The tide has turned with the coronavirus
Last week people were still comparing the novel coronavirus to the flu. This week it's officially a global pandemic.
Italy's been on lockdown for several days. The US just declared a national emergency. A congressional physician has predicted between 70 to 150 million Americans will eventually contract the virus. Upwards of 10% could require hospitalization, and hospitals are so overwhelmed doctors are literally deciding who lives and who dies. It's not a joke.
But there's hope. Social distancing works. That means staying home and, quite frankly, avoiding other people. The earlier, the better. Today if possible.
Indie hackers are doing their part. Often that involves canceling events, which can easily cost tens or even hundreds of thousands of dollars. It's a tough decision, but it's also the only responsible decision.
MicroConf is one of the longest-running conferences for indie hackers. I've been looking forward to it since last year's event and bought my ticket in January. Yesterday it was postponed indefinitely:
Both LTV Conf and Founder Summit also decided to postpone and host their events later in the year.
In the case of Founder Summit, which was put together by recent IH podcast guest Tyler Tringas, the difficult decision came just days before the event:
Our very own @rosiesherry has had to make some difficult decisions as well. On Wednesday she canceled an event that took many months to put together:
"Cancelling any event is super painful," Rosie told me. "However, there are many events out there that need a real kick up the backside. I predict the ones that will survive are those that add real value and place an emphasis on the community."
Rosie shared a useful guide for event organizers which includes tips on how to convert in-person events to virtual events. And yesterday, the founder-focused conference Business of Software announced they were doing just that. Their conference is still on for late March, but now it'll be held online rather than at its original location in Cambridge.
Yes: these are rough times. And for many — especially those of us in the west — the worst is yet to come. But indie hackers are leaders. Almost by definition. And the funny thing about the future is that it can change depending on what you do in the present.
Make no mistake: the indie hackers above are all changing the future. So as the situation unfolds, let's rally behind them, make responsible decisions, and find our own ways to lead.
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My plan was to start social distancing next week after Founder Summit. Based on the infection numbers in the US, I thought I'd be ahead of the curve. Then more news started breaking about the growth rates this week, and how severely underreported the numbers are. Whoops.
So now I'm holed up in my hotel room in Mexico City for another 3 days, ordering room service, avoiding large gatherings of people, and working on IH. Luckily I've got some n95 masks for the flight, which I've had for months due to fires in California.
The most interesting thing to me is how differently everyone is treating this. One or two people I know are actually in complete denial that this pandemic is a real thing. Many more seem to know the facts but are nevertheless throwing caution to the wind and living normally. The majority of people I know are taking it seriously and making plans to isolate if they haven't already. But it's easy to feel like a crazy person when everyone around you is in camp #1 or #2.
Hi Courtland,
Here’s how I understand the UK’s approach, currently still masterminded by the Government’s scientific advisors that have been preparing for this for years, with the Government’s politician’s resisting the will of the shrill mob.
The Global Health Security Index 2019 ranked the UK highest for ‘Rapid response to and mitigation of the spread of an epidemic’ on 91.9, with the USA second, after a significant gap, on 79.7. https://www.ghsindex.org/wp-content/uploads/2019/10/2019-Global-Health-Security-Index.pdf
Cheers, Ralph.
I think this strategy is interesting, but I worry about it. How much data is there showing that humans develop long-lasting immunity to this virus? It might be like the flu where there are constantly new strains, and people who caught it earlier can easily catch it again. I don't believe we have the data on this.
Then there's the issue of hospitalization. Evidence we've seen from Singapore, Japan, South Korea, Taiwan, various Chinese providences, and Italy consistently shows that acting earlier is better for flattening the curve and reducing strain on hospitals. I don't understand the UK government's idea that "holding fire and timing it right" will somehow be better for reducing hospital overload. Where does that come from? Every piece of data I've seen says that timing it "right" means as early as possible.
