trump is not "panicking enough".
It is good for Democrats to try to influence Trump. But vicious anti-Trump attacks should, for now, be put on the back burner.
1
@Ludwig Please keep in mind that The Wall Street Journal is a respectable newspaper, not the White House.
I would be pleased if people in general did not try to make this a contentious political issue, but focused instead on public health.
2
The "Spanish Flu" disproportionately affected Europe and Asia (~25M deaths each) vs the US ~675K deaths. The combination of WWI creating perfect transmissions circumstances and some views that the US was the early spreader and experienced an earlier genetic varient of the flu may have contributed to the difference in death tolls.
It's very hard to estimate the mortality rate of Corona. It seems likely that it is closer to the .4% range based on the lower mortality outside of Hubei province. One of the basic challenges is that the government is understandably attempting to keep panic from creating a self-fulfilling economic collapse while implementing necessary public health responses prior to a vaccine (12-18months from now) becoming available. Much like a hurricane, the President and Congress can take definitive (not the Fed) action to prepare the economy and therefore not cause a panic. The Fed is a blunt instrument but fiscal stimulus can be targeted.
1) Pass a 9 month (could be extended) Full Employment Program - if companies agree to not fire workers, government will pay FICA contributions for both corp and individuals 2) As with a natural disaster, pass a $1T Coronavirus business interruption insurance program allowing businesses to apply for losses created by the virus. The aim is to maintain employment and business integrity to allow for economic continuity while allowing public health officials to do the right thing.
5
So what will be the point of all your efforts to keep businesses going if there are no people to run them? The first duty of any government is to keep its citizens safe. If COVID-19 really takes off, you will see what a catastrophe a failure to provide adequate health services, health cover and sick leave will create nationally, never mind the economy, it will already be shot. From the vantage point here down under of a nation with all such embedded support networks, the US situation looks very alarming. Even worse is the fact you cannot trust what your government tells you.
12
I agree. We buy insurance to protect ourselves from unlikely but catastrophic events and the government should function as the insurer of last resort, not just for businesses but directly for its citizens. Universal healthcare and mandated sick leave are excellent examples. If, for example, air travel is banned, who wants to live in a country that guarantees the future existence of the airline company but not its gate agents, flight attendants, baggage handlers, mechanics and pilots?
7
It's really not wise to travel right now.
People should voluntarily stop air travel.
Since the government is not interested in the safety and health of Americans we need to take the initiative ourselves and STOP traveling for a while.
Also why not close schools and do online classes?
3
One thing to note that’s different than previous outbreaks, is the prevalent use of smart phones. Here is an object that doesn’t usually get cleaned often, is touched repeatedly all day long after touching other communally-shared surfaces, and is many times picked right back up following a good hand-washing. Photo is case in point.
3
Yes. However, typically only the owner of a cellphone touches the screen. Not so with TV remotes. If you are in a hotel or motel, chances are semen can be found on the surface of it. Think about this the next time you are hiding your bags from bedbugs.
My husband’s grandfather died in Chicago during the 1918 influenza pandemic. He was a 38 year old bricklayer from Ireland. He left a widow & three small children. Terrible times.
I hope we can create the kind of environment that will foster cooperation & preparedness and that will mean ending the blame game political partisanship. Is it helpful to put half the US population on the defense because they voted for Trump?
3
I am particularly struck by how much we do not know. The shortage of testing kits and testing means we can't really know what is already the situation here in the US in terms of the coronavirus. In countries with less-developed health systems, or even those, like the US, with a simple shortage of testing kits, the virus could be spreading rapidly, and the reported numbers of cases and deaths could be more a measure of the numbers of testing kits available and administered than of the status of the coronavirus spread. I hope not, and I hope that testing kits become more widely available.
A huge thank you to all those doctors, medical experts and carers who are working overtime now to keep us all safe. And thank you, Mr. Kristof, for a deeply informative column.
9
@Malcolm
In another NYT article today, researchers ARE finding a link between a new case in Washington and one of the first cases reported in the US, a man who returned to Washington around January 19 from Wuhan. They analyzed the genetics of the virus and think the new case is a descendent of the earlier case. If so, that means the first man was still contagious when he was released from the hospital. This is a big story and should not have been buried in the article.
3
Some of the recent US cases have no apparent epidemiological links to previously identified cases. This suggests that there are asymptomatic or minimally symptomatic cases. There are two implications of this: 1) Case fatality rate is lower than the 2% reported from China; 2) containment of the epidemic may be more difficult than previously thought.
A Thai virologist recently commented that this virus is unstable at higher temperatures (much more so, for instance, than influenza). If true, this may have implications for corona virus seasonality. It will be interesting to see what happens near term to the pace of the epidemic in SE Asian countries like Thailand and the Philippines, which are approaching their hottest season.
The 2009 H1N1 influenza A virus came to the US in March/April - at the end of typical flu season - but in subsequent years H1N1 cases occurred in a more typical seasonal influenza pattern.
Nursing homes, prisons, barracks and boarding schools are the kind of settings that are most vulnerable in the US now. It's worrisome that so many people in the Washington State nursing home - patients and staff - are now symptomatic. We should all pay attention to test results and case identification from this site.
1
@Michael
See my comment above: there is a genetic link between Washington's first case, January 19, and these new cases, which opens the question of whether people are still contagious even if they have been declared cured.
2
Nick,
Thank you for a great article.
Everyone in the Congress and the Administration should read this. Very thoughtful approach and analysis. This piece is the best I have read. This well-written piece should be General Order #1 for the corona virus response.
2
Mikey the Pence is in charge for one reason and one reason only: unswerving loyalty to Trump. The bottom line for him is to get Trump reelected, with himself as running mate.
Larry Kudlow tells us to buy stocks.
Trump's already rolled out the Republican solution to every problem: tax cuts!
At yesterday's news conference Dr. Fauci claimed that he wasn't muzzled, and then went on to describe how he was muzzled.
Asked about his anti-science, homophobic response to an HIV outbreak in Indiana when he was governor, Mikey first blamed others and then boasted about how he solved the problem -- nary an apology or any recognition of responsibility or sense that maybe he could have done better.
Our only president himself declares the virus will "vanish" and that criticism of his administration is a "hoax." (Does he even know what that word means?) He also takes the opportunity to bash Democrats, the Mueller investigation, impeachment.
Welcome to America made great again.
11
The need for public health care is here now. If you can't afford to go to the hospital, you'll infect more people. If your place of work doesn't offer sick leave, you'll infect more people. A good public health care system is what stands between us and the spread of this disease, or any other. For profit medicine and pandemic viruses don't mix well. As Kristof says, "We are vulnerable"... without universal health care. Is anybody listening?
16
Nicholas many, many of us have used your $3270 case example for better or worse. But we cannot know the facts.
I often note that it would be extremely helpful once in a while to have a supplementary table with confirmed factual information.
Here we need to know:
US citizen?
What was he told at checkin at the hospital?
What kinds of insurance cover the bill and what do not?
What unit did the testing and is the fee standard?
I thought I read somewhere that only the CDC can do testing.
I used that story in my main comment pointing out that under Swedish Universal Health Care a person being tested would at most be charged a negligible fee but for costly testing might have to meet certain criteria.
Only-NeverInSweden.blogspot.com
Citizen US SE
1
Here in Singapore the government has said that no one will be worse off economically because of coronavirus. As a result we have gone from a country that had the most cases outside China to a very minor outbreak. No one has died and 70% of the cases have led to full recoveries. That’s how a first world country copes with it. The USA in matters of health is not I fear a first world country.
8
can you explain this? is it because of health insurance and or other protections like being paid if out sick, etc
1
@David
I also noticed in the Singapore news that the names and addresses of infected people were given publicly, I assume to alert people that they might have been infected.
The USA I fear is no longer a first world country in More than matters of health. Pity.
2
I like this article which is big on practical advice and only has a little bit of Trump bashing. Indeed some Trump criticism is quite justified, but no one makes all decisions correctly. Obama made a few mistakes and his predecessor made many big ones. Surely there is a difference between the man who got us into Afghanistan and the man who may, finally, get us out.
What is needed is to reestablish conversation between Trump and non-Republicans which means some Democrats and some independents.
And a man as vain as Trump needs more flattery and only a modest amount of criticism. Brickbats may backfire (mixed metaphor that!).
It appears that this Coronavirus is no more dangerous than the flu. There should be no panic. The world should just go about its business.
Dream on.
1
The potential impact of diseases resulting from globalization and environmental degradation have been known for decades. And it has been met with shortfalls in funding and planning all this time.
Maybe we'll get lucky once again and this will be the wakeup call we need to properly address how we live and interact with our planet. But the action of our present government leaves me with little confidence. They're all about greed, literally at any cost to life. I suspect the lesson we're about to learn is not only the first of many to come but one of great harshness.
5
As you say, wash your hands. Public health authorities here in Thailand have done a great service by educating the public about how they can reduce their risks and the risks of others in what has not yet become a local epidemic, despite what superficially seems to be a substantial head start on the USA. For instance, one finds bottles of hand sanitizer placed throughout public areas, along with signs encouraging their use. I've seen no political grandstanding about the jobs of public health staff, even while politics surrounding other issues reaches a fever pitch. Could the American president for once throttle his impulse to wantonly tweet, and instead offer some constructive proposals for how Americans can deal with a malady that as yet has no vaccine or cure?
7
Every museum should have the hand sanitizers inside entry to museum, and inside entry to cafes.
Every grocery checkout counter should have sanitizer bottles. Ditto at pharmacies and other places.
Menus should be disinfected!
1
Great article Nicholas.
Having a pneumonia vaccine may help seniors survive the virus. The baby boomer generation needs a polio vaccination style event to help vaccinate.
A physician recently told me antiviral medicines Tamiflu, Relenza, Rapivab and Xofluza may be of help in fighting the virus also. I wonder how may doses of those medicines are available in the US.
1
"But because of the risk of coronavirus he did the responsible thing and sought medical attention: He went to a hospital for testing. In the end, it turned out not to be coronavirus — but he was billed $3,270."
Did he have a flu shot?
Those who oppose the use of vaccines for religious or other reasons are entitled to their opinions, but they do not have the right to endanger the rest of the population.
6
@EJ - the flu shot given in 2019 is not for coronavirus.
My comment a couple of hours down deals with the problem of cost to patient. That situation is not made at all clear yet at least for the USA.
6
@Larry Lundgren Larry, thanks for your note. I realize this, but my point was just a general comment that those who refuse to get vaccinated against known pathogens contribute to the high numbers of annual flu deaths, measles outbreaks and even the complete eradication of smallpox around the world. From a cultural, behavioral perspective, it would be helpful to get the Chinese and other Asian populations to stop consuming wild animals.
4
@EJ Also, if he had gotten a flu shot, he likely wouldn't have thought he may have had COVID-19 because he probably wouldn't have gotten the flu.
Another point to make about his case; he had insurance, but it was a "trumpcare" junk policy that trump allowed back onto the market: One that doesn't cover pre-existing conditions and had very high co-pays and limited coverage.
11
Thanks for making people aware of a public health threat so they can take precaution. This column is solace when I think about that there are still good journalists who think and work for the benefits of the society, unlike other so called pundits who help to propagate their crystal ball views .
9
Mr. Kristoff is a little behind in his facts. The current estimate of deaths caused by the "Spanish Flu" is 100 million (my grandmother among them), not the 50 million mentioned in the article. I forgot where I read that number, but it was from a reliable source, and my memory tends to better than average.
@Alex Levy - If you read Kristof's replies you will see that you were ill advised to question him even though you forgot where you read that.
He provides real data.
A better than average memory is no match for real data.
6
@Larry Lundgren Kristof got that 50 million figure from a Wikepedia article. As long as twenty years ago, the real estimated figure was 60 million, and it has been revised upward ever since. 100 million is the current figure. Nice of you to stand up for Nicholas.
2
@Alex Levy And I did read Kristof's reply, on the subject of numbers. You are right, and I was wrong. Nuff said on the subject.
2
Totally agree that maybe we should be concentrating at least as much on health as we are on Iran say.
In terms of 'our wits versus their genes' quoted at the end of the article. Can I just point out the rise of antimicrobial resistance in the treatment of pneumonia which looks like a serious complication that could occur with coronavirus. Hopefully this will not turn out to be a serious factor in the treatment of this disease but as far as the future goes who knows?
We need to focus a lot more on the impending wars with infections that are looming in the next 20 years say even if the coronavirus is not as bad as it is feared in my view.
It is simply way too early in this process for anyone to be saying anything definitive about this new to human virus that was unheard of 3 months ago. One early study by scientists in China says they have found 17 different strains of this Corvid-19 virus in their collected data on patients who tested positive. Different strains have different characteristics, including mortality rates and incubation periods. Comparisons being made with the 1918 influenza pandemic in these comments also ignore differences between influenza virus and Corvid19. One of these is that the 1918 virus had a very short time between infection and symptoms of illness, while scientists are finding people infected by Corvid-19 who have been asymptomatic for as long as 24 days, while unknowingly spreading the virus to more people in their communities. Another factor is that the data on the 1918 epidemic came in three waves over multiple years, each wave exhibiting different degrees of lethality. We do not currently have any idea how the coronavirus will evolve as it spreads through the community. Also, viruses are more easily identified and attacked by the body’s antibodies than coronaviruses that hide their characteristics in an outer envelope.
My point is, no matter how impatient we are for quick, certain answers, the reality is that no one has them yet. Give the scientists to study this epidemic and learn its true nature before we lay people start asserting opinions not based on sound evidence.
87
There is an old adage, "Hope for the best, but prepare for the worst."
Unfortunately our leaders appear to be doing practically the opposite: making minimal preparations as though the best possible outcome is the most likely, while accusing others of fear mongering by suggesting the worst might happen. I'm sure if Trump sees this column, he'll label you another liberal fanatic, exploiting a minor issue to try to win votes for Democrats.
As you've pointed out, our feeble health care system, along with the precarious financial situation of many citizens, adds up to fertile ground for the spread of a virus like this. Ultimately, each of us will be responsible for ourselves: wash hands, avoid anyone who is coughing or sneezing, and of course getting to a clinic or doctor's office at any sign of a fever combined with coughing.
Technology gives us advantages and disadvantages over 1918; jet travel facilitates a much more rapid worldwide spread of the infections, but rapid communications and a greater understanding of how the virus spreads gives us weapons to fight back. The trick is to remind each other to use our knowledge by following the procedures I noted above.
66
@TLMischler
"As you've pointed out, our feeble health care system, along with the precarious financial situation of many citizens, adds up to fertile ground for the spread of a virus like this."
If there's a silver lining in all of this, hopefully this will bring unbearable pressure upon our political leaders (Republicans and reluctant Democrats) to enact national health care immediately.
Even if this virus doesn't cause widespread deaths, it's only a matter of time before the next pandemic hits, and starts killing large numbers of people. Are we really going to wait until then to get ready?
What do our politicians plan to do about the fact that under our completely broken health care system, too many Americans will be reluctant to even get tested and/or treated for the virus on account of fears of receiving a huge medical bill? Only in America is the fear of medically-induced bankruptcy a bigger inhibitor to getting treatment than dying from the virus, or spreading it to others.
And if it gets really bad, how are hospitals all over the country going to deal with being inundated by high numbers of uninsured or underinsured patients who need expensive treatment, but can't pay for it?
How will it be decided who gets treatment, and who doesn't (in other words, who lives and who dies)?
It is just so, so incredibly STUPID and shortsighted to keep insisting that Americans can't have universal health care. This is literally going to kill us if we don't fix it in Nov. 2020.
6
@TLMischler We get amber alerts and weather warnings on our cell phones but crickets now about this national health emergency. Scientific information is being muzzled so the Republicans can pretend this is just like any other day when they make up their own facts.
5
I wonder if readers realize how extraordinarily difficult it is for even well paid and fully insured workers to follow disease control measures at a time like this. Several years ago I became ill with a debilitating respiratory infection while working on a short term contract with a government agency. Because I was employed by a contractor I had no paid sick leave, so a medical visit of a few hours duration meant losing a day’s pay. I continued to work, wearing a surgical mask in the office to mitigate risk to my colleagues.
The financial pressure to continue working while ill was almost beside the point. I was continuing on Medicare during this job, paying for gap insurance out of pocket, and quickly discovered that many (most?) private medical practices in Washington DC did not see new Medicare patients. I visited a walk-in clinic which ruled out pneumonia; the only alternative would have been several hours in a crowded ER.
I guessed, based on my history of lung disease and past recovery from recurrent infections, that I would eventually recover, which I did, after leaving my job and getting appropriate antibiotics prescribed by a specialist at home
Conditions like these which put financial pressure on workers to report to work when ill and limit their access to care are a recipe for rapid spread of infection and increased mortality in the face of Covid19.
197
Even if you can see -and pay for- a doctor, an American doctor is unlikely to tell you to stay at home. That's true for adults as well as school age children: a constant cough, a bout of paralysis, shingles? None of this warranted to stop going to work or school. The cough finally resulted in pertussis and pneumonia tests (thankfully negative). The absence of consideration for public health is bewildering when one has lived in Europe. You could say it's not the doctors' fault, in the absence of pay leave, but it's not like they are demonstrating for sick leave either, or just warning you about trying to organize your life differently. After all, you're a client, not a patient, and there's no code for that.
10
Great perspective in this column!
