Differences in health systems and infrastructure also matter. The Spanish flu hit the world in the days before antibiotics were invented; and many deaths, perhaps most, were not caused by the influenza virus itself, but by secondary bacterial infections. Morens et al (2008) found that during the Spanish flu “the majority of deaths … likely resulted directly from secondary bacterial pneumonia caused by common upper respiratory–tract bacteria.
Morens D. M., Taubenberger J. K., Fauci A. S. (2008) – Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: implications for pandemic influenza preparedness. J. Infect. Dis. 198 962–970.
Continuing with that thought, the correct dosages of drugs like aspirin were still being worked out. Aspirin was common treatment for the Spanish Flu, but an overdose of aspirin causes a build up of fluid in the lungs making pneumonia worse.
You are confusing two things. AntiSEPTICS and germ theory were both well established by the Spanish Flu. AntiBIOTICS were not. In other words we knew how to prevent surgical infection but not how to treat a bacteria that had already settled into someone's body.
Louis Pasteur came up with and proved the germ theory in the 1860s. Joseph Lister proved in 1865 that carbolic acid would prevent infection in surgery. Adoption took many years, but by the 1880s antiseptic surgery was widely adopted and Lister was made a baronet in recognition.
The Spanish flu was 1918, decades after the widespread adoption of antiseptics.
The first antibiotic, penicillin, was discovered in 1928. But it did not enter medical use until 1942. This was not a result of doctors resisting a good idea though. Penicillin is created by a bacteria. How do you produce useful quantities of a substance that in concentration kills the very thing that produces it?
You are correct, my bad. But the production problem is what I described. The fungus is resistant but not immune to its own poison. It therefore proved very hard to produce commercially viable amounts. However once a mass production method was found, it was considered vital to the war effort and we quickly ramped up production.
The Broad Street Pump in 1854 London was the thing that really got germ theory going.
Before that, people reasonably were suspicious of germ theory based on their understanding of chemistry. If you dilute a bad substance in the Thames, there is just no way it can be that deadly, dilution wins. They had no idea that the substance could self-replicate.
Dr. John Snow started out knowing nothing, but in a feat of science that still amazes, he helped the world learn a lot. His dogged persistence has saved billions of lives by now.
Fun Fact: After they realized London needed a proper sewer system, they knew that just digging up the streets would never again happen. So they built the sewer system at well above max capacity. Nearly 150 years later, London is now starting to think about improving that capacity.
People did know about self-replicating substances; they'd been using them for making beer and bread for millennia. The nature of yeast was a mystery, but the capacity of fermentation to spread through a nutrient medium was well-known. An edition of Cooley's Cyclopedia I read from around that time attributes fermentation to a particular kind of molecular excitation, which is only true in the sense that it's true of all physical processes on materials made out of molecules. He gives some recipes for producing yeast by spontaneous generation (or, as we now know, from airborne or foodborne spores).
Amusingly, among the numerous recipes for deadly medicines made from mercury, arsenic, and lead, Cooley also gives a number of quite effective disinfectant recipes. He rejects the "contagion" theory that infectious diseases require contact to spread, preferring the "miasma" theory.
I think Pasteur's experiments with the beef broth in the 1860s were what really convinced all philosophers of the germ theory. Snow already believed something similar (contagion from "morbid matter"), but the Broad Street Pump results did not convince the doubters quite as effectively.
A lot of the future-proofing and high quality of the work is due to Joseph Bazalgette. The decisions made and the reasons behind them are really interesting. The Great Stink, The Princess Alice Disaster, London’s lost rivers etc. https://en.m.wikipedia.org/wiki/Joseph_Bazalgette
According to a professor, specializing in pandemics, I heard interviewed while the outbreak was still focused mainly in Wuhan, many ultimately get killed off by bacterial secondary infection.
Encouraging in some ways, under the horrifying circumstances, with the catch that in many parts of the world that secondary infection will be caused by multiple resistance bacteria.
I'd say this pandemic is going to be by far the biggest single consequence post to date for the antibiotic resistance problem, despite being driven by a pathogen that was never sensitive to the antibiotics.
I heard (from a doctor who just received an e-mail summarizing clinical results from Wuhan and Seattle) that actually the primary killer is cardiac arrest.
"This virus is way smarter than I'd imagined. Apparently people don't mostly die of respiratory failure, but of cardiac arrest. Doctors have noted that right as patients begin to recover from their ARDS (severe respiraotry failure requiring intubation), they suddenly develop acute heart failure (dilated cardiomyopathy with EF going from normal to <10% acutely, for the doctors on here) and go into VF/VT or asystole."
The mechanism for that is unknown, but apparently the virus is attacking the heart directly.
So much is still unknown about SARS and MERS that I wouldn't hold my breath waiting for credible answers regarding SARS-CoV-2/COVID-19. And MERS is still circulating (see https://www.who.int/emergencies/mers-cov/en/), so it's not like nobody is interested.
I heard that the virus isn't attacking the lungs or the heart, rather it's the immune systems response after the main infection has done it's business? Probably makes it more bizarre.
That's the "cytokine storm" theory, right? I've heard that but also heard conflicting and inconclusive evidence about it. Some evidence against it is that lymphopenia (abnormally low white blood cell count) is seen in 83% of patients and that patients with lymphopenia have significantly worse prognosis as far as death rates are concerned; this would seem to indicate that it's not the immune system doing the damage. It doesn't conclusively rule it out - you can develop cytokine storms with a depressed immune system, and Spanish Flu was another disease that also caused both lymphopenia and cytokine storms - but it does waggle its eyes suggestively in favor of looking for other causes.
When I learned diaphragmic breathing years ago, there were some studies around suggesting that it helped clear the lungs, especially the lower lungs, of debris and fluid, which can help prevent bacterial pneumonia.
