Numbers

It would be interesting to know how people in different industries have experienced this Black Swan event. For our organisation, it's been a massive administrative and logistical challenge which I believe we have managed adequately for, but we are in an industry that can go on under lock-down. For some retail organisations, it's been just a case of initially rolling out safety policies (social distancing; cancelling events) and then with the Level 4 starting, doing the communication for a shut down of trade. The shutdown affects staff, and staff do need clear guidance of what will happen in this scary new world. 

The experience would be heavily influenced by the approach of the government for the particular countries. Take a shopping mall shop assistant, who in NZ should be getting at least 80% of their wage to stay home. The flow-on effects are all different for each person. 80% might seem like a pretty good rate to have essential staycation and watch Netflix, but many people might struggle with a sudden 20% drop in income. Staying at home does restrict your ability to spend but it probably doesn't make up for the 20% loss. (Not to mention, the feeling of additional loss because your KiwiSaver took a hit.) But the wage subsidy programme is a great idea to enable companies to switch out of the lock-down and back into full gear. In Australia, apparently they didn't think to do a policy to protect jobs and instead allowed companies to shed jobs to keep going and be profitable, and instead increase funding for the unemployed.

But a shopping mall shop assistant in the US might have no pay whatsoever to stay at home. A new word, "furlough", is now increasingly common parlance, for temporary halting employment and pay. How can one prepare for that? Perhaps in such an environment the insurance market fills that gap - income insurance is a product for this kind of scenario. 

I worked through this weekend. It was a blessed weekend of work because it seemed no-one else was doing the finicky stuff, the cerebral stuff, the big picture stuff and the wish-I-had-a-moment-to-do-it stuff. I was almost undisturbed and got enough stuff done to mean I could have a cruisy week while garner a few plaudits for being organised. Today I relaxed on the sofa knowing everything was in its right place.

Numbers are a thing for me. Despite my pursuit of languages, I'm a mathshead from way back. I remember learning calculus and thinking it was a bloody good idea. I love a rule that unlocked the minutiae. When I started my long gradual march into management in China, my organisation weakness at the time was compensated for almost entirely with my ability to use numbers as both a shield and a blunt instrument to get my way. Managing upwards is a cinch if you handle your numbers better than those above you. It takes a very on-the-ball superior to have the time to dismantle a numerical defence or blockade. Usually, without a grasp of the detail to unpick it, they let you have your way. It takes either the bloodyminded or the maniacal manager to take you on and try to wrestle your digits off whatever you were wielding in defence and force an issue. 

Anyone who has read this blog for a little while knows that the numerical side of the pandemic has attracted me. Tomorrow, the United States will clock over twice the number of confirmed Covid-19 cases yet just the same number of official deaths as China, the original OC for Covid-19. The contrast between those two facts could be puzzling. Some might conclude that American healthcare is better than Chinese; or more evenhandedly, China was caught unawares and took a hit before it knew what it was grappling with. I'm no expert but both explanations don't consider the temporal aspect. China's numbers are final, they've gone through the cycle of what is now typical in covid-19 control: (0) outbreak, usually with the initial deaths of the vulnerable; (1) wider spread beyond and sudden accumulation of cases in health systems; regional lock-downs; (2) national lock-down; (3) levelling out and then a decrease in new cases; (4) a levelling out then a decrease in the number of deaths; (5) Attrition of the considerable number of people who are critically ill and on respirators. Most of the dying happens in the last three steps and the US is only up to step 1. It's the second step that they could have done but it seems they can't get past the idea that it has to be a regional approach. Several states have implemented so-called "shelter in place" which is essentially the same as the New Zealand lock-down rules, but with an important difference: they aren't islands. You can drive from one shelter-in-place state to a less affected state, and why wouldn't you? Also due to the lag between infection, symptoms, testing, confirmation of diagnosis and hospitalisation, there are a lot of non-lock-down states who will soon be in the same situation that precipitated the lockdowns. You can almost see California and New York emerging from their lockdowns to find that Florida, Mississippi, Texas, Pennsylvania suddenly carrying the burning torch of coronavirus, ready to pass it back. 

"We are not Wuhan," the Governor Andrew Cuomo of New York said, when saying that his state could not be quarantined like a Chinese metropolis could be ("feng cheng"). It is true but for the wrong reason. Wuhan was a "bloodbath", quoting myself in January and the quarantine. When Wuhan was unfolding the stories were blood curdling. There could be reason to doubt the numbers but accepting the numbers: over 2500 of Hubei's 3148 fatalities were in that one city; which were the vast majority of China's 3314 death to date. During the worst of it there were about 12 days where the daily deaths for China, mostly made of Hubeinese, were between 98 and 149. It makes for a quaint reflection now because Spain and Italy have put up daily death tolls in the 800s and 900s as countries, but they're already at step 3. Cases are tapering out; they are almost set to sit down and let some other countries take the lamelight. New York state, with a population of less than 20 million people, has an increasing number of deaths, now over 250 a day and rising. New York State is not Hubei, it's worse. The rate of increase of new cases is dropping so the shelter-in-place rules do work but it's going to drag out, and the worst of the deaths are yet to come. Probably the only determiner of whether they can keep it to a less than catastrophic number will be if they can prevent the health system collapsing under the weight. The death toll for the state of New York currently stands at 1,342. Wuhan's official death count was less than 100 when it was sealed.

Only god knows it's Friday

Lockdown. Officially only the end of the second day, and already it's hard to know what day it is. In the confinements of ones home, the days all seem the same. I've lived it of course in self-isolation but this time is qualitatively different: when everyone is under lock down, everyone is in the same twilight life. The last two days have been the most frenetic work-from-home days ever. It was apparent during the self-isolation that I'm relentlessly more productive at home but also still wall-to-wall busy. There is a obstruction quotient that causes interactions to be slower; and a competing non-distraction quotient which causes all tasks to be done easily because JS or SS aren't at your door asking the same question they did yesterday.