There is still a great deal to learn about this particular virus. It is unfortunate that the Chinese government cannot be believed at this point, so we do not know what the true stats are. We will have a better understanding of how this virus operates as it becomes more prevalent throughout the world, as well as more data on the affected age groups and/or other variables (compromised immune systems, smokers etc.).
Another unfortunate outcome thus far is the ineptness of the current administration. This one event clearly shows how this this administration is unable to function and provide confidence to the public. The use of the Roy Cohn playbook may work with real estate transactions, but not in serious cases like this. I also want to point out that Trump’s fundamental ignorance of science is also at play here. We have someone who subscribes to conspiracy theories and what we need instead is someone who deals with reality, not reality tv.
7
Excellent article. Very little international travel in 1918 compared to now. That makes transmission of the virus so much the easier.
Here in Scotland, as with the rest f the UK, plans are being made to bring recently retired doctors & nurses out of retirement.
I've commented before about the "Three Wise Men Protocol" being discussed with a view to implementation. (The Protocol is a way of rationing treatment. Three senior consultants in each hospital decide on admission & refuse it to some to ease the pressure on resources & staff).
I remember reading that in a pandemic a point is reached when state services break down completely because staff simply won't come to work.
To me, all the signs suggest that a repeat of 2018 is possible if not probable.
3
Is this Coronavirus 'the Big One?"
As a physician, based on what I've read, I don't think it's a civilization-threatening pandemic. Until people understand its effects better, it will be globally, economically disruptive, and then we'll get used to living with it, and start treating it the way we would a bad flu season, and things will normalize out, although this might take months.
Having said that, humanity dodged a bullet here. This was the dress rehearsal for dealing with a dangerous, communicable illness, and it went badly. Some day there will be a pathogen that will appear that spreads easily from person to person with a much higher morbidity/mortality rate than what we're seeing with Covid-19. What our (and frankly, much of the rest of the world's) response to this pandemic illustrates is our lack of preparation to effectively respond and prevent spread of an easily communicable pathogen; but what's really frightening is that I don't think our government is capable of learning from our lack of preparation. Listening to the press conference today, it was clear that the focus of our President and VP, and even the physicians and scientists from the CDC and NIH, is on spin control, not on how to protect us now or how to put into place better infrastructure and policies to stop future pandemics.
214
You’re probably right. Millions likely to get sick, thousands likely to die, but civilization will be saved. But consider this. Only a few hundred Americans have been tested for the virus so far. On Saturday the FDA cleared hundreds of hospitals to test Americans for the virus. If you are right, there are probably tens or hundreds of thousands of (often asymptomatic) Americans infected with the virus, not the fifteen the president and the senior health officials told Americans about at the news conference last week. What will the reaction be when people find this out over the coming few weeks? I fear the country will go into virtual lockdown as officials all over the country create a patchwork of quarantines, and the federal government does whatever it does. We are in perilous times.
8
@MRW We should prohibit all animal products from Wuhan until the live markets are closed.
2
Nick Kristof offers the salient points.
We don't know if the spreading infection will be as lethal as it is in Wuhan; and we don't know how to to prepare for it. We don't know if we should be going to conferences, graduations or on business trips.
We don't know if the government put aside enough masks, gowns and other gear to safely treat the ill. That seems unlikely since they did not provide that equipment to their own people dealing with returned cruise passengers. We have no direction from the government other than the direction of the CDC - stock up on a few supplies - and the Trump administration telling us to stock up on optimism and stop selling stocks.
But this is what I d know. If it becomes bad enough that government action is warranted, it will late, and be weak. If the virus is bad, it will be the Democrat's fault for impeaching and distracting the President, who can apparently only deal with one issue at time. If it fizzles it will be a media hoax meant to bring him down. What it will never be is something simply to be addressed aggressively and with good sense and expertise.
6
Excellent article and I’d like to see more; especially on the urgent need for the expansion of telemedicine. It's costly to setup, and some doctors have not even converted to electronic medical records. The federal government should provide training, IT assistance, and grants to make the conversion. After all, telemedicine could potentially aid us.
I would also suggest that doctor’s offices/clinics/hospitals place a touchless hand sanitizer dispenser a few feet away from the reception desk with a sign stating that, due to current health concerns and for the protection of all visitors, hand sanitation is now the first step in registration for all, no exceptions.
Receptionists should keep an eagle eye on visitors and firmly, but respectfully, enforce the policy.
2
A couple years ago, I had a videoconference medical appointment for a sore throat. It was easy and convenient. But, I later found out my insurance (which was very good coverage) didn’t cover those kinds of appointments. I need a new policy now and making sure these are covered.
The question that bothers me the most is: Why did we not have testing kits ASAP for the coronavirus? Yes, they will be coming to all the states, but not until the end of this coming week. I trust the CDC as well as the NIH, so the onus of responsibility is not theirs to blame. However, the buck does stop with the Trump administration and its relentless withholding of funding with anything related to the health of this nation. Think back at the Ebola crisis during the Obama administration. Here was a group of leaders who did not second guess our medical scientists and doctors who were experts in infectious diseases. Juxtapose then with now, with a "Czar" who himself puts the bible before science, and his boss who will put from Wall Street to The Wall before the health of Americans which includes his MAGA family. Maybe this will not be as devastating as the 1918 Spanish flu pandemic. God willing it won't be. Yet, 102 years later, considering all the advances we have made in medicine, one can not help but think that our mind set is close to medieval. There may have been just one death so far. But that is one death too many.
74
@Kathy Lolluck viral strain-specific testing kits require the development of a strain-specific reagent, usually an antibody, that can distinguish this strain from related strains. This cannot be accomplished overnight no matter how much money is shoveled into the now much smaller system given the cuts of the Trump administration. You cannot construct a robust public health system from scratch at the start of each potential pandemic. It has to be maintained like an emergency department for when something happens. Factor in our profit-based health care system where people fear visiting health care facilities due to the high costs, the lack of adequate paid leave, the artificially low doctor to population ratio (caused by intentional low numbers of medical schools and even lower residency programs) and this new virus will spread rapidly. We are reaping what we’ve sown.
9
@Kathy Lollock And Trump fired the entire pandemic response team three years ago.
4
This is a concerning column by Mr. Kristoff who has been in unusual places in the world.
It could be that what is more problematic is having a president completely incompetent to build the forces to recognize a growing threat to U.S. public health. In that sense, where is the evidence that his administration is preparing enough test kits not to mention having the personnel to deal with a major outbreak?
15
It comes down to testing. Prime Minister Abe of Japan appeared on national TV last evening and announced that the government would ramp up testing to 4000 per day by the end of the month. So far something like 2500 have been tested around Japan and have started to reveal the breadth of the problem. South Korea tests 10,000 per day and is second on the list of "crisis mode" countries. The CDC in the US announced on its website on Feb. 29, that other than the cruise ship passengers, the US has tested 472 people for the new virus. Trump's claims of having "everything under control" are ridiculous; he doesn't even have the vaguest idea of the scope of the problem. "Fortunately", children and younger folk have death rates similar to that of the flu – fairly low – but among the elderly the death rates push 15% here in Japan. With about 26% of its population being 65 or older, that will affect a large number of people. It's telling to me that the first death in the US was in an extended care for the elder facility. If you "suffer from" being a senior citizen, look out.
61
It is most unfortunate that the Trump administration is THE key to politicizing this pandemic. The fact is I don’t think neither he nor Pence understand what the NIH, FDA, and the CDC have already been doing to ensure we can ramp up testing in the US. This week the CDC and FDA released another assay that can be used to detect the presence of the virus In a blood sample. The assay was developed in unprecedented fashion. The administration does not want anyone but his political appointees to speak to the Americans people fearing that career scientists may actually teach our-citizens about the virus facts about transmission,and that it’s not a hoax concocted by the press or the Democrats!
3
@James I would not get carried away by the testing done in South Korea. The CDC is well known to follow evidence based protocols. The rates at which the virus is spreading in Korea clearly suggests that something is seriously wrong. It could well be they have an unreliable test which is giving them too many either false positive or false negative tests. Thus sick maybe released based on faulty tests. It is better to have a reliable test. Hopefully we will get one this week.
1
My experience: I went in yesterday with flu symptoms with, at times, acute shortness of breath, in a town with a known case and two known exposures so far. The doctor swabbed me for the flu, but "Only the health department" can test for COVID-19," I was told.
I was not sick enough to need a respirator nor be hospitalized and there were only 500--now 1000--testing kits available to the whole of California.
Only the very sickest, where the doctor can justify to the health department using up one of those precious tests, are being diagnosed. The rest of us have no way to know.
893
@Alison
Hope you will be fine. The worrisome thing is that people that don't have symptoms can be carriers. They may show symptoms later or never and still spread the virus.
So who do you trust? Trumps administration that has an election on their mind, or experts in the field of infectious viral disease? I am going with the experts. Too bad they don't have the funds, test kits or the backing of the White House.
I trust the experts.
161
@Alison
If thousands of people have this virus and don't know because their symptoms are so mild, does it really matter?
Wouldn't it be a positive indication of how benign this virus is to a healthy person with no comorbidities or preexisting chronic illnesses?
That would be a great thing. Relax.
10
@Alison I spoke with a woman while shopping today, who said she had her nails done on Tuesday in our small Connecticut town. The brother of the woman who did her nails had just arrived from a visit to South Korea the week before. a few days after returning home, he felt sick, went to his doctor, and was told that he did not have COVID-19. Given all we know about the inaccessibility of the test, the incubation period, and the various means of community transmission, people are likely falling ill around us and we, as you have said, have no way to know.
103
Here's a question...since Cronavirus causes primarily a respiratory disease, if I have had a Pneumonia shot in the past year, would this help lessen my symptoms if I were exposed to the virus?
1
No , it won’t help. Pneumonia shots protect you from a specific bacteria only ,namely pneumococcus.
2
The germs will ultimately win and not just when we are moldering in our graves. They win because of ubiquity and persistence.
Anthrax spores can be found in the soil along the route of 19th century cattle drives when cattle died of the disease and just fell along the route of march.
Viruses dwell in many animal species and we stir them up as we increasingly encroach on animal habitats and participate in eating exotic animals and having exotic pets. We forget we are also getting exotic pests along the way. (see: Nipah, MERS, SARS and now COVID-19 inter alia).
Perhaps it is our administration's intent to encourage a pandemic so we might 'reduce the surplus population" in a Dickensian manner more quickly. Unfortunately, that strategy would have more deaths as shortages would impact survival even more.
Perhaps our greatest hope lies in having the tendrils of the pandemic-in-progress reach someone the White House and plutocrats care about, like themselves. We might even get an infusion of empathy and universal health care to match universal illnesses.
3
In Italy we are experiencing the first curfew since the end of the World War II. Ghost towns, closed schools, closed shops, etc. The public authorities are accountable for all this. After spreading panic, they are now trying to minimize panic. After providing free tests to anyone, they now decide to test only symptomatic people. The lack of proper information is total. We don't know: (i) what concrete risks the coronavirus involves for the population; (ii) whether these risks are more serious than those of seasonal flu; (iii) whether the mortality rate of seasonal flu is higher or lower than that of the coronavirus; (iv) whether a non-symptomatic person is as contagious as a symptomatic person. In this climate of total confusion, everyone acts as they please. I don't know if this will be the big one. What I do know for sure is that, at least in Italy, the coronavirus is the confusing one.
7
"while thousands routinely die annually from the seasonal flu."
Yes, the seasonal flu kills more people but let us stop comparing this disease with the seasonal flu too much because there are significant differences.
The coronavirus seems to be more deadly than the flu and also seems to be more contagious than most strains of the flu and it appears roughly as contagious as strains that appear in pandemic flu seasons.
Each person with the coronavirus appears to infect 2.2 other people on average. By comparison, the figure for the seasonal flu is roughly 1.3
Even with a low death rate of 1.4 percent, a relatively low death rate can take a huge toll if enormous numbers of people can catch it and it is possible since the coronavirus seems to be more contagious than the seasonal flu.
Vaccines are available for the seasonal flu but not for the coronavirus. There are no antiviral drugs either. Doctors can recommend only the usual remedies for any viral illness: rest, medicine to reduce pain and fever, and fluids to avoid dehydration and nothing more.
Mr.Trump is reassuring repeatedly ( Is he a doctor?) that the virus will retreat as the weather warms just as influenza does but this is a new virus and no information available how the weather might affect it.
9
If the Coronavirus takes fifty million lives, the stock market still has a very long way to fall.
1
Great point that uninsured people are likely to delay medical treatment and thereby spread the influenza.
11
One important bit of information not mentioned but being mentioned in Canada by public health officials is the need for businesses, but especially those providing essential services (electric power companies for example) to have trained personnel to back up those that may fall sick. In worst-case scenarios the power grid or nuclear facilities could be affected by workers falling sick.
8
Excellent article that I will make sure to pass along to others. I'm very impressed that you take the time to answer many reader comments.
Thank you for bringing some much needed common sense suggestions to this problem we are facing across the world.
5
I do not know how this will play out. Nobody does. Nicholas Kristof is right; it could be a pandemic. It could fizzle out. Quite frankly I lean towards the latter.
This isn't an Ebola we're talking about. I've yet to read even one account of any patients developing a taste for brains so for me the reaction to this seems a little over the top, akin to being a medicine that's worse than the disease.
But having said that I'll say this. Is it an economic threat, because it hampers our social nature and lays up a significant percentage of the population for a time? Yes. Absolutely it is. Does it hamstring our day to day? Sure it does.
So regardless if I think the reaction has been much a do over little I acknowledge that we need a more preparatory strategy to the eventualities Mother Nature will throw at us. After all, Biology will trump Ideology 100 percent of the time.
With those odds this is why we elect leaders, so to insure adequate planning for the inevitable is in place. The Administration, and others, need to stop whining and alluding to all the media frenzy being some sort of political attack piece and focus on doing their job in setting up plans and processes.
This is what the job entails; so do it is my advice.
John~
American Net'Zen
Yes this virus is dangerous but how many deaths by opioid abuse each year in the USA, how may lives ruined by a car crash every single year worldwide? And for my coutry, how many lung cancers could have been avoided by not or quitting smoking? This virus is not to be taken lightly but this is completely blown out of proportions and medias carry on fanning the flames of fear. What's frightening in such a virus is that it could kill anybody, rich or poor, the Good or the Bad.
Tobacco kills about a half of regular smokers, air pollution dozens of thousands each years so please let's not panick. Panicking may kill more than the virus.
@Robert
I see your point but the article explains quite well why you cannot take risks.
If it turns out to be a glorified flu,fine.
But what if not?
If hospitals are overwhelmed and have to abandon patients, if too many police are ill to maintain public order, if production of essential goods comes to a standstill because workers are not showing up, you have huge societal costs that pale in comparison to cancelling some rock concerts or football games.
6
I'm no epidemiologist but I could argue that the general population can also profit from asymptomatic patients who could transmit their antibodies to others. See the rates and severity of flu between kids who have been to kindergarten and the ones who haven't. If you take an individual then yes it's better to stay at home but a population has a lot to gain from the immune system of others. That's cynical and it implies a lot of death but it does work. But my point was more than a general panick won't save lives and it could kill.
Thank you, Nicholas Kristof, for being one of the so far few sources in mainstream media to offer the general public a helpful bit of perspective in humanity's battle with the coronavirus.
Many times over the past few months have I allowed myself---no, instructed myself---to hold the candle of COVID-19 against the far greater light of the 1918 Spanish influenza outbreak. So far, even at its very worst in China, or even when compared to victims of your garden variety seasonal flu in any average year, the coronavirus has given absolutely no indication that it is "the Big One", impact-wise.
We can be grateful for that. While by no means minimizing very real losses and very real threats, institutions such as the New York Times should be forever educating people in comparative analysis: Continually drum reminders of the 1918 Flu Pandemic into every story on this present virus.
It doesn't have to be loud, and it need not be alarmist or overbearing, but that message should be persistent, even when subtle: This could be much, much worse.
1
@David Bartlett - You can hardly make a comparison since the COVID-19 has just begun.
The American culture does not include the precautionary principle.
That can be a strength in a pioneer society where things are not entirely settled and a can-do spirit is helpful to explore new frontiers.
But mature societies rely more on certainties and advance planning, also in order to balance interests better.
I sometimes feel that Americans don't want to grow up as a society. There have been many wake up calls from hurricanes to elections with a perverse outcome to mass shootings.
The corona virus is another example but again I don't expect lessons to be learned.
11
Whether or not the coronavirus is the ONE, Kristof hits upon a more menacing issue—unpreparedness. Science has seldom been a popular subject, especially when it threatens cultural or religious beliefs. Vaccines cause autism. AIDS was “God’s Judgement.” The fake media and the Dems are hyping the virus to discredit the president.
Federal, state and local budgets often view preventive and preparatory programs as targets for cutting. The last thing officials want is to be criticized about spending and taxes. Stockpiling salt for winter weather sounds reasonable until you have an unusual season with depots of salt and your political opponents at your heels.
Failure to prepare is most evident in addressing global warming. It is the time bomb that is inexorable approaching. The dislocation that the coronavirus is producing may be contained in months. When a vaccine is available, the incidents of infection and deaths decline, and the stock market surges to new heights, all of this will fade and we will return to business as usual.
Kristof is correct in that our continued failure to heed our scientific experts will result in a world wide cataclysm. One that short sighted politicians will be unable to manage.
