A New York History of Covid-19, Written at the Half-Way Point
by Malte Skarupke
You have to write these things down while you still remember them. I was already beginning to forget that there was a toilet paper shortage. Similarly right now the popular thing is to point out that this was predictable and we should have listened to the experts. But the experts were predicting that this would be much less bad:
The consensus forecast generated by the individual responses indicates that we should expect roughly 19,000 reported cases by March 29
To be fair, they thought that the curve would behave similar as in other countries. They didn’t expect the US government to mess up its response this badly.
Another thing that people are already forgetting is what “flatten the curve” meant. It was supposed to be a strategy to avoid the quarantine lockdown that we all now live in. Western countries didn’t want to do what China did, and “flattening the curve” was the appealing alternative. A lot of these things can only be understood in context, because things are changing so incredibly quickly that it feels like we’re living in a whole new world every couple weeks, and we forget. So lets start at the beginning while we still remember:
January & February
This all started off with news of a new virus far away in China. I’m German, living in New York, so my perspective will be US- and German-centric. We hear about new viruses coming out of Asia every once in a while (SARS, bird flu, swine flu) and then everyone goes a little crazy, totally over-reacts and before you know it the whole thing is over as if nothing happened. We all expected the same thing to happen here. I remember talking to someone who used to work in infectious disease research. This conversation must have been late January or early February, and I distinctly remember him expressing the frustration that the field has: They always look like they are over-reacting, and we never learn how bad things would get if they hadn’t over-reacted so much.
Implied in that conversation was of course that this thing was essentially over. And there were lots of reasons to believe that. China was totally over-reacting, but when the disease spread to richer countries like South Korea and Taiwan, it was quickly brought under control and life continued normally. And China was also getting it under control, even if they had to use extreme measures.
Western countries assumed that the behavior of the virus would be the same over here as it was in the richer countries in Asia. No way would it be like China.
The first western country that was hit hard was Italy. That was still far away for me. I didn’t even follow the news until things got really bad. In general during this time everyone was taking this kinda easy. I was following the news in the US and in Germany and mostly they didn’t do much. The US government tried to come up with its own coronavirus tests, and while they did that they casually made it illegal to use existing tests that already could have been used in the meantime. Nobody was shocked by this. There was general head-shaking at the usual incompetence of the Trump government, but nobody was worried.
You see, the West just assumed that things would turn out the same way as in the richer Asian countries, but they missed one important difference: those Asian countries were taking things seriously. South Korea was doing very aggressive tracking of cases and they mostly had the virus under control before it spread widely in a religious movement. (it took them two weeks to also get that outbreak under control) The US wasn’t doing that. When the first case came to New York, governor Andrew Cuomo and mayor Bill de Blasio promised that the government would track down people who the first case had come in contact with. And then they… kinda forgot to do that.
Similarly when the virus came to Taiwan, they ramped up face mask production to 10 million per day (with a population of 23 million) and disallowed exports. The US government did not recommend using face masks. Why? Because there weren’t enough even for health care workers. The biggest US face mask producer ramped up production, but didn’t work 24/7 or anything like that.
In this time nobody seems to think “we have to get this under control, else the economy will crash with an abruptness we have never seen before and there will be mass unemployment before April.” Instead of the usual over-reaction, this time the reaction is casual and unworried.
First week of March
At this point things were going bad in Italy, having more than 2000 confirmed cases, (how cute in hindsight) and the stock markets were going down, mainly because some areas were doing similar lockdowns as China had done. In this time the “it’s like the flu” theory was still dominant. The German newspaper Zeit was showing the number of German cases on its website every day. You could see it increase day by day from 500 to 600 to 800 etc. It seemed out of proportion. You don’t show the flu numbers like that, because it would worry people unnecessarily. So why do it for the coronavirus?
But some people are already taking it seriously and the first big events and conventions are canceled.
This was also the time of “flattening the curve.” Which is a theory that very much came out of the “it’s like the flu” mindset:
The idea was that even if you get the same size of outbreak, it’s better to spread it out. To not get more cases than the health care system can handle. At this time the West still thought it was inconceivable that they’d have to do a similar shutdown as China. There were first signs that the epidemic was out of control, but people still assumed that things would be handled.
If you read this in April, you’ll surely say “that’s not what flattening the curve means. You’re intentionally misrepresenting it to make no sense. Flattening the curve means staying at home to not spread the virus.” But that’s how much people have already forgotten. For example here is a blog post from one week later that explicitly states that these graphs “mean to tell you that we can get away without severe lockdowns as we are currently observing them in China and Italy.”
