They were.
No, they weren't. Key issue here is timely. Without any inside info I knew it will spread when I heard about the first case of Covid without an identified sick contact. Yet, later Trump shows up again saying it's fine, after mumbling about the virus miraculously disappearing by April. Right, he said some people hope, some people think, blah blah.
Closing traffic with China was the right measure; we found out later it wasn't really that closed, as close to 40K entered US from China since. After that it was denial and minimizing until shit really hit the fan.
The current measures will just slow the progression. Unfortunately the economy will suffer regardless, I feel for the people who have no choice because they are living from paycheck to paycheck. And now many lost their medical insurance because of the layoffs, and no, getting a Cobra coverage is too damn expensive when you are not payed.
There is another side of this less known. The hospitals in areas that are not yet that affected are bracing for impact by not doing any procedures, while the patients would rather stay home and not come to ER unless no choice. Sometimes this leads to delays in diagnosis/treatment that they cannot afford. In Michigan they are swamped in Detroit area but we have yet to get hit anywhere close to what they are, it will probably take another month or so to get there. We might not even get that bad because of the current distancing stuff.
A very nice review on timeliness of interventions, it's in the interpreter newsletter from New York Times. I cannot find it online but NYT said they are making free their Covid coverage (and I think the newsletter it's free anyway) so I will quote it here. It's from April 2nd.
The Lesson of Lodi and Bergamo: Timing, Timing, Timing, Timing, Timing
With the federal government often slow or reluctant to implement strict measures, much of the American response to the coronavirus outbreak is left to governors and mayors.
Their approaches have varied widely, especially on one metric for which the importance has not yet fully penetrated American discussion on the pandemic: timing.
Florida’s governor, for example, held back on issuing a statewide stay-at-home order until Wednesday, weeks into an outbreak in the state that has led to nearly 7,000 confirmed cases. Even that number, one of the country’s highest, does not include the many Spring Break visitors who are presumed to have carried the virus back to their home states.
At the other end of the spectrum, officials in Alaska canceled most public events on March 12, the same day as the state’s first confirmed case. Schools were closed the next day and restaurants and bars shortly thereafter, with a stay-at-home order issued on March 22. As of Wednesday, Alaska has 133 confirmed cases, one of the lowest counts in the country.
That variation could turn out to make a big difference in the trajectory of the virus. Because it is often set by state or municipal leaders, it is something that has greater room for local public and political involvement. And because outbreaks are only beginning to hit in much of the country, it is an issue in which there are still major decisions to be made.
All you have to do is look at South Korea, and at the story of two cities in northern Italy, to see how timing — especially by states and cities — can shape the fates of millions of Americans.
Is South Korea’s Success ‘Too Late’ to Reproduce?
Timing does not get as much discussion in the United States as testing or face masks.
But South Korean public health officials, when asked what lessons the world should take from their country’s stunning success at subduing the coronavirus, raised it again and again.
If you impose full emergency measures immediately, when the very first cases appear, then you have a shot at keeping outbreaks under control and fatalities low, they told us.
But if you wait for the outbreak to reach the level of an emergency before treating it like one, officials said, you are too late.
The reason for this has to do with two characteristics of the coronavirus: It spreads quickly, but makes itself known slowly. Uncontrolled, the number of infections can double every two or three days. But it takes up to two weeks, sometimes more, for an infection to be recognized as such, because of a long incubation period, initially mild symptoms and other factors. Over those two weeks, one case might become 50. One hundred might become 5,000.
Put another way, if you were a governor and data indicated that your state had only 100 cases, you might enact policy as if you had only 100 cases. But, at that moment, you might actually have 5,000 infected people, with 4,900 who are not yet visible, but, nonetheless, at risk of infecting others, of falling dangerously ill and of overwhelming your hospitals.
“Such characteristics of the virus render the traditional response, which emphasizes lockdown and isolation, ineffective,” Kim Gang-lip, South Korea’s vice health minister, said. “Once it arrives, the old way is not effective in stopping the disease from spreading.”
