It seems regions that had more than 100 cases during 2002 SARS outbreak are also among those doing better this time fighting the "SARS version 2". I guess the SARS experiences might have acted as antigens to national healthcare systems of those regions, induced they to be more vigilant to specific signs of viral pneumonia and react more rapidly and aggressively once the signs emerged.

Sadly I also think this acquired immunity will wear out in just one or two generations. There is few alive people now who experienced the 1918 influenza pandemic. Our knowledge may remember all the pandemics in a rational way, our society has long forgotten how to react rationally.

@Silvia I'm feeling greatly saddened that my country, Finland, seems to be fighting against admitting the necessity of extreme actions to fight the virus. This attitude stems mostly from the political apparatus, but also the health officials which seem to be at complete denial. At this rate I would start to feel happy if only couple dozen thousand die as a result. :(

They're still quibbling on necessity of closing schools, maybe reaching a decision by midweek. The situation is only couple days behind most of Europe, and most of Europe has closed schools by now, most going to more extreme social distancing measures already.

Thankfully my employer kept an exercise on working from home and decided yesterday that people should do remote work for the rest of the month by default.

@kirma reddit.com/r/polandball/comments/2p30rl/personal_space it shouldn''t be a problem stopping the virus for finland

@Alucard With luck, it would work if schools would be closed. Without that, not really. Helsinki was pretty much deserted last night as most Finns do comprehend what it means when the government suggests to avoid all non-essential travel, socializing (yep, accepted social distance might help) and activities outside home. Unfortunately enforcing regulations and closure of schools is still something left to the future.

@Alucard I suspect the high mortality of the elderly is largely caused by social structure in the country - large portion of people tend to meet their older relatives all the time. Not so here...

The biggest difference between countries' responses seems to be because of two things: 1) How affected the countries have been by the virus - countries do not want to take measures too early, and 2) how authoritarian a country is. More authoritarian countries tend to take more politically motivated actions that may look good but there is no scientific basis for their efficacy. We see the latter effect both in comparison between Europe and Asia, but also in comparing European countries.

Unfortunately authoritarian action in this case is likely to be the right one...

And some sort of denial on the efficiency of extreme measures can sabotage the whole project (I'm mostly thinking of countries still keeping their schools open).

@kirma Closing down schools is a controversial policy that experts do not know will actually help. First of all, closing down schools may make parents who have to keep working rely on the children's at-great-risk grandparents for watching them. Second, in order to have an effect, the school closure would have to last for months. Experts are not sure that kids and teenagers will self-isolate for months even while feeling good, so the disease might spread through them anyway.

i think the high mortality we are witnessing depends on a combination of ageing population, wealth and unreported mild cases. In 2017 29.4% of the population of Italy was over 60 years old, and it is projected to increase to 40.3% by the year 2050.[32] The life expectancy at birth in 2010–2015 is projected to be 85 years for females and 80 years for males.[32] that's why here the mortality has reached the7%-8%

@Alucard Italy is also in a situation where the healthcare system is overwhelmed, which means that people may be dying that wouldn't have died if there were enough ventilators etc.

@C.E. That may be true, but at the same time... the health officials (pretty likely to please politicians) have been giving a series of catastrophically wrong advice on the coronavirus over past month. Basically every statement they have made has turned out to be either hopeful thinking or even worse. People are really starting to feel that politicians and officials are actually preventing them from implementing effective social distancing necessary...

ah yes they issued guidelines : in case of lack of ventilators they will pick whoever has the highest chance to survive. i think we have 5k bed in intensive care, nowhere near enough.

@C.E. That could have been avoided by slowing the spread with aggressive social distancing measures from the start.

Even delaying enough that researchers figure out what existing medications work best on serious cases would help a lot. Also, availability of protective accessories for healthcare would be better on slower spread. So, lockdown wouldn't necessarily need to last like three months to dramatically reduce number of deaths.