3
If this virus continues to spread, which it is likely to do, I wonder what will happen to the most important election we are facing. If schools and businesses are closed, what about polling places? What happens? Could King Trump put off the election and usurp the power he so desperately seeks? We have not perfected electronic voting which would seem like the obvious solution. November might seem like a long way off however, we’d better start planning for the likely possibility that Election Day 2020 could be negatively impacted by a demon other than Putin.
7
Working from home? Realistically, what portion of the work force has such an option? How does a bus driver or a taxi driver work from home? a school teacher? a fast food worker? a construction worker? You see the problem. Working from home is only an option in certain privileged lines of work. Those who can work from home might succeed in protecting themselves, but how will that help the rest of the public?
5
Sweden now has 11 known cases of coronavirus. The report on the most recently identified person provides a look into an important element of Swedish Universal Health Care, the national internet information system accessed at 1177.se.
A person arrived on a flight from Iran to Göteborg several days ago. The person felt ill with symptoms that he/she (hen in Swedish) had heard were possible coronavirus illness symptoms.
Hen went into 1177.se, saw that anyone who had symptoms suggesting coronavirus illness and who had recently been in one of countries identified as countries where one might have been exposed should contact the health care system immidiately. Hen did that, perhaps directly via 1177.se, was instructed to come in immediately for testing.
The tests were carried out and the person was immediately put in isolation and under care, so far doing well, but most important not where others could be exposed.
I do not believe this person will pay more than a token fee, whereas I read in Kristof and elsewhere that a person received a bill for $390 +/- USD.
Will knowing that keep Americans from reporting? Will they be told how the cost of the test will be covered?
Only-NeverInSweden.blogspot.com
Citizen US SE
3
My concern is how many fellow citizens do not fully understand contagion because of educational deficiencies. A MA local school quarantined 14 students who had just returned from Italy. No novel Corona tests were available so their status is unknown and cannot be proven. Quarantine was the pragmatic option by the town's Board of Health.
Parents (not the quarantined students parents) at the school thought it was unnecessary and could not understand why the action was taken. If that is the case, do you think they would self quarantine? This with all the TV coverage of asymptomatic cases and long exposure to illness time lines.
1
Kristof brought off one of the silver linings to this likely pandemic -- better health care will become a necessity. But the other one is that people will reduce their carbon footprints. It is unfortunate that these outcomes must be forced rather than intelligently willed. On the other hand enlightened self preservation may always be the only way humanity and intelligently designed action is ever possible.
It could just be there is a periodicity to all this. Phase one: materialism goes to a self-destructive level; Phase two: this breeds contagions via negligence to other, more important things than biologically pointless possessions; Phase three substantial redress and evolution becomes required by all simultaneously.
One thinks of the greater mortality numbers of the opiod crisis, wars (Iraq II), and even gun violence (vaps) and wonders why only a few (relatively speaking) deaths of a virus cause such a fuss. Oh I forgot I said it already -- self preservation only wakes us up not poisoning the young and old consciously, willfully for profit.
1
The question of is this “the big one” needs more clarification. The big one for the stock markets, President Trump’s re-election, the gun manufacturers, or civilization are all potential effectees. This is not 1918 when people generally believed in governments and their ability to protect their people. Or is it a time when guns where a rarity in households. Or when people had faith in institutions to give them hope and maintain order. In America, people’s lives are like delicate, finely tuned watches that if they suffer a slight bump will stop working entirely. Most families have limited if any back up plans for daycare disruptions or a financial cushion or sufficient medical coverage or spare time to deal with illness. In a country current ‘uneffected’ by the virus, try to find a face mask; underlying panic has already set in. Business is already feeling ill with supply chains breaking down. The Trump government is scaling up to protect his re-election, but not the people. All illness information will be filtered through Pence. Although social media could turn against Trump, passing along crazy conspiracies and fake news not helpful to him for once. But gun sales could benefit, which would be a welcome lift to an industry hurt by Trump’s election.
"While figures are uncertain, the coronavirus may kill 2 percent of those infected; if correct, that would be similar to the lethality of the 1918 flu (it’s also possible that many more people are infected without significant symptoms, which would make the death rate quite a bit lower)."
I think that the remark in curved brackets applies not to the death rate of coronavirus infection, but the death rate of the "1918 'flu".
The number of those infected, the denominator of the death rate, is nowadays the number of those who have been tested and found to harbour coronavirus genetic sequences -- polymerase chain reaction (PCR) amplification of those sequences makes PCR results exquisitely sensitive.
A hundred years ago, of course, the denominator of the death rate was the number of those clinically ill. Many more persons may have been infected but failed to develop clinically substantial disease.
If coronavirus kills 2% of a PCR-expanded pool of subjects (clinically ill and clinically well), and "1918 'flu" killed 2% of a pool of subjects NOT thus expanded (clinically ill only), then coronavirus is perhaps far more lethal than was the "1918 'flu".
Of course I welcome being shown that here I have got the wrong end of the stick !
2
My thoughts exactly!
I can’t help feeling that Mr Trump’s main concern is the damage that this virus could do to the stock market and his chances of re-election, rather than the potential human suffering.
Thankfully here in the UK, even if we do catch it, we won’t be faced with a huge medical bill, just a potential visit from the grim reaper :-)
8
Seasonal flu, colds, coughs and sniffles. Add the on-set of early seasonal allergies due to climate change and we have a trifecta to transmit a broad spectrum of upper respiratory ailments - including Covid19. Proper personal hygiene (washing hands, covering mouth) and courtesy and consideration toward one another (staying home if sick) are the best defenses.
Thank you Mr. Kristof for the most level headed analysis of the Covid19 crisis.
3
I write from Italy and as far as I know I'm not infected. This message is not infected either, so you can read it without danger.
I read that in the U.S. they only give free tests to sick people. In Italy we have had the opposite problem. Because of the panic, many (too many) people were tested in the first days of the emergency (even the totally asymptomatic ones). This led to the detection of many positive cases and to multiply the panic. Now the public authorities, after having contributed together with the media to sow panic, are trying to reduce panic by saying and repeating that the risk of being infected by a totally asymptomatic positive person is low. But we still have ghost towns, closed schools, closed shops etc.. In the end some Italian politicians with their brains in "on" mode understood that panic is the main emergency. Now they decided to test only symptomatic people.
2
Alfredo, the table in today’s NYT article shows 1128 confirmed cases and 29 deaths in Italy. If the lethality is similar to what we know from other countries, there were not „too many“ people tested in Italy. The lethality is similar to China.
9
@Alfredo Alfredo - In other words, you are saying that a person in my USA wonders if she/he has covid-19 so goes to a health center and asks to be tested.
If the test confirms covid-19 you seem to be saying, no bill - free.
If it does not confirm - you pay $390.
Your source. I do not see any reliable information yet on cost in the US and on who pays and who does not pay.
Here in Sweden, if you are covered by UHC, I can assume that the cost is minimal. So far testing is only carried out, I believe, as in the most recent case, an arrival from Iran, for those who not only have symptoms but have been in a location where exposure is possible.
You seem to dismiss the detection of positive cases. Detection should lead to isolation, that is one less source for passing the virus to contacts.
Only-NeverInSweden.blogspot.com
Citizen US SE
2
So I am a computer science professor. In our profession we study complex dynamic systems. To me the numbers do not look good.
The CDC's main advice is to "wash your hands." If this is all my colleagues in the medical profession have to offer in 2020, I am with Mr. Gates: this really may be the big one. I hope I am wrong.
9
A very sensible article. The setup of the American health system does directly work against containment efforts of the virus. The majority of people go to the doctor only when it is unavoidable. And go to work as long as it is in any way possible. While quite heroic, it is as close to a worst case scenario for pandemic containment as you can think of for a first world country.
14
Also an anti-vax, climate change denier President. The big question that I struggle to understand is why has so much of the US electorate has such a disdain for science and academia at the moment. This in a country which wins most of the Nobel prizes, produces the most medical research, uncovered climate change etc. More importantly how to can it fixed?
11
The other half of the U.S., the half that cannot believe what is living in the White House, also wants to understand why we continue to become an idiocracy.
3
The 50 million+ persons who died in the 1918-19 flu epidemic would probably be well exceeded by a pandemic now, whether COVID-19 or another one.
Consider that the COVID-19 virus has a 2% fatality rate (approximately; it's actually been estimated as higher, but let's assume 2% due to improved treatments). The world's population is 7.8 billion. If one-third of the population gets the virus (due to the contagion), then 2% would represent approximately 156 million persons dying worldwide and 6.6 million persons in the United States alone (2% of one-third of 330 million persons).
Two percent does not sound like a high rate but under pandemic conditions (when contagion is extensive), a large number of people will end up dying.
Let's hope that it never comes to that. This is a very serious epidemic that our government needs to respond to immediately.
5
@MVT2216: Sorry, I forgot to divide by 3. Approximately 7.8 billion divided by 3 (one-third of the population) x 2% = 52 million persons dying worldwide and 2.2 million in the U.S.
2
Mr Kristof
An excellent message of warning.
The lack of analytical thinking of the Trump regime is confounding and frightening for the American masses who may have to confront a hitherto unexperienced health crisis capable of transforming the socio-economic fibre of society in unimaginable ways. In any case, coronavirus provides an efficient litmus test for judging Trump's best interests : namely only himself !
11
Noted epidemiologist Dr. Larry Brilliant says in a very recent informal interview, "This is not the zombie apocalypse, this is not going to be a mass extinction. ... [but] We have a lot of work to do, this is going to be a bumpy ride. It is not the end of the world [and] it is going to cause us economic, emotional, and political distortion."
Dr. Brilliant (who has four honorary doctorates) in addition to his medical degree and PhD, was on the WHO team that eradicated smallpox in India and is currently chair of EndPandemics.org. In the interview (it's on YouTube), he concurs with informed opinions that coronavirus will be a significant challenge, psychologically, economically, and politically.
In that light, it will be vital that those of us who are not medical professionals or first responders keep our sanity, our compassion and generosity, and our creativity all intact.
6
In a single day, we learned that a long term care facility 8 miles away from downtown Seattle ( in Kirkland) had one elderly resident sent to a hospital and diagnosed with Coronavirus, a nurse at the same hospital is in isolation, and as many as another 50 people at the Kirkland long term facility are suddenly ill with suspicious respiratory symptoms that the CDC is testing for the virus.
This is in addition to one death in the Seattle area. Plus a high school boy in Everett 30 miles north of Seattle is infected with the virus.
CDC does not want the general public to buy N95 masks, and worsen the shortage available to healthcare workers.
Ok. But surely if someone rides the rapid transit system in Seattle, for example, it is not foolhardy to wear a regular surgical mask. And gloves! ( Especially is one is a child, a senior citizen, or if one has a special vulnerability such as asthma or other health conditions.)
I would welcome for now surgical masks and disposable gloves being worn by food service employees, hotel maids, grocery store and drug store workers.
Masks minimize the ability of those people to unknowingly touch their face—which we are told can transmit infectious exposure to their system. Their masks also protect the rest of us, if they are unknowingly infected.
8
You don't need a surgical grade mask to not touch your face. a Halloween grade mask would do that.
All co-pays and hidden costs as well as prescriptions should be free for patients getting tested for coronavirus. And free also for non insured patients going to hospitals or clinics. Health providers should not be making money and raise their profits out of the disease.
12
Donald Trump predicts when any new flu vaccine becomes available it may not be affordable for many people also known as voters? The profit motive alive and well in Trump world.
4
Simon Cardew, when you vote in November, vote Republican and take a selfie with your ballot, so you can prove that you are eligible for vaccination once it is available. If the Dems win, just keep that selfie for yourself.
1
Knowing who is infected with the Covid19 virus and isolating them
is the most important first step for preventing an epidemic here.
As such, the development of a point-of-service test for Covid19, which can be be done in a doctor's office, urgent care center, or more safely in a specially designed protected lab facility, is essential. Such tests are available for influenza and strep infections and give results in a matter of minutes at moderate cost.
I suspect that the development and dispersement of a rapid test for detection of Covid19 is one of the highest priorities of the government in collaboration with academic scientists and private industry in its efforts to prevent an epidemic.
7
We were ready to travel to see our daughter in Deerfield Beach. Everything was reserved, booked and paid. But we canceled it two days before departure date.
Would it be necessary? I don't know, but I think it was prudent. We planned to go to NY and Boston too, straight to crowded places.
My daughter is liver transplanted for 32 years. My wife has strong cardiopathy and Sjogren Syndrome. I have three stents after a heart attack. And despite of these ills, we live very well. But we couldn't risk.
Am I right? When should we travel again? I guess nobody knows...
Hope to see her soon.
Hope this illness pass too fast.
17
As I have written elsewhere, this will test Justice Brandeis' axiom that the "states are the laboratory of democracy.'
We can expect Congress to provide massive funding for needs mentioned in your article and for federal health care professionals (hampered by Trump administration budget cuts) to work to keep us safe. But the White House is AWOL, sporting Trump's big lies, that it is a hoax and that Democrats want a million people (themselves included) to die.
In such circumstances, the states and municipalities become the first line of defense One of our daughters, a seasoned ER Nurse Practitioner, sees DC hospitals preparing but wonders about the protective resources available to heath personnel nationwide. She hopes someone is making preparations for temporary field hospitals should more beds be required.
A data point. Around the time of SARs, I participated in a simulation (a kind of war game) designed by the CDC and the National Intelligence Council (NIC). It was remarkably predictive of the hop scotch movement from country to country of COVID 19. The game managers, for want of time, had the game virus burn itself out (which we may hope for but should not expect) without sweeping the world. The managers did, however, point out another, quite grim scenario, a relatively mild epidemic, followed by a killer pandemic the next year. That was the pattern, apparently driven by mutation, of the Spanish Flu. That's why a widely available vaccine is essential.
5
National health care is not - should not be - a partisan issue. We ALL need health care. Health care is a human right. Every human being in America, including immigrants, legal or otherwise, must have access to good affordable healthcare.
Of course it is the right, humane thing to do.
But also, it's self-defense.
The potential cost to the nation of untreated people going to work every day, because they can't afford to seek help and they can't afford to stay home, is catastrophic.
Yet we persist in our delusions of "freedom."
What is so "free" about slavery to the health insurance industry?
25
If its not the next one will be.
I remember decades ago seeing a WIRED article on pandemic, with airport lockdown and hazmat suits, and people dying on the streets.
Stuck with me since then. WIRED wisdom.
Family planning and negative population growth our only crack at survival.
If not the genes and germs will do it for us.
4
It seems important to focus on one current difference between the 1918-19 pandemic and COVID-19. The “Spanish” was at its most lethal with young adults. Wiping out part of an emerging generation. The current virus seems to leave them ( and children) mostly unscathed. It is older adults like me that are most at risk. While not fun for me the effects on the world are very very different.
6
Every minute, world population breaks its own record. And with every new host, comes a new opportunity for the "the big one" to evolve. The fact that we're unprepared and medically price-gouged makes the current pandemic bad, but is the Coronavirus "the big one?" I say no. With a population of 8 billion, when "the big one" comes, we're not going to be asking that question.
4
This whole crisis is making me see so clearly that the US healthcare system based on the individual, but that health needs to be conceptualized in terms of whole populations--the health of the "herd." We are vulnerable because we have chosen to look at healthcare as a commodity individuals must procure for themselves, rather than as a something that must be guaranteed for all in the society to keep us all healthy. If the waiter in the restaurant is sick, we are all at risk. We are victims of the historical arc of ideology in the US, away from democratic socialism a la FDR, to Reagan-esque individualism.
23
This is true about food service. I drive three people to the ski area who work in food service there. They are contractors who receive no benefits. The young ones simply quit if they get sick. But the older ones have families to support and come to work even if sick. The managers are always short staffed and look the other way when they do.
11
Managers must work sick too. I’ve been in that industry. There are usually only a GM, Chef and 2-3 managers at restaurant, even the really big ones. There is no such thing as a sick day because there is no one to cover you. The culture is to simply work while sick. Same for staff, it’s terrible. Most “hourlies” don’t have benefits. Any they do have are very basic and don’t include sick pay. Some places are so severe they even fire staff who call out sick or spent too many days out sick. I’ve seen colds, flu, norovirus ect rip through restaurant staff and everybody just keeps working. There is tremendous pressure from owners, corporate bosses, general managers to keep the engine running no matter what. Ive known of restaurants that ran for days without hot water or refrigeration. I even knew of a chain restaurant that had a significant fire in the kitchen. Per their corporate, they were not allowed to stay closed. They threw some tarps over the damage and reopened later that day. There is a great (hidden) human cost to much of the hospitality industry, and it often puts its employees AND the entire community at risk.
19
I appreciate this column but I wish it had omitted the quote from Dr. Hotez: "If we see a situation in the U.S. like we saw in Wuhan... it's game over. ... Things start to fall apart."
These expressions — "it's game over" and "things start to fall apart" — are meaningless hyperbole. They serve only to contribute to the sense of panic. This is counter-productive communication on this important and sensitive issue. Please try to quantify and characterize possible negative outcomes rather than merely dramatizing them or expressing dread about them.
15
In 1918 governments didn't have labs where diseases were being bioengineered as weapons.
While it is a possibility that this virus occurred naturally, no rational path has been shown to indicate how this virus evolved in the wild.