The recommendations at the time were really just “don’t shake hands, don’t touch your face, stay home if you’re sick, wash your hands often” etc. And this is what the experts were saying. The guy who wrote that Twitter thread is a professor at University of Washington. He teaches a course called “Evolution and Medicine” and he wrote a book called “Calling Bullshit – The Art of Skepticism in a Data-Driven World” and even he shared this completely bullshit graph. Why is it bullshit? The line for “healthcare system capacity” should be much, much lower. We had signs at the time. In China the healthcare system was completely overwhelmed with just a couple tens of thousands of confirmed cases. They had to quickly build new hospitals.
But people’s beliefs change slowly. In this early stage of the outbreak you don’t have a full mental model for how the disease spreads and how badly it affects people. The pieces don’t fit together in your head. Some people say that it’ll get really bad, but there are always some people saying that. Meanwhile others are saying that we just have to flatten the curve and avoid shaking hands. So you just update your beliefs slightly and take this slightly more seriously, but you still tell yourself “nothing to worry about until we hit like a million cases.”
Over the weekend we go out for drinks because I thought it would be fun to see the city all quiet. I have fond memories of going out for drinks during Hurricane Sandy: It was very quiet but people still went out to bars and you could suddenly have good conversations with neighbors and strangers. But this wasn’t like that. There were still lots of people out, but everyone was trying to keep their distance from each other. At the bar we have to get table service. Nobody is allowed at the actual bar counter. To not spread the disease.
Second Week of March
At this point things are changing rapidly. There is a weird reality distortion field in which all news and conversations seem to be about the coronavirus.
Italy is starting nationwide restrictions. Nobody is traveling any more. Airline companies and hotels are freaking out. Restaurants and bars are forced to work at reduced capacity. The stock market crashes completely. Everyone is trying to work from home. Companies that used to not allow working from home suddenly do allow it. All big events are canceled.
There’s a shortage of toilet paper. Nobody quite knows why, but it’s all over the world. It seems like some people bought more toilet paper because they thought they were going to spend more time at home. Then others bought even more, and soon there was a panic and people bought huge piles of toilet paper. Then even normal, non-panicked people who needed toilet paper bought two packs “just in case.” There are lines for toilet paper and stores have to ration it. Similarly face mask prices are going through the roof. You used to be able to buy 100 for $10 on Amazon, now that same pack cost $120.
On the weekend my friends and I have our first “virtual happy hour” where we have drinks over a video chat. Going out is now really bad manners.
Third Week of March
This is the week of lockdowns. Italy is already on lockdown, Spain is locking down, too. States in the US are closing down schools and smaller events than before. At first, gatherings of more than 250 people are banned, then gatherings of more than 50 people, then restaurants are closed. The government changes its mind every couple of days.
Everyone is working from home if they can.
Still nobody is actually doing anything about the virus. Every action is purely reactive. My girlfriend is Taiwanese so I hear from her family. Her sister is getting her temperature checked at work three times a day. Companies are working half from home, half in the office. The halves alternate but there is no overlap between them to ensure that if somebody gets the disease, they can at most get one half of the office sick. These measures are on top of the mass-production of face masks and the extensive testing and tracing that I mentioned above. The US is doing nothing proactive like this at all. (I also follow the news in Germany and they’re similarly passive or reactive)
At this point people have also done the math on the “flatten the curve” myth and the first graphs are circulating with the “healthcare capacity” bar drawn in the right place. It is ridiculously low. Public opinion is slowly shifting and it’s becoming clear that lockdowns are the only way forward now that the disease has gotten out of control. (there are two possible ways to contain the virus: control it early, like the Asian countries did, or let it get out of control then force everyone to quarantine)
Third Week of March
New York is starting to look kinda bad and mayor Bill de Blasio wants to do a lockdown. Governor Cuomo is completely tonedeaf though and says “I have no interest whatsoever and no plan whatsoever to quarantine any city.” But things are changing so incredibly quickly that by the end of the week he is forced put the city on lockdown. One week later he will be in panicked firefighting mode, trying to get more ventilators and hospital beds because the hospitals are overwhelmed and people are dying. It’s really rare that, when a politician screws up, you see the results this quickly, but it actually helps his popularity a lot. (as a programmer I am very familiar with this dynamic. If a programmer is in panicked firefighting mode, fixing crashes as quickly as they can, they’re celebrated, even if they are also the cause of all the problems that they are fixing…)
But it’s easy to sound smart in hindsight. At the time my beliefs were still changing more slowly than the situation was changing. From Italy it was becoming clear that the virus spreads very quickly and even relatively few cases can overwhelm hospitals completely, but I still thought that the lockdown was an over-reaction since we just didn’t have that many cases in New York. We were already doing so much, working from home and closing restaurants. Did we really have to close everything else, too? (grocery stores, pharmacies and liquor stores stayed open though, thank god)
Also in this week there were still experts that said things wouldn’t get very bad. Here is a video of a German expert who was predicting that there might be something like 30 deaths per day in Germany and that all these reactions were totally out of proportion. That number was nine times too low, and that’s only because German hospitals were never overwhelmed like they were in other places around the world. If people had listened to him he probably would have been wrong by a factor of 100.
