Sobering report. Standard epidemiological protocol: Isolate virus; contact-tracing & testing of ppl; Quarantine infected #Coronavirus must be seen in terms of State Capacity & Public Health axis. Pointless along authoritarian-democratic axis when set of things done is similar.
Global Cooperation between virologists, health workers thru WHO & China's & US CDC has been a shining example to humanity. Important to take a step back and remember that we are in a forever war w microbes. Many more of them than us... #coronavirus
Fantastic resource: interactive map of #coronavirus infections and deaths around the world. Data from CDCs/WHO.

Created by Center for Systems Science & Engineering, John Hopkins. Updated daily.
Constraining transport to buy time for CDC is vital. Bar-yam/Taleb on Precautionary principal: It will be costly for ppl, China,🌍economy in the short run. But failing to do so will eventually cost everything. As w exponential stock of CO2 & climate action.
2 weeks after lockdown of cities, rate of new infections slow down. Emergency measures to control outbreak have worked. Whew!
Rate of new infections slow down even further. Thank emergency measures to control outbreak. For the first time in weeks public health ppl are breathing again.
Containing coronavirus has been nothing short of a war-effort. Thread on extraordinary times, extraordinary measures.
Xi's speech on CCP's war-effort to contain virus is a world-historical document. No aspect of technology, local-centre politics, economy, social control left unadressed. Even 5G makes an appearance! Each sentence a Rorschach test...
Quarantine has been epidemiological protocol since Renaissance Italy put contagious ships on 40 days of isolation. How to do it in a modern economy where risk of ppl preemptively fleeing lockdown orders is large? Thus spreading it further, faster. Secrecy?
Fascinating, brilliant essay on Coronavirus in the web of life.
The Birth of Biopolitics -- Coronavirus, 2020.
Its turtles all the way down.
Its politics all the way down ie what a system chooses or not chooses to prioritize.
"The first thing is, they said testing is free, treatment is free. Right now, there are huge barriers in the West. You can get tested, but then you might be negative & have to foot the bill. In China,they realized those were barriers to people seeking care"
Any country —large or small, poor or rich— can contain an epidemic if they prioritize it. Nigeria contained Ebola in 2014 within months thru contact-tracing. If a country can hunt ppl to the ends of the earth w GPS guided drones, it can contain an outbreak
Singapore's quality of transparent information from Health Ministry is just excellent. "The cost of the scare is worse than the disease itself, so it [is] important for our leaders to be rational and communicate well”
That Diamond Princess "quarantined boat is an ideal—if unfortunate—natural laboratory to study a virus. Many variables normally impossible to control are controlled". It had 3,711 people on board, 705 tested positive & just six deaths. ht @jeremyfaust
For those who thought quarantining Wuhan was just an authoritarian overreaction - Italy extends quarantine to entire country. It was always about public health and state capacity. China bought us time (the month of Feb) that was squandered outside Asia
Exponential growth on semi-logarithmic plot is a straight line. So these show China& SKorea success in slowing spread from what would have happened w/out public counter-measures. Else health systems overload in days & ppl die of other causes not just covid
A dispatch from the front lines in Seattle - America's ground zero. Virologists working around the clock to diagnose cases & reveal routes of transmission. Public health ppl have been alarmed since COVID19 overwhelmed China in Jan and raced to buy time.
The Demand for Inpatient & ICU Beds for #COVID19 in US - "Even after the lockdown of Wuhan on Jan 23, the # of seriously ill COVID-19 patients continued to rise,exceeding local hospitalization & ICU capacities for at least a month" ht @mlipsitch @ruoranepi
Priority everywhere isnt only social distancing but increasing # of ICU beds & ventilators. Surge of hospitalized ppl sadly inevitable. Patients require ICU to survive but only so many ICU beds. Lifting those two constraints means less Emergency Triage
Testing is severely bottlenecked in US. CDC Director Redfield isn't confident that US labs have an adequate stock of the RNA extraction kits used to extract genetic material from any virus in a patient’s sample. No RNA extraction, no PCR, no 1M tests/wk
Its no longer normal time but timescale set by virus. In 'viral time' each day matters ie #FlattenTheCurve so medical systems don't overload. But 3 bottlenecks -- ICU beds,Ventilators,RNA extraction kits for PCR tests --remain. ↗️Beds easier, but ↗️latter 2 are global public good
In a radically new 21stC crisis but a mid-20thC analogy —the Berlin airlift. Replace milk & gasoline from US to Berlin with ventilators & RNA extraction kits from China to Rest of the World. And airlifting physicians who operate ventilators.Thats the real blockage in 'viral time'
In 'viral time' where each day matters & hospitalizations surge everywhere its only a matter of days/weeks before there are Seattle Airlifts, Seoul Airlifts, London Airlifts. Almost no other solution to the physical problem of pandemic provisions.