In contrast there are numerous reasons to believe that this virus was being studied and manipulated in a lab. The presence of HIV sequences attached to a Coronavirus, the outbreak beginning near a level 4 biohazard laboratory in Wuhan, a lab that was studying Coronaviruses and bats carrying viruses without showing symptoms support theories about this being a man made contagion. The long asymptomatic period during which this disease can be transmitted would be an advantage for a bioweapon and was clearly of interest to those studying bats carrying diseases without showing symptoms.
China has a history with previous SARS outbreaks occurring because of leaks from a level 3 lab in Bejing, all indicate the possibility that this is a man-made disease.
The repeated and adamant denials of this possibility despite the unusual configuration of this virus do not reassure anyone that examines this issue closely.
4
Who could possibly benefit from a disease that spreads and kills indiscriminately and therefore derails the world economy? Although many are tempting to believe, what most conspiracy theories lack is something very important: MOTIVE.
7
@cynicalskeptic
This is all a debunked conspiracy theory, promulgated by that tower of intelligence Tom Cotton.
Hello Mr. Kristof, thank you for this very informative and factual column. I have been a NYT reader for few years now, and this is the first time I see the columnist replying directly to readers. It shows care and professionalism.
As for the Coronavirus, yes, let's watch our hands more often.
8
My Grandmother recounted her experience of being a nurse in Philadelphia in 1918, and seeing bodies stacked “like cordwood” on trolley cars there. She lived a long and wonderful life to the age of 111, and didn’t tell of her memories until she was 100 years old. People tend to block out such painful and traumatic times. We can see now as measles and pertussis come back, that because so many don’t remember, they are more comfortable not having their children vaccinated. They even question science, hard facts, and statistics in favor of conspiracy and rumor. In the end, we cannot escape our own nature and weaknesses, no matter how many giants like Jonas Salk walk amongst us. Whether it is this variant of Corona virus, Ebola, or some other virus, there is no doubt in my mind that a massive intrusion is coming.
11
As illustrated in this article, COVID-19 is exposing the deep flaws in the systematic decimation of the public sector over the past 40 years. The case of Mr. Azcue shows why healthcare is a public good, not an individual one. Affordable healthcare for all is in everyone's best interest. Imposing unconscionable costs for seeking healthcare hurts everyone.
Same with paid sick leave. Making people choose between staying home and being unable to pay rent versus going to work sick hurts everyone.
Any ideology that treats public good like these as individual ones is morally and intellectually bankrupt. We're all in this together. We need a government that recognizes this fact. Maybe I'll move back home once we get one.
Until then, I'll continue living in a country with heavily subsidized public healthcare and eminently affordable private healthcare, while continuing to vote for the government we need through my local consulate.
12
One thing to consider:
The world is much "older" than it was then -- those above 60 make up a significant portion of the world's population.
They are far more vulnerable to these viruses. My mother, who has battled respiratory and other ailments for the past two decades, said this today:
"If I get it, I'm toast."
11
@J
The Spanish flu was unusually deadly to people in their teens through thirties which helps explain its high death rate. So the average age being older doesn’t really matter in comparing the two.
The coronavirus is acting more like the regular flu in who it’s impacting, so your mother is right to worry, with the exception that it hasn’t been fatal for very young children. I don’t think China has recorded a child death which is something positive, if you can say that, to get from this.
3
I heard that twitter can spread the coronavirus.
I don’t but it is something that I heard.
2
As the technology is getting more advanced, I personally don't think it will be as bad as the Spanish flu back in 1918. But we definitely cannot underestimate the impact of this coronavirus. In particular the Chinese government suppressed the news and statistics in the beginning, making everyone hard to prevent, especially places that are close to the chinese border. Even though we now have better research techniques and equipments, however things have mixed with politics and it seems the WHO is kowtowing to china, making the epidemic even more underestimated.
We have to prepare for the worst, of course. But it is important for us to fear the coronavirus calmly. Thousands of people routinely die annually from the seasonal flu. If the government introduces the extreme methods against the coronavirus, economics could collapse completely. In such a situation quite a few people of the poor would be damaged fatally.
1
Trump relies on fear and anger at his rallies. So, if there are reports of the virus in the community where “trumpers” live it seems to me fear, so characteristic of their rally behavior will dominate. Now, as to who they will get angry with I guess depends on whether they could ever blame their president or whether they accept whomever he blames ...Pence, health care personnel or??
It’s very sad and tragic for our nation that negative emotions fostered by Trump & the GOP over rule legitimate facts.
10
My grandfather died in the 1919 flu epidemic. My father was two years old. He never knew his father. My grandmother had to rear five children on a farm in rural Wisconsin. You can imagine the hardship. That pandemic cast a long shadow on my family.
26
I don't understand why we are discussing this here. Just learn what Chinese has done to suppress the outbreak: Minimize human-to-human interaction for 2 weeks.
Yes. it will be painful but it worked in China.
3
What about physicians and other providers who are literally taking their lives in their own hands to help the sick? Doubt lawyers would do the same. We did this in the AIDS crisis too. Shouldn’t we have our health care covered and our loved ones looked after in the event of our death? Many MDs might just call in sick otherwise. A time honored tradition but the social fabric is fraying...
10
Well, they're not literally taking their lives into their actual hands. They're taking a risk, but it's an extremely small risk, because it's likely they're not over 70 and in poor health.
3
@Dan Stackhouse actually no, healthcare workers are at much higher risks due to the repeated exposures and at much higher levels than the general public. That’s why you see young doctors and nurses die. They see patient after patient and the repeat exposure can cause severe illness.
22
Dear CB,
Actually no, they are not at great risk of dying because they are not elderly and in poor health. Don't buy into the massive panic over this.
Of the 3,000 people who have died from this so far, nearly none have been health care personnel.
1
"For decades, experts' warnings to prepare have gone unheeded."
How many times of late have I seen the quote "At the start of every disaster movie there is a scientist being ignored"? Climate Change is at the tipping point and now this. We have an incompetent in the White House, a raft of them in the Senate and our relevant Government Departments are headed by retired Corporate CEOs rather than experts and academics in their fields of expertise. How can I not think this is not going to turn out well?
22
Many government and private third party payers’ reimbursement rules require that patients and healthcare providers be in clinical facilities during telemedicine encounters. Thus, telemedicine, as currently structured in the U.S. will not ensure that patients are at reduced risk of exposure to the secretions of others with coronavirus.
3
I wager how serious (statistically significant) this gets, as to who dies and where they die, will boil down to the pulmonary health of the infected and their long-term environmental surroundings. This not 1918. Advanced/rich Western citizens do not live and sleep and live in mud huts heated by lumps of coal and wood which we share with livestock. Nor do we cook with wood in or over leaky iron stoves in poorly ventilated small spaces. We do not expose ourselves thoughtlessly to working long hours in particulate heavy air without respiratory protection. Did tobacco products have "filters" in 1918? Of course not. On and on the differences between the pulmonary environment now and 1918 go. No Americans today have ever experienced the horrendous environmental working conditions older Chinese workers suffered through in their manufacturing transition towards modernity. It will be interesting to see how 'lifestyle' affects mortality when the dust settles. Hope I live to read about it. Now where did I put my smokes?
3
The article and reader comments make some very good and frightening points. The only certainty I can find in all of this is that again, our government has not done an adequate job of putting the interests of it's people ahead of it's own interests. This deterioration of priorities will certainly not change under Trump's occupancy.
16
Other developed countries have one big advantage over the United States - they have universal healthcare, so that cost is no barrier to access to medical treatment. The consequences of a growing number of people who are sick but can’t afford the cost of a visit to a doctor, who are paid hourly and can’t afford to miss work is a recipe for a disaster.
36
This comment should be the most upvoted by those who are in the United States. An epidemic is, by definition, a community problem and when there are people who cannot afford to go to the doctor and who have to work in order to be paid regardless of their health, everyone should be very worried. A rational assessment of the much-invoked “self-interest” should lead to universal health coverage and national standards of worker protection including sick pay. It may save YOUR life!
5
@Edie Clark
Cost is no barrier, but actual access is, as government controlled health systems become overwhelmed. Compare waiting times in Canada, UK, France, Italy, Australia, to those in the US for a variety of procedures.
We have an expensive healthcare system, with a lot of the expense tied up in administrative morass, but the care is the best in the world.
1
Comparing the mortality of the Spanish flu with the Coronavirus just seems off so I looked up the numbers. Numerous sites list statistics of a 10-20 percent mortality rate worldwide for the Spanish flu.
2
Fact based and well done. My dad was in the Army Dental Corps during 1918. He is long gone, but impressed upon me the death and disruption the flu caused then. I was in high school in 1957 the a large flu outbreak took place. Schools were not closed but for two weeks less that 1/4 of the students who should have been there. His comment to me then was, "This is nothing." Hopefully, we can look back on this problem with a similar comparison to 1918.
2
"We may also have to think about reducing occasions when people are crowded together; that may mean more people working from home to avoid offices, buses and subways. It may mean avoiding sports events, school assemblies, parties and even unnecessary visits to crowded doctor’s offices..."
Can we please stop with all the Mays and Mights and Possiblies. So much hesitation, people need to stop being afraid of clarity and firmness - this is a pandemic which Will sicken and kill many, far too many, and for which we Should stop congregating and traveling as much as is possible. The pandemic will absolutely grow, there is no doubt whatsoever about that fact. Only Dr. Messonier & a few others have used strong language, and how grateful I am to hear it. We need honesty and firmness as we encounter this huge awful threat, not endless hesitation and prevarication. No more denial, no more heads in sand, we are overdue for serious comprehensive plans put into action as soon as possible.
7
I desperately hope to be wrong, but there NEVER will be free testing in the US. People will have to be sick to consider going to hospital. Even then, hospitals will find ways to not spend money on people without insurance.
A cynical person in me thinks there are people, a LOT more than we'd like to admit, who are thinking 'this can really work out to weed out who's unworthy to be in the US anyway', starting from Mr. Trump himself.
19
'The United States is also vulnerable because of longstanding deficiencies in our health care system. We are the only major rich country without universal health insurance and paid sick leave, and we have fewer doctors per capita than peer countries', well at least you are not socialists with a decent healthcare system, because that would be just terrible wouldn't it?.
38
I appreciate your thorough insight. I question the opening anecdote of the dear nurse who arrived for duty, felt a touch I’ll, then died by evening. Scare tactic. Otherwise I’m with you.
5
Paging Doctor Osterholm...
Epidemiologist Mike Osterholm has been warning and advising us for decades now, and we are stuck with an "administration" that has ignored information and actively hampered our ability to deal with a pandemic, maybe even an epidemic. If this isn't the stuff of science fiction and absolute hubris...
8
We need to do better, but can’t. It takes organization, and discipline. But we’re a disorganized, mostly anonymous, undisciplined, chaotic, often anarchic people and country living in a mental state of anomie.
16
Fear Not, The Stable Genius will guide us through this.
Having defeated ISIS, this should be a cakewalk.
5
he said there will be a miracle.....
1
What happens if a pandemic bankrupts private insurers and millions of "self-insured" businesses where Blue Cross or Cigna or United administers the plan but the employer pays the doctor and hospital bills?
7
while writing that experts have warned for decades, the author finds ways to blame President Trump for this possible crisis.
Please don't politicize an epidemic. I'm appalled.
5
Nobody is blaming Trump for the epidemic. Nobody. They are questioning this administration’s preparedness for a pandemic.
3
the most troubling recent revelations are of more cases of re-infection of those thought to be virus free.
7
This will probably not be the Spanish flu. COVID-2? may be.
1
While the outbreak makes the case for M4A all by itself, America has a problem of monumental proportions with the millions of uninsured and the high deductibles for the insured or no sick pay.
America will have to measure the impact in dead people before it can treat the sick, because nobody visits a doctor for a fever under these circumstances.
Free consultation and treatment is Kristof's very sensible proposal. Yet, again, it will feed billions of dollars into the maw of the health industry. Why in heaven would a corona test cost the insane amount $3270? The government must thus not just foot the bill but also say how much the bill will be, in particular after the public has and is paying so much for research already. I do not know for sure, but by Canadian or European standards, such a test can cost no more than $200.
A.J. Deus
Social Economics of Poverty and Religious Terrorism
16
We need to confront our fear of death and stop obsessing about COVD19.
We have damaged the planet beyond repair; these microbes and viruses appearing are due to climate change and the heating of the atmosphere. We must accept this reality.
Doesn’t matter who is in power and much they deny it. Mother Nature does not care. All the political posturing will not change a thing.
This is the planet’s way of correcting itself.
We humans are a meaningless speck.
So stop panicking, accept that we may die, we all will someday. But it’s game over for the planet, it simply cannot sustain 9 billion people.
9
What is being omitted here are the facts, China has taken an aggressive stance to fight this virus’s and it’s working. Trump has taken an aggressive stance and the numbers show it.
The US, China, India, and Europe should consider this a dry run for the “Big One” How do we minimize exposure, keep key trading venues open, and ensure the Media does not create a panic. This also opens the door to the issue of the gross misuse of antibiotics by some countries. There will be another outbreak the question is have we learned our lesson from this one.
2
What on earth are you talking about?
Trump’s more aggressive with imaginary ‘hoards of people’ coming over the boarder.
The ‘numbers’ represent the beginning of the virus in the US.
Antibiotics are not used for viruses. Except under this administration which thinks men are women and smoking doesn’t cause cancer.
2
"Is This Coronavirus ‘the Big One’?" - No, it is clearly not. But if we're smart, we'll consider it a good practice run for our ability to deal with a truly serious pandemic.
So far it seems as if the news media is getting plenty of practice at stirring up panic. I hope that what's left of the CDC is working just as hard.
2
We tried telemedicine yesterday on my husband’s return from a trip to Europe. I was pleasantly surprised by the experience. The absence of direct contact seemed counterintuitively to promote more in-depth interrogation and thinking. I did have to feel my husband’s neck to look for lymph nodes, but it was fun more than a hassle. We also really liked not having to stress about contagion, either from or to us.
I don’t know about the US but France had an action plan during the swine flu episode, including finding fridges big enough to store corpses. The problem, of course, is that public services, which play a crucial role during an epidemic, have suffered terrible budget cuts.
2
"In the end, it turned out not to be coronavirus — but he was billed $3,270."
A few minutes on the internet and checking costs in countries not the US and one finds that the costs of testing and charges are significantly lower. What exactly makes Miami so expensive??
18
@Joshua Schwartz
Miami is still part of the United States, which does not have a universal healthcare system.
1
A nation that spends almost $700B/yr on its Dept. of Defense, does not have enough protective gear for its health workers?
108
So why hasn’t anyone mentioned google tracking? It shows me everywhere I’ve been.
We should all turn it on( its probably on unless you turn it off anyway) and share it with the CDC when asked. The tracks can then be cross correlated to calculate where the paths of infection vectors cross. This would help immensely.
8
Are you an epidemiologist? Do you know what they do and how they do it? Or do you just google it?
@Alberta Bound
Not having professional credentials do not preclude me or anyone else from common sense assessments. Seeing the track of ones travels would obviously be helpful. Disagree? Thanks for commenting just the same.
I think there is plenty of evidence that this is not "the big one." I've posted twice about some of the many elements that made that flu unique and devastating (it remains the only flu to have targeted young, healthy adults of child-bearing age) but that does not lessen the severity of this crisis.
Because the real crisis is not the C-virus; it's this country's ongoing inability to take preparedness seriously. If we end up weathering this as well as China seems to be then it will be because of pure dumb luck, not our expertise, planning or approach.
Just imagine if this were as infectious as the 1918 flu. We've let thousands of travelers who've been to hot-spots return with no testing. We don't have test kits other countries have. We've knowingly allowed those who've come in contact with the sick to return to the wider community. In short, we've done everything we can to encourage this or any virus to spread indiscriminately.
There is the chance for a silver lining here. If this does not shock this nation into realizing what happens absent national healthcare, nothing will. And "the big one" is out there. So, will we take this wake-up call seriously? The CDC needs to be fully funded, we need to partner with other nations, and we MUST have national healthcare and livable wages. Those who live paycheck to paycheck will not stay home when sick; it's a luxury they cannot afford, and ultimately, it was quarantines that curtailed the 1918 flu.
There is no quick cure here.
17
Recommend 100 times.
"Experts can’t answer the questions that we all have, but they say that we will get through better if we make preparations while relying on science and evidence rather than on muddled political leaders trying to talk up markets or score political points." How do we do this when we can't trust anything that comes out of the White House and, despite Trump's denials, muzzled CDC and NIH officials, along with reports of Trump's fury at Dr. Messonnier, who told us the truth this past Tuesday when she bluntly told all of us "It's not if but when." Well, "when" is now here. Since Trump's press conference this past Wednesday, COVID-19 cases in the US have risen from 60 to 70. Who knows what the count may be by tomorrow morning? I can't rely on my own government to tell me the truth. Don't tell me not to panic. At 68 and with a bum ticker and hypertension, I am in the high risk category of dying if I should contract the novel coronavirus. Trump is messing with MY LIFE, and millions of other Americans just like me!
14
@Jan N Reducing risk from coronavirus and similar flus is simple; avoid people and if you can't then maximise hygiene. If you need health care find somewhere that minimises risk of infection (that can be difficult). All the government can do is to encourage people to be tested rapidly and then isolated. The Chinese have mainly relied on techniques that were known for most of the last century.
