I live in the Azores on an island with less than 15k people which was mostly closed last year. There are only two ways to enter the island: the port and the airport there isn't a lot of movement and everyone coming in is tested twice. On top of that people here are terrified of the virus and take it very seriously (masks, distancing, etc) and can even be hostile to newcomers.
Still, cases keep popping up even without systematic testing. There are no deaths or even ICU cases but the virus keeps finding its way in. I believe that, like New Zealand, we are just postponing the inevitable.
I believe that, like New Zealand, we are just postponing the inevitable
New Zealand (and Australia) don't have cases, because every single traveler who enters those island nations is kept in hotel quarantine, and tested multiple times before being released only after the quarantine period ends. It isn't the same as testing people when they come in and letting them straight into the community if they test negative.
That said, with vaccines now being rolled out, it may well be that these countries managed to dodge the bullet. It's hard to see what was "inevitable" about Covid, except the dogma (still promoted by the WHO, when I last checked) that travel bans are bad.
New Zealand and Australia have had cases outside of quarantine despite every single traveller who enters those island nations being kept in hotel quarantine, tested multiple times, and being released only after the quarantine period ends. Some of those cases are directly traceable to quarantined travellers, some aren't. In any case, even those measures which aren't practical except in an island nation aren't effective enough to prevent outbreaks when implemented on a larger scale; the bigger the country the more opportunities for one of those cases to turn into something that's not easily controlled.
Some of those cases are directly traceable to quarantined travellers, some aren't
One of those countries has been able to trace all cases in the last few months and makes extensive use of genomic sequencing. The leaks have all come out of hotel quarantine breaches. I believe that some Australian states that do not receive overseas travelers have not had a single case in months.
It may (or may not) not be feasible for bigger and non-island countries, although I suspect that the border closures will happen far more swiftly if there's another pandemic in our lifetimes.
The state which has the most international arrivals (NSW) just had its first locally transmitted (ie not in hotel quarantine) case in 55 days.
The positive case is a security guard that works at quarantine hotels. Immediate and immense efforts have been put into place to contact trace as many contacts as possible, and to sequence the genome to understand the direct link between existing cases.
We expect these occaisonal breaches in quarantine, and as long as they remain occaisonal they are relatively cheap and easy to contain. Meanwhile restrictions continue to ease and life is almost as normal as you could want - and will certainly be even better once the vaccination program is in full swing.
China successfully followed the same strategy, so the strategy certainly can work for large, non-island countries.
China had a few outbreaks (after Wuhan, obviously), but it responded to each one with quick restrictions on the affected location and mass testing of everyone in the region. That worked to contain these subsequent outbreaks.
As a result, China has been essentially CoVID-19-free for about a year now.
It's hard to tell what on earth is going on in China because a lot of the information coming out of there seems... dubious. As you say, they've had a few outbreaks which they responded to with large-scale lockdowns and mass testing, but if you believe their reporting the mass testing generally didn't find any cases at all which (if accurate) would mean the whole thing was for nothing. This seems unlikely. There were also weird WTF moments like in-hospital spread in a major city in a border region with a known outbreak going undetected for way too long at a time where even western countries that were "failing" at testing had enough in place to detect that. Also, a lot of the information about the source of the outbreaks and their successful methods for eradicating Covid is really obvious propaganda. On the other hand, their hospital system doesn't seem to be collapsing under a mass of Covid cases either.
It's not that difficult to know what's going on in China. There are many millions of Chinese people who call friends and family outside the country regularly. You can go read Chinese social media. There are Westerners in China who post to Western social media. There are even many people on HN who live in China.
> if you believe their reporting the mass testing generally didn't find any cases at all
That's not true. Their mass testing typically picked up further cases, which were isolated:
* In the June 2020 Beijing outbreak, mass testing uncovered over 300 cases.[1]
* In the October 2020 Qingdao outbreak, 9 additional cases (beyond the original three) were caught by mass testing.[2] That suggests that this outbreak was detected early.
* In the October 2020 outbreak in Kashgar, over a hundred additional cases were detected through mass testing.[3]
And of course, there was a more widespread outbreak in December (still concentrated in the Northeast), which peaked at over 100 new cases a day nationwide, and which was stopped with widespread lockdowns and mass testing.
> Also, a lot of the information about the source of the outbreaks and their successful methods for eradicating Covid is really obvious propaganda.