@kirma yep, in the early stages we had so called experts telling people that the flu killed more people and there was no need to panic...ofc people understimated the menace

in their defense i think the message was not understood : when a 60 year old hear that the new virus is not as bad as the flu he thinks that since the last time he got the flu was during the fall of the berlin's wall he will not get the new strain or that he will barely feel it, he definetly does not realize what are the effect on people already ill

@kirma Still, the actions that we take should not just look good, they should actually work.

@C.E. It is true, but when effective action is actually shown to work on some location, why deny its efficacy?

For instance, take the closing of the borders in Denmark. I don't know any expert here in Sweden that thinks that actually works.

Even their own experts have questioned it publicly.

@kirma What action are we talking about? School closings? Where has it been shown to work?

Well, school closings were definitely part of more extensive policies in China, for example.

They could at least suggest that in countries where schooling can be done remotely and parents can do work from home they would choose that.

@kirma That was in combination with curfews, cordon sanitaire's covering entire cities, etc. You can't just point to China and say, "see? It works to close down schools."

@kirma There are lots of parents that cannot work from home because it's not possible for their line of work.

Yes, but frankly I have to say that officials have been here the biggest preventing factor for reducing the spread of the virus. Time after time they try to belittle it, probably because otherwise it would expose the fact they haven't done their work competently.

It's easy to do your job when the world does it for you and no trouble is to be seen. Just don't make the mistake of thinking that's all the responsibility you have if you're, for instance, a high public health official.

@kirma Our governement agency enjoys a very high level of trust, as do most Swedish government agencies, and they're helped on by a more or less united front of Swedish independent experts. The agency itself is also protected by law against political influence.

There is a general feeling right now, I think, that we are doing that right thing and that our leadership will keep on doing that. That allows that government to take just the decisions that the experts recommend. They don't have to contend with the armchair epidemiologists or do things just to quell people's anxiety.

I think measures like massive quarantine may turn out not be the best or the only choice. There should well be different ways to make this right at different regions. For example Singapore has done differently than China, and they are doing great currently. The important thing here is if a healthcare system had the chance to develop a battle-tested strategy or not, before this outbreak.

@C.E. Well, I hope the best for Sweden. The Finnish counterpart seems to have shown utter incompetence in providing expertise in the case, which is probably the most important one during its existence.

They did actively push the "regular flu kills more" agenda for quite a while.

About the disease, for majority it's not deadly as say plague at all. Public should not panic on that point. But it's neither as mild as flu. Many people infected will need healthcare or be hospitalized. The bad thing comes from its extremely high contiguous part. This high contagion will, in such a short time, put so many people into a situation requiring professional healthcare. The request per day is so high that no healthcare system on earth is able to handle.

As I said before, this is a DDoS to our h/c system. People are turning into rain of bullet shooting to our own h/c system.

@kirma Yes, I was actually going to say that we can only say whether the leadership was actually good after the fact. In 2015, a high trust in the government allowed it to receive a huge number of refugees. At the time, the government had a lot of support for this, but in hindsight there are very few that want to return to the policies of those days. It's too early to say how our response to the coronavirus will be considered in the future, looking back.

But there is worse thing. Taking N95 medical mask for example. As a highly contagious disease, medical staffs at the frontline will need strong protection, including N95 respirators. But normal N95 can only provide ~4hr protection, this creates a extremely high consuming demand.

However, according to this video - it's in Chinese but has English subtitle, China produces 2.7 billion medical level masks per YEAR, but to maintain the basic function of our society during this epidemic, the consuming demand is 238 million per DAY. So all masks produced in one year can only provide 11 days.

Protection equipments will quickly run out. After that, we have seen massive infection among medical staffs. At this stage, our h/c system is not just saturated, but crippled, even at the edge of collapse. Now remember China produces half of the masks in the world, so this pandemic will be a really tough war for any h/c system in the world.

@C.E. The unfortunate part is that the pandemic is can be the biggest single killer since the second world war. Yet, especially politicians liked to take "can't happen here" attitude, just because it conflicted with their agenda.

@Silvia I don't know of N95 masks (I do have some equivalent FFP2 masks though), but surgical masks are appearing on local Chinese community lists at very reasonable price.