Even though the days are merging into one, I've used Friday as a my measuring stick day to mark the progress of Covid-19, so just to shock you a bit:

• if New York State were a country, it would have the 6th most cases and the 8th most fatalities, despite being much smaller than almost all the states in the top, bar Switzerland.
• in 7 days, Italy's fatalities doubled from 3,405 (shockingly surpassing China) to 8,215, where China is no longer a relevant comparison.
• if Italy felt bad for doubling deaths in a week, Spain went from 831 to 4,365 to make it seem like it had been "flattening the curve"
• Diamond Princess fans were shocked when the model sample went from 8 fatalities to 10. The now ignominious sisters, Diamond, Grand and now Ruby, have a lot to answer for but Diamond has often been taken as a perfect sample to prove that Covid-19 isn't as fatal. There were 712 diagnosed cases and for a long time only 7 fatalities, which for a cohort of older people might appear decent. Except for the fact that they would be receiving the high quality unburdened care in Japan, and even with that they had a large number of still "Serious/Critical" cases (15 is the number quoted on worldometer.info). If that number of deaths continues to rise, some of the viruskeptics will have one less straw to pull. 
• Horrifically for our neighbour, Australia has gone from a mere 756 cases (and 7 deaths) to 3,166 cases and 13 deaths in a week. And still they don't think to pull the cord to stop the bus.

The inanity of the US/Australian cases for a mottled lockdown is that it even if it puts out the fire in parts it allows the cinders to burn and reignite. New York State might heroically lock down and smother out the virus locally but it will still be surrounded by dubious states with unknown degrees of contamination. Same for Australia who have the worst parts of a lock down without locking down and then still allow it to burn. Perhaps the Australian example is a Machiavellian plan to flatten the curve while still preserving economic life. Or perhaps it's just an ill thought through, inconsistent, incoherent plan. Next Friday we'll see where they are. 

I used to get my figures from Chinese sources when this virus only had a garnishing of non-Chinese cases, but now I use https://www.worldometers.info/coronavirus/#countries as it's the quickest to update. It's crowd sourced so subject to change but it's still the best out there, and the best statistics. best of which is the logarithmic charts. (Nerdy, I know.) One of the side benefits of a pandemic and comprehensive tracking is the abundance of geographical locations that you feel you must know. So your task today is to state where the following places, with confirmed Covid cases, are:

• San Marino
• Aruba
• Andorra
• Guadeloupe
• Martinique
• Curacao
• Cabo Verde
• Eswatini
• Turks and Caicos Islands
• Sint Maarten

Anyway, none of these places are like Cocomo, where you're not gonna go. 

Masking the flu (a bit more grey)

Two persistent Corona-topics that come up again and again: comparisons with the flu and evaluations of the efficacy of masks. They are rapidly getting into "that old chestnut" territory but their persistence make them tough nuts to crack.

The flu thing is irritating because of the aversion people have to "grey" I raised in a previous blog. People still want to yanny/laurel Covid-19 to being either the average lurgee or the 1918 "Spanish" Flu. Every time there is an article that minimizes this pandemic I feel the threat rise and more people take it lightly.

But the attitude to face masks is also irksome. It seems a loaded topic and there are experts who come out to downplay their efficacy and discourage their use. It is true that mask use require a little guidance for best use, and you can see lots of people using them unnecessarily, I would say that it is irrational to discourage use if it's an available resource.

I'd like to explain it with some evidence and reasoning. Feel free to dispute it. The first thing is that mask wearing cultures have fewer cases. Early on South Korea, Japan and Singapore all were the secondary epicentres to China. Right now, South Korea has slide down to the 10th most cases, Japan the 27th most cases, Singapore 44th. Of course, this is not to say masks are responsible for the relative improvement, the clear "flattening of the curve" but it coincides. No mask wearing culture is having a hard time with this after they were collectively ambushed by this pathogen.

My second argument is about what's called inoculum, that is the amount of contagion that you take in. Young health workers die of Covid-19 because they don't just have casual contact with the infected, they get it again and again, small and big amounts. They are inoculated with different amounts, and in this situation more means less chance of living through infection. The experts may say that masks still allow viral particles to sneak past the sides. But if you are in the early phases of infection, most of your shed viral particles are not likely to go out to others if you are wearing a mask. If you are sick, you'll definitely have access to masks in a culture that values masks. That means your contacts would have much reduced inoculum and are also less likely to die from their infections. And if you are a healthy person in situations with repeated exposure to possible infected people or in enclosed environments you have less likelihood of breathing in droplets. Infection is not a binary thing. It too happens in degrees and the degree of infection is affected by barriers such as masks.

The focus on hand washing in western countries is noble and there is now a spotlight on the touching of the face by hands. People unfairly pick on the health ministry people who just like us are compelled to scratch, rub and pinch their faces, with their ill luck that they're often filmed doing so while advocating that we all shouldn't. My nose is forever uncomfortable and I know that I have terrible habits in this area. I thought of putting plasters on my fingers to make me aware when I did. It didn't work. You know what stops your subconscious touching of your nose? A mask. Experts point out that you might touch your mask and transfer virus to your hands. True, and that's why masks and handwashing go together.

It's a no-brainer. There has been some conspiratorial perspectives why masks have been discouraged. Firstly, western countries aren't well stocked with masks. If the whole population needed a mask (should be one a day at least, or once every 4 hours if you follow the directions), we would need almost 30-40 million masks a week. By discouraging the public use, the health sector can buy out the available imported stock and secure all the local production. I agree with this but would prefer that there was increased production. Our country had two months' lead time to stockpile and I heard our local production could do 200,000 a day. Still, on the news tonight it showed nurses in South Auckland without masks. You see staff for "essential service" not wearing masks.

Masks may be a cultural thing. Service staff do not want to mask up because it's hardly a welcoming thing to wear. How do you feel when you are welcomed by a person in a mask? Cold and alien. In China, dare I say it, service has no such scruples. But there is a messaging in it, too. Now we too have our daily updates on the TV about the local outbreaks and case numbers. In China, all the officials doing the presenting did it masked. The reporters asked their questions masked. Even Chairman Xi got masked. You could tell immediately that this is a serious thing. Even my in-laws on the farm who themselves would barely think of wearing a mask wore them, not just because their children begged them to but because the leadership showed that it was the thing to do. In China, you could say it might get to the point of virtue-signalling, but you could also argue that it's legitimate hygiene-signalling: I'm safe. I care about your safety. In Guangzhou you couldn't take public transport without one, and it was seen as socially irresponsible not to.