Anecdotes != data, but I've had 1 'chest cold' in the intervening years, whereas as a child and teen most of my colds were chest colds and clearing my lungs was a major step in every recovery.
can the system dispense as many as needed antibiotics in time? Or, I guess, they just drop them via helicopter...even if it means that some will be taken for no reason
Harris believes that the rapid spread of Spanish flu in the fall of 1918 was at least partially to blame on public health officials unwilling to impose quarantines during wartime. In Britain, for example, a government official named Arthur Newsholme knew full well that a strict civilian lockdown was the best way to fight the spread of the highly contagious disease. But he wouldn’t risk crippling the war effort by keeping munitions factory workers and other civilians home.
Yes, you can compare. There are differences - there are always differences - but there are also similarities. Any reasonably smart person can pick out some signal from the noise, if they just try. Meanwhile, those who do not learn the lessons of history, etc. And contrarians (using the polite term) are gonna do their thing too, no matter how injurious, because its fun for them.
The basics are the same. If it spreads (R0 > 1) and the number of sick people in the hospitals grow beyond some limit you will have a lot of problems. No fancy high-tech thing is going to help if it isn't a rapidly deployable cure.
Plus, on top of all that tech the good old politics seems the same. Many countries botched testing, too little too late. So great we had its RNA code online in a matter of days, and even had success stories here and there if some dickheads can't mange the coordinated response.
I think that's a little overblown. It's true in the strict sense that general purpose manufacturing capacity was more common and the production of many goods was more distributed, but on the other hand that manufacturing capacity would have been very limited in capacity and scalability. I'm not convinced it would actually make a big difference in practice.
Actually I was thinking more about scale than about absolute impossibility: simple things like emergency hospital beds and the like, a modern city could still make them at artisanal scale, but not in volume like they could back then. All those amazing efficiency gains we have from flatpacks, automation and specialisation come at the cost of reduced flexibility.
There is still plenty of ability though. I have a table saw in my garage, If I'm needed to stop my computer job I can make a couple jigs and turn out bed rails, someone else in my town can turn out legs, (repeat for a lot of other parts), then the whole kit gets sent to other people with just a screwdriver.
Not for long. You could probably sustain that for a 3-5 weeks. I live in an area of upstate NY where this would be possible in 1918.
Today, no sawmills, no regional tool and supply manufacturers, no regional raw materials. Iron ore from the lake Champlain area could be smelted in the Albany area and made into nails in many places.
Today, you’re 100% dependent on diesel and open roads to Newark, the I-81 corridor and rail traffic from the west for food. 75% of the regional produce producers of gone. Most (50-70%) of whatever is left of dairy production will be driven into bankruptcy this year.
There is plenty of transport, and plenty of diesel fuel. Thus my city doesn't need to be self sufficient. I'd expect my beds to be exported to other nearby cities, while they work on making ventilator parts.
I'm not sure if it is needed though: there is probably more than enough lumber in the local lumber yards currently intended for local construction projects but when nobody is building/remodeling...
Actually I live in a manufacturing city so I'd expect we would be making ventilator parts, since I don't have machining experience I'd be repurposed to packing the parts into boxes. Any city has enough tablesaws to build beds, not every city has as many people who know how to run a lathe as mine.
There is implied failure of services in Spookies response. Already here in vegas, my step dad works at a bread factory as supervisor, they are seeing an increase of demand. He's had to go in several times late at night to relieve someone who was on a longer shift. He says if they lose one person they will start falling behind.
The short term consumables or raw resources are the ones that matter the most. If people stop going to work to make bread or toilet paper or refine oil it's going to put a strain on a lot of things. The oil and chemical industries are really going to be important for producing medical items like gloves, sanitizer, cleaning agents, plastic ventilators, sanitary plastic containers for equipment and needles, etc. Not to mention the effects of lower oil production and the strain and cost on shipping those things back and forth to their respective factories.
But it will have to be pretty bad before we have to worry about that I think.
A lot of that can be attributed to the bullwhip effect. It is the effect that even small demand fluctuations down stream, e.g. consumers, in a supply chain can have on parties, and availability, up stream, e.g. manufacturers, suppliers, whole sellers and so on.
One of the reasons why panic, and the resulting changes in consumer demand for certain products, is so dangerous. Not because stores are running out of toilet paper, but because of the mid term effects this has on availability of all kinds of things. This effect is impossible to predict upfront.
So, yet another reason to stay calm and avoid this kind of stress on supply chains providing goods of daily need.
This is, in my opinion, a common misconception about modern day supply chains. JIT is mostly used for the last delivery step, component deliveries for automotive final assembly lines are the best example for this. And even there is a certain buffer, a well planned and monitored one.
All other steps involve buffer stocks and inventories. This inventory is sitting local warehouses for example. Or just dead weight in the various locations. More often than not, this is due to inefficiencies.
That beingsaid, JIT is simply to hard to implement to use it for anything else then the most important parts. and even there only for the very last step, everything else smply has to many variables for JIT to work.
The best example are automotive supply chains that kept running all the time through February.
And stuff like groceries are not run JIT, with the exception of the replenishment of shelves and local stores from a regional warehouse. And that is not true JIT.
How were hospital beds made in 1918? Basically by hand ("artisanal"), but with lots and lots of very cheap labour. Those conditions still exist, since training someone to cut and bend metal tubes, drill holes and screw them together is not hard.
This effeciency doesn't simply go away, so. In the worst case scenarios we are discussing here, the relevant products are only asmall portion of global trade and supply chains. You could, for example, completely ignore Apple's operations under this scenario.
These critical porducts, and the coresponding manufacturing base, will be part of the critical infrastructure to be kept running. Automation is a huge benefit for this, as these operations can be run with a very limited number of people. Distribution and transportation is the same, it can be kept up for the essentials with a very limited amount of people. Even internationally, container ships continued to sail from Chinese ports. Granted, sometimes they sailed empty, but that was due to the shut-down of Chinese manufacturing.