I assume you're talking about the cold chain. I don't see how that's "obvious propaganda." There's good evidence from contact-tracing that some of the subsequent outbreaks originated in people who work in the cold chain. It may seem strange from an American or European point of view, because the cold chain is way less of a problem than the literally millions of infected people walking around in Europe and the US. But in a country with essentially zero community spread and strict quarantine at the border, much less common pathways become a concern. It only takes one person touching a contaminated package and then touching their eyes to set off a new epidemic.
> There's good evidence from contact-tracing that some of the subsequent outbreaks originated in people who work in the cold chain.
Well, that's technically true. It just probably didn't come from the goods being handled like China claimed. In particular, formites and surface contamination of any kind don't seem to be a major source of transmission, and the Beijing outbreak they originally used this to explain seems to actually trace back to infected truckers travelling from somewhere in China with a previously-undetected outbreak that wasn't noticed before because locations outside Beijing didn't have the same level of testing. That is, they found it within their cold chain because that was where they were looking. This is also a lot more consistent with what we know about how Covid is transmitted.
> formites and surface contamination of any kind don't seem to be a major source of transmission
When there are millions of infected people walking around breathing and coughing, then fomite transmission is not a major source of transmission. But it is a source of transmission, and it could become the dominant source of new introductions of the virus into the country if quarantine of travelers is good enough (to go to China, you generally have to get a negative PCR test before your flight, then quarantine for two weeks in a special hotel on arrival, and finally get another negative PCR test). That's not to say that cold chain was actually the source of the Beijing or the Qingdao outbreaks, but there's evidence that points in that direction. In other words, this isn't simply propaganda.
But the larger issue that we were originally discussing is the overall situation in China. There clearly has not been significant community transmission over the past year, showing that the strategy (sharp lockdowns followed by strict border quarantines and mass testing during localized outbreaks) has been effective.
This is enforceable in remote island countries, but in ie Europe its not. You can't 100% lock the borders, there would be shortages of basically everything, from food to materials used in all industries. Europe is not so unified as US for example, there is a lot of independence, for better or worse. Food is transported on trucks, till it reaches from Spain say Poland it crosses minimum of 4-5 countries, each with their own covid situation, laws, rules, bans etc.
If we knew back a year ago how bad things would get and are still getting, I believe such a lockdown for say a month could pass, otherwise not and there isn't a central authority that could enforce it. And saying it was to be expected doesn't make much sense, spread of predicted outcomes was basically between yet another flu to another spanish flu.
What could've ended the pandemic around 6 months ago was human challenge trials on vaccines, and paying much more for earlier supplies of vaccines including those donated to other countries. (What counts as an impossible supply challenge is very different at the $500 price point than at the $50 price point.)
> What counts as an impossible supply challenge is very different at the $500 price point than at the $50 price point.
Considering the insane profits pharmaceutical companies are currently recording, the issue has more to do with these companies favoring their benefits to the detriment of the general population which should come as no surprise to anyone having experience dealing with a pharma company.
The issue is particularly prevalent in Europe because as usual, apart from some grand posturing in the media, Europe will do nothing to fight back.
I think most of the companies are selling the vaccine quite cheaply.
Moderna and Pfizer are asking for 15-20 $ / person for vaccine that has value of thousands of euros.
Which, as Eliezer notes, is part of the problem. That together with flexible delivery schedules in agreements mean that companies have little extra resources and incentives to invest in fast vaccine production.
Comparing an island nation of 5 million people, that can effectively close it's borders and "avoid" new focuses of infection, to countries of 100+ million of people, where the difficulties of border closing are effectively unsurmountable, is extremely disingenuous. The whole approach governments took in facing this pandemic needs to be studied in the next decades. It's an eye opening thing to see how viruses spread pretty much the way they do, and there is almost nothing we can do to stop it. It's really humbling to see that if you keep everything open (i.e. Florida) you get the same results as if you make your population effectively stop to live for one year (i.e. California).
well vietnam also did extremely well. and new zealands managed isolation (which i just went through) could easily be replicated anywhere there are hotels
In my country of 8 millions (Switzerland), about 340'000 people commute to Switzerland each day to work [1]. These people come from Italy, France, Germany and a bit from Austria. A lot of these people do important work, such as working in hospitals, administration, services, ...
Locking down the borders completely would just have been impossible. You would be suddendly in need of nurses and doctors. Sometimes, more than 50% of the personal in bordering hospitals are cross-border commuters [2]. Yes, you could discuss on how Switzerland is taking advantage of "cheap" labor from neighboring countries, but it does not change the fact that for Switzerland, closing completely the borders (with 14 days isolation) is just an impossible task.