I haven't yet donned a mask in New Zealand because I genuinely have thought that the cases prior to the current week have all been people who travelled in and still at a low incidence. My line was crossed with community transmission. When I go to the supermarket this weekend, it'll be in a mask.

Lock it down!

It's a quintessential scene in a disaster movie: the peril is impending, the people surge for their lifeboats, their security from zombies, their escape hatch and their dangling rope from a leaving helicopter. The protagonists of the movies just make it to their refuge, and the camera sweeps to those who just missed as the velociraptors sweep in, as the lava pours down the valley to cut off all hopes of escape. It's time like these that almost evoke the cinematic. I was told of a real scene today that made me think of these movies. Yet in this actual story, it wasn't the apparent threat, this virulent disease, that was surging forth but the measures to ameliorate it that are an existential danger to companies. It was the sign of an organisation sitting on the beach when the tsunami roars in. There were tears and there will be tears, but before I tell you about that let me set the scene from a mountain top where I peered to the beach below:

"Going online" might sound like an easy process but for any school its a massive undertaking. I've never been tempted to move our school online, and I don't think we've been depriving our students of much by not. The virus indirectly got our feet wet though: in February we were going to send a teacher to China to prepare students for study in New Zealand but just as we got all of our ducks in a row, the covid-19 outbreak in China shot the plan out of the air. Instead we chose to prepare them remotely. The platform was chosen while I was still in a lock-down in China but with my acquiescence. I eventually returned and supported the teacher and learned a little bit along side him. I even covered a part of his class to get my first taste. Perhaps it was because I'd already been under one lock down, when we had our first case I proposed setting up our academic pandemic plan and promptly held a non-standard team-meeting to focus on safety procedures and an initiation into the platform for the whole team. We then did a whole organisation, whole study body campaign of information, then I helped teachers do a session in their classes to have the students download the app with support from the different language team members. Then we were to have a "trial" day where everyone would do a class online. Our problem was this week was meant to be a 6-weekly test week. It would usually be a Tues/Wed affair with Thursday for marking and result approval. I targeted Friday 27 March as my day to have all classes online as a trial for everyone to learn.

Then the PM raised us to level 2 on Saturday and I went fully for pulling testing to one day, Monday, and the online trial to Tuesday. Then there were another 30 cases on Sunday and the CEO put all programmes on pause for the current week at our sister school and asked what I wanted to do. I insisted on plan A, saying we'd complete testing on the Monday and do Tuesday as an online class and pause from Wednesday. Everything just worked. Even the announcement of level 3 on Monday didn't shake the plan. All testing was done. Online classes were scheduled. Communications went out. Monday was done. 

And today is that Tuesday. Our teachers were plunged online. It's hard when you're used to one mode and you're forced into another. Even though they had two weeks to familiarise and even had me to coax them into trying it out with me on the weekends, many still weren't sure before classes. There was a bit of panic and floundering but also some realisations and learning. There was one student complaint. One teacher who couldn't follow directions. Today is done. We have a few days to consolidate how we're doing things before we properly launch next Monday. I'm just glad we scrapped through to an acceptable way of doing things.

That takes me back to that beach: The actual setting was an educational industry meeting, perhaps as recently as yesterday, where there was an educational leader from an English language institution which had dragged its feet, or perhaps didn't move them at all, to get "online". This person was crying in front of the group, not knowing what to do. Their organisation was not ready and the virus had moved fast and, now, to actually implement online teaching is tantamount to impossible. Teachers, even techsavvy ones, might not "get" how the new platform works or how to prepare and present material. Language learners of low levels, with varying technology are no longer concentrated in the one room for "easy" training. (Actually even explaining to them step by step in person can be a challenge.) There can be no classes. There can be no training. There can be no teaching. Many of them communicate just with e-mails and phone calls and they have no tools to really even overcome the chasm that they're about to dive into. The tidal waves washes in with torrential tears.

And now it's a game of 28 days later... Not the zombie movie, it's the length of a notice period and also the length that the Level 4 Alert is pencilled in to last. If the alert were just to be 4 weeks, it'd be the most ironic notice period ever. But it is hard to say when real normalcy will resume. For our own school, students will end their enrolments but many students will almost have to extend their study as there are no flights back to their countries. (Aside: What does a government do with people who are overstaying their visas or have rejected visas?) For a period we worried that we would have no more students coming in. Now it's possible that our students won't be able to leave. We've now entered the twilight zone. We're in lock down. 

I'm now an expert on twilight living: I spent about two weeks of my three week China trip in lockdownesque situation in the village. I spent another two weeks in self-isolation after returning from China. And now I'll be in another lockdown here for at least another four weeks. Lockdown. Lockdown. Lockdown. But there's no safer place than the home. The global deaths from this thing went from 10,000 to 15,000 in five days. That's a 50% increase in five days for something that pretty much has always seemed devastating. Die in, die out. Who would want to be on the streets?

Strategising the peaks

It's easy to get rub ourselves into a soapy lather over the rise in Covid-19 cases in New Zealand but if I wanted to cool myself down, I assure myself that there must be a tactician, probably a chess player, behind the scenes planning moves, feints and stratagems that fit into a grand plan. Go back just one week to that "Self Isolation policy for all arrivals". At that time there were only 5 cases - and that 16 day strategy lasted all of 5 days before the announcement of a complete closing of the borders. In some ways it might seem that the self-isolation policy was a misstep, but you don't need to be too generous to think that it was actually a telegraphed phase in a bigger strategy.

The day she announced the self-isolation policy, the Prime Minister, with just five cases, said that the plan was to "flatten the curve", the curve being the surge of cases. Without any prevention measures, the outbreak would have a large peak that would overwhelm the health system. So to flatten the curve it implies that there would be measures deployed in the face of the virus to dampen that surge. For there to be a surge, there needs to be the spreading of the virus. For there to be a spreading of the virus there needs to be cases and community spread. The plan of flattening the curve was clearly informed by the need to have a long term plan of herd immunity through gradual spread, rather than containment. This article in the New Zealand Herald it elaborates clearly a strategy of "managed peaks" as New Zealand's best bet.