In a true worst case scenario, dedicated ports will be kept running. again wth close to no people involved.
Administration for all this can be done to a huge part from home. Feet on the ground are by no means as important anyore as they used to be.
a situation like this should be avoided at all cost so. Hence the measures currently being taken.
Could it? We often no longer have random factories waiting around, ready to be repurposed. Neither do we have well functioning internal supply chains for the needed raw materials. I don't think people truly understand just how dependent any given country is on global trade (and especially Chinese manufacturing).
yeah, but even in 1918 not every city had a refinery or blast furnace. And even back then, a lot of the basic stuff was imported (think opium, cocain (probably the top medicines back then...), rare metals...). On top of that, in 1918, a lot of the things you (and I) take for granted were not even found (for example antibiotica). And instead of random factories, each city (heck each small town) has like 10-15 CNC-machines ready to produce anything which was done in 1918 - a problem might be all things chemistry/mining related, but the real important stuff (which was known in 1918) also back then has been produced centrally (and still is)...
The hard part is the basics - things that get commoditised tend to get manufactured more efficiently, and at massive scale this tends towards centralisation.
As a concrete example, in the entire country of New Zealand, no one manufactures window glass. Every window, everywhere in every building, ultimately gets shipped into that country in a container.
We'd also miss shoes as there are no "real" factories locally anymore. I think we make nails but I can't tell if we can really make bolts. So I'm not talking about cars, computers or aircraft. No way. Windows. Shoes. Bolts.
So OK, we're missing commodities, most industrial chemical processes, feedstocks, experienced manufacturing labour and plant expertise, all of which went south when NZ was one of the first countries to drop its pants and remove import tariffs. OK. I don't have a dog in that fight, there are reasonable arguments to stop subsidising things you'll never be internationally competitive at.
That said if all imports stopped tomorrow for, let's say, 2 years, it's surprising what you can do without or improvise. The main thing I think we'd really miss is life sustaining medicine. A loss of exports would actually be more catastrophic since our farmers would a) have no reason to exist and b) not be able to keep the finance wheels turning.
We're unbelievably wealthy compared to people in 1918 and we have a lot more slack and fat in our systems than we really know.
> The main thing I think we'd really miss is life sustaining medicine.
Yes, we need flexible chemistry machines on the style of CNC mills. The good news is that they aren't that far away, at the next pandemics we will probably have them.
you didn't have those meds at all in 1918 either (and this was OPs point). and for the NZ case: did NZ ever have a real industry? With a 4.5 Mio. population today I somehow doubt that... As for basic industries (and meds): in western europe at least, we still have those things, small-scale and specialized, but we have it, including all the supporting industries (what we don't have is electronics, which 1918 wasn't a thing yet ;)). We needed to import the raw materials for 200 years. So?
I have nostalgia for local production but also recognise it can be harmful to subsidise inefficient industries. Hard to draw the right line between cronyism (obviously tariffs are actually a tax on locals) and resilience. Strategically, NZ unilaterally dropped a lot of tariffs on the advice of economists without considering, game theoretically, how to extract corresponding concessions with trading partners. This started in NZ in the late 80's. They then negotiated largely empty-handed (What will you give me? Wait you already did that.. nothing else?) and had a lot of trouble getting other people to drop their tariffs. Which are still there, in many cases! So there's my dog I guess?
Uranium glass. Radium-dial watches. Gas-lantern mantles of urania and thoria. Lindane. In California, denatured alcohol. The meat of the heath hen or the baiji dolphin. Opium. Caribbean monk seal oil. Spermaceti. Ivory billiard balls. Low-radioactivity steel. Most patent medicines. Old-growth wood of some kinds of tree. Chemistry kits. The Revigator. Large sheets of monocrystalline mica.
It's probably going to be more difficult to find something that is still widely used and is manufactured, but cannot be manufactured in a particular city in 1918 but not 2020. It would require deep knowledge of the industries of a particular city or of a particular industry. For example, right now I think all three of the ruling engines in the US capable of cutting a research-grade diffraction grating into glass are in the single Richardson Gratings lab in Rochester, New York, but one of them was built at MIT before 1918. So perhaps Boston (or Cambridge at any rate) was capable of producing such artifacts in 1918, but not today; but, if that is true, rigorously establishing the truth of that claim would require considerable investigation.
Similarly, many US cities have many fewer watchmakers, compounding pharmacists, and piano tuners than they had in 1918; in some cases the number is indeed zero.
You can make soap at home, a factory anywhere can trivially make it. And face masks are paper plus string, again hardly difficult to manufacture in any city in 2020. (In the UK most paper was made centrally in 1918, I happen to know this because I live near the site of the former paper mills - https://www.thepapertrail.org.uk/).
Look, I have a lathe at home and can make an engine if I want to, thing is other people can't because they never were interested in that. And I used the simplest things possible as examples.
Realistically, where would you start with these in a typical deindustrialized town today? "A factory" is a poor answer, some towns have none really, and factories are not interchangeable anyway.
There are small factories - everything from workshops to industrial estates - all over the place. If anything it's much better now because CNC machines and lathes are cheap, widely available and very versatile.
Yes, they're cheap and widely available. That's because we import them from China.
If your plan for resilience against a long-term disruption of global trade has a critical dependency on global trade, you may need to rethink it somewhat.
face mask: some variation of paper cloth. Go to the local cellulose factory (I doubt every city had one back then, they were and still are near cheap energy/wood), specify the quality of the paper you want and get it (you have to pay for it, because today they are probably producing paper for $$$ bills). Some yarn: cotton/wool has always been imported in some locations, a local workshop will build a spinning machine @1918s quality in no time. The same for sewing machines (those things haven't changed a lot if you don't factor in automation (which even today noone bothers to pay for the existence of cheap slave labor in Bangladesh)).