Thailand’s 50m people with 3,000km of mostly unpoliced border, they made it work. Vietnam made it work. Locking borders early and moving to quarantined entry apparently works, and when some knobs walk over the border with Covid, as has happened with both countries, you can unleash an almighty track-and-trace and isolated lockdowns because the health system isn’t already on its knees.
They're not islands in a strict geographical sense, but there are a dozen or so countries which are de-facto islands for any practical purposes - accessible only through large bodies of water, with land borders mostly impassable or crossed so infrequently that they don't matter.
South Korea, North Korea, Finland, Vietnam, several central American countries and others. Even China fits the bill. Not sure how frequent traffic across Thai borders are, but my impression is that SE Asian countries are not very well integrated.
Track and trace works way better when you have 20 or so people infected than when you have 100,000. It's not even the health system, just the logistics of tracking everyone down. I kind of experienced both - the first in Koh Lanta and the second in London.
Its likely illegal for California to close its borders to Florida. But that probably would have slowed the spread significantly, at least in the 3rd wave where the Mid-Western / anti-mask states led the 3rd wave.
This country was in this together. For better or for worse. Closing the borders of states was never an option.
> Its likely illegal for California to close its borders to Florida.
I wonder if that's really the case. A year ago I'd say the same for Australia. Yet most Australian states closed their borders at some point as a response to local cases spiking. (I agree it's less practical in the US, but I do wonder about the legality)
Whatever the answer I feel like it would take the courts a few weeks at least to figure it out. California (or more realistically Hawaii) could have had a full three week border closure before anyone settled the case law.
Not very many roads enter California, as it has natural geological borders. An ocean to the west, hilly forest to the north. On the east, a 3 km high mountain range which leads into a hot desert, cut by the mighty Colorado. The terrain is a lot more forgiving to the south, but there’s an artificial border with Baja California there.
Plus, most of the infrastructure is there for the agricultural inspection stations. Just use it to stop human disease instead of plant disease.
And if I kind of zoom into Google maps I count 36 crossing between the Oregon/California border just between the Pacific ocean and I-5. Sure, a lot of those are probably logging roads and such, but that's just a 60 mile stretch.
I do not live in the US, but I love that your system allows you guys to have effectively 51 experiments on how to deal with the spread of a virus, and see the results of every strategy. Do you really think that, if you can't even control your borders between states, your border on the south with Mexico for instance, would ever be effectively controlled to avoid the virus to come through it? The complete failure of California (even when compared to states where the demographics tend more to the older generations) tells me everything that is needed to understand if the lockdown approach works or not.
California is far from a monolith, though. Alameda County, where I live, hasn't been that bad, and has had a strong lockdown policy. Other parts of california have larger populations of anti-maskers. And the California prison system has been a complete disaster, largely because of incompetence and inhumanity in the administration.
It's a distant island nation at the end of the transport network.
One of the reasons New York, London and Brussels have been hit so hard is that they are global hubs in the world transport and financial power networks.
Not really. There are two basically insurmountable problems with taking New Zealand's success and expanding it to the entire globe. Firstly, the effectiveness of this is limited by wherever it works the least well. Secondly, even if everywhere could implement the same measures as New Zealand as well as they did, over that large a scale there would be places which had much worse success just through random chance alone. You can see a few places where New Zealand got lucky already, like the recent outbreak of unknown origin not spreading as widely as it might've or the infections amongst border workers back when they weren't being widely tested. You can also see this in Australia, which is similar geographically but bigger and has taken many similar measures with slightly worse results. Scale up three orders of magnitude, and I've no doubt fun new failure modes will appear which aren't even visible yet.
China is the most populous country on Earth, and geographically, one of the largest. It has followed a similar strategy as New Zealand and Australia. That strategy has worked to keep the country essentially CoVID-19-free over the past year.
It's what I've been told by numerous people who live in China. It's what I see on Chinese social media, and it's what Westerners who live in China are saying on Western social media. I'm sure there are many on HN who live in China - they can also tell you what things are like there.
If there were a major ongoing epidemic in China, it would be impossible to hide. Hospitals would be under the same sort of pressure that they are in Europe and the US. People would have family members and friends who got sick or who died. That's not happening. China is simply too tightly connected to the rest of the world to keep things like this a secret. In December 2019, the existence of the outbreak in Wuhan was known around the world within days of the first patient test results coming back.