1
If the 1918 flu only has a 2% mortality rate that would mean 2.5 billiiom people were infected which is more people than were alive at the time. It looks like most sources list it as 500 million infected and 50 million dead which is a much higher mortality rate than this current virus. Needless scarmongering in comparing the two.
2
I hope the scaremongering will result in some action to prepare adequately for a pandemic. We can not blithely assume it will never happen here. Wouldn’t it be smart to get ready?
3
@Zejee
It would be very smart. It’s also smart to not cry wolf so people take you seriously when a major pandemic like the Spanish flu strikes again. This is nowhere near the lethality of that flu nor is it killing young people the way that it did. Constantly telling people it’s the end of the world is not a wise policy when it comes to anything. Titling something is this the “big one” falls under the doomsday category.
China has published autopsies of those killed by the Coronavirus. The lung tissues were attacked by the virus and inflammation causes the body to generate viscous thick mucus which prevented the exchange of oxygen and carbon dioxide. Essentially the victims died from slow asphyxiations as oxygen levels drop in the blood while the victims were still conscious, more like death from water tortures. Those older victims has already damaged lungs from smoking, and heart attack was possible as victims' racing heart trying to push blood through lungs faster to gain more oxygen.
4
@xeroid47
I'm amazed that anyone can survive any respiratory disease in China, given how bad the air typically is and how many people are heavy smokers.
Great article Mr Kristof. I could not agree more with your suggestion that the govt announce and ASAP that they will pay for any un-or under-insured person who needs to be tested for this virus. And then provide them with the medical care they need to recover. Trump’s response and lies are appalling, exceeded only by the right-wing media’s ability to further the spread of his disinformation. I keep waiting for the adults in the room to show up, but it seems as tho not even a crisis that threatens us all has been sufficient enough for the members of the GOP to grow a spine or a conscience.
That being said, I’m so thankful for the scientists and medical experts that are working so hard to contain the spread of this virus. And I’m very much hoping that remdesivir may help save us from a pandemic similar to the one 100 years ago.
5
Talk to any physician and you hear the same thing. Coronavirus is already endemic in the US. Most cases are mild and this facet of the disease prevents early detection and containment. The real focus now should be to protect vulnerable populations such as the elderly, health care workers, people with breathing issues and the immunocompromised. Office heallth care workers are likely to now dump any patient with cold symptoms to the emergency room.
15
I am not sure that this country has the will to make it possible for people to seek medical attention immediately when they feel ill. If we do make that possible, it will only be after it's way too late to be helpful. If 200 million people in this country contract the virus and the virus has 2% fatality rate that means there could be 4 million deaths.
9
Coronavirus is *not* the big one. No need to scare people unnecessarily.
Yes, it is a worry and has a higher death rate than common flu induced pneumonia. It is a good "warning" and practice for the modern world to go through the steps of "containing" and "controlling" the virus.
The biggest problem I see is the lack of testing the virus - due to the limitations of testing only people who had been to China. The containment efforts in China and around the world were too little too late.
The world is one big incubator that can pass disease so easily when the world has become so small due to air travel.
The disease also shines the light on the dependence of the US economy (manufacturing, medicine, other items built/manufactured now in China and not North America). North America would be wise to consider bringing some key manufacturing to the US/Canada, and not outsource everything to Asia.
12
@Radha "Coronavirus is *not* the big one. No need to scare people unnecessarily."
Really, you or anyone, has no idea. It has just started. In a year or so we will know for sure.
12
@Joe Rockbottom
No, we don't know for sure, but from what is coming out of China and now other countries, it does not appear to be the "Big One". I still stand by that statement.
What is of concern is the hyperbolic headline to this article. Is it just to get readership? It definitely puts everyone on edge.
Coronavirus is a serious pandemic. But it seems the press is hyping it in opinion pieces without really delving into the case studies, interviewing the actual people themselves who have been affected by the virus first hand.
@Radha
I hope you are a medical professional of some sort, perhaps an epidemiologist? MD? Biology PhD perhaps?
Otherwise your claim is just a subjective opinion.
Enough accurate information has gotten out of authoritarian China for MDs I know to be plenty worried. We need to remember the extent of Xi Xinping's fascist control of information. We know very little about what is really going on in China. Unfortunately our president will be making the same attempt to control information.
1
Even if this coronavirus turns out not to be "the Big One", we should not be complacent, because "the Big One" is certainly coming, probably within the next fifty years.
Man-made climate change is thawing areas of the earth that have been frozen for literally thousands of years, and fossil fuel companies are able to drill in these areas. I've read that their drill bits are bringing up various viruses and bacteria that have never been seen before. So far, they've been harmless to people. Sooner or later, one of them won't be.
In the meantime, it's instructive to see how totally worthless yet another Republican administration is in handling a crisis. Seriously, you'd think the American voter would learn. The GOP brought us the Great Depression, and the economic crash of 2008. While Trump didn't cause the coronavirus, by having stripped the CDC of the position that deals with pandemics, he's made it that much more difficult to cope with. I guess his base prefers his pep-rallies to his reality.
43
Thanks for another informative read Mr. Kristof, and great job on Real Time last night!
I work in tele-medicine for Intermountain Healthcare in Salt Lake City. I also work in urban Emergency Rooms. As a clinical social worker I would almost always prefer human to human interaction, but will definitely feel safer from our tele-health site if this becomes a true pandemic.
But tele-medicine has its very real limitations. Our nurses can't set IVs over skype. Our MDs can't listen to lungs directly over a PC connection. Tele-medicine is a great way for good doctors to reach more people to diagnose and treat illnesses, but until technologies progress to the point that robots or other mechanics can replace front line nurses the human to human care-giving is a necessary risk. Some such technologies exist, but certainly not at the scale needed for a Pandemic.
On a side note: maybe the silver lining to Trump's failed presidency will be a collective realization that we must depend on each other, organize at the community level, and approach dangers like this with expertise worthy of the challenge.
Trump's method will undoubtedly be full of lies, draconian measures that won't work, and by the end of it somehow blaming the fiasco on Democrats. The scariest part of that is how many people will cheer him on.
Keep up the good work...
23
This is astute analysis. There is an urgent need for preventative measures to control this potential pandemic. There must be an immediate government funded program to manufacture Coronavirus testing kits. Testing and treatments for those suffering from the disease must be free and subsidized by a large government program. This may cost well over 10 billion dollars and should be voted on immediately.
It may be necessary to cancel sports and theater events. There should be a government program to insure income for those who have the disease so that people don’t try to work when ill. Hospitals need immediately many more expensive ventilators that must be bought by a government fund and manufactured as though it is wartime. The time is short and we are very poorly prepared and I strongly doubt that Trump and his anti-scientific administration are up to the task. We need luck to prevent a disaster! This is not a good place to be at right now!
11
Q: Is This Coronavirus "The Big One"?
A: No
The mortality rate outside of Wuhan's province is higher than the normal flu, but not the 2% as has been bandied about. Much closer to the flu numbers that we don't think twice about each year. Many folks do not understand the terrible air pollution (which diminish the lungs) and sub-standard (by our standards) medical care in the most directly affected area of China.
When this is all over, this year's stats will look like another flu year.
The media reaction/hyperbole is vastly overblown.
If the long-term average stats I have read are accurate (and I got them from the CDC web-site), here in the US we AVERAGE between 30 and 100 deaths from the flu EACH DAY OF THE YEAR. And we don't bat a collective eyelash.
10
@Angry Liberal On the other hand, most of us have gotten the flu, perhaps multiple times and survived without hospital care. That makes it less scary. When I've gone to the doctor to be treated for the flu, he didn't find it necessary to don a hazmat suit and a face shield. Clearly this virus is far more contagious than the seasonal flu.
As far as the mortality rate, we won't really know what it is, until the outbreak diminishes significantly.
13
Medical care is not sub-standard in China. They have very good care but were over-whelmed by the numbers...as we might be. We’ve had two months to prepare but wasted that time.
13
@Mary Sampson
Exactly. And many people who feel sick will not approach the U.S. profit-driven healthcare system because they don't have insurance. They will quietly suffer at home.
16
Fifty-seven countries so far have residents with the coronavirus. This started in China and has spread throughout the world. And more may be affected before it is all over. How can you prepare for a pandemic that may or may not happen. President Trump is not a mind reader but to his credit he acted quickly and put precautions in place such as not allowing Chinese citizens to enter. He has pledged to spend as much money as needed to stop this scourge and has put in place doctors and a coronavirus team that is top notch. He is watching this very closely and keeping us up to date. China has had the most people who have caught this virus and the largest number lost to this sickness.
We have superb medical facilities and doctors who are keeping an eye on this dreaded disease. They will not take any chances nor cut corners so we can eliminate this pandemic. Anyone who develops the coronavirus will get the best medical care in the world. We have the resources and they will be treated with the utmost care and respect. This is no time for anyone to worry about getting the help they need. They will most definitely get the best.
1
@KMW “We’re amazingly unprepared,” Dr. Irwin Redlener, a Columbia University professor and director of the National Center for Disaster Preparedness, told me.
But I guess you know better.There are relatively few confirmed cases in the US, but that may be because few have been tested. We know initial test kits were found to be faulty. Do we have enough test kits? Is the CDC limiting testing in order to please the president? If you don't test, then the numbers will be low, but the absence of proof is not proof of the absence of infection.
At a time like this, public trust in the government is crucial. Unfortunately, Trump has squandered his credibility. Already we see he is more concerned about how this affects him than he is about how it affects us.
13
Are you kidding? We’ve had two months to prepare & do not even have test kits to diagnose the virus. Patients are arriving at community hospitals & we are not prepared to diagnose them & insure our hospital professionals are safe.
13
But the superb resources are not accessible to all. So there is a greater chance that the virus will spread. Many Americans can’t afford to go to the doctor.
11
To those who are nihilistically cynical about government: what is the alternative to a government that is strong, well-organized, and able and willing to override narrow parochial interests for the greater good?
If a conservative is a liberal who has been mugged, will a liberal be a conservative who lost a family member to a pandemic, because the government, science, and knowledge have been undermined so long by Republicans?
11
Good article, but quit calling the Great Influenza the Spanish Flu. My recent scholarship on the epidemic generally traces the influenza’s origins to pig farms in the US.
5
@Anthony Davis
It is commonly known as the Spanish flu apparently because during the war none of the countries with epidemics wanted to give that type of intel to enemies and only neutral Spain reported it. Thus, many people the world over mistakenly associated it with Spain and the name stuck.
14
@Anthony Davis
To maintain morale, World War I censors minimized early reports of illness and mortality in Germany, the United Kingdom, France, and the United States.
However, in neutral Spain, newspapers were free to report the epidemic's effects (such as the grave illness of King Alfonso XIII).
These stories created a false impression of Spain as especially hard hit - even though the flu was a global one - thereby giving rise to the pandemic's nickname, the "Spanish flu".
Salud !
2
@Grainy Blue
Well, it's long since time to change the name to something more accurate.
I’m fascinated by the first story - of the nurse in 1918 who fell ill from the flu and died just hours later. I wonder what the likely mechanism of her death was? Nowadays at least, folks who die from viruses tend to succumb many days after infection and to complications thereof (such as bacterial superinfection and/or multi organ dysfunction), not to the acute viral illness. (And they tend to be in baseline fragile health, not a young worker reporting for her regular shift.) I’d love it if an infectious disease doc would weigh in and educate us!
4
I would imagine she succumbed to septic shock. I am a PA in Ob-Gyn, but I have seen my share of septic shock and it is astounding how quickly it can develop with resulting multi-system organ failure, particularly in an era before antibiotics.
6
@GBR
That was one of the signature traits of the disease...people often died within hours of becoming symptomatic. We know exactly how and why...they drowned in their own fluid; many turned blue as a result. Autopsies revealed this consistent finding...virtually everyone who died had lungs filled to capacity with fluid.
It's why this flu stands out in history. It was truly of a magnitude and order unlike anything seen before or since and it instilled absolute terror in the populace.
At one point, the coffins were piled three wide and ten deep all down the main street of Philadelphia, the epicenter of the second wave of the flu. The mayor had been warned that a virulent flu had come in on the troop ships and under no circumstances was he to hold a planned war-bond rally, but he decided to go ahead and thousands crowded into the city. The rest is history.
At one point, the gravediggers were so terrified that they simply threw down their shovels and fled. Children and infants starved to death when both parents died and people were too afraid to enter the home.
It really is impossible to exaggerate how monumental this event was. There are now superb histories and documentaries about it, but for decades it remained an un-discussed subject. Along with Katherine Anne Porter's "Pale Horse, Pale Rider," I would recommend William Maxwell's unbearably poignant novella, inspired by the death of his mother and the baby she was carrying, "They Came Like Swallows."
26
Nick, if you want all of those suggestions to be taken seriously, you have to find a way to convince Trump that his re-election depends on implementing them.
Frankly, I don't see a chance of that happening, and the administration already seems far more concerned about the stock market's decline than it is about the potential for a deadly pandemic. He seems to think that the disease will just disappear "like a miracle." Or something.
22
I became fascinated with the 1918 pandemic as a teen when I read Katherine Anne Porter's harrowing "Pale Horse, Pale Rider," her autobiographical account of her own experience with the flu.
Her boyfriend, a young soldier, carried her to the hospital when her fever went over 105, so hot that it literally burned the color from her lovely black hair. She was so sick that the nurse put a toe tag on her and left her on the hospital floor assuming she'd be dead within the hour, and there were no available beds. She awoke on the floor of the morgue.
Hers is one of innumerable stories of the strange quirks, twists, and tragedies of that horrific event. She recovered and returned home to find her lover dead on the floor; he had died hours after bringing her to the hospital. Friends said she never really recovered. At 28, she had snow white hair and a dead love but she channeled that loss into some of the most beautiful writing imaginable.
I went on to read everything I could about the pandemic but was intrigued that I never heard it mentioned in any history class. In fact, that's a central point in PBS's superb documentary, "The Great Flu Epidemic." It remains not just the definitive documentary on the epidemic but the best documentary on any subject I've ever seen. I've sat through it, riveted to every word, multiple times.
One of the main questions it asks is why an event so tragic remains so little talked about. It seems it was so epic it crushed the survivors into silence.
53
Whether Covid-19 becomes widespread in the US or not, it will test our delivery systems for everything from groceries to medicines. Companies have pared down delivery systems and in transit inventories to a bare minimum. That is good for efficiency and corporate profits. But even the threat of the virus can trigger a widespread rush to stockpile essentials, as has already happened with masks and bleach. There is little reserve capacity anywhere to replenish inventories after an unexpected surge in demand.
11
This overview makes an excellent point - many people do not have health insurance that will guarantee covering the cost of testing - and the cost could vary wildly. The Federal government needs to assure that people who are tested do not need to pay for the test. The secondary problem as pointed out is that many people do not have adequate sick leave. Even if they have some limited paid vacation, that is what they would use for sick leave and it would not be adequate. Low wage workers who have to stay home because schools close would likely lose their incomes, if not their jobs. The economic cascading effect of this is probably more significant than the risk of mortality to the average person. The markets seems to grasp this - however I do not think the Administration does.
14
The U.S. advantages over pandemic China, Italy, and Iran are the Centers for Disease Control and National Institute of Health, global leaders in research and practice in epidemiology and virology, our wealth, and high-tech medical system. Our disadvantages are: the large number of uninsured and underinsured who will first hesitate to get treatment, then flood county hospital emergency rooms; our leadership, Trump, who cares only about the stock market, has underfunded preparation for a pandemic, is anti-science and ignorant, lacks empathy, and is incompetent as an organizer; our obsession with profits which make it difficult to shut down workplaces, public gatherings, and transportation; our individual liberties that prohibit quarantining and shutting down an entire city as China did with Wuhan, that limited the spread of the virus and seems to have stabilized the pandemic there for now.
At this point the virulence of Covid-19 seems highly variable, from deaths and critical care pneumonia to asymptomatic carriers who walk among us like the Body Snatchers, and infectivity could be two people per sick person or many more. We’re supposed to wash our hands frequently and wait passively for a vaccine in around 18 months. Americans like to be in control, and we aren’t. We’re hostage to Trump and Mike Pence, who fought an HIV epidemic in Indiana with prayer. Maybe the virus will run out of steam and die out. Maybe.
8
Do not fall for our feelings of superiority. Our medical system is not better than China or Italy. I don’t know about Iran but I have experienced medical care in China & Europe. They are just as good as ours & have more doctors per capita than we do,
4
Death rate outside China is about .07 according to latest numbers, not 2%. Could it be the Big One? Sure, just like every hurricane could be the Big One. But at this point in the game, more people are likely to die from hyperventilation than the virus. No doubt the media will be the calm voice of reason, like always.
7
It's time that we stopped treating healthcare as a privilege deserved by those who can pay for it and recognized universal health coverage as a necessity in a world where epidemics are an increasing threat. There are a lot of reasons why it would be beneficial to society, but the threat of infectious disease is the strongest argument.
Universal means everyone. Every person who is deterred from seeking medical care by financial circumstance is at greater risk of spreading infection. Nature doesn't compromise. We need to stop debating whether we can afford it or whether this or that group deserve coverage, and focus on getting it done.
We are fortunate that while this virus is very communicable, it's fatality rate isn't that of SARS or MERS, or Ebola. In the latter case we'd be in Black Death territory or worse. And there is no reason why this could not happen! Viruses do mutate. Today's COVID-19 may not be the same as tomorrow's.