Soap bar: we have a lot of animals around here and butcher them locally
giving you everything you need (https://www.essentialchemicalindustry.org/materials-and-appl...). You just have to find someone who is willing to do the necessary stuff 1918-style :)
I don't think that's true, case in point being the (eventual) Chinese response in Wuhan, which appears to be extremely effective (if you trust their figures). It's all about government determination, which is mostly missing now, just as it was then, based on the article.
> Or it is harder to force people into quarantine.
From the article:
> Harris believes that the rapid spread of Spanish flu in the fall of 1918 was at least partially to blame on public health officials unwilling to impose quarantines during wartime.
I think there's a quantity/quality difference between the cities of 1918 and today. Even if we have more people in cities today cities in 1918 had much, much worse health and cleanliness practices and allowed much more opportunity for disease to spread.
China was able to build a 645,000-square-foot medical facility in 10 days with 30 ICU units and 1000 beds. Coordinating such a feat in such a short time would not have been possible in 1918.
That’s less than one bed per million heads, country-wise. I think the militaries of many rich countries can do the same today, scaled for population (they will use containers, but that’s what was used for that Chinese hospital, too)
I also think many countries could do something similar (ignoring technical progress) in 1918, given they had had ample practice in world war 1.
It kinda simpler to do if you have all the manufacturing under your control(as west moved all production to china), and have construction companies used to such rapid development(building useless buildings for sole purpose of keeping people employed)
>> China was able to build a 645,000-square-foot medical facility in 10 days with 30 ICU units and 1000 beds. Coordinating such a feat in such a short time would not have been possible in 1918.
While its a great feat--and China is prob the only country that can do it--that's nothing if we get hundreds of millions infected with a virulent version. 30 ICU units might serve a town with 35000 people
Not quite. We built Liberty ships in extremely fast timeframes, but more substantial ships took far longer. The long lead time components could take a year or more.
Well the US is struggling just figuring out how to test for the disease on anything but the smallest of scales, so I doubt anything like that is replicable here.
well, the ICU units are the main problem here. I guess other countries would choose to upgrade existing rooms here. And a 1000 beds in rooms with drywall separation - we did this in Germany for the refugees and (maybe contrary to China) we have a relative abundance of existing superstructures (communal gyms, old military sites)...
We also have tons of old, maybe obsolete I don't knw, military and emergency stuff sitting in warehouses for things like that from the cold war. My impression is that all measures currently being taken are there make sure we don't need to go to these extremes.
Having electricity is worthless if there isn't enough for anyone to run a heater, because it's all being used to run a protein folding simulation no one needs.
It's about intelligent use of strategic resources, not the fact that those resources exist at all.
It's not obvious that we're better at intelligent use of strategic resources than we were a century ago.
Our economic systems promote brutal winner-takes-all internal competition, not strategic cooperation, and that makes them ridiculously brittle when they have to deal with an unexpected stressor.
Assuming that we are as stupid at using strategic resources as our ancestors back in 1918, we do have a lot more of them. With much easier coordination and communication. and mch higher degree of automation, requiring an order of magnitude smaller work force to keep things running.
> This article was amended on 7 March 2020. An earlier version wrongly stated that “a solution of ethanol, hydrogen peroxide and bleach will disinfect surfaces"
Hydrogen peroxide and ethanol, when sprayed into a combustion chamber, make a dandy rocket propellant. Mix 4:1, H2O2:ethanol. Theoretical specific impulse of 245 seconds. Source: table from poster published by Rocketdyne division of North American Aviation Inc, early '60s (gift from Dad)
Reader confidence in the author's scientific chops somewhat diminished.
Just basic hygiene is much better than in 1918. I think it's instructive to look at the Spanish Flu, but I agree that too many people are using it to draw direct comparisons. With respect to viral spread, many things are greatly improved today as you mention, but some are worse (such as the ease of global travel).
As the article notes, most the deaths of the Spanish flu were due to the bacterial infections which subsequently emerged in the patients. These would be prevented by modern antibiotics.
They sure do, but in small numbers. Mostly the old or infirm. A nasty flu virus like COVID will push those numbers but they're still outliers, doubly so with modern medicine.
Not to mention influenza has a segmented genome that makes it exceptionally good at mutating, whereas Corona viruses have much more stable genomes, comparatively.
There's a surprising amount of well-intentioned but misinformed speculation in this thread.
"We don't know" is the best answer to a lot of the questions about Spanish flu. What we do know is that it disproportionally killed young, healthy people who could go from no symptoms to dear in 24 hours. There's a lot of speculation as to why. I've seen medical experts theorize this is likely due too a cytokine response, meaning basically that a healthy immune system goes nuts. Apparently there are other diseases that have fit this pattern.
The mortality rate is estimated at about 3%. Influenza is 0.1%. Coronavirus is somewhere between those.
Best guess of why the second wave was so deadly was due to a mutation that likely happened in Europe.
It's true we have things we didn't in 1918 but we still have surprisingly few tools to combat viruses. Fun fact: only one virus has had a cure developed and that was Hepatitis-C in recent years. To be clear, vaccines != cures.
We also have problems we didn't have in 1918, specifically mobility of people. It's that mobility combined with people being highly contagious while being asymptomatic that makes this particular diseases such a challenge.
The mortality rate of Covid-19 seems higher than that.
The around 3% mortality rate is what you get by dividing the number of deaths by the number of infection (past and present) (as of today: 5359 / 140875 = 3.8%).
But this is incorrect as the number of currently infected people is quite high (half the total number of infections) and unfortunately, a few will die in the near future.
If you divide the number of deaths by (recovered + deaths), the mortality is much higher (as of today: 5359 / (70174 + 5359) = 7.1%).
Which seems actually about as high as the Spanish Flue right in between the low and high estimate (20M/500M, 50M/500M). And it's source for worries since our medical systems are 1) much more developed than in 1918, and 2) they are not yet completely overloaded.