Even Western media began grudgingly admitting several months ago the virus was essentially gone from China. For example, German/French public radio did a pretty interesting documentary on post-CoVID-19 Wuhan. The first scene is in a packed discotheque:
>It's what I've been told by numerous people who live in China. It's what I see on Chinese social media, and it's what Westerners who live in China are saying on Western social media.
Yep, that's how censorship works.
I'm sure you won't see too many people talking about Tiananmen Square on Chinese social media either, but that doesn't mean it didn't happen.
Are we really going to pretend that the Chinese government hasn't been heavily censoring information which makes them look bad?
Early on in the pandemic, the Chinese covid death counts started to skyrocket, and activists within the country were using Github to make sure this information did not get 404'd. The same day these activists were dissapeared, the skyrocketing "official" chinese covid death count immediately went down to "0", where it has remained ever since. When using Google to browse the death counts by country, you can't even look at the death counts for China, the button is disabled.
China doesn't have the power to censor Western expats on Twitter, or the millions of live conversations going on at any given moment between people inside China and people outside. This view of China, that it's a black box that information can't escape out of, is simply not reality.
>China doesn't have the power to censor Western expats on Twitter,
Yes, they do, directly and indirectly.
Directly: Li-Meng Yan, the Chinese virologist who blew the whistle on covid in December 2019, but the Chinese government covered that up. She defected to the US, and published a research paper critical of the Chinese government, and Twitter banned her account.
Indirectly: How likely do you think it would be for the chinese government to renew an expats visa if they were doing activist work like the chinese activists who got dissapeared for reporting covid deaths on Github? They didn't even let a WHO investigation team into their country for almost a year
Li-Meng Yan didn't blow the whistle in December 2019. She's a Hong Konger who started making crazy claims months after the outbreak began. She flew to the US, claimed she was persecuted, and now works for Steve Bannon. She's made all sorts of crazy claims, including that SARS-CoV-2 is a bioweapon.
The first pneumonia patients in Wuhan got their test results showing a suspected SARS-related coronavirus on 27 December 2019. The local authorities put out an alert on 30 December, which was instantly noticed by people around the world who track emerging infectious diseases. In other words, health professionals around the world knew about the Wuhan outbreak within 3 days of the first suspicious test results.
I don't think you realize the sheer volume of communication between people in China and the outside world. Many millions of everyday people are in regular contact across the border. There are many millions more people with VPNs who say whatever they want on Western social media. Even Chinese social media is way too active for the government to thoroughly monitor. Almost anything major that happens in China nowadays is known about outside China pretty much instantly. The idea that there's been a massive epidemic underway in China over the past year and that the government has been able to keep that information from leaking to the outside world is utterly implausible.
> They didn't even let a WHO investigation team into their country for almost a year
Which WHO investigation? The WHO visited on 20 January 2020, just three weeks after the outbreak was identified.[1] Months later, for political reasons, the Australian PM started demanding an "investigation." China didn't like the accusatory nature of the Australian demands, and it took months to negotiate a process that all sides considered reasonable. But the WHO was in Wuhan long before Australia began demanding a different sort of investigation.
As far as I know, it was well-reported in the papers that the WHO team was first blocked from entering. And then once they were allowed in, all the data was sanitised for them.
First of all, I'm talking about the WHO team that went to Wuhan in January 2020, not the team that went there a year later. The WHO was on the ground in Wuhan within weeks of the initial detection of the outbreak.
Second of all, you should take the claims of Western media about China with more than a grain of salt. The WHO team that went a year later wasn't blocked from entering. A few team members began traveling to China before their visas were approved. The data wasn't "sanitized." One team member said he wanted to see additional data. The newspapers trumpeted that, claiming that China had hidden everything. Other members of the WHO team then criticized the newspapers, saying that they had been given extensive access to the data they wanted.
I’m skeptical. Even countries like Singapore have constantly had 1 or 2 locally transmitted cases per month they can’t trace.
Now multiply that across 170 countries some too poor to do what Singapore did.
If every country had locked down like NZ, we would have just had a series of lockdowns and flare ups and more lockdowns. It certainly would have kept the case numbers much lower but can you imagine the fatigue after going through your 12th lockdown?
I can imagine the fatigue of what I’m currently going through of constantly locking down for 4 months at a time!
Compared to that, having to lock down every couple of months for a week or two doesn’t seem anywhere near as bad. Oh, and we wouldn’t have 130,000 dead in the UK and 500,000+ dead in the USA!