I wonder where they come from, they have been out everywhere for quite a while.

N95 is the standard in US, which I remember lies between EU's FFP2 and FFP3.

@kirma I'm not sure. I don't have N95 or FFP2 level masks. But the production amount has increased quite a lot in China since past month.

Mask is just one aspect. H/c equipments used in ICU will also be in shortage. We all have seen what a sad and difficult decision Italy has made...

The thing is no country has prepared for this. Nor will any be prepared. Because a pandemic happens so rare, people will think it's not worth it.

Some may be more unprepared than others, though. :(

To cope a pandemic, a h/c system's redundant capacity will need to increase exponentially against the growth rate.

It's just not possible.

Contrary to the WHO recommendations, Finland has essentially stopped testing, only cases needing hospitalization are tested. The number of reported cases dropped to 25% of cases yesterday. These numbers become worthless...

Measures to flatten the curve may be less expensive than being constantly prepared for a once-in-a-generation pandemic. The problem is that there is a lot of anxiety because it remains to be seen if the countries that have not yet been overwhelmed will be. People are afraid that what's happened in China and Italy will also happen where they live.

But I don't think we can tell for sure that we were underprepared until the healthcare system in question has actually been overwhelmed.

How it went in China is actually an encouraging example, not something to be taken for granted.

I'm not in a position to judge measures of other governments. What our gov did is scary and hurting. I don't know if there is a better way for us. But I can see Taiwan and Singapore have been doing quite well.

@C.E. I think governments need to take response to educate people how as a united community should we react rationally. To Flatten the curve will need actual action from all the people.

It's not measures forced by authorities, but should be come from people's real feel and need. Everyone should understand what to do and why.

@Silvia Surely, but authorities can also help it actually happen. Just saying "live completely differently than before, figure out how to negotiate this change with everybody else" is not going to be particularly effective.

well, we'll see. That is what I really want to see. In less authoritarian countries it's very hard to tell people that they must do something. It mostly stops at making recommendations and then hoping that people will follow them. Will this work? I don't know. For sure, we cannot, as you say Kirma, take it for granted.

@kirma I think that is not enough as a proper education. Say on youtube we can see some medical experts explain scientific details about the virus, the disease and the epidemiology. This should be supported officially by authorities.

@C.E. It's like a centralized system V.S. a distributed decentralized system. I really believe there are lots of right ways for each of them.

Anyway, stay safe everybody. The war might not be end until we have vaccine.

@Silvia yes, it's not easy. We in uncharted territory. Stay safe.

@kirma It's sunny here in Germany and I'm told beer gardens were full yesterday. There's actually plenty of space to go out and still avoid people where I live. The city is spread out. But people still socialize.

Though not being German I do not fully understand the situation, it is claimed that the federal government doesn't have the authority to do much. Then it is up for everyone to be responsible but of course if people don't feel the immediate danger then they won't do much.

@Szabolcs People were told to avoid public gatherings here. City centre has maybe one third of people on the move in comparison to normal. But what now? People flock to nearby national nature reserves, and now officials have to tell them to avoid that.

They could go to just a random forest a little further away, but most city-dwellers wouldn't have an idea where to go.

I suppose everybody just felt it's a great way to go out without getting exposed...

Those national nature reserves (or at least nearby parking areas) tend to be completely filled during summertime, but now it's couple degrees above zero...

In case of misunderstanding I'm not a supporter of centralized system because of its possibility of single-point failure. I really would like to see alternative solutions to this challenge. It would be sad if people turn to certain architecture only because of once-in-a-century pandemic. It will feel like walking in a desert wearing a raincoat just in case of rain.

A good centralized system will require a wise central unit, while a good distributed system will require a majority of wise member units. I'd say none of them are easy.

@Silvia I understand your point. A system that works and is reliable at delivering positive results is a good goal whatever way it's achieved. Sadly it's also possible that the only power structure that has powers to initiate change thinks that it would get less blame through inaction than decisive action although action would be a necessity.