It was actually possible at the five case mark to shut the door. It was already pretty clear that wherever the disease landed it burst through any line of defence. We could have contained the disease outside our shores and extinguished whatever signs of it there were within. That would be an easy strategy - but also it's a very temporary strategy, unless you want New Zealand to become an autarky a la North Korea.

The key is to have a few cases, not too many cases at one time. Like a captain on a ship planning to tack, they waited to a particular time and then slammed the door to the entry of imported cases on Thursday night. Today it was announced that there were two cases not from travel. For some this is a moment to fret, not realising that the strategy is clear: the majority is going to get exposed, slowly, with the contagion slowed with social distancing, and tracing easier with movements restricted. Local transmission is how you get the virus to the non-travelling population.

It is not a politically easy statement to make: we want you to be sick, at some time, in an orderly way. Britain, of course, made a similar statement but with negligible testing, existing wide community spread and fatalities already emerging. It will be interesting to see how our Prime Minister would answer if asked directly if they were intending people to get infected, even though she has coded it. 

Which brings me to China. Their official numbers seem to indicate that the community spread is negligible, the outbreak extinguished and that the only source of cases was from the outside. But they still haven't started the school year; there are anecdotal stories that there are still lock downs and the sealing of towns. My theory is that China is also maintaining a low level controlled infection of the populace. But also that is not a palatable fact, hence the suppression of accurate numbers of true local transmission.

It could be possible that New Zealand has too many cases - we just don't know how many cases are actually out there. With the speed of this outbreak, a week is a long time. Every week from here to Christmas will be a long time. With a bit of luck, we'll have vaguely normal lives and a slow inevitable infection, while treatments and vaccines are eventually developed. Fingers crossed.

Blindingly grey

In my teens and my early 20s, I often dabbled in Taoist (Dao) philosophy and sometimes aspired to get my head around the esoterism of Buddhism. But I was a shopper of ideas, I took what I liked and called myself what I wished. One of the core beliefs for both of those though was a negation of duality. Even if the Yin-Yang symbol was a swirl of black and white it was clear that there were degrees. And even the complete black could collapse into white and vice versa. It was a bit like a tonic for the mind when I was young, but the conclusions are all the more obvious as you age and gather experience. The black and white truths that you hear around the place become a bit ridiculous.

From chapter 2 of the Daodejing (Laozi/Laotzu):

"Under heaven all can see beauty as beauty,
only because there is ugliness.
All can know good as good only because there is evil.
Being and nonbeing produce each other.
The difficult is born in the easy.
Long is defined by short, the high by the low.
Before and after go along with each other.
So the sage lives openly with apparent duality
and paradoxical unity."

Paradoxical unity where good and bad are part of a single whole. Can you find a pole on a circle?

Anyhow, the more I manage a team the more I wade in the grey. The more I cross cultures the more hazy things appear. I can't live in apparent duality when its only really apparent to others. In this interminable moment in time, the duality is crisis/no crisis; pandemic/common cold; correct approach/foolish incompetence; infected/pure; young/old; others/self; overreaction/prudence. Why does it really have to be one or the other? And how can you know when you're in the dark in world of paradoxical unity. 

Truth and reality are textured and not polar. Perhaps it's only in the spheres of life that we're familiar with that it's clear things are in degrees and the art is clear; perhaps it's only the unfamiliar terrain of other topics where we use duality as a heuristic. There are some many angles of this pandemic where a little grey goes a long way. There is a lot of dispute how fatal covid-19 is. From the "official" statistics for any country right now, an initial fatality rate can become clear, but it almost every place but China and the Diamond Princess the "smoke has not cleared". There is still some grim accounting to do... But the Diamond Princess shows a 1% fatality rate; China has a 3.5% fatality rate, although all provinces apart from Hubei have barely 1% fatality. Trump famously spoke from his gut and said he thought it was below 1%, more like the flu, and that most cases aren't counted. But not all flu cases can be counted either. And now Italy and Iran seem to be outdoing even Hubei, and even if they had tested everyone. Previous I did mainly through the prism of response time and approach. But there are other angles, too.

What is infection? I speak now with no epidemiological knowledge, but just empiricism. Being marked as "infected" is not actually whether you "a virus detected" It touches some and even with exposure doesn't others. The first drop of grey is the assumption that all people are the same in the face of a virus. Texture. The other assumption is that we meet the virus in the same way, that it's either a hit or a miss, a binary. What an infection is whether it be viral, bacterial or fungal is when a particle or particles of the disease successfully establish and propagate themselves. For covid-19, the action is mostly in the lungs so how much of the virus gets in them, where it manages to get to and whether it is on more than one occasion must be a factor. So grey. And then is it detectable? Maybe a healthy well slept person inhaled one particle and overcame it without it becoming noticeable or even detectable, did it really make a sound? A paler shade of grey? And in many countries they are more thorough and transparent than other countries so 

On the contrary, there had been a lot going around that this disease only kills the old and for the rest it's a bad flu. So much black and white in that thinking. Chinese will be quick to raise that Li Wenliang, the whistleblowing doctor and many other doctors died young, showing that the amount of exposure and stress does a lot. There is a chain reaction when the virus becomes so prevalent that people can't avoid multiple infections and the fear and anxiety deprives people of sleep and immunity. I believe in the other provinces in China, there was never much density in cases, and people masked up quickly, especially the sick ones, so the infected people only ever had a few particles to deal with, and so then it was only the elderly failed to cope. 

The only duality should be whether you live or die. (Unless you're Buddhist.) Deaths may be absolute but causes of death are not mutually exclusive. If someone with "pre-existing conditions" has covid-19 and in the stress of the disease has a heart attack, what exactly killed him? (What really killed Rasputin, anyway?) It doesn't take bias to induce some different standards in reporting. And if the fatality rate is officially assigned deaths over official verified detected cases, any single percentage is not really comparable. 