26
Healthcare privatization is a two edged sword. We have lots of choice here, maybe less wait-time, but we also have healthcare bean counters who are working overtime right now. I am actually an economist, but if ever there was an example of the short-comings of the private sector we will see it now. Here is a trial balloon...once sensible criteria are met, tests for the corona virus are free. Our under-funded public health sector is not up to it, and the private sector...well they won't do it.
11
It's easy to cut funds when there is no obvious need. It's much harder to restart things afterwards. Trump made the classic mistake of saving money because there was no big disease out there threatening us. Of course Trump is not the first head of state to make such errors. Others have cut funding to vital programs and watched as their citizens suffered for this penny wise but pound foolish approach later on.
What I do not understand is how this country keeps on failing to learn lessons from situations like the coronavirus, Ebola, HIV, the continued shootings, etc. Why do we need to continually rediscover the wheel? Why must we hurt ourselves by refusing to change for the better when it comes to real access to medical care, affordable and decent housing, and all the other things that make a country civilized?
2/29/2020 9:28pm first submit
35
@hen3ry
We need to paint the toenails of the rich.
Everything else can wait or die.
3
@hen3ry "It's easy to cut funds when there is no obvious need. It's much harder to restart things afterwards. Trump made the classic mistake of saving money because there was no big disease out there threatening us. "
This is an excellent example of how ignorant Trump and his sycophantic cronies are. In point of fact, all those funds and people were working daily on threats that most never hear about. I have worked at CDC. We worked DAILY on outbreaks of infectious disease from all over the world. The point is that NO ONE KNOWS WHICH WILL BE A BIG OUTBREAK. We need surveillance so we are not caught unprepared, but Trump, an pseudo "businessman" at best, is one of those who, when they cannot comprehend what someones job is, decided they are "doing nothing." in this case is is literally fatal mistake. Those scientists and epidemiologists are working DAILY to develop detection, research new viruses and other microorganisms (remember, plague (yersiia pestis) is a bacteria but has killed millions. Without those people on the front lines are are blind to what is happening. Trump deserves to be pounded daily on his failure to understand how the real world works.
Trumpers, are you all paying attention to what your Dear Leader is NOT doing?
3
Thanks very much for this thoughtful and well-researched article.
Something that I'd be interested to learn more about: For those of us who work in jobs that put us in regular close proximity to other people -- including people who may not be in the habit of covering their coughs and sneezes -- how can we best protect ourselves? Good hand hygiene is important, but perhaps not so effective against another person's decision to cough within the range of 2-3 feet.
If some practical suggestions can be given for how to deal with this situation, then perhaps that will help settle down the run on surgical masks. I suspect this may be a response to a lack of official guidance on how to protect oneself from cough/sneeze droplets when we don't have the luxury of remaining far away from others.
6
It looks like the authorities in Hubei came very close to losing control of the epidemic. It is essential that health officials keep implementing quarantine policies and there are many reports that they were simply overwhelmed by the number of patients. The decline in cases in Hubei is slower than other parts of China indicating that there are still many infected patients that are not identified. One point about death rates is that they are for patients who have modern medical treatment including access to an ICU. Without it several percent will die. The true death rate in Hubei is something we are likely never to be told.
6
“I hope it’s not that bad, but we should assume that it will be until we know otherwise,”
Good advice for a pandemic and also for adapting to climate change.
How we respond in the coming months to a virus will be good practice for preparing for the long term disruptions from climate change.
15
“He went to a hospital for testing. In the end, it turned out not to be coronavirus — but he was billed $3,270.”
How many masks can a hospital buy with $3,270? Why do they rely on disposable masks instead of decontaminating re-usable equipment if they are in a dangerous environment? How many hospitals have SCBA and decontamination showers? Yes, they are underprepared and now the bat virus has come home to roost. Imagine if fire departments asked people to not buy fire extinguishers because firefighters do not have enough fire trucks. Public trust is key and they have lost it. Especially when they have to go from containment to mitigation and require masks to be worn in public.
6
The CDC is contradicting Our Leader. That means Republicans MUST push for the abolition of the CDC. But think positive--it also means there will be fewer Republicans voting this fall.
3
The American people do not have universal health care because our Politicians depend on the deep pockets of the insurance companies, pharmaceutical companies, and private medical providers, to fund their campaigns. Our people don't have paid family leave because our Politicians depend on the deep pockets of American business to fund their campaigns. Every other first world country on the planet has these things, and we are being denied and held hostage by all these bastions of power. Somehow, the thought of a plague being visited upon this country, that would ultimately result in the pharaohs granting us universal health care, and paid family leave sounds vaguely familiar.
38
You can't generate costly public support to prepare for an event which, while sure to happen some time, might not occur in anyone's lifetime--such as a pandemic, or an earthquake. Furthermore, you can't produce a vaccine effective against a virus that does not yet exist, and other expensive medical preparations become quickly dated and useless, so let's quit complaining that preparations for 'the big one' have not been made. We deal with these emergencies (in the true sense of that word) as they break out. The Centers for Disease Control thinks we may be one year from a vaccine; that's pretty good, it could be a tough year, but it's not as if no vaccine is possible and will never become available. A little confidence and optimism at the present time might not be a bad idea.
1
Doesn’t it worry you that we are not adequately prepared for a pandemic? It will happen eventually
1
@Randeep Chauhan
While I totally agree we are in a very precarious state vis-a-vis new superbug antibiotics, they have no effect on any virus. They have been overprescribed for ages for conditions they can’t touch. One of the reasons we are in this awful predicament.
3
This virus is not the "big one". For a real big one, at this point we'd need a death toll in the hundreds of millions. There are about four times as many people on earth as there were during the Spanish influenza, so for a comparable death toll we'd need around 400 million dead. That's just not going to happen with covid-19, we won't get anything near that amount.
The world has about 640,000 deaths from the flu every year, and that's not seen as the big one (we're all used to it and it's every single year), so since covid-19 won't hit that mark, this definitely isn't it.
If enough people stop using the measles vaccine, that could get back up to about 2.5 million deaths a year, worldwide, but that wouldn't really be the big one either.
So, I know the press is hugely into spreading massive, insane panic over this minor virus, but please remember, a much more fatal virus is bound to come along sometime, and the world and humanity desperately needs that kind of thing. A million species are doomed to go extinct because of us, and the only possible prevention at this point is for humanity's numbers to be trimmed considerably. Nobody likes this, but it's true, and that's why I will be blase about covid-19 until I die of it, and thus I'll stop needing to worry about anything.
5
PS: before I'm corrected, I was going with the maximum Spanish Influenza death toll, which is estimated at about 100 million; the lowest estimate is 50 million. Also note that that flu did not kill nearly as much as the waves of bubonic plague centuries earlier, each of which definitely was the "big one" at the time.
And I know a lot of people are set on being incredibly stressed out about this virus, and will feel compelled to chastise me for being optimistic. Don't bother, as you won't change my mind, but if you want to be super anxious about this, I won't hold it against you. Also it won't make any difference either way.
2
@Dan Stackhouse
I'm with you on this one Dan.
1
Excellent. Bayes’s theorem: The probability of dying from the virus= Probability of getting the virus X Probability of dying once you get the virus.
You reduce the chance of getting the virus by preventing spreading of the virus.
You reduce the chance of dying once you get the virus by getting the best care you can.
One should never forget that although a virus may not be very lethal it can nevertheless cause significant morbidity, time off work, reduced economic activity and burdening society and the health care system. For example although there have been only a few thousand deaths in China, the whole country has shut down with significant losses. Same in Iran and Italy. Hard to Imagine both Milan and Venice almost empty . So a low death count is misleading . The morbidity associated with this virus has been significant and cannot be ignored.
6
That's not Bayes' theorem. It's just conditional probability.
5
Bill Gates knows nothing about this. Ignore him. He's just trying to feel important.
The mortality fraction from the new coronavirus is very much less than that of the 1918 flu. Figures of 2% are great overestimates because they ignore the large number of asymptomatic or mildly ill people who don't go to hospitals and aren't diagnosed or counted.
Our ability to treat and vaccinate will be much greater than it was in 1918: vaccines are being rapidly developed (no flu vaccine in 1918) and antiviral agents (none of them in 1918) are showing promise.
There is no reason to panic. The implications are similar to those of a seasonal flu. Spread is uncontrollable, but death rate is low.
6
With so much fear about the virus I thought I would share something just sent to me:
In a space of love, you become a vibrational catalyst and a force for positive change. If more people were praying for a solution to the recent viral epidemic, than fearing it, a vaccine would be found within weeks. Fear feeds a virus. Love starves it.
If more people were praying for the world's corrupt and wounded leaders, than hating them, they would transform in ways you cannot imagine and become a force of love. Fear feeds greed. Love starves it."
@Mary, I am retired as a Professor of Microbiology at a major NYC Medical School (I spent most of my research time in vaccine development against malaria parasites). I am completing supportive of you on the importance of love. But to the best of my ability, I am not aware of the importance of prayer or love in the development of new vaccines. It takes teams of dedicated researchers scrambling for financial support of their research and working night and day to develop vaccines and to see these vaccines tested through years of field trials to establish efficacy and safety.
36
@JerryV
I worked in the pharmaceutical industry for years so I realize the needs you mentioned and fully agree. But all our minds are connected and good vibes (which is prayer etc) can't hurt. It's proven too when prayed for one does better. What have we got to lose....this way we don't add any drama or chaos. Peace.
1
@JerryV
Thank you for what you say and what you do. I am amazed at the span of odd pronouncements and beliefs in response to articles about this crisis.
Some people are mystical and spiritual; others go to the opposite extreme and declare that reducing the populaiton through suffering and early death is actually a positive outcome.
I expect to read these strange statements on Breitbart, which I have been monitoring. But to see such sentiments on the NY Times message boards is a little disillusioning.
People on Breitbart, which is for me a staging ground for ignorance and paranoia, many are speculating that the virus is a Democratic hoax to bring down Trump. That is in line with my expectations.
But others posting seem relatively well-informed and have contradicted some of the Trumpian fools. Those people now have nowhere to go; they are starting to realize that they voted in a dunce, who is now failing when we need intelligent leadership desperately. I pity them. They are worried about their families just as we are.
4
No. It’s serious, but not even close.
3
@Paul Edwards
yet.
I called my son, a resident physician and asked about his hospital's preparation plans.
He said that they will not be able to get many needed items, because they are from China, and the supply lines are closed.
37
We are woefully underprepared for a synthetic smallpox attack. Smallpox has a contagion factor of 7, vs coronavirus of 2.5 and a mortality rate of 30 per vs coronavirus of 2 per. Synthesized smallpox is a here and now issue. The govt only has 1.7mm of the antiviral cure stockpiled. The vaccine does nothing for post exposure.
2
Heck if it's weaponized smallpox, we would have no chance of avoiding massive death tolls like never seen before in history. Here's hoping such a monster is never unleashed.
A thought: if these international viruses become a regular thing, there might not be a single "Big One." There may be several, each of which might by itself cause significant-but-not-catastrophic death and economic disruption; together they may add up to a "Big One" over time.
8
What happens in the U.S., when lower-income people aren't covered by insurance for all practical purposes? They'll hang out of getting tested for fear of being slapped with a bill about the size of who knows what . . . a month's income or more? Who's going to pay for protection from the pandemic? Society or the people who get infected?
7
The speed with which Covid 19 has spread suggests that there are significant numbers of infected people with a mild form (subclinical?) of the disease walking around spreading the virus. Because healthy people walking around sneezing on people are more likely to spread the virus than those who are sick in the hospital, it follows that often there is a selection process at work favoring a more mild form of the disease. We can hope therefore that if we can delay the spread of the virus in its early stages, in time it will evolve to a less virulent form.
2
On February 18, the BBC reported on the largest epidemiological study so far. See https://www.bbc.com/news/world-asia-china-51540981 for the BBC summary of the report. The report also include a link to the Chinese CDC report if you want to dive into the methodology of the study.
The most severely affected are older males with cardiovascular diseases, diabetes, and other chronic conditions. The bigger risk in the US is a lack of medical resources if Covid-19 strikes across the nation within a short time frame, rather than rolling across the nation slowly. Also, the US has a larger proportion of its population who are older people than China and the obesity rate here is higher. Obesity contributes to Type II diabetes, one of the factors identified in the epidemiological report for severe illness.
3
I think perhaps the greatest way in which "we’re amazingly unprepared" is just the ability of the average Joe to assess the risk and to understand what are reliable information sources (which is related to the general problem of many people not being able to discern what news sources are reputable and credible).
In Orange County, California, people went cuckoo about the possibility of the Fairview Developmental Center, a former state mental hospital that sits on a whopping 125-acre piece of largely open land in Costa Mesa, being used for isolating patients. In fact, I think it's hard to imagine the virus "escaping" from such a facility as long as the staff who go in and out follow proper protocols (which apparently they didn't do at some of the military bases to which some Wuhan evacuees were taken). This uproar makes me think people don't seem to have a basic understanding of transmission vectors. And of course a lot of people don't understand the genesis of the virus as well and latch onto conspiracy theories about weapons labs, etc. Other people are walking around doing their daily routines in a very uninformed or under-informed state, as if nothing is going on at all.
So I would say it's our general ignorance, willful or not, that makes us the most unprepared. In such circumstances, people under react, over react, or don't react at all.
28
I'm surprised Mr. Kristof didn't mention the Spanish flu virus persisted through the spring, summer and into 2019. That's why around 50 million died. If Covid-19 is resistant the warm weather, we could be facing a dystopian situation.
"May you live in interesting times."--common translation of ancient Chinese curse.
6
Mr. Kristof wisely emphasizes all the things we need to do better right now to confront the coronavirus. But it will the poor or the working poor who as usual who will suffer the most as they often lack medical benefits, sick time and have jobs that keep them out in the public confronting the disease daily.
But beyond this humans are slow moving creatures compared to viruses and bacteria that can change in a few of their generations and two weeks is equivalent to millenia in our understanding of time. To create a vaccine takes us six to 18 months a time period in which a virus can mutate in countless ways. We need an investment in resources that can counter this to prevent even worse viruses that will inevitably come along and constant awareness and vigilance.
7
What's most concerning is the paucity of research into developing newer antibiotics that are effective against coronavirus and other difficult to treat maladies. We are woefully unprepared for a "superbug" scenario; we know it, too.
3
There are absolutely NO antibiotics that are effective against any virus. They simply don’t work that way. Antibiotics are only effective against bacterial infections, and they are becoming less and less effective because of the ignorant assumption that they must be good for anything that make# you feel sick.
1
There is much about this outbreak that we, as physicians, just don't know. The good thing is that we are working diligently to try to find out what we don't know but we don't know where the end of this will be and what that end will look like. Fear of the unknown is a powerful thing. As a physician, I am reading daily but doing what I know is best for preventing the spread of influenza which is flu shot, good and proper hand-washing along with making sure that those who are coughing/sneezing cover their mouths and noses. Education and prudence are our best weapons now.
11
I know I am not the only one who is at least as concerned about our incompetence and compromised political leadership than I am about the actual coronavirus.
As a gay man, I lived through an epidemic already and I'm here to tell you, we're all going to really wish we had a government we could trust.
154
Another wonderful piece by Mr. Kristof. I am a high school U.S. History teacher and I have been teaching my students about the 1918 influenza for the last sixteen years. Obviously, this year, more than others, my students were especially interested. One alarming similarity that you didn't mention was that many politicians, not knowing what to do, resorted to denials and half-truths to try to calm the public. It didn't work in 1918, either.
161
I would love to see a random sampling of 1000 people who have had mild colds or "regular" pneumonia this winter season, and see how many of them actually have coronavirus antibodies. I know three elderly people who had flulike respiratory diseases with extreme fatigue. All recovered, thank goodness/knock wood, but I wonder if they had it--it easily would have been transmissible from Wuhan within the time frame.
9
i live in a tiny town, 5500 people, but it's right in the boston-providence-worcester triangle. just read on facebook page for the town that there are students from our town, and a few others, who have been in italy. guess i'm not as far out in the boondocks as it feels sometimes.
1
There is flu vaccine fbut it isn't that effective, particularly in older people. Nobody should think that a vaccine will save us if it is anything like the flu vaccine. People should get flu shots but expectations for protection should be low, especially after age 60, The flu vaccine is better than nothing for the most vulnerable age group but unless a vaccine for this coronavrius is far more effective a vaccine will not be the answer.
2
@Bob There's a flu vaccine available for those 65 years of age and older. Since the VA reimburses for the shot, at Walgreen's, I went to get it, and found the VA only pays for the regular vaccine, not the one designed for codgers.
1
@Jeff, The vaccine for codgers (and I am a proud codger) has 4X the amount of antigen (the active immunizing component). It somewhat boosts the antibody response (and presumably the protection) in older people but comes nowhere near the booster effect of a booster injection of vaccine (even the wimpy vaccine) in the neighborhood of 2-3 months after the primary shot. Is it possible for you to get vaccinated with your Medicare Benefits?
1
I worked in virology research as my first job.
The Marburg Virus was within the memory of senior researchers.
For virology research today, we use cell cultures which are grown in tanks and come frozen by parcel service. But before that, virology researchers imported African green monkeys and kept them in the labs to get the cells. We still has the old monkey facilities in the building.