If it were to spread rapidly and overload our health systems, the mortality rate could rise even more, let's hope it doesn't reach that level.
> The mortality rate of Covid-19 seems higher than that.
Sure if you intentionally mislead people by cherrypicking data.
> The around 3% mortality rate is what you get by dividing the number of deaths by the number of infection (past and present) (as of today: 5359 / 140875 = 3.8%).
140875 is the number of confirmed and tested infections. The number of actual infections is certainly much higher. So the mortality rate is most likely much lower than 3.8%. After all, most coronavirus infections are mild for the vast majority of people.
> If you divide the number of deaths by (recovered + deaths), the mortality is much higher (as of today: 5359 / (70174 + 5359) = 7.1%).
Sure if you ignore the hundreds of thousands of infected who "recovered" from mild symptoms.
> If it were to spread rapidly and overload our health systems, the mortality rate could rise even more, let's hope it doesn't reach that level.
The standard pattern. Try to fearmonger with intentionally misleading stats and then try to come off as a good samaritan. Why do all the coronavirus fearmongering comments all follow the same template?
"The virus infected 500 million people worldwide and killed an estimated 20 million to 50 million victims"
"Somewhere in Europe, a mutated strain of the Spanish flu virus had emerged that had the power to kill a perfectly healthy young man or woman within 24 hours of showing the first signs of infection."
I knew this, but its still utterly terrifying to see it expressed so bluntly.
As the article says, rapid population movement was a key factor in its spread and mutation. We can't take the world back to a time when international travel was rare, so when we're done with the immediate effects of the Covid-19 pandemic, we (as a species) need to get better at rapid vaccine creation. Like an order of magnitude better. Otherwise the next one could be one that takes us down.
For one thing, most countries are not self sufficient in basic necessities (not even food!). You could do it for a very short time, but not sustain it. Also, the economy of the country depends on international trade. Modern economies actually don't have a lot of slack. If you shut down trade, quite a few companies will just go under. You would have to back that up with huge subsidies. It would be a massive undertaking.
Viruses don't live long enough to survive ocean shipping, so as long as the (tiny) crew is kept isolated, ocean shipping is fine. Within a country, it's not hard to disinfect a truck and keep the driver isolated.
Of course, if the originating factory is shut, then you're screwed - but that's true regardless of trade.
Also worth noting: it takes a tiny number of people to produce tons of food (calories). Maybe not true for artisanal salami but for bulk basics.
The US is the single largest exporter of grain in the world. Not the largest producer, not the largest consumer, but the largest exporter.
And the US farming population is ~1% of the total US pop. Modern tractors and combines are amazing.
Doesn't mean there aren't a ton of bodies involved in processing and transportation, though. You can probably find local-ish wheat in the US, but you're not going to boil and eat the wheat berries for a porridge like it's 1850 (though you could); you're going to buy breakfast cereal.
Well, if there's a widespread virus that has "the power to kill a perfectly healthy young man or woman within 24 hours of showing the first signs of infection" the "economy" and "international trade" would be the least of our worries...
In addition to the reasons others have given (self-sufficiency, and it being too late this time), closed boarders as a general and ongoing solution is very brittle. All it takes is one infected person to get across the border and you have no defence-in-depth. As a short-term measure in combination with other public health efforts, it might have some merit, but thats all really.
International travel, especially between Europe and the US, was very much a thing back in 1918. Even more so for the younger, male population who tended to be packed in ships for the journey.
My point was the massive mobilization, and subsequent de-mobilization, of armies during World War I. Especially starting in 1917 across the Atlantic when the US entered the war in large numbers.
Sure, not comparable to the way are traveling today, but the numbers still were in the millions. And they were cramped into ships for weeks, as compared to aircraft. The Diamond Princess showed us that this a nice breeding ground for a virus.
EDIT:
Some numbers:
USA: 1.5 million men demobilized by February 1919, so it started right uring the second wave, in the US. Another roughly 2 million men in cramped demobilization camps in Europe. Later these US troops were moved from these camps to French towns and cities to ease tension among troop caused by crowded conditions. Also happening right during the second flu wave.
Germany: roughly one million men simply walked home after the armistice in Nov. 1918, leaving roughly 6 million men under arms. These were demobilized in the four month after the armistice. So you have 7 million men travelling across the German Empire. During the second wave of the flu.
Austria: No numbers found after a quick gogle search, except for 400,000 soldiers taken prisoner by the Italian during the desintegration of the Austr-Hungarian army. The demobilization in Austria collided with the desintagration of the Empire, so it was even more chaotic than the German one. Also taking place after the armestice in Nov. 1918 and during the second wave of the flu.
Great Britain: demobilized roughly 3 million men between the armistice in Nov. 1918 and late 1919. Mostly from the Western Front. During the second wave of the flu.
France: Demobilized 2.5 million men between Nov. 1918 and April 1919. Also from the western front, also during the second wave of the flu.
There we talk about young men, the demographic most ht by the flu. All war powers kept the flu under wraps during the war, that's why it's called the Spanish Flu, Spanish newpapers were the first to report it. All these men travelled, moreor less coordinated, across Europe and the US. Most of them coming from the Western Front, from cramped conditions with sometimes bad hygenic conditions. And they met up with the young female population upon return, for obvious reasons. All in the time frame of a couple of months.
The equivalent would be to move a large protion of our elderlies around the world now.
EDIT 2: From the submitted article: "Historians now believe that the fatal severity of the Spanish flu’s “second wave” was caused by a mutated virus spread by wartime troop movements."
EDIT 3: It was much easier to find demobilization numbers thn mobiliztion numbers. The second wave hit before the Armistice in November. Demobilization is,if you want to call that, the return ticket of all these young people taking their trips to the western front. So they all moved there in the months before. And they travelled, from the trenches, to rear, on front vacation, to field hospitals, to hospitals elsewhere. They also travelled on the same ships that ran across the Atlantic, with much larger crews than we have today. The amount of traffic during the months before, and drung, the second wave was mind boggeling. Entente powers geared up for the huge, planned, 1919 spring offensive.
