15 March 2020

Covid-19: How We Should React and Are

I really stepped in it last week. I started trying to talk sense to people on FB about the coronavirus right as the panic was getting really revved up. I know better than to do these things. It was a moment of stupidity and I regret it. I walked away from it over there, but late in the argument the brighter of those arguing pro-panic actually hit upon something that made superficial sense: a basic chart of logical progression of a communicable disease with and without steps taken to mitigate its spread. They used it to justify the semi-quarantine behavior which has now been imposed by various universities, sports organizations, and governors around the country.

----- THE MODEL -----

If I make my hand-drawn graphics bad enough no one will steal them.

There are a number of these depending on how you want to skew the chart:

What do these varying charts tell us? That while the basic chart is valid and could be applied across the board to anything from the common cold to the bubonic plague, nobody has figures on coronavirus. Therefore, they can fill it in with whatever fantasy figures they want to.

Particularly of interest is the placement of the inelastic medical capacity line. Almost all the graphs I've seen arbitrarily place it above the level of the interdicted course of the disease and much lower than the spike in the natural course. Neither of these are necessarily true. It could be higher than the spike. As well, as is somewhat demonstrated from the last chart, both interdicted and natural course progression of the disease's spread could be above inelastic medical capacity and it's possible that we would be replacing a quick hit with a drawn out beating and suffer approximately the same number of deaths. Remember, the point of interdiction, per this chart if not in our hind brains, is not that we keep people from catching a highly communicable disease - it's to slow the rate of infection and make the course of the infection through the community take longer in order to  allow our near term inelastic medical capacity to deal with it better. Wishing it so does not make it so and without actual numbers to make any of the lines on the chart adapted to the reality of a particular disease we are in the wishing it so zone and have no proof that the imposed interdictions will lead to a total reduced mortality number.

Another point of interest is level and length of quarantine needed to make the curve drop. A number of sports events have been cancelled and schools closed; most of this is short term theater dealing with the perception of risk rather than the reality. In fact, if this is a persistent virus (one that we'll deal with over a period of years) the closing of schools is idiocy as the risk to those under the age of 40 appears to be minimal. This is the lesson we should have learned as far back as polio.1 Catch it young and you're immune when you get older; both you and society are better for it.2

And, assuming the fearmongers are right, it will be persistent. We do not exist in a closed world. China has the disease under control now, but remains on lock down because if it opens its borders the disease will come back from other parts of the world and it still has a huge number of people who have avoided exposure. The same will apply in the US.

Imagine (because that's all we are doing at the moment) a disease that does persist through the Summer or that we realize will come back with a vengeance with the onset of colder weather. Are Harvard, Yale, and Local U. going to close their physical campuses for the foreseeable future (Congratulations, you've been accepted to Harvard. After you pay us a gazillion dollars for tuition, you will now sit in your bedroom and log in to Harvard's streaming lectures on YouTube3). And multi-billionaires with large portions of their fortunes tied up in sports industries are going to say the right words and let their investments bleed millions upon millions of dollars a week for only so long. As well, Americans aren't exactly the most patient of people. Even the media hyping up things can only keep them engaged and fearful for so long. Unless they see the bad they will eventually start ignoring the hype (become inoculated if you will). They're not short term dumb. They can figure out that exposure is just as likely at their local grocery store which is full of people shopping while they constantly pick up and put down items (and other similar activities in their lives). If they don't see the disease spreading around them while locals are engaging in these activities all the warnings in the world about long term potential projections are going to wear thin. Unless the disease becomes much more prevalent, schools and sports are going to open back up with many promises of medical safety and people will go. We're not a totalitarian country. This is almost impossible to prevent and almost assuredly will happen much sooner than the model would state is appropriate. Remember, in order for the model to work there must be a long term interdiction.

Here's the model adjusted for this pattern of behavior:
Keep in mind, I don't have any numbers to work with any more than anybody else does. I don't know how high or long natural course would run. I don't know how long controlled interdiction would take for best effect. I don't know how big the spike would be once control is lost, although it would obviously have some tie to how late it was in the interdiction (because of the number of people left who could be infected). The thing is, I've not seen anything out there that indicates anyone else has the numbers either. Anyone who wants to can fool with the numbers in this model just like they could in the ones above to make it look the best for whatever their position is.