In viral time, delay is extraordinarily costly. It wasn't about narratives (flu or not! lockdowns! authoritarians!) or whether case-fatality-ratio was a single #. It was about 𝘥𝘺𝘯𝘢𝘮𝘪𝘤𝘴. Production could have ramped up in Jan & Feb. It still can.
Finally Europe searches for ventilators as cases surge. Italy asked its only ventilator maker to 4X mo. production, deploying armed forces...Germany orders 10,000 ventilators from a domestic supplier. In US, Defense Production Act.
Excellent presentation on learning from pandemic response. Practical recommendations to govt officials as they start to mobilize & requisition sites. Family transmission is common; centralized quarantine is critical. ht @XihongLin
Acute necessity of building temporary hospitals ala Wuhan/Lombardy. With schools, gyms, hotels, airports shutting down many can be repurposed as centralized quarantine facilities. ht @XihongLin @HarvardBiostats
Does anybody know whether this plane carrying critical supplies is landing on the West or East coast? Seattle perhaps but could be LA, Boston, NYC.
UK moves to Asian model:"Perhaps our most significant conclusion is that mitigation is unlikely to be feasible without emergency surge capacity limits of the UK &US healthcare systems being exceeded many times over" ht @MRC_Outbreak
Sadly more such events as shortage of Personal Protective Equipment (PPE) in US. Healthcare workers in contact w cases & susceptible subjects need more protective suits, goggles, caps, masks & gloves. ht @XihongLin @HarvardBiostats
Hospitals are creatively adapting to shortages (until supplies come), limiting visitors & non-urgent patients towards tele-medicine. Moving clinicians to COVID treatment is tough. Dispatch from San Francisco⬇️
Different countries are developing the necessary rhetoric to accept critical supplies from China until domestic production is ramped up. Could come under strain as covid returns to Asia via imported cases from Europe & US hotspots.
Key to interdependence in 'viral time' (1) no country can cope with sudden surge alone (2) no such thing as containment in 1 country. "According to official data, China IMPORTED 56 million respirators & masks in the 1st week after Jan lockdown of Wuhan"
How soon before the hi-organizational part of the American State — the Military — enters to fill dire hospital shortages? It remains the Industrial planning State within the State along w a massive logistics & supply chain reach.
A shortage of Swabs (glorified Q-tips) also limit US testing. An Italian MNC is manufacturing them at speed but Fedex cargo planes are disrupted. Enter: US military transport airlifts. Just as Ma's 🇨🇳donation, all land in Memphis.
Places now aware of outbreaks that started weeks ago. "We believe that intl seeding events started to occur in mid-Jan. Thus we have a critical~10 wks from then to late-March to contain these nascent outbreaks before they become sizable"-Trevor Bedford,Feb
"No one wanted to say what has now become clear: Feb was our chance...We lost that entire month...we now live in a new era of work stoppages, overwhelmed hospitals, dead elders, & a wrecked economy" #viraltime seen thru virologists Chu & Bedford's eyes
"Lockdown+mitigation in Wuhan helped reducing R from 3.8 to 1.25 but not good enough. Centralized quarantine + universal screening further helped reduce R to 0.3" - @XihongLin @HarvardBiostats
It took almost three months (until March 6) to reach 100,000 cases of COVID-19 in the world. Another 11 days (March 17) to get to 200,000. Then just 4 days to get to 300,000 cases yesterday (March 21). #viraltime
We would have been much better prepared if everyone had read & acted on WHO's Feb 24th fact-finding report. Effective interventions, the ICU surge that comes for weeks after cases peak, healthcare workers attrition, PPE...