But at the end of the day, over 400 people died each day in Italy over the last two days. No matter how you cut that, it's a slaughter. I like to go back a week, the global death count was just below 5000, with just over 3000 of those in China. This evening it topped 10,000, with about no movement in the Chinese numbers. Outside of China it essentially went from 2000 to 7000 in just 7 days. It is clear exponential growth. Italy was also locked down 7 days ago. It's been speculated that with the usual course of the cases, it takes 3 weeks for the cases done before an action to fully bite. That means that they need to hold themselves together for another 14 days before the worst will be over.

Back last Friday we had just 5 cases and now we're at 39. Currently all of them are considered to be imported cases. That might change. We're in the early stages where people who get it might only get a single particle and fight it off asymptomatically, perhaps even undetectably. The actions to close the border might have been timely enough to create a "small peak" of infection, which is ideal. But with 2 weeks for symptoms for the sicker of them to become apparent and 3 weeks for the worst of those to hit the ICU's and respirators, it's far too early to tell. At 39 cases, it's already close to the point that we may have a death. And that's when people really start to lose their minds. Crisis/No crisis.

Extra! Extra! Read all about it! pt 2

After waiting almost a week for our 6th case, 7th and 8th cases rolled in today. Both of them were recent arrivals back to NZ almost immediately adding an exclamation mark to the new policy that was released yesterday. 

Yesterday I spoke positively about being in this 16 day experiment. It might be the case that this new mode will persist for some time. With a bit of luck there will be small outbreaks that will be controlled. In the event of a larger spread in one area, there might be some regional quarantines, where healthcare staff and resources from other areas could be diverted until the crisis has abated. It would be a slow but sure flattening of the curve.

One experiment that I'm happy not to be a part of is that adopted by the United Kingdom, or at least the experimental approach they released at the end of last week. (There is some sign they have already waivered.) The initial approach was that they were not going to mandate restrictions on gatherings. The philosophy was to let the virus in and get the population to gain the immunity by allowing the majority of the population to get it. There is a perverse logic to it but the standard understanding of this virus is that that would be a very bad idea. That would be to heighten the curve, or keep the curve where it is. That is essentially what happened in Italy and Wuhan, although deliberately. 

But already there might have been some hesitation. Perhaps it was the death toll shoot 11 to 21 in a 24 hour period. 

I've never really been a Twitter user, probably because I preferred long-hand blogs, and anything short went on Facebook. But the SkyCity Convention Centre fire showed me that it was a quick way to get important official information. The pandemic again is showing it as a place I can go to for much needed information or commentary. I probably will never be a regular Tweeter but I think it now has its own unique place in my social media.

Extra! Extra! Read all about it!

Today was an interesting day. After the having the end of the world as we know it on my mind for much of the week, and feeling like I had to personally bid modernity goodbye, I did wake rather positively this morning. I can't remember the exact hopes I had for the world but things seemed more in control. Then there was news of the inevitable sixth case, a traveller from America, showing it wasn't just Italians and Iranians "seeding" foreign countries with the virus. (Trump literally pointed the finger at Europe for seeding the virus in the States!) But then the blockbuster news rolled in: New Zealand will require all arrivals to self-isolate for 14 days. The implications of it took time to parse. All the international sporting competitions suddenly hit a very hard wall. An overseas based Kiwi friends quick visit home was nixxed. I had thoughts of my students who were due to land after midnight Sunday but who will now not be able to start class; thoughts of our potential students who were due to depart but now might be left in the lurch. But the really unconsciously from behind the fluster of thoughts, there was relief. There needed to be some change to the status quo that left the country in a brace position. And it was good to see the Prime Minister speak in the language of flattening the curve.

To be clear it's a policy that will be reviewed in 16 days. Even though this is going to be a pain for our company short term, I can see some good things even commercially. Currently we are the only English speaking major country without wild community spread. For all schools of New Zealand, we could be the safest haven from this scourge.

16 days is a long time. Just a little peek back to 27 February, 16 days ago, Italy had but 12 deaths. Now it has 1266 deaths. In fact even in those quaint days when it seemed so bad, it was just 53 people dead outside greater China. Now we're perched in the low 2000's. The world might have changed a lot at the end of this tunnel. Switzerland and the UK are on 11 fatalities - will they replicate Italy's carnage and be near 1200. The US has just crept into the 50's. Will it play its outbreak like a microcosm of the world and also be in the 2000's.

We also aren't out of the woods. Because the door was essentially open to a huge number of outbreak countries with unfettered entry into New Zealand until tomorrow night, there could be further cases. There's been an astonishing absence of cases after the bans on Italy, Iran and South Korea stifled the rise. It's very plausible though that we'll have a few other American or European originating cases. Closer to home, with 8 deaths from a certainly inaccurate 64 cases, the Philippines could also have potentially given us a case. Australia also with its 199 confirmed cases represents a potential risk. More likely, and I'm thankful that it hasn't happened yet, there must be some virus in the community. It might be bouncing around a few healthy people, knocking them down for a moment, before they get well; but not before infecting another one or two. It's possible that we might have even had an unnoticed death, because it could have been the final nail in a lost cause, or two. When there is only testing with strong cases, as we're doing now, it's hard to know whether there is some community transmission or not.

16 days is a long time. If we do have some more challenging cases to contract trace and quarantine, it'll make for coronavirus's first real battlecries in NZ. There is no way NZ can keep itself 100% Corona-Free. In fact, it will need to let it in one step at a time almost in a controlled way to really "flatten the curve". The worst case scenario would be that we don't get it because our vulnerability will remain - the populace would have no immunity. Ideally we have pockets of people gain immunity so that for each outbreak the chances of the non-immune encountering an infected person are reduced. The more we get into that territory the less chance there is to everyone.

Covid-19 does present a rather unique global threat. I'm proud our country has so far been unscathed and also proud of the bravery to make the move today. Let the 30 March 2020 be an important milestone for the world and New Zealand. 16 days will reveal a lot.