Unless we see significant numbers of hospitalizations (which should happen under either natural course or controlled interdiction because we are early in this disease's course in the US) sometime between the end of March and the middle of April the semi-quarantine behavior will start to fray if not outright breakdown. This turn away from the semi-quarantine could be held off a bit if widespread testing indicates the disease is present in a large way and the media hypes the numbers (the media really, really, badly wants those numbers to splash across your screen). However, if the disease has too large a geographical and population spread to actually quarantine and our hospitals are not being overwhelmed that won't keep the populace and businesses at bay for long. If it doesn't show much of a footprint at all the semi-quarantine will crack even faster.4

Will there be large enough infection reports and large enough hospitalization numbers to forestall the public and billionaires losing money hand over fist? I don't know. Nobody does. The things we're dealing with here are fear and faith: knee-jerk, we're all going to die fear and if we undertake this holy discipline we will all be saved faith. And neither of these things is of necessity in this situation wrong or right.

One thing's certain, if this disease is as highly contagious and resistant to Summer months as is being suggested, two weeks or a month or even a couple or three months is not going to stop it. There will still be large swaths of our population that have not been exposed when the semi-quarantine lifts, or more likely is forced open. If the disease is highly contagious this should at the very least lead to the broken control spike shown above and, if it shifts locations, a brand new natural course spike.

The models above probably only work up to the city or county level; they do not work well for an entire State, much less the entire U.S. The correlation between a Covid-19 outbreak in the Seattle-Tacoma area and the possibility of one in the Oroville-Osoyoos area (Washington-Canadian border) could be quite small; it would almost surely be non-existent with the Princeton-Bluefield area of West Virginia. The model breaks down when the area considered is not closely interconnected enough for significant cross-ties such that the virus can spread.

Even if we stomped it out completely within our borders, we do not live in the closed system imagined in models such as those above. Other nations will be going through their flare ups and we are internationally too connected commercially and too many people believe with their hearts, souls, and pocketbooks that our borders should be open to all, to keep it out. Once the semi-quarantine lifts and travel from other nations resumes, a highly contagious disease need only be carried to a couple areas that have not previously had outbreaks and we're right back where we are now.

 ----- CORONAVIRUS -----

Covid-19 isn't our first go around with a coronavirus. Previously, the world has dealt with SARS and MERS (at least these are the ones that have made a big enough media splash that I know of them). They are all cross-over diseases from bats although they can travel through other animals to get to us. SARS was found in a number of creatures although the identified culprit - at least initially - was masked palm civets sold for food. The only secondary animal MERS has been identified as coming from is camels. I don't think they've found the animal through which Covid-19 transferred.


As best I can tell, in its prior incarnations spread of coronavirus has been primarily nodal and spread in large part by health care professionals who were infected without realizing it. Medical professionals in the U.S. being previously alerted to the current virus should not pose this risk, but it stands to reason that a place of higher risk - particularly for those in high risk, medically vulnerable categories - is actually a doctor's office or hospital.5 If Covid-19 is a real threat, visits to medical centers for non-important reasons are contra-indicted. If grandma has to go to the doctor or hospital and it's not an emergency,  (1) waiting in the car until she can go directly to whatever room she's going to be examined in is better than being in a waiting room with a group of people who might be contagious; you can do the paperwork in the room.  (2) Health care professionals (and this means everyone in the office including the person whose sole job is to do the paperwork) should be wearing a mask that covers their nose and mouth when they enter the room. Remember you wearing a mask is of limited use to you (you can still catch the disease by touching your face); the masks stops particulates from passing from the wearer into the air around him and this is what you need to be concerned about.  (3) The first thing the medical professional should do upon entering the room is wash his hands with soap (preferable) or at least use hand sanitizer before touching you or anything else in the room. The EMT's, nurses, check in/paperwork  staff, medical technicians, and doctors you're dealing aren't taking these steps? Unless you are visiting your dietician or psychiatrist, they are passing up steps to insure your safety because they are a pain in the rear, off-putting, and may put a dent in profit flow. When will you know the medical profession as a whole considers this a real and imminent threat, not just a contingent, theoretical threat? When the vast majority of medical professionals start taking steps similar to the ones listed above and start making you sign a sheet saying they did so (to satisfy their insurance provider6).

