Planning, luck and hot-spots

Planning, luck and hot-spots

This Vox explainer on why some place become hot spots and not others is worth a read, particularly as we confront the sad reality that the mitigation strategies to buy ourselves time to build up the health care system and ramp up testing are going to fall apart long before our national government gets its act together, if it ever does:

First, sometimes it just comes down to chance. Some places just happen to have populations, like the elderly and those with underlying medical conditions, that are more vulnerable to Covid-19. Factors beyond an area’s immediate control, such as its population density and perhaps even its weather, can also contribute to the virus’s spread. Whether any given place experiences a super-spreading event, in which one or more individuals transmit the coronavirus to a disproportionate number of people, can partly come down to chance, too.

Second, early action did appear to prevent coronavirus cases. Even in states that are not suffering a high number of Covid-19 deaths, chances are those figures would be even lower if they — or if the country as a whole — had acted sooner. There’s good evidence for this in some states, but there’s also research of past pandemics to back it up.

“A hot spot is a reflection of the combination of the random nature of things — in terms of who gets hit harder earlier — and then the timing of what we call non-pharmaceutical interventions” such as social distancing, William Hanage, an epidemiologist at Harvard University, told me.

The key here is that states have direct control over one of these two factors. They can’t do much about luck. They have little ability to predict whether someone infected within their borders happens to spread the virus to a lot of people, and little control over their local weather or population density. But they can take swift, aggressive action to mitigate their chances of an outbreak — to limit the risk, for example, that someone becomes a super-spreader or that people are gathering in very dense crowds.

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They point out that luck does matter:

For example, the age and general health of a population can contribute to just how bad a major outbreak gets, with older and less healthy populations more likely to become seriously ill and die from Covid-19. Italy has suffered one of the deadliest coronavirus outbreaks in the world — with a death rate of more than 10 percent among confirmed cases — and one potential explanation for that is it has the second-oldest population in the world.

Cities, states, and countries could perhaps have taken some steps prior to Covid-19 to shield their more vulnerable residents from infectious disease — by, for example, providing better health care or elderly care services. But once the coronavirus hit, places had to deal with the realities on the ground.

There are other factors outside of any particular place’s immediate control, too.

Timing is a big one. If a place is among the first hit by a new disease outbreak, it’s going to have fewer examples to learn from in figuring out what to do. States now look to New York as an example of things going very wrong, but that was possible only because New York got hit hard before most of them. Whether a place is among the first hit is largely up to chance or, at least, variables largely outside of any government’s control.

Places with higher population density are likely more vulnerable to the spread of the coronavirus. Places that rely on packed public transportation are likely more vulnerable, too. It’s possible that colder weather can make the virus easier to spread, as is true with some other viruses. (New York City, perhaps not coincidentally, checks all of these boxes as the densest city in the US, with the highest rates of public transportation ridership, and relatively cold weather.)

Whether a place gets hit by a super-spreading event can also come down to chance. There are things that governments and members of the public can do to mitigate the chance of such an event, like trying to keep people at home, restricting travel, and stopping large gatherings.

But there are some things that are harder to control. Perhaps someone spreads a virus widely before she’s symptomatic and before it’s known that the community is having a problem with that virus. Maybe some people are just more infectious for reasons we don’t yet know. Some communities can have infected people travel to them at the wrong time, widely spreading a disease.

It’s kind of like rolling a die. A die can be loaded in all sorts of ways, which vary from place to place and time to time, to prevent a bad roll that leads to a massive outbreak. But there’s always a chance that the roll goes very, very wrong — maybe the one person in an otherwise well-behaved town who disobeys a stay-at-home order turns out to be highly infectious despite showing no symptoms, launching a super-spreading event.

With the coronavirus, there’s also a lot we don’t know, from exactly how and where the virus most often spreads to just how deadly Covid-19 truly is. There could be variables affecting coronavirus outbreaks that we don’t even know exist. That makes outbreaks of the virus less predictable, leaving more of the situation to chance than would otherwise be true.

Of course, governments can do a lot to prevent things from getting out of hand. Sadly, some of them are led by idiots.

While chance plays a role in any place becoming a hot spot, that doesn’t mean countries, states, and cities are powerless — far from it. Experts say that during a big outbreak, governments should do what can feel like an overreaction: The big goal is to prevent things from getting bad, so once policymakers are reacting to a bad outbreak, they’re already acting too slowly…

Consider the stories of California and New York. Despite reporting some of the first Covid-19 cases in the US, California has avoided a massive outbreak. Again, some of that could come down to chance or uncontrollable variables, such as New York City’s higher population density and use of public transit, or California’s generally warmer weather.

But one likely contributor is that California, particularly the San Francisco Bay Area, reacted quicker to the outbreak. The Bay Area issued the first shelter-in-place order in the US on March 16, and California issued a statewide stay-at-home order three days later — while New York didn’t impose its own mandate until March 22. Even before these orders, some parts of California seemed to adopt social distancing early: OpenTable data suggests that seated dining on March 1 was down just 2 percent in New York City, but 18 percent in San Francisco. (It was down by only 3 percent in Los Angeles, though, so not every city in California acted the same.)

The extra days and weeks may not seem like that much time. But when coronavirus cases and deaths can double every few days, that short time span is important. “It’s exponential,” Hanage said. “And if you’re too late with it, you’re making the problem much, much, much worse.”

This is, of course, because we now know that the virus can be spread by asymptomatic people. Without adequate testing that means it spreads before people are aware that its in your community. If they wait until people start showing up at the hospital it’s too late.

The experts all warn that that anyone who thinks they’ve escaped the pandemic and don’t need to bother preparing, should think again

“Even if you’re not rolling the dice now,” Hanage said, “you’re almost certainly going to be rolling them before this is over.”

The only answer is for the nation to continue social distancing as much as possible and building up the testing capacity and, hopefully, the development of a vaccine. The article goes on to explore just how massively we are failing.

It’s unbelievably depressing to realize that the country that sent a man to the moon and back is simply incompetent on every level. It means this will go on much, much longer and cause much, much more suffering than it should.

I think you all know why we are in this situation — our toxic right wing has ruined us. For too long we’ve accepted that American politics are a form of crude entertainment. This is where it’s gotten us.

Read the whole article if you get the chance. It’s vital that they get the testing regime going if we have any hope of coming out of this halfway intact. I wish I had more hope that this government is capable of leading such an effort.

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