EDIT 4: Nice tid bit, not only for the second wave. "By the end of the summer the virus had reached the German Army. The virus created serious problems for the German military leadership as they found it impossible to replace their sick and dying soldiers. The infection had already reached Germany and over 400,000 civilians died of the disease in 1918." from here: https://spartacus-educational.com/FWWinfluenzia.htm.
I would have thought barbed wire, artillery, tranches, chemicla warfare and machine guns would have formed a nice barrier. Social contact, trenches have a lot of that, seemto be a much bigger factor it seems. Proves the point of avoiding gatherings, self-quarantine and sch things, IMHO.
Do you think a vaccine is the right answer? Surely development and stockpiling of anti virals is the key, Tamiflu or similar. The lead time for vaccines will also be far too long and the protection against flu like illnesses is variable over time. What do you think?
> Surely development and stockpiling of anti virals is the key, Tamiflu or similar.
Tamiflu doesn't have any effect on Covid-19. There might be antivirals that are effective, and testing is happening now. I'd argue we should be trying to find ways to speed that process up for next time.
> The lead time for vaccines will also be far too long and the protection against flu like illnesses is variable over time.
Thats what I was saying: can we (humans) get better/faster at doing this?
What is stopping you from making a vaccine for COVID-19? I can promise you nobody will be upset with you if you do it, you don't need anyone's permission either.
I don't think he's saying vaccine creation is easy, I think he's saying it's a hard problem that needs a concerted effort at developing shortcuts.
Also, this is technically true, but vacuous:
> What is stopping you from making a vaccine for COVID-19? I can promise you nobody will be upset with you if you do it, you don't need anyone's permission either.
Even if by some herculean effort and unbelievable luck, I brewed up a Covid-19 vaccine in my garage, I would be unable to help people at scale with it unless it passed millions of dollars worth of testing for regulatory approval.
Okay - so ... "we (as a species) need to get better at rapid vaccine creation. Like an order of magnitude better" ... and andyjohnson0 will do what exactly then to make this happen?
I think you are being needlessly antagonistic here. I think they were simply stating that we, collectively, would benefit from prioritizing vaccine development more than we currently do. Perhaps they felt stating that would in some way convince others that this is true and maybe more people would vote for it.
May I suggest you be more charitable in interpreting people here? I think you'll find conversations more productive.
Why are you being so obtuse? I'm not saying that every person should actively work on vaccine development. That would be absurd. I'm just asserting that finding ways to speed-up vaccine development should be an international priority.
I'd vote for politicians who support this. I'd happily pay more taxes to support it. I'd support the development of international institutions in this field. Is that good enough for you?
> I'd vote for politicians who support this. I'd happily pay more taxes to support it. I'd support the development of international institutions in this field. Is that good enough for you?
Have at it then, you could even donate to private research if the government won't come take your virus research money from you under threat of force. Enjoy!
This is massively harder than you expect. Vaccines need longer term testing because they can have serious side effects, including making you more vulnerable to the virus.
in case you don’t read the article, there is an interesting historical anecdote: why it’s called “spanish flu”
> Interestingly, it was during this time that the Spanish flu earned its misnomer. Spain was neutral during World War I and unlike its European neighbors, it didn’t impose wartime censorship on its press. In France, England and the United States, newspapers weren’t allowed to report on anything that could harm the war effort, including news that a crippling virus was sweeping through troops. Since Spanish journalists were some of the only ones reporting on a widespread flu outbreak in the spring of 1918, the pandemic became known as the “Spanish flu.”
The goal isn't to stop those people from being infected, it's to delay their infection. A massive spike of infections would overwhelm the hospitals. The same number of patients, slower, is doable.
Please stop calling it the Wuhan virus. It's well recognized that such terminology promotes discrimination (even if it's not intended to). The disease is COVID-19; the virus is SARS-CoV-2. Even if it's only for the sake of clarity, please use the correct terms.
You may have missed Spanish flu being used a few times in this thread. Please also fight racism against Spanish people. You are doing important work. Gracias!
"Spanish flu" was coined and popularized literally over a century ago, and it's a bit late to affect what it's called. COVID-19 is still fairly new, and we can use what we've learned in the last hundred years to avoid the mistakes - linguistic and otherwise - of the past.
> I don't recall anyone complaining when MERS, NDH-1, and Hanta virus were prevalent and in the news.
That means absolutely nothing. People learn. General awareness of how such terminology affects people is a relatively recent phenomenon. For just about every racial slur you can think of, there were lots of people outside of the affected groups who could have said they "don't recall anyone complaining" either. Not hearing - or refusing to hear - such complaints is itself a form of discrimination, hence my "blind eye" comment.
> I won't be a partner to their attempt to clean up their PR through social censoring
> it will assist the Communist Party in controlling the narrative
I knew the anti-China sentiment would come out into the open sooner or later. Protip: not all discrimination, or defense of discrimination, comes from outside. Ask any feminist.
That's an exceptionally non-constructive comment. There's nothing hypocritical or inconsistent about suggesting that we change what we can and not what we can't. We can't change the "Spanish flu" moniker. It's too late, it having been written into textbooks for generations. If we could erase those references, I'd say we should, but we can't. The best we can do is refer to it by a different name - "1918 flu" seems common - when discussing it now.
The appeal to tradition here is the idea that we should continue that practice even when we know better and have an opportunity to do better. I reject that. Is "cling to tradition regardless of effect" really the hill you feel you must die on? An odd attitude for anyone in tech, I must say.
Maybe not, but this disease is not named "Wuhan", it's named COVID-19. Insisting that we call a virus by a different name to try to blame a specific region when the rest of the world has decided to call it something else... I dunno, that smells off to me.