Mind you, this wouldn't all be on the medical folks. People aren't taking this seriously unless they  (1) don't touch their faces while at the doctor's office or anything else unless they absolutely have to,  (2) in the parking lot before they touch their car clean their hands with sanitizer, and  (3) when they get home immediately get out of their clothes and immediately wash those clothes with soapy water, and at the very least rewash their hands and face with actual soap. The same process should apply if you go anywhere where many people have been or are: the grocery, a restaurant, the bank, the gas station, etc. If you've touched it, leaned on it, sat on it, etc., you must assume other people have too and some of them are contagious. Viruses survive on items for hours and can transfer to your clothes - not just your hands. Medical facilities may be an obvious danger, but others are substantial as well.

What? You're not doing those things? You're not hunkering down at home during the semi-quarantine getting groceries delivered or at least ordering them online or by phone and going to pick them up at your grocer's drive-up service?8 The steps I outline above are patently ridiculous on their face? Please tell me again how much you believe in this terribly, terribly contagious disease.


 The current reactions and patterns of behavior are a panic reaction at worst and an attempted reset at best. Defending against coronaviruses requires nodal tracing and actual quarantines. The fact that we've pushed the button on semi-quarantine and relying on the models above says that our medical establishment, at the very least, is perceived to have failed in its duty to stop this disease so that it has to run its course. I'm not certain that it's true the disease has slipped all containment, but that's really kind of irrelevant since we've already pushed the button.

Here's the model for defending against this disease.9  Remember the Covid-19 has up to a two week period from infection to the appearance of symptoms.

(A)  You start tracing backward from known cases toward the first case. I think cheesy novels and movies would call this person Patient Zero. Although it's more than likely there is more than one source who brought the disease to the US, "Patient Zero" should be traced if possible in the locale of each outbreak. As you move backwards, you also move forward from each person identified to check for further infection. Of course, as you go you involuntarily quarantine each person identified until they are clearly non-contagious.

But, what if the disease has spread beyond 20 people or 100 or 1,000 or . . .

(B)  At a certain point (I'm not sure exactly when), you engage in non-voluntary geographical quarantine. It may be a street. It may be a neighborhood. It may be a section of a city. It may be an entire city. You lock it down. If medically possible, you can allow people to leave through check points where they are checked for the disease and if they are negative have them strip, shower, and hand them new clothes to walk out certified disease free. Nobody goes back in except medical personnel, food trucks, and appropriate escorts. After two months you raise the quarantine unless the doctors tell you it is still spreading in the zone.

Yes, I see the multitude of problems with that just like you do. The larger the quarantined area the more of them present themselves and the less likely that a full on quarantine may be entirely effective. However, the perfect cannot be the enemy of the good and if the disease is highly communicable and has a high mortality rate this may have to happen in order to control the disease enough that you can go back to relying on (A).  It's essential that (A) be effective.

(C)  Put in its best light, the current reaction is an attempt at (B) through voluntary means and we'll have to see how effective it is. Governors keep adding more restrictions which are being accepted for the nonce despite the fact that they may not be within the various governors' powers in their particular States. It's only a matter of time before small and large businesses that are edging toward bankruptcy start resisting. If you're a bar owner in Cincinnati10 and no or few cases are reported in your city before the end of March, you're going to want to open your business back up. Your customers, likewise having seen no or few cases and being Cincinnatians (who believe in two things: BEER and the Catholic Church - leaning more toward the beer), are going to want you to be open (the return of the speakeasy). The Cincinnati Reds and FC Cincinnati aren't going to be eager to keep losing millions because they're closed either. They and their leagues are likely to start fighting back legally. This dynamic is going to start repeating everywhere in large parts of the country where big outbreaks have not occurred. Assuming - as the people pushing the current reactions seem to be doing - that the disease has slipped all possible containment and adding the additional assumption that people will actually spend the next few weeks isolating themselves voluntarily at home (unlikely,11 but let's run with it), the next few weeks will allow the majority of people with the disease to present with symptoms without spreading the infection as much and be removed from the equation (quarantined). Medical professionals can go back to using (A) to root out the disease.