In #viraltime, urgency of Testing Kits + Ventilators + PPE form a parallel medical "swap line" from E Asia to Rest of the World like Fed's $ ones. Airlifts too decide who lives & who dies; they too are contested geopolitically, nationally & subnationally
Recommendations from ethicists on how to handle life-and-death decisions in absence of sufficient equipment and supplies: "Fair Allocation of Scarce Medical Resources in the Time of #Covid19". Scarcity has cascading effect on hospital services used by all.
US cables embassies yesterday to emphasize that it is facing “historic surge in patients seeking care... No country can fight COVID-19 alone”. Politics of Medical airlifts from E Asia to Rest of World as explosively geopolitical as Fed's dollar swaplines.
Microbes break Modernity's fiction of Nature vs Economy vs Society. They shape us; we shape them.
"The earth is a unity for influenza A virus in a manner not yet found for probably any other parasite" (Hope-Simpson,1979).
Excellent info on why & how masks are so effective. Needs to be a social norm change esp In hotspots with so many asymptomatic carriers. ht @linseymarr Virgina Tech researchers pull together essentials of viral airborne transmission.
What accounts for Trump's U-turn from blaming China to praising China?
Only a guess: the urgency of airlifting provisions (ventilators+PPE+tests) as US hospitalizations surge & needs become desperate in #viraltime.
"War-economic production is often conceived of as a natl enterprise. But most war economies in the 20thC were deeply international in their supply lines. The medical mobilization against COVID-19 will have to be similarly global" ht @njtmulder #viraltime
Medical Airlifts now nonstop in #viraltime @njtmulder. A trickle turns into a flood. Irelands' "Aer Lingus to fly Airbus A330 planes to China 60 times to collect medical supplies"
"We find ourselves afraid and lost...caught off-guard by an unexpected, turbulent storm. We have realized that we are on the same boat, all of us fragile and disoriented ... all of us called to row together, each of us in need of comforting the other."
The flight is the dramatic start of what might end up being the largest government-led airlift of emergency medical supplies into the US. "We have essentially a flight a day, mostly from Asia" for the next few weeks. #viraltime.
FEMA's 2nd "Air Bridge" flight delivers medical supplies from Shanghai to America's 2nd city- Chicago. The next 20 odd flights will be allocated to hospitals across US based on how quickly they run out of N-95 respirators, surgical masks, gloves and gowns.
Russian Cargo Plane With Medical Supplies Lands in New York. The plane is carrying “60 tons of medical equipment, ventilators, masks & other protection gear.”
19thC Cholera from Calcutta, out to Bombay's port,then out to rest of the world on ships. Led to greatest public health intervention ever—Clean water piped into homes, shit piped out —& total redesign of cities.
States make Disease; Disease makes the State
National Academy of Sciences issues rapid expert consultation to White House on bioaerosol spread of Covid19. Concludes virus can spread via normal breathing & on various droplet surfaces. #masksforall
To many in the collaborative scientific world, the incoherence of US's catastrophic public health response with its excellent biomedical labs is acute. Vaccine R&D could play as important a biopolitical role as Fed's financial geopolitics ht @adam_tooze
US Ambassador - "No one country can fight this battle alone...our 2 countries will...find ways to jointly cooperate to combat this common enemy that threatens the lives of all of us"
China Amb: "Time for solidarity"
Going back to Xi's Feb 3rd speech and what jumps out is its sense that 𝙖𝙡𝙡 could be lost. That all that is solid could melt into air. The most important thing that has lacked in the West, compared to East Asia, is fear. #viraltime
Michael Pettis thread on the scenes in Beijing: "The social terror and widespread feelings of gloom and pessimism that were common a 5-6 weeks ago in China have evaporated, and will evaporate soon enough in in most other countries".
“Not everything that counts can be counted, and not everything that can be counted counts.” These are some deep truths of science and especially now. Thanks @yaneerbaryam
Must-read from @danwwang on life in China, both the hammer & the dance.
Most of us have a general sense that the Columbian exchange was the most significant crossover event in history. Empire, ecology & economy were fused in ways scarcely believable. Follow (& contribute!) to @natterjee's #10plagues
Arundhati Roy reads from her haunting new essay ”The Pandemic is a Portal”.
We long for a return to 'Normality'. We try to stitch our future to our past...& refuse a chance to rethink the Doomsday machine we have built for ourselves
China bought PPE/vents etc in Jan from everyone. It blocked exports; then ramped up production. US & European companies and charities sent it to them at hour of its greatest need. Both moral & self-interest to contain in 1 country.