In Marburg, Germany, virology researchers became ill from the monkeys. The mortality rate, with the best medical care and rapid isolation, was greater than 20%.
In less developed countries, the mortality rate of Marburg was greater than 80%.
Those monkeys had transited a London air terminal before arriving in Germany.
Humans are part of a vast ever-mutating microbiological system, not separate from it.
What I learned from that work, and carry to this day, is the realization, and acceptance, that at any time, a contagious microorganism could emerge and severely decimate our species.
74
@robwpdx
Fascinating. Of course atomic and hydrogen bombs also do a pretty good job of lowering human numbers.. Some say the world will end in fire, some say in ice... and there's always the hope for a meteor!! or a invasion of aliens. I am most concerned about over population and famine... but people seem to be poor at self-regulating... so Mother Nature sometimes does it for us. Much better than war IMO>
2
The most alarming news in my view is that Dr. Anthony Fauci will not be allowed to make public statements without permission from the White House. The CDC was overruled about the return of Americans and those who cared for them on return lacked training, experience and protective gear. These decisions were not informed by infectious disease experts, but rather by laymen. Why is the government ignoring the opinions of those who understand infectious disease? Why is the government controlling the opinions of the experts? Passivity and ignorance are our enemies in this battle. The virus does not care about politics or markets.
252
@minnie
Generally beaureacrats override medical professionals at every turn-and they get annoyed if you don't do what they say
and they can fire you
so.......
The damage wrought by the 1918 epidemic was a combination of factors including large caches of men in the close quarters of army life, an organism which cause the body to over react (in the healthiest and under react in the young/old typically targets of flu), poor understanding of the organism, poor judgement of people told to isolate the sick, ... the list goes on and on. The pandemic probably helped shorten WWI. We know more now than then. We just need to know how to use The Know How.
3
One wonders what the situation will be come Election Day. What was once thought to be an election of great turnout, may turn out to be quite the contrary. People may be too fearful to venture out and queue up with other folks who may be coughing and sneezing.
If this virus is big (not necessarily the “big one”) it will have a devastating effect on just about every facet of life.
3
Demagogues look for reasons to postpone or cancel elections. Usually national security is the excuse. A pandemic may be just what they need.
8
@Phil, You may be right but I hope you are wrong. Federal Elections are run by the States and not by the Federal Government, so I hope that this might block intervention buy the White House.
2
@Phil
Then it will be the vote by mail states who vote. ;)
1
Health homecare attendants in NYC generally do not get paid sick leave, nor paid vacations. They take care of the elderly and disabled. They come to work sick, at times, to care for fragile people.
I had that experience, several times, with my mom. I would send them home with cash, because sometimes they didn’t even have enough of a monetary cushion to buy groceries if they weren’t paid for the day, or days of illness. I would also call a car service and pay for it, so that they wouldn’t get on public transportation with fevers of 102f, coughing and sneezing.
I have paid health workers’ rent three times, in order to keep them home and away from my mother. The agencies they work for, and I have dealt with a few of the very best ones in the city, have no mercy, if they call in sick, they don’t get paid. And, many of these ladies (most are female) live paycheck to paycheck.
They WILL go to work to take care of your elderly parents, even sick as can be.
So, if your parents or loved ones rely on health home aides, and you want your parents to live, be prepared to pay them out of pocket to stay away.
185
@Lily
My elderly parents had similar experiences. Sick home health care aides arriving and several times infecting my parents before we could intervene.
My mother got quite ill once.
Perhaps the arrival in the future of home health aid robots guided by Artificial Intelligence in lieu of actual humans may not be such a bad thing after all.
Some of the experimental Japanese home robots seem even to be programmed to express empathy and caring.
I've been a bit doubtful so far, but with all the foibles of us humans -- disease, fatigue, errors -- maybe more robots in our future, including health care support, might be a true positive?
6
@Lily
Who are these agencies? They’re breaking the law since NYC mandates paid sick leave unless a company has less than five employees.
2
Oops! I misspoke!! The case fatality or mortality rate for the Spanish flu for which the data are not totally reliable is thought to be 2-3 percent. The coronavirus is more likely only 1 percent based on Chinese data and the fact that many mild cases are neither tested nor reported. The major difference, however, is in the age group most affected. The Spanish flu (and here's my error) killed a very high percentage of young people while the coronavirus affects the elderly. So, it's not the overall number that's important, but which age group is most at risk.
2
Is this Coronavirus "the Big One? It is possible, we have to be prepared
A recent article in the medical journal JAMA explains that there are two critical factors that determine the effect of an epidemic: transmissibility and severity. One or the other, but not both, characterized previous outbreaks. “Neither the 2009 pandemic influenza A (H1N1) virus pandemic or the severe acute respiratory syndrome coronavirus (SARS-CoV) or the Middle East respiratory syndrome coronavirus (MERS-CoV) epidemics had the combination of both high transmissibility and severity,” the authors wrote.
Scientists have studied seasonal flu for decades. So, despite the danger of it, we know a lot about flu viruses and what to expect each season. In contrast, very little is known about COVID-19 because it's so new. This means COVID-19 is something of a wild card in terms of how far it will spread and how many deaths it will cause.
2
Minimum wage workers who risk losing their jobs if they take time off for illness may well be one of the major vectors for the spread of this virus. And since the initial symptoms are very similar to a common cold, most of those workers won't think twice about going to work, but they would think twice about being checked at a clinic or hospital if the bill could be in the thousands of dollars.
Getting tested for the virus should be free, and all businesses should be required to send sick employees home with full pay.
39
@Carole Grace
It's not just minimum wage workers, it's the working-fool culture of America. If you don't show up, even half-dead, you're branded a slacker. Everyone is willing to take a bullet for the corporation, who couldn't care less whether they live or die.
Paper ballots in November means we could vote from home, we will have paper trails, and we can mitigate problems related to Senate Republicans not adequately funding election security measures.
Above all, we need to keep in mind that we are only as protected as the least well-insured and most vulnerable members of our society. And that should not inspire a great deal of confidence right now.
50
The article says:
"But because of the risk of coronavirus he did the responsible thing and sought medical attention: He went to a hospital for testing. "
But is that the responsible thing to do? He was not in an emergency situation and if he were infected, going to the hospital increases the chance of spreading it on the way. Seems like it would be better to self-quarantine and let the local health department know. If they want to test, let them suit-up and come out and get a sample.
At some point we are going to cross a threshold in which we can no longer play whack-a-mole on individual cases and will have to treat it more like other endemic flu-like diseases - fluids, rest, aspirin, and if you have serious symptoms come to the ER, but otherwise stay home.
2
I wish we could read these articles in the NY Times from public health experts rather than by opinion columnists who know little about the topic. It's not legitimate to imply that he have done nothing nor progressed from the 1918 flu. First of all we know a lot more about viruses and corona viruses in particular - corona viruses in general are common causes of respiratory disease, even if typically less severe. Second, our scientific tools and approach are enormously better and more sophisticated. It was possible to clone and sequence the genome of this virus in days - weeks time and develop a sensitive molecular diagnostic test. In a matter of months we the atomic structure of this corona viruses spike protein in complex with its cellular receptor have been solved, which will aid in rapid development of vaccines and targeted drugs. I also wonder how severe the 1918 flu would have been if we had the tools and knowledge we have now. We now have rapid development of an annual flu vaccine, molecule diagnostics to track the spread of the virus, and much better clinical support systems to help people survive and infection.
11
@Larry Figdill
we know next to nothing about the current novel coronavirus—AKA Covid-19
2
This essay might be a bit over the top. Compared to 1918, given current antibiotics for secondary infection (and other types of drugs to support the critically ill), better overall hospital and outpatient care support facilities compared to 1918. We might fare a good bet better today (esp. in developed countries) where the state of health care was a good bit more primitive.
There are, for now, no vaccines similar to what we see with influenza, that might also lessen mortality. Still, there is a reasonable bet they are coming and will hopefully be available within a year.
We've heard doomsday predictions before but I prefer to be more optimistic (disclaimer: I am in the high risk older male group). I can also understand that these sorts of views might not sell newspapers...or could be wrong. I would never argue against calls for a more robust public health care system, epidemic or not.
5
@JSK From what I've read, developing a vaccine for the new corona virus will take a minimum of a year, and up to a year and a half, so it's of no use to us in the current outbreak. I'd never argue against a robust public health system either, but far better to have prepared in advance, than to have cut back and eliminated programs, and have to put programs and offices in place in the face of a pandemic.
4
@Jeff
As I said, unless we are lucky it would take at least a year. I would not accept your argument that it would be of no use, given that there could be more than a single wave and this could take longer than we think now. There is still much to learn. For instance the analogy to WWI is also flawed because so many people in Europe and elsewhere were malnourished.
As for the political damage being hailed down on our health care system, including public health, we would probably agree.
@JSK it’s almost certain that if Spanish flu happened today we’d respond much better, prevent more cases, and save more who are ill. Let’s say ten times better? Then 5 M would die worldwide. Kristof is simply saying it makes sense to prepare for the worst before we hope for the best ..... something, incidentally, my grandmother said too ....
I’m a history teacher and the stats I’ve read for the 1918 pandemic were 500 million infected and 50 million dead. That’s a 10% mortality rate. I just double checked it the other day after reading another article that claimed Covid19 had a similar mortality rate. 2% is a lot less than 10%. We should all take this seriously but not inflate the problem.
5
NO! It's not "'the BIG One.'" The fatality rate for the 1918 Spanish flu was close to 50 percent. Right now it appears that it's only 1-2 percent for the coronavirus based on Chinese data. And with so many mild unreported cases, it may even be lower. The problem is that the Trump administration is muzzling the experts and engaged in blame, spin, misinformation, and inappropriate actions. If the experts would speak instead of Trump and his loyalists we might all be better off with less panic resulting for fact-based answers to questions like the one posed here.
5
@Paul Wortman The reported fatality rate I've read for the Spanish Flu was 2%, not 50%, and this mornings numbers (CNN) were 85,055 cases, 2,922 deaths, which is over 3%, but these are preliminary numbers. Still, they are serious enough to make comparisons to the Spanish Flu.
2
@Paul Wortman
I remain skeptical that any comments seen on these boards have been particularly accurate. There are many circumstances to take into account, not the least of which was the degree of the population that was malnourished; https://en.wikipedia.org/wiki/Spanish_flu . I understand Wikipedia is hardly a definitive source, but it is a starting point.
"We should also ensure paid sick leave. Do we really want to go to a restaurant where a coughing, sneezing food preparer still goes to work out of financial need?"
We should ensure paid sick leave, not because it keeps sick food preparers from coughing on your food, Nicholas, but because it's the right thing to do.
46
@william Pretty sure Kristof has always agreed that it's the right thing to do, but this public health issue is an additional argument that might be more convincing to some folks.
8
@william
I am sure that Mr. Kristof would agree that everyone deserves healthcare and paid sick leave. I have learned in speaking to my Republican friends, that if one presents the argument from their own self interest, for example, they don't want sick workers coughing on the food they are served, they are more likely to see the point that a health population benefits THEM, too!
6
Let's hope that China is held accountable by the U.S. and other nations for attempting to cover up this outbtreak. The time has come for nations through collective security to ensure that what China did in this case never happens again. It's clear that more could have been done by the U.S. and other nations if China had put aside it's totalitarian wall and permitted the world to see what was happening. The time period immediately following the outbreak was critical for the U.S. and other nations to know what was happening. The U.S. and other nations must learn from this pandemic and work together to ensure that it doesn't happen again. It starts with addressing China's negligence and punishing the Chinese government so that any future autocratic governments think twice about preventing other nations from understanding what's happening should an outbreak occur.
2
Please write about the budget cuts to the CDC and other agencies that are now on the front line! People really need to know what Trump has done to harm us all when something like this virus or any other major health threat occurs.
Just this week I saw the numbers, one as high as a 53 percent cut! Sadly I can't remember which news story or column the numbers were in, but they were a shock and should be right out there for us all to see. It is not like the Ebola preparation. The agencies don't have the right personnel or funding to do their work this time. Scary!
26
With today's report of a death in King County, Seattle's big box stores are crowded with shoppers stocking up on essentials.
Just returned from Costco, where the lines are 20-30 minutes long and the aisles are jammed. Our checker reported that today's was the largest single day sales event in Costco history - at least for our north end store.
Only a handful of customers wore masks, but all were stocking up for possible food shortages in case of quarantine. The shelves that were first emptied: frozen vegetables, canned fruit and vegetables, and, interestingly, all ramen products.
34
Your suggestions on paid sick leave and temporary government reimbursement for out of pocket health expenses are excellent and should have already been in a pandemic contingency plan. Obviously these would cost $billions but many lives could be saved. So, what is Trump doing besides holding press conferences?
24
Wouldn't it be interesting if the Chinese don't end up having the best results controlling the virus because their authoritarian iron hand can more successfully enforce quarantines than can other less authoritarian countries. This despite their ham-handed handling of the initial cases of the virus. It will be interesting to watch.
One thing I find interesting is the contrast between what I see happening in Yokohama and what I see on the news in other cities in and out of Japan.
The entire island of Hokkaido is under a state of emergency, citizens asked to self-quarantine (stay home unless really necessary) for the next three weeks. I see images of empty Italian plazas.
Yet in Yokohama, arguably a "hot-zone" of Japan, life seems to be going on rather normally. Yes, a little panic shopping has begun (thus far limited to face masks, hand sanitizer, tissues and toilet paper) but streets are busy, people are going out to eat - a friend went to a pub last night to see live music, said it was packed. In short, Yokohamans seem to be doing their best to keep calm and carry on.
I'm not sure if people in other cities are overreacting, if Yokohamans are under-reacting, or some of both.
But I take comfort living in Japan. Yesterday Prime Minister Abe announced that all corona testing will be covered by Japan's national health insurance. It's nice to live in a country with universal coverage and leaders who believe in science and the opinions/advice of medical experts.
277
I checked online ticket sales for a few different movies in a few local theaters (Sunday afternoon/evening), I see many are >50% full, some of them approaching sold-out.
So while the government recommends avoiding crowded places, and spring-training baseball games and the spring sumo tournament will be held without fans in attendance, Yokohamans seem determined to keep calm and carry on, if movie theater attendance is any indication.
6
@Bill in Yokohama
and yet Japan's handling of the cruise ship was a catastrophic failure.
Scientist decries ‘completely chaotic’ conditions on cruise ship Japan quarantined after viral outbreak
https://www.sciencemag.org/news/2020/02/scientist-decries-completely-chaotic-conditions-cruise-ship-japan-quarantined-after
1
Just think of all of the restaurant workers handling dirty dishes for the minimum wage, no sick leave and working while sick to put food on the next patron's plate. Makes a compelling argument for higher wages and paid leave so they can ride this out if they fall ill.
Think of the tax cuts that forced budget cuts to systems that would fight this more confidently.
Think of all the money diverted to the military and the wall which could have been spent on healthcare and education.
Our foundation has eroded and our heavy debt will cause us topple over. The top 1% and all.
95
Think of all of the people without paid sick days who have to choose between coming to work sick or a days pay.
7
"Health care workers lose confidence and things fall apart."
This is something that cannot not be over emphasized. I work in a major medical center. All our nurses and doctors, as well as all support staff are busy EVERY day. We can't afford, as a community or country to allow them to become infected or even exposed, because we can't afford even a minor reduction in the size of our work force. We don't have a reserve force to be activated in the case of an emergency like this. The scary fact is, as of right now our hospital doesn't have an adequate supply of personal protective equipment and that is true of every hospital in the world. Not do we have a means to get any. No-one does. It's one of the risks of living in an on time delivery world.
We are entering uncharted territory.
239
@Steve, RN What about military doctors coming in to help in major medical centers?
2
I have been worried about another 1918 style epidemic, but I also wonder if our personal hygiene has improved since then, and if that might help contain the spread of the virus?
5
Pence being appointed as the one in charge isn't very reassuring.
46
Only a few hundred people have been tested for the virus in the US. Thus we have no idea how many people in the US have been infected. I’ve heard informed speculation that the number of infected people in USA may be 1 to 2 million. Only a very small percentage are likely to get sick, let alone die. But suppose it becomes clear over the next week or two that there are tens or hundreds of thousands of infected people in USA. The ensuing panic could lead to a virtual lockdown of the country. Hope not. But very possible.
7
I should add that today the FDA approved widespread testing for the first time. Starting Monday hundreds of hospitals will, for the first time, be testing for the virus. It is possible that by this time next week it will be clear that tens or hundreds of thousands of Americans are infected. Then what? Lockdown?
6
Wonderful overview article. But I have personally never seen/read that 50 million figure from the 1918 pandemic, closer to 18 million. Still a lot (more than died in the World War), but still - nearly 2/3 less.
21
@Tony Deitrich Thanks for reading the column, but the standard estimate in the literature for mortality from the 1918 Spanish flu is indeed 50 million and up. Some estimates are 100 million. Note that this is the worldwide figure, and there is great uncertainty about the deaths in South Asia in particular. There's also uncertainty about the lethality; most estimates are about 2 percent, but some are 6 percent.
443
@Nicholas Kristof
and estimates on mortality are based on incomplete and/or questionable numbers.
10
@Tony Deitrich The 50 million estimate is readily available online, eg,
https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html
36
Viral infections frequently lead to secondary bacterial infections; and often it is the bacteria, not the viruses, that kill people. I don't know the extent to which this was true during the 1918 influenza pandemic; and I don't know how true it is in the present (COVID-19) case. Perhaps someone who does know can educate us.