I understand fears that people won't want to stay isolated for too long, but I find myself asking, so what? The consequences of people getting restless and breaking isolation seem lower than the consequences of there being no isolation in the first place. 🤔 It's also quite pessimistic. People in Italy, China, Japan, etc seem to be doing okay. Historically, citizens of every country (including the UK) have managed to make it through much more stringent asks.
Finally, it seems to me that lot of government (in)action in the US, the UK, and many other countries is driven by a fear of panic. But are we seeing evidence of panic anywhere?
If this were some sort of natural disaster or catastrophe, I would understand. That kind of panic results in looting, rioting, crowded streets, overloading public infrastructure, etc. But "panic" in the face of a pandemic looks like people buying goods and staying at home… which is exactly what we want.
Unless I'm wrong, what's overloading hospital systems is not people panicking. It's society continuing on as if nothing is happening, resulting in massive numbers of infections and patients all at once.
If anything I'd say that the countries you've listed above are some of the ones that have been controlling the situation the most and acting with a long term interest more than fear of panic.
People need to calm down and understand 2 things:
A lot more people will catch this virus than it's estimated, as it is still unknown how it is actually spread (https://www.nhs.uk/conditions/coronavirus-covid-19/) as a result I think the herd immunity route is pretty sensible all things considered.
Taking quick decisions =/= taking smart decisions. On the economic side of things, in Italy for example, I can tell you first hand that this is going to have massive consequences on par of the crisis of 2008 (lived there in that period) and it was grim. People are already lamenting some of lockdown policies as it will cut revenue streams for a long time in the future.
On the health side, a lack of social interaction will help, but only so much, as per above, the virus may linger and return next winter. That is the exact scenario of recurring flus with new strains. You either get a vaccine or you're immune to it (get mild/minor symptoms).
All in all, I think the UK's approach is interesting, perhaps "different", but it's hard to criticize coming from us (a bunch of hackers) or (anyone in that case) when healthcare systems and scientist don't agree themselves :)
I do understand the negative economic effects of these voluntary shut downs and social distancing policies, but I suppose I'm just not seeing how the equation balances out, as there are significant consequences to the herd immunity approach, too. We can only estimate of course, but at this point it seems like:
And this is all for the chance — which is not guaranteed or necessarily supported by existing evidence — that we'll develop long-lasting herd immunity to prevent a second round of this.
(That said, nobody I've seen is advocating the above full doom-and-gloom scenario. It looks like the UK wants to simply limit or delay the social distancing measures, not eschew them completely.)
However, I do think it's tough to support the notion that people are panicking and rushing action. A very calm and rational cost-benefit analysis can easily lead to the conclusion that swift action is best, and that also seems to be what most experts are advocating.
Hi Courtland,
My understanding is you’re right, it is like the flu, and new strains are expected. But the new strains of flu each year don’t effect everyone at once because that previous immunity is good enough for many. What’s needed this time is for the herd immunity to build up because the expectation is that C-19 will be a seasonal thing, just as flu is now.
It has an immediately effect on the curve, yes. But it also stops immunity spreading so the population is still very vulnerable when those early actions are lifted. It gives the ‘resurgence’ bump shown in this chart from The Lancet, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30567-5/fulltext#fig1 and animated in https://thespinoff.co.nz/wp-content/uploads/2020/03/Covid-19-curves-graphic2-stopthespread-v2.gif from https://thespinoff.co.nz/society/14-03-2020/after-flatten-the-curve-we-must-now-stop-the-spread-heres-what-that-means/
That last article from New Zealand says ‘Taiwan, Singapore, and South Korea are examples of #StopTheSpread. They’ve all used slightly different strategies which we can learn from. But they acted quickly, with no half measures… The important thing for any country that is able to #StopTheSpread is to not become complacent or if stop doing what needs to be done… Until a vaccine is ready, and that could take one to two years, we are all susceptible to this virus. If we turn our back for a minute, we’ll be back on the path to a serious outbreak.’
And that’s the problem. The populations within nations will turn their back and won’t have built immunity.