Does it not? It clearly says that countries like the UK knew full well that the best way to combat the illness was to isolate and quarantine people and cities, but decided not to do it to avoid harming the war effort - resulting in a lot more deaths. How is that not an answer to this question?
I think GP was wondering why the flu was so deadly per person rather than how it racked up a huge body count. The article explains the body count but not why any particular person would die at a higher rate than another strain of flu.
"Not only was it shocking that healthy young men and women were dying by the millions worldwide, but it was also how they were dying. Struck with blistering fevers, nasal hemorrhaging and pneumonia, the patients would drown in their own fluid-filled lungs.
Only decades later were scientists able explain the phenomenon now known as “cytokine explosion.” When the human body is being attacked by a virus, the immune system sends messenger proteins called cytokines to promote helpful inflammation. But some strains of the flu, particularly the H1N1 strain responsible for the Spanish flu outbreak, can trigger a dangerous immune overreaction in healthy individuals. In those cases, the body is overloaded with cytokines leading to severe inflammation and the fatal buildup of fluid in the lungs."
Yes, we have drugs which reduce the effectiveness of the immune system, preventing this from happening. Of course you don't want to weaken the immune system too much, it's a difficult balance to strike I'm sure.
This is false. Clinical management of the syndrome is purely supportive. There is ongoing work toward a variety of possible treatments - cytokine release syndrome can also result from a garden-variety flu, and as a side effect of some other therapies - but there's nothing outside an early experimental stage thus far.
I'm watching the UK government decide not to implement 'delay' measures today, ostensibly to protect the economy. It seems there is always a reason not to do the right thing.
Have you watched the presentation yesterday? Or just reading the news articles today? Because that's precisely not what they said.
What was said was - from epidimiology point of view, there's no point in telling everyone to stay at home right now when the spread is in the early stages. It will have a marginal effect, and the spread will continue anyway. By government's own estimates 80% of people in the UK will get infected, and imposing a quarantine right now won't change that. What would help is setting the quarantine for 14-18 weeks, and they know that people won't abide by that, so instead, they clearly said they will impose quarantine just before UK hits the predicted peak infections - to lower the stress on the NHS and to achieve the maximum effect of the quarantine. Like, it all made sense if you watched the actual conference.
I watched a part of the presentation, but it was actually unclear to me what is the peak infections mentioned. I mean, in Italy, the numbers are very small compared to 80% of population, and the health system is already not able to cope, and mortality rate is quite high. Does it mean that UK will wait for their numbers to be 10 times the current Italy numbers before starting the quarantine?
No, it means that UK government knows that it cannot stop the situation getting a lot worse, and a quarantine will be a lot more effective as a tool later on. They seemed to be quite realistic about this, not going " it will be all fine, trust us". They know things will get fucked and a full quarantine is one of the many tools to use against the virus - so let's use it when it's most effective. Otherwise like they said - if we quarantine the entire country right now, it won't stop the spread anyway. So we'll come out of quarantine and then have to do it again in a month - and people will get fed up with it and won't obey a quarantine if it goes on for too long or too frequently. So if the spread is inevitable, let's use the quarantine at the point that prevents the most possible number of infections.
I can see some discussion about trying to figure out which restrictions will work best with the psychology of a given population.
But the idea that the "most effective" time is going to be later doesn't make much sense to me. Marginal rate changes in exponential spread are most likely to have the biggest impacts early. It doesn't much change the total volume of people who get sick, but it very likely changes the volume of people who get sick at once, and that can save lives.
This sounds like saying "we can only imagine quarantine working if things get fucked, so we're going to let things get fucked, so that the quarantine will work except for the fact that things are already fucked oh well too late."
Sweden is making the same decision and they explained it quite well. A quarantine means children stay home from nurseries, daycare and school. This increases the stress on the medical system because some doctors and nurses have to stay home to take care of their children.
In addition, new constellations of people gathering become likely. E.g. children from different schools may play together more in the neighborhoods, opening new pathways for the disease to spread.
So when a quarantine is not expected to help in most cases (because most people are not infected), the drawbacks easily outweigh the benefits.
I think I get it now and I think it's probably not about the stresses of closing school: I think it may actually be a calculated gamble that what you want is the low-risk population widely exposed first, falling ill at a rate just below the level at which you can treat people. If that rate threatens to climb, then maybe they close the schools and try to slow the rate. Otherwise the at-capacity wave is moving people from the "not immune potential vulnerable & vector" population into the "immune and not a vector" population.
If that's the case... it seems like it heavily relies on timing, good data & models, and more precisely timed and effective social cooperation, and I'm not sure I'd want to bet on having all those pieces in place, but it is interesting.
Also something that was mentioned during the conference with the prime minister yesterday - if we close the schools and tell the kids to stay at home, who are some of them going to stay with? Their grandparents. The group that's at the highest risk from the virus.
They are smaller pools in the neighborhood, than in a school. Slowing down the infection rate is the whole game right now. Closing schools is a huge step toward that.
It seems strange a hospital cannot respond to daycare needs in their own population in a situation like this...
It’s not the size of the pool but the novelty of the configuration of people. Every time an infected individual meets a healthy one that’s a new chance to spread the infection. But you can only spread it once to each person, so if you meet the same people over and over that’s okay. When you ask people to change their routines, you also encourage new “lateral” disease spread.
I don’t think hospitals have “emergency daycare” available generally speaking. If it does come down to quarantine, I’m sure efforts will be made. It is still a cost and a negative outcome of the quarantine so my point remains: when the benefit is very small, the costs easily outweigh the benefits.
Now that isn't right. Meeting the same people over and over spreads the disease - we don't all get it at the same moment, and each contact even with the same person is a new opportunity to get infected (because they got it from somewhere else since your last contact).
Social distancing, reduce frequency of contact, stop meeting in large groups. That's the whole ballgame now.