If secondary bacterial infections are common and dangerous complications of COVID-19, antibiotics will form a critical (even though imperfect) line of defense that did not exist in 1918.
75
@Michael Yes, that's correct. Part of the treatment protocol will be antibiotics to prevent bacterial pneumonia. In addition, we clearly have much better monitoring, plus excellent mechanical ventilators and so on. And of course the 1918 virus was an avian flu, not a coronavirus, and for reasons we don't understand it killed a lot of young adults back then, while the present virus seems to be lethal principally to the elderly.
187
@Michael I asked my doctor about obtaining the pneumonia vaccine and was told that it is not recommended for people younger than 65 who lack other risk factors (a history of asthma, for example). So without meeting the recommendation criteria, the vaccine might not be covered by my health insurance. (Without insurance, it costs $125.) The doctor's office didn't think I would need it, since the vaccine prevents bacterial pneumonia, but not viral pneumonia. But if secondary bacterial infections are a risk, insurance companies should be encouraged to cover ALL available vaccines. We ALL are at risk, now.
44
@Michael It is now widely believed that the cause of rapid death in the 1918 flu was due to a cytokine “storm” where the immune system over reacted and the persons lungs filled with fluids. This is one reason that flu tended to hit younger vigorous people harder, their immune systems were stronger and so the over reaction often proved fatal.
93
Could a corona pandemic severely affecting the USA become the trigger that brings about universal health care there? Is that what it will take for the USA to join the rest of the world (or much of it) on this issue? (Issue which is not one elsewhere.)
38
For the record, lethality of the 1918 flu was substantially larger than 2%. Using the numbers from this article (50-100 million fatalities) and the 1918 world population of about 1.8 billion, we see that it killed between 2.8% and 5.6% of the ENTIRE world population. However, it is estimated that between a fifth and a third of humans contracted the 1918 flu; if correct, this leads to the mortality rate of at least 8.4% and more likely about 15%.
5
Regarding the Spanish flu, I read somewhere that some forensic scientists now believe many died from aspirin overdose. Don't remember much more than that little tidbit...
In 1918 my father was a freshman at Villanova University. He received a phone call from his father who told him to return home immediately to his West Philadelphia home. His father (my grandfather) was a funeral director. The amount of bodies to be buried at that time was so great that every able person must have been tapped for the grim task of disposal. Let's hope coronavirus does not duplicate the 1918 pandemic.
73
@T Brogan The world now has nearly 5 times as many people in it. Proportionally, we'll be lucky if that does not happen.
2
@T Brogan My grandmother and grandfather lived through the Spanish flu. So many died in their mining town that the dead had to be stored in the schoolhouse awaiting burial. School had been cancelled but there were a multitude of ghost stories that came afterwards. Scarcity of food and everything boiled is what I remember most from my grandmother’s recollections.
10
@T Brogan My mother's family is from Philadelphia. She remembers hearing about the 1918 influenza: "Grandmomma said in 1918 they were carrying them out at the rate of a thousand a week." It was actually worse than that, though. At the height of the Philadelphia epidemic, they were "carrying them out" at the rate of a thousand a day. But nobody wanted to talk about it afterward.
7
Nicholas Kristof's column may be the best of the opinion pieces I've read in the past couple of days related to the coronavirus, relying less on references to political theater and the stock market. He provides education about pandemics and warnings about our unpreparedness and need for wise scientifically informed leadership. Also addressed are some immediate solutions so people who are at risk to spread infection are not deterred from receiving medical attention.
358
@Jeffrey Freedman Thanks. In looking over it again, one thing I should have said about eight times: Worry less and wash your hands more!
347
@Nicholas Kristof Dear Mr. Kristof—I am a huge admirer of your work, and thus I hesitate to presume to make a suggestion to you. But since this topic is of such concern to all of us, I wonder if you would consider adding something about the importance of hand-washing to this excellent column. I realize you cannot do that for the print version, but wouldn't it be possible to add it to the online version as an update? Again, my profuse apologies for what could be construed as a criticism when I am such a devoted reader and admirer of your work. Thank you a thousand times for all that you do.
22
@Nicholas Kristof, Valid point. I don't believe we know much about how this corona virus is transmitted. Is it like flu viruses that tend not to remain viable on surfaces or hands for long periods of time, so that most transmission is through the air by coughs or sneezes? Or is it like common cold viruses that may remain viable for up to an hour on surfaces or hands, so that most transmission is through touching surfaces previously touched by people who have shed viruses. It may well be both, so that people should wash their hands thoroughly and avoid touching their eyes or mouth, as well as wearing face masks in the presence of sneezing or coughing people or within crowded public transportation.
8
We don't yet know if this coronavirus is the "big one", but we do know how ill-prepared our "administration" is for handling it.
After Trump spoke this afternoon, it is clear that we are now all on our own. Each family, each individual. Under this "president" our federal government will do nothing but worsen the problem. Expect our "president" to continue to lie to us about this illness. Expect our "president" to continue saying it is all a hoax, even though several community acquired cases have already been documented in this country. Expect our "president" to have his toadies oversee the containment efforts - all the while ignoring the advice of skilled scientists. Mike Pence as "Virus Czar"? Positively Kafkaesque.
And expect that all of the "president's" supporters to also believe it is a hoax. This means that some 45% of our citizens will not be taking even the most basic of sensible precautions. Trump has, with his reckless talk, essentially primed tens of millions of his adoring fans as nothing more than disease vectors. If this disease spreads rapidly, they'll be to thank for failing to take the crisis seriously.
So expect that the truth will not be reported. Expect that medical resources will not be available when they are needed. Expect hospitals to be overrun by the many tens of thousands of folks (or more) without health care coverage, or who cannot afford their deductibles. In short, expect to see this virus play out as it would in any Third World country.
655
@JS
The not so ironic fact is that the members of the cult of Trump, many of whom will likely believe that the coronavirus is a "hoax", will also likely suffer the most from their lack of belief in science and their lack of preparation.
It has been taking all of my equanimity to damp down my feeling that they will richly deserve it--but even they do not deserve that, and we, their neighbors who will be endangered, don't either. We can only hope that the unavoidable reality will trump (pun intended) the cult identity for most of them, and they will take precautions and seek treatment.
58
@JS I agree, and there's a parallel with the 2009-10 swine flu. At the start of the flu outbreak, Republicans and Democrats said in polls that they were equally concerned, which makes sense. Why should concern about the flu depend on politics? But then Rush Limbaugh and Glenn Beck said that it was a hoax and recommended against vaccination. So Democrats were 50 percent more likely to get vaccinated, and the far-right demagogues like Limbaugh probably resulted in the unnecessary deaths of some Republicans.
411
@JS Seems one big lesson politicians should learn (but seldom do) is the importance of truthfulness to maintain credibility. Reading John Barry's story of the breakdown of society in 1918's environment of government mistrust is chilling. So is his account of government officials in a recent pandemic 'war game' about an epidemic, in which, despite hearing Barry's lecture on 1918, officials were still inclined to 'manage' the truth rather than telling it. Barry ends with the disconcerting, 'And that was only a game.'
Then one notices, Barry's article isn't even a response to current events: the article is from 2017.
And that was only a history lesson.
29
Thank you for this insightful article.
I wholeheartedly concur with this statement: "We may also have to think about reducing occasions when people are crowded together; that may mean more people working from home to avoid offices, buses and subways. It may mean avoiding sports events, school assemblies, parties and even unnecessary visits to crowded doctor’s offices..."
In concur with this statement because in September, 1918 Philadelphia decided to continue with a parade, despite the world-wide toll of deaths that had already occurred AND the call of medical care providers to cancel that parade here in my home city. The result was thousands more unnecessary deaths.
I have no doubt, but no way to confirm, that my maternal grandmother attended that parade; she died in October of 1918 from the flu. My mother, who was but 1 year and 8 months old, also contracted the flu; she obviously survived as I wouldn't be writing this comment. My maternal granddad, a recent emigre from Italy, was left a widower with two young children to raise!
What is needed now is political will at the local and state levels to deal with a potential looming crisis, as we cannot expect anything good to come out of the White House (sadly).
All of our elected representatives need to pressure the CDC to make testing kits for the Covid-19 virus widely available in all cities and towns FOR FREE. Ramping up production of these kits must be a national priority.
77
@Retired Faculty Member The specter of that epidemic runs through so many families. My maternal grandmother, too, died of pneumonia in 1919. She left behind six young children and her husband, a Polish immigrant in Derby Connecticut. It was a struggle in a working class household. Not long after, my grandmother at age 14 left for NYC to make her own way. I have thought often through the years of the rupture in that family. Last night I looked newly at the photograph of my great grandparents.
33
Neither I nor anyone else knows to what extent the coronavirus will impact the world. However, as a physician, I would suggest that we be a bit hesitant about yet making any comparisons to the 1918 epidemic.
Medicine in the United States in 1918 is nothing like it was a century ago. Let us recall that, among other things, back then we had no modern antibiotics, an important consideration considering many of the deaths back then were believed to have been caused by secondary pneumonia that might be treated today and tuberculosis was widespread and essentially untreatable, an important consideration for an illness like coronavirus that also affects the respiratory system.
Perhaps the one good thing that might come out of this is that people might be convinced that a national health insurance plan covering everyone in the country actually makes sense and isn't some wild eyed communist scheme as has been so frequently depicted. Curious how the people receiving the bills that Mr. Kristof describes aren't singing the praises of their private insurance plans despite us hearing how much everyone loves them.
663
@Steve - echoing your thoughts, the NHS is offering home and community coronvirus testing, including a drive through service in west London, to anyone who may be at risk. No-one is too poor to access the test (and treatment if necessary), which is to everyone's advantage.
68
@Steve Good points that we shouldn't rush to compare the state of medicine today with 1918...
However, antibiotics don't work on viruses like the Coronavirus or viral pneumonia, so we still may be up against something we are not well prepared to fight.
25
@Steve
Medicine has changed since 1918-- but so has the ease of travel, particularly in crowded conditions like airplanes and only somewhat less crowded cruise ships.
Did the number of soldiers being shipped to the European front equate at all with current travel rates? I don't know-- but we have already seen this disease spread by modern forms of travel. This is one of the things about this crisis I fear the worst.
27
The similarities between the new coronavirus (SARS-CoV-2) and the Spanish flu virus strain of 1918 are striking. Because of antigenic shift, which occurs with regularity in influenza, the world had not seen such a strain before. As a result, there was no immunity to the virus. Millions of people died.
The coronaviruses, like influenza, have animal reservoirs. For coronaviruses, it is bats; for influenza, pigs and birds. The jump from these animals to human beings frequently goes nowhere because the virus does not transmit easily from human to human. But sometimes, as in pandemic flu or the current coronavirus, there is easy transmission from person to person, likely related to binding of virus particles to specific receptors in the human respiratory tract.
Scientists and doctors have been sounding the alarm about pandemic influenza and SARS-like viruses for years. Yet, funding for public health has dwindled over the years as our politicians seem more interested in tax cuts than investing in public health infrastructure. Our country and the world is grossly unprepared for this situation, and the world (and stock market) have responded with panic.
In order to address the inevitable spread of Covid-19 (and prevent the next pandemic flu, our government (and the world) will need to make a financial commitment to public health and medical research. It will not be easy, but it will be impossible without financial support.
136
@Paul Cook
"public health has dwindled over the years as our politicians seem more interested in tax cuts than investing in public health infrastructure."
to be accurate, you are describing Republican politicians, including Trump who cut $700 million from preparedness programs (established under Democrats) even _after_ the first cases of coronavirus where reported to be spreading in China
65
I think the incompetence of Trump filters down and makes more bad decisions possible like the workers in California that were exposed to the virus and then sent home. or the reluctance of the CDC to even test people that had the disease. The USA being number 35 in the list of the healthiest nations in the world also does not help.
All this does not bode well for the future.
In the end we may be facing a perfect storm of bad events.
It may be that in the end the coronavirus leads to real health care.
122
Just curious, is the CDC reluctance for testing because they don't know the sensitivity and specificity of the test among a population where the disease is still relatively rare and don't want to cause a false panic? Or might the CDC lack the funding/resources to mass produce, and train persons to conduct the test in non-CDC laboratories (because it would be too many tests for the CDC to conduct)?
8
@person trump cut cdc funding by a lot!
@person trump cut cdc funding by a lot!
Thank you Nick Kristof. Although at this time of crisis we’re sadly lacking in the leadership we need from the White House, I’m seeing plenty of good leadership showing up at the state and local level. And from our health organizations and universities.
And the consensus seems pretty clear about what we as ordinary citizens need to be doing at this moment to prepare. So let’s stay calm, stay informed, take the sensible steps needed to protect ourselves and our families in the event of a period where normal travel and commerce are disrupted, and isolation from public contact may be necessary.
I’m encouraged to see the leadership we need at this time coming from the likes of public figures like Nick Kristof and Bill Gates, dedicated leaders in the science and medical communities, and ordinary people everywhere.
67
Mr. Kristoff has addressed a scary event with calm and compassion. His recommendations for action are outstanding, and we can feel safer as we follow them. Thank you, Mr. Kristoff.
212
@TDHawkes Thank you. And, calmly, wash your hands regularly! :)
99
"We must ensure that no one is deterred from seeking help by the costs. The White House and Congress should immediately establish a system to ensure that patients need not pay for coronavirus testing and treatment."
Thanks, Nicholas Kristof--this is the best suggestion I've read yet about how to reduce the risks of massive COVID-19 spread in the US.
Our healthcare system is notoriously fragmented and unequal. Which is why, we should level the "paying" field, because the virus itself has leveled the playing field--nobody is immune.
Without the extension of free care for what could be "the big one,", survival rates will mirror America's massive wealth inequality--the poor dying en masse while the wealthy the best treatment their money can buy
449
@ChristineMcM
We might also recognize that even illegal immigrants can become infected with and spread coronavirus, perhaps it is time we stop saying no health plan should cover them much less having policies frightening them away from any contact with civil authorities.
120
@ChristineMcM - Government underwritten coronavirus care is a wonderful and valuable strategy to mitigate the disease but I think most of us know that is a fantastical dream as long as Trump is president and Pence is the US czar of Covid-19. So much of the bad things that have happened under Trump, we know nothing about and won't for many years.
46
@ChristineMcM
Remember the COVID-19 virus most adversely affect those of us over 75 with the highest death rate. Of the many billionaires how many fall into that category?
1
Complacency is easy. There is a temptation to trust that in this day and age, we are safe from the killers of the past. But such security is illusory. The marvels of modern medicine have their limits. Humans’ response is reactive to a pathogen’s onset. And our lives are still so closely bound physically that even technology cannot spare us much need for proximity and contact with one another.
Coronavirus itself may or may not prove to be indomitable. But the possibility for formidable and massively lethal outbreaks still remains.
18
I see a big difference between 1918 and now. In 1918, one person could infect 20. Now, there is faster action to quarantine the infected. The young boy found to be infected in the US--they closed his school. So while the virus is infectious, if one person infects only one other, the spread of the disease is much slower. Unfortunately, people do not think statistically and in the face of ignorance, irrationality and conspiracy rumors, their actions can cause more harm than the disease itself.
48
@Larry klein Thanks to Larry and many of you for thoughtful comments comparing vulnerabilities now and in 1918. On the plus side, we have FAR better medical care, including excellent ventilators, oxygen supply and of course antibiotics to deal with secondary infections. On the negative side, we have a much older population now, with far more people in their 70s and 80s, many with smoking histories or COPD. And today's population is much more urban with citizens in constant contact with others. At the end of the day, I'm not sure how much any of this matters, since the 1918 avian flu is quite different from the 2020 coronavirus. The 1918 flu was unusual in that it killed young people and killed them very quickly (which may have limited transmission). What epidemiologists keep telling me, and what I tried to convey in the column, is simply: We don't know the answers, but it's prudent to prepare for the worst.
280
My father, who was born in 1922, was named for an uncle who died on a troop transport ship heading to France in the 1918 flu pandemic. He was buried at sea. My family doesn't panic about epidemics, but we are painfully aware of the possible consequences, even without the crowded conditions of those ships.
37
@Nicholas Kristof
Perhaps the most disturbing takeaways from John Barry's excellent narrative about the 1918 - 1919 flu epidemic appears in the Epilogue. He worries that USA hospital beds are currently far fewer than necessary should this type of black swan event occur once again.
As of 2016, the US ranked 32nd among developed countries in the ratio of hospital beds per 1000 citizens -- 2.9.
https://en.wikipedia.org/wiki/List_of_OECD_countries_by_hospital_beds
The emphasis on just-in-time inventories has bled out into the thinking of hospital management, and I would not be surprised if the ratio has gotten worse in the last four years.
In RI, two hospitals have shut down in the past several years. Even before these closures, family members rushed to the ER waited well past midnight before a bed was available in the hospital proper. If just a single nursing home were to be exposed to COVID19, the crush of 50 or more elderly patients needing hospital care would put a severe strain on the entire system. How many more until the admission process is entirely overwhelmed, I cannot be sure. I hope we never find out because the US building a 1000 bed hospital in a week's time as China did in Wuhan is not very likely.
At a time when wealth care in the US trumps health care, we could very soon be reaping what we have sown.
46