It depends if you think the vast majority of the population can avoid catching this over the next year by shutting down a country for a month. How many months can it remain shut down? What about food production and delivery? Waste collection? Is a curfew imposed? The UK doesn’t think that’s possible; containment is over. It worked in that it added a useful delay, but it can’t solve the problem.
The UK Government is taking advice from Behavioural scientists and know the public simply won’t persist in taking measures like isolating the whole family at home for many months. Here’s one of the Government’s advisors making the point: https://youtu.be/AXAON7JgyT0?t=2930
The modelling says self isolation by an individual with symptoms cuts infections by about 20-25%, isolation of a whole family is 25%, and cutting off access to the vulnerable cuts them getting it by 30%, helping mortality. But none of these are sustainable thus they need deploying around the peak to affect the largest number. https://youtu.be/AXAON7JgyT0?t=3100
That video also gives the current estimate of how many weeks until the UK peak, how long it will last, and the percentag of infections which occur around the peak. https://youtu.be/AXAON7JgyT0?t=3870
No, it’s worse because they won’t do what’s asked for them having tired of playing ball thus there won’t be the flattening of the curve, it will just have been a local maxima before the real, delayed, peak which could coincide with winter when healthcare is already stretched by flu. It’s the resurgence bump above helped by a false sense of security, ‘We’re over the worst’, and a sense the Government cried wolf because it wasn’t too bad.
China is an outlier due to the style of government. Democracies like Italy have done okay for a week or so. I think they’ll be struggling to maintain this level for the months required.
Well, in the UK’s case there’s examples of the Blitz and many years of rationing, including long after the war ended. But they’re different as they’re imposed by external agencies, not self imposed like self isolation for an altruistic reason: the good of the community.
I haven’t followed the USA’s actions, but the UK’s actions are measured and timed, matching the science AFAICS.
I don't think it is what we want because it’s not sustainable. Instead, they need to mitigate the rate of infections whilst trying to get on with their lives, e.g. thorough hand washing and not transferring the virus from hand to mouth. That is sustainable, will delay the onset of the peak, and also lower its height when it does arrive.
Cheers, Ralph.
Good points, all. I have wondered for a while what China's plan is to stop a second surge, since they've contained so many people so effectively.
I do think there's merit to at least allowing your healthcare system to make the changes necessary to handle a second surge. I believe we estimate that mortality "should" be around 1%, but it's effectively been over 3% worldwide primarily due to lack of preparedness. Perhaps a few months of quarantine isn't meant to wipe out the spread, but to buy time for infrastructural preparedness. This seems doubly important in the case that the type of herd immunity we hope for doesn't actually materialize.
Also, there's just so much speculation at this point. For example, it's impossible to actually know what levels of isolation are sustainable, and for how long. Italy's government seems more optimistic than the UK's, but who's right? From what I've seen from politicians in the US, our non-response has been due more to blundering and misinformation than any equations about herd immunity. There's also a large % of our population espousing the "don't panic" position, and even some who think the virus is a hoax or conspiracy, and of course business owners who are against closings, so there's strong political pressure to wait and see.
It'll be interesting to see how things play out, especially since this will be happening in weeks or months, rather than years or decades.
Hi Courtland,
Yes, bringing it back to start-ups, what’s the ‘exit plan’? Same with other countries attempting a long shutdown, but without the benefit of a Government willing to use brute force.
I still think a few weeks quarantine is difficult. It’s easy for us that are used to sitting at home day after day, still earning money, with savings to fall back on. There are plenty that have no savings, and if they don’t go out to work then their children go hungry. After a week or two, word of mouth will reach them via Facebook that their mate has had C-19, he’s ‘had worse hangovers’, and is back earning a crust. They’ll venture out too.