American and European officials and journalists have been keen to learn other lessons from the South Korean model, like the importance of testing and of wearing masks. But they can be reluctant in acknowledging that their countries have failed so severely at the timing component that it may be, according to Ki Mo-ran, an epidemiologist advising the government’s coronavirus response, “too late.”
But maybe it’s not too late for the meaningful, if shrinking, number of cities and states that have not yet been overwhelmed by the virus. Especially if they can learn from two Italian cases.
The Cautionary Tale of Lodi and Bergamo
Lodi and Bergamo, located barely 30 miles from each other in northern Italy, looked at first to be on near-identical trajectories.
Both are provinces the size of small cities (Italian provinces resemble American counties). Both were hit early; Lodi registered Italy’s first confirmed coronavirus infection on Feb. 21. And both saw infections steadily rise throughout late February and early March.
For those first two weeks of Italy’s epidemic, Lodi and Bergamo saw near-parallel infection rates. A few dozen confirmed cases, then a few hundred. In each, a handful of patients, mostly older, began to die.
Then, on March 8, Bergamo’s infections surged exponentially, doubling in just a few days, then doubling again. Hospitals became, according to health workers, like trenches in a war zone. Deaths became so numerous that the military was sent in to relieve overburdened morgues. It became Italy’s hardest-hit province and, for many, a symbol of the country’s trauma.
Lodi’s confirmed infections, which had been slightly higher than Bergamo’s throughout the crisis, meanwhile, began to level off. As infections soared the country, this small province, a short drive from Bergamo, saw its curve bend.
What happened on March 8? That was the day that Bergamo, like the entire Lombardy region, was put under a severe lockdown. But those measures did not overt what became a public health catastrophe.
The crucial moment had come two weeks earlier, on Feb. 23, according to a comprehensive study by a team of Oxford University epidemiologists and public health experts.
That was when, just two days after Italy’s first confirmed infection, Lodi imposed rules to mandate social distancing.
It was one of Italy’s earliest interventions to limit the spread of the coronavirus. And, for those first weeks, Lodi’s strict measures appeared to be entirely useless. Its cases were rising right along with Bergamo’s, and at moments, even faster. The burdens of social distancing looked unnecessary, even counterproductive.
What was little understood at that point, or at least poorly appreciated, was that two-week lag between when an infection occurred and when it was recorded.
Lodi’s measures might have begun working immediately, but infections that took place before Feb. 23 continued to emerge for two weeks afterward, making the policy look as if it had failed. It was not until March 8 that the apparent decline in new infections was reflected in the numbers.
In Bergamo, during those same two weeks, what looked like a few hundred cases had probably, by the time that the lockdown was imposed on March 8, already spiraled into thousands.
Jennifer Beam Dowd, the Oxford study’s lead author, wrote on Twitter that Lodi represented “real-world evidence of flattening the curve.”
It may help to think of coronavirus data as if looking at a faraway star. When you see a star in the sky, you’re not actually seeing the star as it is. Rather, you’re seeing the star as it was perhaps thousands of years ago, because it took that long for the light to travel from that star to your eye.
Coronavirus data can be like that. Because of the two-week lag, we were often looking at — and making policy based on — data that reflected how the outbreak looked two weeks ago.
Lodi’s lesson was that it saved itself from a much worse fate by acting early. Not just early in the sense of being proactive, but in a way that appeared foolish, even absurd at the time. By the time Lodi recorded a single-digit number of confirmed cases, its outbreak was already well underway. By treating those first handful of infections like a provincewide epidemic, Lodi responded as if it were two weeks ahead of where the curve appeared to be — which it probably, in reality, was.
Bergamo’s lesson, or one of what are surely many lessons to learn from its catastrophe, is that waiting for an emergency to appear before responding means you are too late.
Lodi and Bergamo are worth keeping in mind as you watch how American mayors and governors respond to the very first cases in their cities and states.
Are they choosing to be Lodi, and to look foolishly overreactive for two weeks and then, by the third or fourth, like saviors? Or are they choosing to be Bergamo?