(A) and (B) are a rational way to handle this situation that concentrates effort where outbreaks are actually occurring.  (C) is a broad approach which damages a lot of things outside the areas that are exposed. It also engenders a lack of belief. People in large parts of this country where there is no, or very limited, outbreak are being trained. I'm already seeing and hearing "Why are we doing this? There's nobody near here that's got it." and seeing people who intellectually agree with (C) continue to do all the same things they would have at stores and restaurants anyway. And this is with us on what, day two or three? Imagine a week without anything happening where I'm at when the initial panic has worn well off. We need to refocus on rationally handling this situation.

----- THE HOPE -----

Remember SARS, Covid-19's more contagious and much more deadly big brother, died off by Summer in 2003. Of course, that's not a guarantee the Covid-19 will. MERS seems to keep going through Summer. However, the background of COVID-19 at least seems superficially more like SARS. I don't know what the probability percentage is, but there seems to be a good chance that the natural barrier of Sun, heat, and fresh Summer air will come to our rescue.

If the Summer kills it off, the newly announced vaccine testing will prove fruitless as they are saying it will take 18 months before the earliest vaccines for the public could be available. Assuming this disease presents the threat we are assuming it is, somebody needs to explain the word "expedite" to the FDA and whatever pharma is creating this.

----- IN SUMMARY -----

Try to remain calm and rational in your behavior. Push those who are making decisions for us all to act rationally as well. Know where your towel is.


1  Way back in the stone ages, I wrote a paper on polio in High School. As I remember it, the disease existed from time immemorial, but only became a problem when improved hygiene stopped kids from catching it. Kids would just shake it off; the older you got the more devastating the results could and were likely to be. And a quick check of that paragon of medical knowledge, Wikipedia, seems to confirm it's still the dominant theory; I'd look on WebMD, but I'm pretty sure all it would tell me is that I've got cancer even if I just asked about the history of polio. Anyway, as best I can tell, we should be bathing our kids in water filled with every bacteria and virus we can cram into it. They'd shake off all the diseases and grow up to be Kryptonians. I AM NOT A DOCTOR AND THAT IS NOT MEDICAL ADVICE. I am a lawyer and that's why I'm paranoid enough that I included a disclaimer over something I wouldn't expect any sane parent to do.

2  Yes, I realize it is not viable to tell parents that they should expose their kids to the latest panic disease for the greater good. Nobody wants their darling to be the 1 in 100,000 who actually suffers so that society will flourish down the road. And God help you if you were the school administrator who spoke the truth about the matter. At the very least you will get clubbed over the head with your words. Job loss and law suits follow. Few people are willing to sacrifice themselves for a long term demonstrable good.

3  Of course, Harvard would overpay some pretentiously named company ("Ivy League Connections", or the same name but in Latin or Greek) to accomplish what YT streaming could do cheaply and efficiently. I wish I'd have had the foresight to see this panic coming; I'd have sunk all my money into one of these companies and be a multi-millionaire by mid-summer.

4  And let's be honest, I'm a "social distancer" by nature, but I had to meet someone at a restaurant this weekend (for business, most of the menu there is currently of limits) and it was packed: parents, kids, old-timers, everybody. I went to two grocery stores to pick up my groceries this weekend (went to the wrong one first) and both of them had normal looking customer levels - and so did the other stores in the shopping centers. People are already ignoring the semi-quarantines or treating them as vacations more than anything else.