‘French Prime Minister Édouard Philippe said the number of people in France in intensive care was growing and earlier guidelines for the public were being ignored’ ― https://www.bbc.co.uk/news/world-europe-51892477
I agree with buying time to boost preparedness. The politician in charge of the UK Government’s health department has said today that there’s about 5,000 ventilators in the UK, that many more times that were needed, and they’re arranging for private-sector factories to change their production lines to make ventilators. He’s said if a company makes them, the Government will buy them.
Meanwhile, lots of health-care staff are to be re-trained to assist with severe C-19 symptoms. And the Government’s looking at using ‘Henry Ⅷ’ clauses to requisition land for burial grounds, and take over hotels for more bed space.
I think behavioural scientists will say it’s not guesswork. :-) The UK is planning on having those 70 and over to self-isolate around the peak for weeks, but aren’t saying how long yet, though it’s rumoured to be four weeks. They point out that longer is hard to sustain and has negative health and mental impacts of its own.
Yes, very. Dispassionately, it’s a fascinating mix of approaches. Science v. political expediency. Trade offs. Aligning with annual seasons. But then politics is a lot about deciding who dies, e.g. pros and cons of lowering speed limits. If there isn’t already one of those ‘city building’ games about controlling a virus pandemic, there soon will be. ‘Interesting times’.
Cheers, Ralph.
Looks like the UK is backtracking as of today?
Hi Courtland,
The UK is in a fine old mess, stuck in a lock-down from which it has little realistic strategy to exit. It's suffered high deaths by failing to protect the most vulnerable. Stopped the health-service functioning, storing up many thousands of extra deaths yet to come from cancers left undiagnosed or untreated, etc. Its using a PCR test and getting increasing positive results but without disclosing the amount of 'amplification' being used; a positive results only means a fragment of the virus is present, not a whole live virus and it's possible to be positive through 'shedding' fragments many weeks after the end of being infectious. Children missed many weeks of schooling, affecting the long-term outcome of the poorest. The economy is hosed, worse than the 2008 banking crash. And it's far from over yet.
Meanwhile, Sweden's herd-immunity is ticking along nicely: https://www.telegraph.co.uk/politics/2020/09/10/ignoring-lesson-sweden-makes-tougher-covid-crackdown-inevitable/
Cheers, Ralph.
Hi Courtland,
That Imperial College team say their report 'informed policy makers', rather than the policy makers saying they were swayed by it. Having watching the Q&A with the Chief Scientific and Check Medical Officers from yesterday, https://youtu.be/wTC8-og9W3Q, the approach is still herd immunity, but they think testing and deaths show the UK is on the cusp of a quick upturn and so they want to slow down the spread more severely, e.g. by telling me to cut unnecessary social contact. They also said London is about three weeks ahead of the rest of the UK and so the new measures were particularly important to follow there. (London has a high non-UK population.)
There's no house arrest, like some other European countries, and I went around the shops like normal this morning, continuing to observe the hand-washing and keep-your-distance guidelines. Lots of others were doing the same, certainly not deserted here in the county town of Dorset. Some were clearly not following the guidance, e.g. standing two feet away from a friend they bumped into to natter at length, so COVID-19 is still happily being spread, building that herd immunity.
On the topic you raised of whether one has immunity afterwards, Whitty says in the above video that it's normal to have some immunity after an infectious disease, it's just a matter of how long, and if it's not very long then that affects any vaccine's effectiveness too so it would seem herd immunity is not at a disadvantage there.
Lastly, you may be interested in this English transcript of The Netherlands' Prime Minister Rutte's address to the nation from yesterday. He too says going for 'group immunity' is the approach they're taking. https://order-order.com/2020/03/17/prime-minister-mark-ruttes-address-dutch-people-english-full-text/
Cheers, Ralph.
The leaders of the US buried their collective heads in the sand when C-19 was first brought up. It took until, yesterday (I think) for the Cheeto to say anything at all was wrong (and he barely admits to that). I have ZERO expectations that we will get through this anywhere near as well as the UK (or frankly, any country that tried something before they got kicked in the nads).