The chaos of numbers obscures a simple fact: "Capitalist globalization now appears to be biologically unsustainable in the absence of a truly international public-health infrastructure".
ht Mike Davis (who has literally written the book on pandemics.)
The first flight carrying Medical supplies from Shanghai landed in NYC on March 29th.
Since then, SIXTY-EIGHT flights nonstop from Asia carrying more than 57 million N-95 masks & 11,000 ventilators have landed across US #viraltime
"A purified inactivated SARS-CoV-2 virus vaccine candidate confers complete protection in non-human primates [rhesus macaques] against SARS-CoV-2 strains circulating worldwide"- 🇨🇳Sinovac
Fingers crossed for Clinical trials!
US declared coronavirus a national emergency on Mar 14th. Since then
Mar. 14th: 14 deaths
Apr. 14: 25,000 deaths
Apr. 24: 50,000 deaths 
Chilling graphic
"Source said they are cargo flights carrying medical supplies.
5-6 flights each day from Beijing to New York
4 flights each day from Beijing to Los Angeles
These "China-US Express" flights are scheduled everyday at least in the next 3 days." #viraltime
Peaks & decline as happened in China or S Korea, didn't just happen. We have to actually do what they did. We can stop the virus. Thread.
Almost at 58,220 covid US deaths. Weekly death tolls match yearly tolls during Vietnam war. Last week was 1968.
Meanwhile, from the first case in January, Hanoi has taken no chances. Vietnam has had ~300 cases and no deaths. Fig ht @bwbensonjr. @nickturse
Trump's 'Wuhan virus' creates a primitive space. Its a civilization vs nature trope deployed to "exonerate liberal-capitalist civilization, & its imperatives of technical, & economic power, denying its share of complicity".
LEGO propaganda is funnier than just plastering the word February over and over again.
Plateau of 1000s of infections & deaths a day is not acceptable. Hunkering down & hoping for 'testing testing testing' is not a strategy. Eradication is the goal. To do that, cases must be found, isolated, and their contacts traced & isolated comfortably.
The first flight carrying Medical supplies from Shanghai landed in NYC on 29th Mar. Since then, 117 flights nonstop, largely from Asia, have landed.

Oddly, little reporting on largest govt-led airlift in US history. #viraltime
"Factors associated with COVID-19 hospital deaths from e-health records of 17 million adult NHS patients". Hazard ratios are adjusted for covariates, esp age & gender, so throw up surprises...
States that eradicated virus did it by community participation. Social democracy is about collectively solving new problems. "Taming a pandemic & rapidly building out a massive safety net is fundamentally about the relation of the state to its citizens"
My go to for past few weeks has been @youyanggu's ML model. It's projections have been remarkably accurate for #COVID19 in 40 countries & US states. Brazil, India, Mexico, Canada & Russia are surging next couple months. 
S Korea doesn't do #FlattenTheCurve defeatism. Both State & society learnt from 2015's MERS outbreak to #StampItOut. This is what Test+Trace+Isolate alongside disease surveillance at border looks like to keep new cases down. Thread⬇
A stunning stat: More reported covid deaths in New York than ALL of Asia.

If you tell ppl in US/EU that "we have 1 of the worst responses of any country" most refuse to believe it. Idea of a Sri Lanka or Vietnam doing better doesn't fit. ht @Comparativist
The UK had developed a test as early as 10 January. It was contact tracing in February. But what went wrong in pursuing the Test + Trace + Isolate strategy? Substantial inquiry by Lawrence Freedman (of Chilcot Report).
One reason why UK&US didnt pursue #TestTraceIsolate was belief that effort reqd would be overrun i.e futile. It looked at E Asia w its 1000s of teams of epidemiologists, tracing 1000s of contacts a day, thorough isolation in hotels w follow-up, & balked.
There is no shortcut to #TestTraceIsolate state capacity. UK/US switch in March from eradicating to mitigating virus was defeatist. Ppl won't go back to work without TTI. And when 2nd wave comes, the lockdown will be revealed insufficient. ht @devisridhar
In Hong Kong, it wasn't state capacity, but bottom-up civic mobilization w 2003 SARS burnt into collective memory, that contained Covid. "Hong Kong’s health authorities openly credited the near-universal mask wearing among the people for avoiding a surge"
Even after terrible past 3 months, just 5% of France has been infected (~10% around Paris). 90-95% are still naive to the virus and therefore fuel for fires of 2nd wave. There is no herd immunity shortcut to #TestTraceIsolate public health infrastructure.