5  Been to a hospital lately? I've been twice in the last three months: once through the emergency room which led to an over night observation room and the return was for the (never to be adequately damned) chemical stress test. If a patient came in with a highly communicable disease and it wasn't quickly identified everybody in that place would be exposed in maybe a day - two at the outside. Sure, I'm certain they have protocols for dealing with identified communicable patients, but what happens when little Bobby comes in with a broken arm and is sniffling and crying the entire time it's dealt with? Three days later his parents bring him back and it turns out the sniffling was at least partially caused by a highly contagious, by bodily fluid, new form of yellow fever (THIS DOES NOT EXIST AND TO THE BEST OF MY KNOWLEDGE IS ENTIRELY A CREATION OF MY IMAGINATION - so don't freak out6). Even if the doctors and nurses who dealt with Bobby on day one washed their hands immediately after, how many surfaces did Bobby touch? How many surfaces and pieces of equipment did nurses, technicians, and doctors who touched Bobby touch? Then there's Bobby's parents who are almost surely infected as well and went to the cafeteria everybody in the hospital uses, to the gift shop, and to the administrative offices to sign a promissory note giving Acme Medical (Your Friendly Medical Monopoly) title to everything they and their progeny will ever own. It'd be a miracle if that disease didn't spread through the hospital.

6  Yeah, a footnote inside a footnote. Live with the meta-ness. The Army gave me all sorts of shots, but there are three that stick in my memory. The GG shot was the Army's go to for stopping any infection ahead of time, given out en masse pre-deployment to overseas. It left a lump that was a nuisance for a couple days right where I sat down. Mine wasn't as bad as others. I was well down the line and mine had been out of the fridge long enough to warm up. Those who got them earlier got cold shots (the Army cared about effectiveness, not your comfort) and complained a lot more about them going in, staying hard, and hurting. 

I also got the first of the three shot Bubonic Plague series. It burnt some for a day and I was told I'd get the other two shots in Egypt after deployment. When I went to the medics there, they looked at me like I was stoned and told me they didn't even know such a thing existed and definitely didn't have any. I do not know if getting one shot without the others gave me some immunity to the Plague and I have no interest in finding out. Absolutely none. No, I will not be your test bunny.

HOWEVER, the shot that sticks out most in my mind is the Yellow Fever shot they gave me. It's a live, weakened virus and I got it in the morning. By about eight that night I was on my bed with three blankets wrapped around me convinced the Army had killed me. The next morning I woke up hale and healthy, but that night I was pretty sure I saw some guy in black with a scythe.

7  With the level of alarm currently being expressed by the media and public, there is no way that medical professionals and facilities can claim a lack of notice that their normal operational procedures are inadequate even if they track with industry standards. If someone comes to a doctor's office or a hospital and within the next two weeks gets Covid-19 that facility had best have taken demonstrable steps in the knowledge of potential viral contamination on site. Otherwise there's going to be an interesting couple of years in litigation. Insurance companies know this and I'd bet they are already covering their bets by demanding requesting demonstrable changes in patient interactions. (of course, all this is dependent upon laws which the companies have gotten passed to protect their bottom line make sure their clients are protected from frivolous law suits)

8  This is an amazing service which locally both Krogers and Food City do. I discovered this when I first started having medical problems and was concerned with the idea of walking around a grocery store shopping. Now, I'm a believer. I take ten minutes to place an order before work and on the way home I pick it up on schedule. They bring it out and load it up. It saves me lots of time and I'm pretty sure money - despite the five dollar charge. If I went in, I'd make impulse buys of more than $5 and often enough they waive the fee if there's been any inconvenience.

9  Yes, this model will be very basic. I'm not trying to talk about the intricacies involved. I'm trying to lay out what needs to be done in broad strokes.

10  No reported cases as of 14 October 2019.

11 Dear Diary:
Day One: Stayed at home. No sports except cricket and bowling. Watched some bowling. Cricket's weird.
Day Two: Cleaned garage. Maggie and I worked on giving Little Janie a brother. Twice. :-)
Day Three: Watched reruns. Tried once more for the little brother. Helped Maggie cook supper.
Day Four: Little Janie was a terror today and Maggie wasn't interested in another try. When I offered to help with supper again, she gave me the look and announced to me and Janie that we were going out to eat at Garbinis. The place was packed and I was so glad to get out of that house.
. . . . .
Day Seven: It is so great getting this free vacation. I've been hitting all the stores I can never get to because of work and the guys and I took a round on the course this morning. Paul shot a +1 and was mad about it.

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