What about reinfection? According to a publication from China (I found on hacker news a while ago) reinfections occur and there seems to be 2 varieties of the virus. Which to me means this strategy can fail and put people at risk of getting a disease more than once with the second one being more lethal.
Hi onStack, Sir Patrick Valance, the UK's Chief Scientific Officer, answered a similar question from a journalist at a press conference yesterday about a Japanese case where re-infection might have occurred. Apparently, this is possible with all infectious diseases. It seems to be rare in C-19's case otherwise there would be many more reports, or it would just be the accepted norm. I agree that a significantly different strain or mutation could cause a second infection, and spread through a herd with immunity to an earlier strain, but Chris Whitty, Chief Medical Officer, said in the same press conference that a vaccine would have that weakness. Cheers, Ralph.
i start to hear this "heard immunity" over the last 48 hours, but reports indicate we - humans - don't develop that for this type of coronavirus...
is there a source that specifically points out that immunity is actually built up for c19?
Hi David, The consensus I've seen is that the sufferer develops at least short-term immunity once they're over it. How long that lasts isn't clear, but I've seen nothing that suggests it's particular short. And C-19 might mutate when it comes around next year, just as the flu does, and be sufficiently different that the immunity doesn't match. Cheers, Ralph.
Edited to add some background on herd immunity. https://en.wikipedia.org/wiki/Herd_immunity#Mechanism
I'm in Europe, in Portugal, luckily I live in the country side. I have been anti social all my life which seems to pay off in situations like this. I've been isolating myself for a while except the trips to the shop for food. That is what worries me, the food...
I think this epidemic will not go away for at least 12 months till we can have a working Vaccine. The most hit countries in Europe will be the ones who don't report cases. Like in Hungary, they just don't do testing, the health system was destroyed from the corruption long before the virus hit it .
I think 80 percent of the people can catch this. We need to make sure that the 20 percent are the ones above 60 and the rest don't catch it at the same time but slowly to not cause a bigger crisis in the health system. I'm 28, non-smoker so I'm positive I survive this but I fear for my parents.
Update (March 15):
All the above symptoms have mostly abated, and I've got plenty of competing theories as to why they cropped up in the first place.
But of course I'll continue to self-isolate as if I'm a confirmed case.
Oh no! I don't know how it works in the US, but here as soon as you got symptoms you need to call a dedicated number and a doctor will come to your home and got you tested.
Hi Andrea, Here in the UK, if you have symptoms then you stay at home and don't bother contacting anyone, or getting tested. There's no point since we're past the containment phase and into the delay phase so the authorities don't need to track those I've come into contact with recently, etc. Only if the symptoms are severe, e.g. I have trouble breathing, should I trouble the doctors. The capacity to test is kept for those admitted to hospital to confirm the cause of their symptoms for the correct treatment. Cheers, Ralph.
I've heard many Italian experts say that UK's strategy is a suicide. I really hope they are wrong.
Well, those experts may have a vested interest in defending the actions so far. The UK is about a month behind Italy and can make different decisions because more is understood about C-19. We've many months to go yet, and the UK is aiming to avoid a resurgence when restrictions are either lifted or human behaviour means they stopped being followed.
This chart shows the risk the UK is trying to avoid by bringing in harsh restrictions all at once and too early. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30567-5/fulltext#fig1
The other facet of the UK's approach is to cut mortality by restricting access to those most vulnerable but only when the epidemic is at its peak so it has most effect.
@channingallen How are you feeling now man? I was also feeling a few mild symptoms last week but they seem to have passed on, so I'm hoping the same happens for you.
Same! All the symptoms have mostly abated, and I've got plenty of competing theories as to why they cropped up in the first place (e.g. temporary work burnout, a bacterial throat infection from a few weeks ago or the antibiotics I was on as a result, etc.).
Doing daily home workout and hacking on IH without a hitch. Thanks for the concern!
Good to hear you are doing good. IF you have any fever , a doctors recommendation is to take Paracetamol only. Don't take ibuprofen because It will make the symptoms worse!