Loomin' Gloomin'

In language teaching there is such a term as "activating schemata", which essentially means processes to help students consider the ideas, experiences and vocabulary of a topic, before they need to read or listen to that topic in their second language. For the non-teacher non-learner this might seem like a superfluous step, but language learners should know one of two feelings. One is when native speakers are discussing something and you cannot understand anything till you realise the topic, and then suddenly, like flicking a switch, you suddenly understand everything. Another situation is when you try to read a piece of unfamiliar writing in your second language, but then you figure out its purpose or the context, and then suddenly you can relate it to your previous knowledge. The latter situation is funny with novels. The first few pages take some time for a learner to get through before things become easier to follow. Schemata is your mental structure of knowledge and experience for a topic.

When I first heard the news about this novel coronavirus in Cantonese on my walks to the swimming pool in early January, it wasn't very intelligible. Even though I knew it was talking about Wuhan, deaths and numbers, it took a second and third take. Once I had the topic, I could use my knowledge of Mandarin to recognise familiar words. But more importantly, because of previous reading and news about contagious diseases, I could anticipate the topic or what usual content would be in a news item so, as previously mentioned, my comprehension of those native speed news items went from 5% to 66%.

I do not know whether the activation of schemata is a terminology in other fields but I can imagine it does in psychology. When you enter a special situation, you access memories of your previous knowledge and experience of things different to it. If you have never been in that situation, you probably access what you have read or the films you've seen. And thus it is with pandemics. We've all vicariously enjoyed the thrill of outbreaks elsewhere but almost no-one has lived through a pandemic. So all we have are the world of fiction to bring the images and themes of what could happen, and they tend to apocalyptic. The empty streets of Milan and probably still the streets of Wuhan will evoke 24 Days Later. The sight of people in dehumanising PPE (the "hazmat" suits) brings back visions of Contagion.

Perhaps it was with these schemata that I've been perceiving our non-fictional world. Perhaps irrationally, I feel a bit dream-like: that the honking cars and bustling people are a bubble that is bursting; that this virus could be enough to make a pivotal moment in history.

At its worst possible extent, at least on the first wave of this disease, the death rate can't be much higher than 5% of those infected, and not all people will be infected. Perfect medical care would keep the death rate under 1% but it won't be. Quoting myself from 30 January: "The logistics of an epidemic are apparent immediately. There is simply no place for a surge in any one kind of sickness realistically. They would not have the redundant space and expertise to deal with even a quadrupling of cases, let alone a septdectupling (don't check the dictionary for this word); no place on Earth can really cope when the inevitable Black Swan outbreak strikes. I was reading a story about families queuing for quarantine and being denied it because hospitals have expected standards for quarantine and can only accept a maximum. "Come back tomorrow to check if there's space." Hubei will be a bloodbath." Iran and Italy are repeating this. Spain and France are about to be repeating this. And when it does, it doesn't even matter if it is Covid-19 that people are dying from, sufferers of all conditions will perish because of a lack of healthcare. And now the economic carnage and paralysis are apparent too. When the globe goes into recession and then into depression, there would be a wave of starvation and civil unrest. Those thoughts of post-apocalyptic disorder remind me of the Stephen King book The Stand, which I only ever read half-way.

Yes, my feelings are steeped in the apocalypse. Another historical scene my mind conjures up is England before the Blitz in the Second World War. Here in New Zealand we aren't impacted, yet it feels like it cannot be stopped. A great darkness beyond the horizon. The government, if I were there, would require 14 day quarantines on everyone (except for well quarantined countries), but not on trade; put strict rules of no fevers or coughs in public spaces, etc. I'd be a tyrant. But for the lack of a tyrant goes Italy. It would be nice to have New Zealand use its isolation to keep a basic civil society healthy.

Last Friday I had some fun with the predictions. It's amazing how fast things change. My prediction for Italy lasted three days. It shows that with this virus 7 days makes a big difference. The quote doubling rate for cases is meant to be 4 days, but for deaths it is some other sort of metric. Italy's death toll increased five and a half times what it was a week ago; Spain and France have shot off in the same direction as Italy, although still behind the 8-ball. I actually thought I was being liberal in my estimates but not a single one was over. When I was wrong, I was outstandingly wrong.

	Actual	Predicted	Actual
	6-Mar	13-Mar	13-Mar
S. Korea	43	60	67
Italy	148	300	1016
Iran	107	400	429
Japan	12	15	19
France	7	12	61
USA	14	32	41
Spain	3	6	86
UK	1	7	10
Switzerland	1	2	7
Australia	2	3	3
Thailand	1	1	1
Iraq	2	12	8

Anyway, there is good news coming out. There are huge moves in cancellation of events. I was fully prepared to deride the authorities for allow Pasifika to go ahead, but now it's off. I'm following the cricket, where there is no live crowd. The key understanding if this is out and about is to "flatten the curve". If all people were to keep their active social lives, the probability of healthy people encountering unhealthy people is lower on average, the average infection rate is lower, the smaller the spike on the healthcare system, the lower the demand for ICU's, the lower the harm to the healthcare practitioners.

I had the privilege/burden of being the Local Pandemic Manager for the our city campus. I have thrown myself into it because if you have read anything I've blogged in the last two months, I really care about this issue. At least on my small scale, I feel I'm doing something useful. My motto is "Don't be a hero", to stop those chronic people who can't bear to take a sick day, and our company has a flexible work-from-home policy, which is being used. We are rehearsing the use of our web-based teaching in case we need to switch off in-class teaching and switch on online.

Chicken Licken Good

Last, last blog for my weekend, I swear. I've found someone who reckons the numbers in the same way as I do. This is the analysis of the complacency in the US and a reasonable prediction:
https://www.youtube.com/watch?v=3etuaYTDwFI
The catch-cry is "Case, case, case, cluster, cluster, boom". Pretty much all of his recent videos are pretty scary in the North American and European contexts.

For New Zealand, I believe containment is still possible but requires a good dose of luck, and need to drop any pretence that blocking people of particular passports will prevent an outbreak. There will need to be a more realistic policy. Even though there were loons recommending the closing of borders even at the early stage when I was abroad, it's getting closer to actually weighing up the economic and political pros and cons of extreme methods. Some of the Pacific Islands are being very rational in essentially killing of tourism because they know that even a small outbreak would paralyse their minimal health systems. New Zealand has relatively larger resources but it still wouldn't take too much to bring it down. The one likely case in North Shore hospital has put a whole swathe of staff into 14 day isolation.