It shouldn't still be a surprise, but age & gender conditional probabilities of infection, hospitalization & death is so stark. In France, 3.6% of infected go to hospital. Young recover after illness (sometimes debilitating);10% of elderly die, men more so
Delay is extremely costly in an exponential outbreak. @Yaneerbaryam @normonics @nntaleb urged social distancing & travel restrictions on January 26th. Anything you do early sounds alarmist; anything late, horribly insufficient.
"If you read the western press, truly successful countries like Vietnam, South Korea, & Taiwan are only held up as oriental curiosities, never as just human nations that could be learned from. They might as well be on Mars" ht Indi Samarajiva
The country has decided its open again. The virus has decided it has prey again. Good time to revisit classic Predator-Prey model ht @kjhealy @Kumar_EconIneq
Real time data on mobilty, commutes & contacts 
E Asian CDC public health guidance to prevent outbreaks: Avoid the 3C's
1. Closed spaces with poor ventilation 2. Crowded places with many ppl nearby 3. Close-contact settings w loud vocalization
Xi's speech at the 73th World Health Assembly. Highlights: ⬇️
Cheap vaccines; set up pan-Africa CDC; Debt service suspension; global medical stockpiles; assessment of what went wrong by WHO after epidemic is suppressed.
Whether Corona or Coal, its becoming more & more clear, that the fate of the world turns on the China Question. How would things be now if epidemic control strategy in Xi's pivotal February 3rd speech was widely read & acted upon in other countries?
Amazing that so many countries -- large & small, poor & rich -- have built their #TestTraceIsolate system alongside border surveillance to nearly stop the virus. 45 and counting! ht @yaneerbaryam @EndCoronavirus 
Put this out on Mar 25th when corona was surging and going to hell in a handbasket in so many places & got pushback. Now, nearly 50 countries have beat back the virus with focused #TestTraceIsolate effort.
“The world has come into this moment with divisions among its great powers& incompetence at the highest levels of government of terrifying proportions. We will pass through this, but into what?”
Martin wolf questions US/UK ability to mimic E Asian states.
The first flight carrying Medical supplies from Shanghai landed in NYC on 29th Mar. Since then, 151 flights nonstop, largely from Asia, have landed.

Oddly, little reporting on largest govt-led airlift in US history. #viraltime
Even after terrible 3 months, w over 200K lives in Europe, just ~5% have been infected (higher in large cities). 90-95% are still naive to virus. There is no deadly herd immunity shortcut to building #TestTraceIsolate health system.
Delayed action -> virus plateaus in US/EU at horribly high levels
Brazil, Mexico, India, Russia, S Africa have surging infections. Their path without #TestTraceIsolate is 10 TIMES more deaths by August.
Sao Paulo, Mexico City, Mumbai: Time to act is now.
Latin America accounted a third of cases reported this week. São Paulo, the largest city in Brazil & the W Hemisphere, is sliding to the catastrophe of NYC.
India's mad, bad & dangerous lockdowns began March 24th. Modi ignored scientists who advised #TestTraceIsolate ala Kerala. Ignored bureaucrats who advised PDS foodgrains for all in cities regardless of papers. Thread on cascading economic & health crisis⬇️
In an exponential outbreak, timescale is set not by us but by the virus' generation time or time btw h-to-h infections. Time has ticked ferociously fast since December. In #viraltime, delay, from unknown to known, known to reaction, is extremely costly
Virologist @trvrb in Seattle whose Jan post was like a bomb: "This genomic data represented one of the 1st...indications of sustained epidemic spread. As this became clear to me, I spent the week of Jan 20 alerting every public health official" #viraltime
New York Times memoriam front page for May 24 as US death toll 100,000
"There is a problem with numbers: They are the same whether counting grains of sand, or people. Complexity is a better measure. Each person is an incredibly complex and irreplaceable treasure." - @yaneerbaryam
Nice thread on how Japan's cluster response team formed 3C rule:
1. Closed spaces with poor ventilation
2. Crowded places
3. Close-contact settings w loud vocalization
Role of rapid learning & citizens' changed behavior.
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