Of course, reducing the frequency of contact with other people in general is good. I don’t think anyone is arguing against that. What I’m saying is that quarantine can cause more novel contacts.
Statistically speaking there is a good chance no-one at your work place has the virus yet. We are still counting infections in the hundreds or the thousands in populations of millions. If all you do is to spend time at home and at work, there are good odds you’re just switching between two disease free spheres. You can’t get sick without meeting sick people. The only thing that will change that steady state is contact with new people (by yourself or your coworkers/family).
The point the government was making in this case, I believe, is that quarantine can in fact cause more novel connections, faster, and perversely increase the velocity of the spread. The people who are at home will not just sit there. They will meet other people and those people may be from outside of their ordinary, currently disease free social sphere. Thus new vectors of infection spread are introduced that would not have existed without the quarantine.
A quarantine can certainly help down the road, it’s a numbers game. But right now they’re doing the math and think it would be a net negative.
Again, not right. New people are not necessary at all. People are not in little bubbles with no communications between them. If there's even one person in common between two groups, then infection can/will in time cross between.
An infection travels like a game of 'telephone' passed from one to the next, right across the world.
Quarantine will initially regroup people, but in much smaller groups. If the disease is not yet widespread, then your new cohort will also likely be disease-free. There may be a tiny spike as an infected person in a large group joins a different, small group. But this is a good thing, since that group is smaller, and fewer people will now be at risk.
That does not contradict anything the government said. All else being equal, of course smaller groups, in the sense of people seeing fewer other people, is better. That’s not the argument. Nobody is saying “we should see more people”.
All else is not equal. You pull the quarantine lever, you increase social distancing but you also increase local mixing. Costs and benefits. The right choice at any given time depends on the disease spread. Computer modelling and simulation tells us when there is a net benefit.
Ideally, a government would quarantine all probable cases with the aim of extinguishing the disease.
But if the disease is spread enough (inside or outside your borders) so that is impossible, the next best thing is to reduce social interaction just before your health system collapses, and just enough to avoid a collapse. That minimizes both the cost and time of isolation.
I understand that the approach has some degree of internal consistency, but it requires a huge amount of trust in the underlying models, and in our ability to pull the right levers at the right time in the future. I can totally accept that any approach _must_ address what happens for the entire period from now up until immunity or vaccination - we know we can't keep everything shut down until 2021. But the government is hoping to tap the brakes when the outbreak is going at 100mph, compared to controlling acceleration from the standing start of lockdown. This is an immense and shocking gamble. I hope it works, although would mean every other country appears to be making a huge mistake by shutting down now.
Imposing a lockdown to soon does a lot of harm and very little good. In fact it makes things worse, because after a few weeks people get fed up of the lockdown and start breaking isolation.
So if you lock down a few weeks too soon, people start breaking isolation at exactly the point it's most important the lockdown is maintained. All of this was explained in the presentation.
> It's dawning on me that what China and South Korea are achieving, although impressive, leads to a lengthy stalemate that makes life impossible for millions of people.
It's not a stalemate, they're still getting new cases at a pace that allows their medical system to cope.
> In the absence of a vaccine
It's a pretty safe bet one will become available pretty soon. Meanwhile, more is being learned about how to handle infections and improve the outcome.
> the aim is to flatten the curve but still get the whole thing over and done with in about 6 months
There are 4000 ICU beds in the country in total, most of which will be in use due to other kind of cases at any one time. [1] But let's assume you can make that number available for coronavirus patients for 6 months. So you have 4k*26 = 104k ICU bed-weeks available. There's been talk of 60% of the population getting infected to build up herd immunity [2] (somehow ignoring that there seems to be a nontrivial reinfection rate [3]), so almost 40 million people. It's not very clear how many infected people end up needing intensive care. In Italy, it was 10% of the people who tested positive [4]. But only the worst cases get tested once the epidemic is widespread, so let's say maybe 0.5% of the infected people need ICU (wild guess here since no country with a large number of infections is testing people with mild symptoms, but I think I'm being conservative). 0.5% of 40 million is 200k patients. If each of them need an ICU bed for 2 weeks, that's 400k bed-weeks.
Basically we're talking about most of the 6 months period of the NHS being overwhelmed and coronavirus having a high mortality rate.
Yes. But if instead stretch the epidemic out over two years with very extreme social distancing measures (if that is even possible), what would the human cost be in terms of food shortages, loneliness, fear, suicide, depression, economic depression, people with other health conditions not being able to get treated etc. It's not straightforward.
None (farmers are distant already), some, relief (fear would come from warehouses of sick and dying, not too much time at home), unknown, unknown, some, none.
Has anyone done the math on how long a flattened curve stretches out if you flatten it enough to not overwhelm the medical system?
So for example, if we have 100,000 ICU beds in the US and we somehow make them all available for COVID-19 patients (unlikely), how flat do we need to make the curve to not go above 100k ICU patients, and how long will that flattened curve last? A month? Six months? Two years?
Assuming 70% of the adult population gets it, that's roughly 140 million infected. Assuming 5% need ICU beds, that's 7 million ICU patients. And assuming the average ICU stay is 2 weeks, we'd need to therefore spread our ICU patients over 140 weeks, or almost three years. Is that how long we can expect social distancing to last if things go perfectly?
When we saw the Chinese building hospitals in a couple of days, maybe we should have started building all around the world, slower. We had the time...
Also build respirators, train ppl.
Even now is better than later...
Yeah, just to be clear, I think there's no chance in the US either. I just saw something that said we actually only have 45k beds, and they're mostly already full anyway. Plus there's no chance we're going to be able to keep this clamped down for months. We'll be overwhelmed in weeks.
Morens D. M., Taubenberger J. K., Fauci A. S. (2008) – Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: implications for pandemic influenza preparedness. J. Infect. Dis. 198 962–970.