@kirma @Silvia Eastern European countries are democracies. Yet almost all of them have reacted much more quickly and much more decisively than Western ones. All of these countries have much fewer cases than in the West, yet they restricted borders earlier, started to require quarantine for incoming people earlier, closed schools earlier, closed restaurants earlier, etc.

At least in Romania, some of this was done out of fear that the healthcare system couldn't cope (and also because of a large number of people returning from Italy). But it doesn't matter how advanced your healthcare system is if you do nothing to break the exponential growth. It'll be just a few days difference in when it gets overwhelmed.

It could be that people who never lived through a real crisis just develop a false sense of security and fail to see the inevitable coming.

@Szabolcs None of the actions that you mention are recommended by Swedish experts, for Sweden, on basis that they are not effective or they have side effects that are worse than the benefits. I strongly disagree with the idea that this comes down to complacency. We will see how it unfolds, but we must remember that it’s not about the number of measures you take or how early, it’s about taking the right measures at the right time.

@Szabolcs That is what I fear to be happening in Finland. Nobody wants to act, and nobody wants to take the responsibility. The government says that public health officials (which are either incompetent or want to maintain good relations with politicians) define the actions, and public health officials demand no actions as they hear politicians being indecisive and unwilling to act. It's a nightmare.

It's exactly what one shouldn't be doing according to this British Ebola guy from WHO.

the calm before the storm. guys if you like reading more on deadly virus try "the hot zone" (they made a tv series of this one) and "virus hunter". you will realize how lucky we are that this virus has such a low mortality rate and how many more are out there ready to jump from direct contact to airborne

The most amazing part about this indecisiveness is that it's actually starkly against both WHO and ECDC guidelines.

We should have just listened five years ago

@C.E. Four days ago the German health minister said that closing borders is useless, therefore they will not do it. Now they are doing it. (The neighbouring countries not mentioned in the article have already closed them earlier.)

> it’s about taking the right measures at the right time.

I'll put the headline picture here:

@Szabolcs So what was it that changed in the last four days, the science or the political situation? I know that their neighbors are doing it, in fact I noted previously in this chat that Denmark did it despite their own disease control agency saying it does not work.

@Szabolcs It's only exponential once it's community spread. The first cases of community spread coronavirus in Sweden were discovered this week, at which time Sweden immediately enacted social distancing policies. But to do it earlier than that only serves to hurt the economy, it is more economically efficient to trace those who have been in contact with an infected person and ask those to self-quarantine.

The picture compares the situation of no social distancing, and social distancing. We all agree that social distancing is necessary. However, what about specific measures? Such as closing borders and closing schools? What we need are graphs that show what will happen with or without such specific actions.

@C.E. Have you seen the exponential growth video of 3Blue1Brown?

Many basic things but at some points he is talking about the behavior when you have separated social groups.

@halirutan The point there seems to be that even a little travel means that the outcome is not very different from having just one group. I think that’s basically our situation because each country already has some infections?

@C.E. I just watched it once (with the kids nearby) but I believe the point was that even when you have separate social groups that mix elements at a different rate, the growth is exponential but with a different rate.

Which is basically what all lockdown measures are hoped to do: change the rate.

For me, the best part of the video is the final statement:

> If people are sufficiently worried, there’s much less to worry about, but if no one is worried, that’s when you should worry.

His main point, I’m pretty sure, is that you can think of each group as an individual and apply the same math that applies to individuals to groups, i.e. the number of infected groups will grow exponentially, the growth rate will depend on the number of infected in each group. This rapidly leads to all groups becoming infected even with a minimal amount if travel.

But yes, that last quote is good. This is a very serious situation and we must take it very seriously.

@C.E. Yes, but the rate will be different. What I'd be really interested in is how a half-decent global model for the situation would look like. Is it like predicting the weather or can it be a bit more precise..

There is a lot that could have been done even before community spread started (not to speak discovered, which is much later), such as enacting border controls and filtering out people coming from infected areas. But they refused to.

Taiwan did that and managed to keep things under control so far.