It is quite possible we are in a similar situation to the US, where there might already be background spread of covid-19 with mild cases and extreme cases which haven't yet been considered to be coronavirus due to the patients not having had travel histories. Fingers crossed our actual diagnosed cases and the recent suspected cases are the only examples of infection in NZ...

Complacency

Elbump.

I was watching Real Time with Bill Maher, an HBO current affairs / comedy show filmed in California. The host, who is usually quite an observant, funny commentator, said he thought the reaction to the Covid-19 was too much, and laughed at the statistic that it's only people in their 80s who were really at risk, "If I was 80, and I still had 6 to 1 odds to live through this thing, it's not the worst."

Comedy-show or not, there is a rather common sentiment in the not-yet-ravaged world that Covid-19 isn't something bad. Apparently old people don't count while the rest of the people just have a "mild flu". But it could be argued that this impression is not the case. Children clearly aren't that affected by this virus, but in Wuhan it was definitely all age groups that were affected, with the elderly much more exposed. I am guessing that it's the same for Italians. It is because it's a novel pathogen that our bodies aren't equipped to fight. And when it infects easily in bulk it overloads the systems there to deal with it.

I'm guessing the maths really goes something like that 90% have mild symptoms or are asymptomatic, and these are the dangerous ones for they may still go to work, or go about their lives; 10% have a pretty bad time of it and may require care, especially if they have some underlying conditions; 5% of which absolutely require care in a timely way; 1% of which will have difficulty making it through unless they have excellent care. If the number is manageable and care is available, all but the unfortunate 0.5-1.0% will survive; but anything less than ready, available care will be too much for some of those 5%; and if conditions are really poor, even the rest of those 10% are at peril. I imagine that in the peak time caused by this coronavirus the health system temporarily doesn't have much time or beds for anything else, so don't have a heart attack, car crash or stroke during it. You'll be out of luck, even if your cause of death is nothing to do with covid-19.

And if there is anything to say about the complacent mindset it's this: The figures that people are using to base their suppositions of an overreaction are dominated by Chinese and Korean figures. Factored into these figures is the positive effects of the most extraordinary efforts, sacrifices and extreme techniques to keep them low. If you think that those figures represent the threat of this virus on an unsuspecting, unprepared population, you need only cast your eyes over to Italy and Iran.

'Nuff said for this afterthought. Elbump. Night.

Conspiracy theory

"Comments are disabled." I'm not sure how many people feel frustrated when they read this message on a video or article. The content of the item should be the most important thing, yet I feel my eyes drawn to the bottom to gauge the response, or a preview of a key point. And sometimes there's that pang of annoyance that there is no village square. In western media articles tend not to have comments but in China pretty much everything is up for everyone from Einstein to Rainman, to the village idiot to opine. Just as in YouTube videos, comments to videos can seem at time dominated by trolls, "bots" or China's own innovation, "the Five Mao party" (those employed en masse by the government to comment a particular way to media, Mao being a unity of currency, half a yuan, that they would be paid per comment).   

I like the comments section and in China I felt that it was a good resource for learning crude expressions, Chinese memes and general language. It wasn't long into the outbreak that the nationalistic comments came out that Covid-19 was "definitely" a biological weapon from the United States. I interpreted this as a reaction from the perceived shame of a disease of this magnitude, again, coming from China. The racism against China in the wake of the outbreak has been widely reported, and China historically still has a rather large chip on its shoulder. The patriotic response is to say that the virus was the doing of outside forces. There was a touch of this in the pointing to the 2009 H1N1 pandemic with faulty numbers and to the US 2019-2020 flu season (which was heavier than normal), something which became an obsession for some, probably because they were house-bound and had nothing better to do. I even had a discussion with a trusted friend where it was clear he had both in mind that the US had done nothing to stop it (2009 outbreak, killed millions but with a low mortality rate), and it was killing lots of people (not much more than 0.1% of those infected but still had a death toll higher than the covid-19 deaths). The kind of discussion where apple and orange distinctions might be nuanced and interesting if it weren't for the baby watermelon growing nearby.

Then Zhong Nanshan, China's most reputed epidemiologist suggested at a press conference that covid-19 did not necessarily originate in China. He's appointed by the Chinese government but a very trusted figure. It could be that he was intending for the animal-to-animal transmission might be complicated considering there are all sorts of bat->pangolin->human routes that could have arisen anywhere before Wuhan became the world-famous Wuhan. In another article interpreting the comment it focussed on this reading that understanding the source of the virus helps consider the cures and treatments. 

But the other reading meshed with the others, that the virus was not Chinese (Zhong's word "necessarily" was dropped); America has been suffering a bad flu season, which has been actually covid-19 without any testing. And America now are finding patients with no contact with people from China, Italy or Iran. Thus it's not a Chinese shame but an American hoax, that China has defeated while Americans mock and ostracise Chinese. 

The conspiracy theory doesn't hold much water though. Firstly, there haven't been any hospitals (yet) in America with throngs of sick people. There were in Wuhan because it went into the human population there. If the 2019-2020 flu season was actually covid-19, at least a million US citizens would have already died. (Despite the facts that flu strain testing is fairly simple these days. And the US system is not one cohesive department so covering up an outbreak is more difficult.) And finally almost all covid-19 cases in China have Wuhan-traced origins. If it were Americans who were spreading it, you'd presume that Shanghai and Beijing would get the first cases, or at least a barrage. Almost all initial foreign covid-19 cases can be traced by chains to China, and now even now, the new cases in New Zealand, for example, are traceable to outbreaks in another country that comes from China. 

The origination of the covid-19, or any virus, should mean nothing to your sense of national dignity. If the theorists truly resent the racism upon China, they shouldn't show the same statist thinking or racist thoughts that breed the racism. One nice thing that I saw on the media sources for covid-19 information in China is that they regularly had announcements to "eliminate rumours". Though "rumours" can be code-word in China for truths that the government doesn't want out, these announcements generally did what they should: address foolish ideas people get and share. Like re-using face masks, gargling with bleach, whole village died from covid-19 etc. But there was no elimination of the conspiracy theory, despite its wide usage. Probably because it suits the state's needs.

