Thoughts

Inside China’s All-Out War on the Coronavirus

A lot of the times I see people saying:

  • Death rate is only 2%, it’s almost just a severe flu. Panic is the real problem here.
  • Looks like people are not dying much in Korea, so I guess they have better medical system in China.

“Death Rate is Low”

The consequence of a pandemic is mostly not in the immediate deaths that it causes, but in all the costs that it imposes on normal live. E.g., all other hospital departments will be in paralysis once the infected grows past thousands in any given city. Even if only a small percentage of them is critically ill, the resources they require will still overwhelm the system. Then where will the normal sick people go, people who will be having heart attacks and giving births nonetheless?

And this is just the medical resources.

To quote The Flu Pandemic and You, a book written by a Canadian emergency physician and public health physician:

SARS killed relatively few people, and on a world scale it ultimately had negligible impact when measured in human illness burden and fatality, especially in comparison with the potential impact of a worldwide influenza pandemic. Nonetheless, it disabled health care systems around the world, resulted in massive travel disruptions, and interfered with thousands of people’s personal liberties by way of quarantines and movement restrictions. Its impact upon societies was massive, although the scale of illness was actually relatively small.

Although not all parts of the world may be hard hit simultaneously, the interdependence of economic systems means that disruptions in an industry in one part of the world may affect some linked industry in another country. Disruption may be most significant if events of a pandemic impair essential services, such as power, transportation, and communications.

The rippling effect has barely even started.

“Better Healthcare Elsewhere”

The death counts in China were concentrated Hubei, where local medical resources were overwhelmed, leading to a death rate of 4.3%. While outside of Hubei province, the rest of China came up with merely 0.86%.

In my home province Jiangsu, there were only 631 cases out of a 80 million population, and the death toll remains nil as of today. However, the scale at which people self-quarantine to achieve this is hard to imagine. Many people simply chose to stay home, period. My mom, being on winter holiday as a college employee, never went out even once during the whole of February, with my dad going out once every week or two to stock up on groceries. Not to mention the massive number of people who were actually forcibly quarantined at home, their necessities being delivered right to their door all throughout.

To conclude, unless you were already very weak or had pre-existing lung problems, you only die if you started needing ventilators and couldn’t get one. AKA, you should only start seeing real deaths in any given region when the number of sick reaches such a point, that local resources can no longer manage to keep the critically ill alive. Plus, it takes around 1-2 weeks from contraction-of-virus to critically-ill-or-death.

Which makes the U.S. numbers look really weird, as the count of death vs. case reported reverses there. As of March 6, with 12 deaths yet only 231 confirmed cases, suggesting a death rate of 5.2%, way above either 3% or 0.8%, even without accounting for a 1-2 weeks contraction-to-death delay.

One signal to watch out for is if the first case in an area is a death or a severe case, because that suggests you had a lot of community transmission already. As a back of the envelope calculation, suppose the fatality rate for cases is about 1 percent, which is plausible. If you’ve got a death, then that person probably became ill about three weeks ago. That means you probably had about 100 cases three weeks ago, in reality. In that subsequent three weeks, that number could well have doubled, then doubled, then doubled again. So you’re currently looking at 500 cases, maybe a thousand cases.

NYT, a mathematician at the London School of Hygiene & Tropical Medicine

Inside China’s All-Out War on the Coronavirus

Some takeaways from the front lines in China, taken from a NYT article:

A World Health Organization team led by Dr. Bruce Aylward just spent two weeks in China monitoring the fight against coronavirus. Donald G. McNeil Jr., our infectious-disease reporter, got the download:

Are cases in China really going down?

I know there’s suspicion, but at every testing clinic we went to, people would say, “It’s not like it was three weeks ago.” It peaked at 46,000 people asking for tests a day; when we left, it was 13,000. Hospitals had empty beds. I didn’t see anything that suggested manipulation of numbers.

How did the Chinese reorganize their medical response?

First, they moved 50 percent of all medical care online so people didn’t come in. Have you ever tried to reach your doctor on Friday night? Instead, you contacted one online. If you needed prescriptions like insulin or heart medications, they could prescribe and deliver it.

If you’re in China and think you might have coronavirus, what do they do?

You would be sent to a fever clinic. They would take your temperature, your symptoms, medical history, ask where you’d traveled, your contact with anyone infected. They’d whip you through a CT scan.

Wait — “whip you through a CT scan”?

Each machine did maybe 200 a day. Five, 10 minutes a scan. Maybe even partial scans. A typical hospital in the West does one or two an hour. And not X-rays; they could come up normal, but a CT would show the “ground-glass opacities” they were looking for.

And then?

If you were still a suspect case, you’d get swabbed. But a lot would be told, “You’re not Covid.” People would come in with colds, flu, runny noses. That’s not Covid. If you look at the symptoms, 90 percent have fever, 70 percent have dry coughs, 30 percent have malaise, trouble breathing. Runny noses were only 4 percent.

The swab was for a PCR test, right? How fast could they do that? Until recently, we were sending all of ours to Atlanta.

They got it down to four hours.

So people weren’t sent home?

No, they had to wait. You don’t want someone wandering around spreading virus.

If they were positive, what happened?

They’d be isolated. In Wuhan, in the beginning, it was 15 days from getting sick to hospitalization. They got it down to two days from symptoms to isolation. That meant a lot fewer infected — you choke off this thing’s ability to find susceptibles.

Who pays for testing and treatment?

The government made it clear: Testing is free. And if it was Covid-19, when your insurance ended, the state picked up everything.

In the United States, that’s a barrier to speed. People think: “If I see my doctor, it’s going to cost me $100. If I end up in the I.C.U., what’s it going to cost me?” That’ll kill you.

New York Times: Inside China’s All-Out War on the Coronavirus

I saw one highly voted comment from an American guy under one NYT article, saying “I am lucky enough to have healthcare through my employer, but when I got ill, my boss still threatened to fire me if I took any time off” and that “even though you Australians have healthcare, I’m sure you run into the same problems just like we do”.

Actually, no.

No other prominent country allows its health care to be tied to parties that could get rid of the beneficiary any darn time, and that for sure is not the norm. The U.S. has a truly medieval way with the healthcare system.

My biggest two worries right now, one is for all the third-world countries that definitely don’t have the resources to treat their ill–what will happen for them? And the other, for all the Americans who would have gone broke to get treated. They, unlike the third-world countries, are much more closely tied to the Dow Jones, and by extension, the rest of the world.

May we all get well soon.

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