Even though I agree that our system in Hungary is full of corruption but I just wanted to point out that a) we report the cases: 23 currently infected and b) we do tests. Also the nurses and doctors are working hard here just a well as everywhere in the world. These are strange times and all country should realize that they should invest more or better way in their healthcare systems because everybody was unprepared for this.
Happy to see a fellow portuguese here as the top comment! Hope you and your family are holding up okay :) I suppose the worst is yet to come, but we took good measures early enough. We'll see if "flattening the curve" really works though, or if complete containment is necessary.
Hi onStack, It's best to assume there won't be a vaccine in a useful time-frame and plan for that. What then causes C-19 to die out is herd immunity, so you're right in that 70-80% will catch it, and they need to. What's important is the pace of infection to avoid overloading healthcare, who is infected to avoid the most vulnerable, and the timing of infection to avoid a winter peak. AIUI, that's shapes the UK's plan that I've described elsewhere on this thread. Cheers, Ralph.
I live in Italy and I can tell you the only way to contain coronavirus is shutting EVERYTHING down and forcing people to stay at home. Eventually every country will have to do this.
I left Milan and started isolating myself almost 3 weeks ago when people were still living normally and many told me I was exaggerating. But this virus takes up to 14 days to manifest itself, so don’t wait to isolate yourself until a lot of people start to show symptoms!
I’m really surprised by how other countries are not taking this threat seriously.
In Italy the curve of new cases has started bending, It means the shutdown worked out, just one person gotten sick from another, not ~4 as when it's not controlled.
What makes me worried are some other countries which don't follow Italy's path. The biggest is Russia.
Hi Andrea, It doesn't follow that because other countries aren't duplicating Italy's actions that they're not taking it seriously. Perhaps either the circumstances are different, or they think Italy is doing the wrong thing. Or they're not taking it seriously. :-) I agree that's an option, but an unlikely one. Cheers, Ralph.
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Hey there! Yeah I thought it was inevitable but some countries are taking a different approach - stay safe!
I started social distancing myself yesterday. Cancelled plans for a lunch and a happy hour. Nobody is allowed in my house. One great thing about working as an IH from home is that I can run errands (store, gasoline, etc) when it isn't busy to limit my exposure.
Stay safe everyone!
I've started social distancing myself and my family since yesterday. Day to day our biggest impact is taking our two youngest out of nursery, that will be a challenging dealing with on a day to day basis. My husband teaches a JuiJitsu kids class twice a week and he has pulled out of that.
My husband and I have had super unreliable childcare in the past, so having to juggle that isn't new for us, just not very relaxing with a 2 year old in the house.
Huge kudos @rosiesherry that must have been so difficult.
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It depends if you're looking at this from an individual vs societal perspective. SARS is scarier as an individual, but didn't spread, so less of a risk to society as a whole. But SARS-CoV-2 is a bigger risk to society, due to its higher r0 and high hospitalization rates. Personal survivability isn't really the story or the concern here.
Hi getflookup, Oh, I agree, it's certainly more survivable, as is a dose of the flu for most of us, but the problem is there is no immunity within the herd to C-19, unlike the flu, and so many of us can catch and suffer C-19 at once, and that will include those very vulnerable to it, just as they are the flu, the elderly and those with other existing conditions that weaken them. Because of them all getting it at once, the hospitals can't cope, they won't get adequate treatment, and many will die. Just as the flu leads to deaths each winter. The fuss is about the numbers suffering severe symptoms requiring hospital treatment at once and how to mitigate. See my reply to Courtland on this thread for a bit more detail. Cheers, Ralph.
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I hadn't heard of convalescent serum and tried searching. It isn't clear it did help with Spanish Flu. Scientists thought it was a bacteria and isolated a bacterium whereas it was virus. The antiserum could have helped with secondary effects. If you know of a resource that describes the success, I'd be interested; I only tried a few matches.
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Great! I will check it out!
i think the correct link is endcoronavirus.org.