Anyway, less than 12 hours since my predictions in my last blog, Italy will make a fool of me for the wrong reasons. In a single day reporting 49 deaths (essentially raising their total by a third) and 778 new cases (up by 20%) doesn't make any sense. Deaths should only rise more than new cases toward the end of an outbreak. But the rise in new cases doesn't match an outbreak slowing down. The approximate daily rises in confirmed cases there since Monday is: 300 new cases, 500 new cases, 500 new cases, 700 new cases, 700 new cases. The only real understanding of this is a lack of testing kits or the delay in getting results. Or, they are retrospectively counting previous fatalities now as covid-19. It's grim for sure. Also as an ominous post script: France's cases increased by 53% (deaths from 7 to 9).

  

Drowning in Corona

Covid-19 might be an above-average pathogen at this stage for the human species, but the disease is not just one of the body; it's also an economic plague. It was a unique sight to see the Chinese economy screech to a halt. The skies were blue; the roads clear; workers were all home. The flow-on from that is a lag in deliveries out of the world's factory. There is the irony of the production site of many medical equipment and apparel being Hubei grew sharp and grey when almost every country realised that local outbreaks would consume reserves within weeks. New Zealand had plenty of crayfish and beef with no place to send them to. The crays were sent back to the sea. The welcoming gates of our ports slamming shut to Chinese, tourist operators were all at sea, too. And for those education providers, students who were to come after Chinese New Year were blocked from coming. And that's where the pain begins in my small world. But that story has barely begun.

Last Friday was when New Zealand discovered it's long awaited first case in Aotearoa. It was an astonishing run. We should have had a huge exposure to it but strangely nothing happened. On that day, 67 people in the world were known to have perished to the epidemic. Seven days on it's 342. And New Zealand's personal tally arrived at 4 confirmed cases (no deaths). While these 300-400% increase are, well, hmmm, let's not talk about it, at least... well, at least it's still nothing in terms the world population? It's good to sometimes know at this early phase, we can minimise it. 

I should have mentioned in an early blog, that I have that mindset that takes a secret joy in watching the world burn. There is a thrill in numbers rocketing, carnage expanding; and along with that is a certain dissatisfaction when order has been restored. (I believe I'm not alone in this regard; please don't challenge this belief.) Hubei, the once darkest hole in the Coronaverse, had its darkness shrunk down to a single point surrounded by glorious light: There were 126 new cases in Hubei province, of which all 126 were in Wuhan. All other Hubeinese cities enjoyed their first day of unanimous viral pacification. If they weren't still homebound, they should be celebrating without fear in the streets. It is quite possible that these days, the greying darkness of Wuhan has been eclipsed by the abysses of Qom and Daegu.

 

In my previous blog, I related my not-so-novel thoughts on the inverse relationship of early testing and fast action with the death rate, and in the blog before that the thought that the "wonkier" the numbers the more it indicated a lack of testing. China is only solidifying around the 3.4% fatality rate after all the grim accounting through the eventual expiry of the critically ill. There are still lots of people still hanging on in China, but with few cases to fill the beds of the recovered, the statistical certainty is becoming etched in there. Interestingly, the WHO said that 3.4% is the global fatality rate for this disease, and that should be not at the beginning of the outbreak but at the end after the dust has settled. Ergo, no country should really have a rate of 3% or higher before the outbreak is over. If it is, they have either: (a) not tested sufficiently so the total number of cases aren't apparent but the number of deaths are more certain; (b) their health system was overrun so that normally survivable cases died (e.g. Wuhan); (c) their numbers are bogus. I like tables so as of today the official numbers are below:

	Diagnosed cases	Deaths	Fatality rate
S. Korea	6284	43	1%
Italy	3858	148	4%
Iran	3513	107	3%
Japan	1056	12	1%
France	423	7	2%
USA	232	14	6%
Spain	208	3	1%
England	116	1	1%
Switzerland	111	1	1%
Australia	60	2	3%
Thailand	47	1	2%
Iraq	38	2	5%

Italy already has a worse death rate than China and majority of cases have not recovered yet. I'm guessing it is a mixture of (a) and (b). Iran is probably a mixture of (a), (b) and (c). Both of these are clearly out of control. Italy's population is of comparable size to Hubei, which with considerable effort has as of today 67,592 cases and 2931 deaths (4.3%). It could be interesting to see where they end up. 

The funny one in the mix is the USA. They are still early days but clearly have a big case of (a) and possibly a bit of (c), because the political pride of their president has been woven into a mask. The health system isn't close to being overrun, so even if you assume that the 14 deaths are a 2% fatality rate of the actual number of cases, they should have at least 700 cases, which means that 400-500 cases are in the community without knowing that they're spreading a highly contagious virus. 14 could though be an anomaly - majority come from a single rest home. But all countries with significant infections have elderly. Japan, home to the oldest population, has managed to keep their death rate to 1%. 

Iraq's 2 deaths from 28 diagnoses is a bit spooky. With two deaths very early in its reporting, there must have been a significant time between the arrival of the virus and the initial testing. Australia's numbers are too low to worry so far. One of the two deaths was off the Diamond Princess.

I'd like to have a bit of fun with this, if you don't mind the darkness of it, and predict next Friday's rate:

	6-Mar-20
	Diagnosed cases	Deaths	Fatality rate	Diagnosed cases	Deaths	Fatality rate
S. Korea	6284	43	1%	8000	60	1%
Italy	3858	148	4%	7000	300	4%
Iran	3513	107	3%	8000	400	5%
Japan	1056	12	1%	1100	15	1%
France	423	7	2%	600	12	2%
USA	232	14	6%	1500	32	2%
Spain	208	3	1%	400	6	2%
England	116	1	1%	300	7	2%
Switzerland	111	1	1%	200	2	1%
Australia	60	2	3%	100	3	3%
Thailand	47	1	2%	55	1	2%
Iraq	38	2	5%	300	12	4%