A couple of weeks is basically the bare minimum. New Zealand seem to have gotten a little lucky with their latest outbreak; one or two people not noticing their symptoms, or going for a walk with someone different, or interacting for a little longer at a restaurant and they could easily have ended up having to lock down for months like Guernsey or the Isle of Man. (Arguably, it's still a little too soon to be sure they've gotten away with it.)
So the population of a whole city is normalized on lock down as if they were inmates of some large prison camp, while the government uses all sorts of surveillance mechanisms to track whoever they please freely for some very marginal public health benefit, and this whole situation is considered "great". What kinds of things have been normalized in the supposedly free countries by this pandemic.
You assume wrong about my nationality. One doesn't have to be Trump-loving caricature of an American to deeply mistrust restrictions of basic individual liberties.. And if not marginal health benefit then most definitely highly ambiguous, debatable health benefits as far as a large weight of evidence is concerned. Some countries with lockdown measures have had lower mortality rates while others with just as strict rates have had high mortality rates, and many countries without much in the way of restrictions have had mortality rates little or not at all different from those of other countries with severe restrictions. There is no existing consensus here and all evidence seems to be all over the place. The themes I mentioned in my previous comment however are normalizations that bode dangerously for the future of supposedly free countries, the future of social globalization (a good thing overall because it strongly counteracts nationalist tendencies) and none of this is to even mention the still unknown long term consequences of the vast economic destruction cause by so much callous but ambiguously backed lockdown policy in so many places.
To put your numbers in perspective, in a population of 330mio with life expectancy 70-75y (USA numbers), every year around 4mio people die for some reason or another. Not saying covid is not a problem, but these numbers don't really support the claim.
Yeah but that's unrealistic proposal that looks nice on paper, but completely ignores real human nature and how complex and diverse real world is.
Who has the authority for global shutdowns? Nobody. Many nations wouldn't agree on that and political discussions would be endless, everybody has their own agenda regardless of virus. Can you imagine some Europeans telling USA 'OK now whole of your nation will stay at home for 2 weeks'. Not going to fly on any US level. Or Americans to Chinese.
Globally it haven't been handled OK by any means, but these naive suggestions don't help getting a workable solution.
'If only all people behaved rationally' can be wished in any discussion, sure, but it doesn't get us anywhere closer to solutions.
Well, no, that’s exactly what I’m saying would not be the case. The longer lockdown would not need to be anywhere near as strict as the lockdown that comes after a month of opening everything back up.
Wow, so now instead of the ‘three weeks strict lockdown to stop the spread’ fantasy we now have this ‘lockdown light’ idea. Where did this theory come from?
The only chance for lockdowns was in China, early on. Being a country with virtually unlimited money, manpower and an authoritarian regime Covid could have died in there. Quarantine enforced by millions of soldiers and police.
Once out, you're dealing with about 200 countries divided in tens of thousands of localities and hundreds of thousands of politicians with their own goals and beliefs. So, not doable.
That's impossible. China is not North Korea. All it takes is just 1 asymptomatic infected person to leave the country - perhaps 1 hour before the hypothetical country-wide lockdown - for the virus to spread.
No, it's even worse than that. Signs of covid have been found in Europe dating back to October 2019, before anyone in China knew that this existed.
Besides, western countries didn't take the virus seriously in the beginning at all. Even a month after the Wuhan lockdown, the Dutch didn't take much action, while Trump said it's just the cold. The attitude was basically: it's only a disaster in China, outside China it's not serious.
> The attitude was basically: it's only a disaster in China, outside China it's not serious.
Your comment is on point. I'm certain that many European countries benefitted from the escalation in Italy and pictures of army trucks filled with body bags. From then on, most took the virus a lot more serious.
'It's only a disaster in X, in our country it's not serious' has been a recurring theme and it's one of the things that makes me bearish going forward.
It has been already analyzed in very fine detail, what you mention is an obvious double/triple check. If you have a sample that changes whole global narrative, you can make enough detailed tests on it to have statistical chance of error close to 0. Too bad they don't have earlier samples, we could possibly find it way earlier.
It wasn't October 2019, actually Italy had September 2019! A few countries had it back-identified before official Wuhan ones. France had December. Its very well possible that Covid originated elsewhere, but that's another topic.
I remember the Chinese guy Zhong Nanshan saying if the world took his/Chinese advice, basically Wuhan like policies, that the whole thing could be gone by June 2020. But I guess with Trumps and Bolsonaros running countries that wasn't on the cards.
Thanks to COVID-19 fatigue amongst the population, such an effort very close to impossible.