You still can’t buy toilet paper anywhere. Nobody can get face masks, even hospitals are running low. But my girlfriend found a store in the East Village where you can buy single ones for $2 each.
Fourth Week of March
New York is now officially on lockdown and governor Cuomo immediately switches from being purely reactive to surrendering:
The numbers he is presenting there are essentially saying “the coronavirus has won. We give up. We’ll hit the worst case prediction for the disease and the economy will tank even further and we’ll just have to work with that.”
Luckily he doesn’t just give up completely and at least tries to get enough supplies for the overwhelmed hospitals. Still purely reactive, but somehow it makes him incredibly popular.
The federal government is still inactive. Trump keeps on screwing up in more ways than I can remember and the biggest action to come out of the federal government is… a stimulus package? I can only imagine the conversation went something like this:
Senator A: Have you heard? That virus caused the stock market to crash.
Senator B: Oh yeah, I thought that might happen. Should we do something?
Senator A: About the virus?
Senator B: No, about the stock market.
Senator A: Yes, that’s a great idea.
The stimulus package includes money for hospitals but that’s the last line of defense. There is no sign of the defense in depth that we saw from other countries. Maybe they were thinking “if nobody does anything, in the end the hospitals will have to deal with this mess, therefore we should give money to hospitals.”
A quick calculation for how much the measures from other countries cost: Taiwan increased face mask production to 10 million per day. The US has a higher population, so lets say they tried to do 100 million per day. If those face masks cost 10 cents each to make, that’s ten million dollars per day. (I’m using 10 cents because I assume that quick production like that is more expensive than usual) Do it for a hundred days and you’d be at $1 billion. Which would have been 0.05% of the stimulus package. (and yes, I didn’t mean 5%) But no, the US government is still actively trying to stay out of the virus response. Trump doesn’t want to order companies to produce ventilators because he does not want to interfere with the free market… Like everything else, his opinion also changed within a couple days:
Also in this week the reality distortion field of the coronavirus is complete. It feels like the world has completely changed. Anything that is not about the coronavirus feels weird. Like you watch a show on TV and there’s just people hanging out, shaking hands or hugging each other. Or there is a crowded street. And it all just feels like it’s from a different world… This is also the only week where I saw New York’s East Village noticeably more empty than usual. Up to this point people were still out at somewhat normal rates. (except in the evenings, since restaurants and bars had closed) Now it’s maybe 1/4 of the usual amount of people out and about. I heard that other parts of the city were completely empty. Probably the areas with offices and stores that were closed.
Some grocery stores have long lines outside of them. They only allow a certain capacity and people outside have to wait six feet apart. Keeping people apart is supposed to help prevent infection. The line outside of the Trader Joe’s on Grand street is more than five hundred feet long. (I remember it was around the block, and then measured on Google Maps how long that block is) There’s no food shortage though. You just have to find less popular stores.
First Week of April
This is the week of logarithmic graphs. The number of cases is still going up around the world, but if you plot it on a logarithmic graph, you can see that they’re slowly flattening out everywhere. It’s the first time we can see that an end to this might be visible. Before this point, things just kept on getting worse every day; now there are signs that the situation can stabilize. There is a two week lag from a measure going into effect before you see it in the numbers. At the beginning of this week we are pretty certain that the early measures, closing of big events, has worked.
Governor Cuomo is now incredibly popular because he has been organizing the last line of defense, the hospitals. The federal government is also slowly understanding that they can’t just be purely reactive and that maybe we shouldn’t rely only on the last line of defense. At some point things will have to go back to normal and for that you need to be proactive. Like have more tests and face masks. They’re just taking small steps at this point, but at least the conversation has changed.
The CDC finally recommends that people should wear face masks. You can find them in most stores, $50 for a pack of 50 face masks. There are videos going around showing how to make your own simple face masks. This has a noticeable effect: In the East Village (where I live, so I can only keep on talking about it) at least a third of people are now wearing face masks outside. Things are also becoming more crowded again.
In this week you can also find toilet paper in every single store. The reality distortion field is still active so it doesn’t even seem weird that there are big stacks of toilet paper near the checkout in stores that never sold toilet paper before.
There is also mass unemployment now. Restaurant and bar workers were already hit hard earlier, but this week it’s hitting one of my friend who works for a big hotel company.
Second Week of April
More people are being laid off or furloughed. It hit my girlfriend this week. (she works for a luggage company, also affected early because nobody is traveling) We’re finding out how generous that stimulus package actually was: With the increased unemployment benefits we will actually be fine. Which is good.
Reporting on the mass unemployment, the New York Times writes “The dire employment data suggested that Washington’s recent $2 trillion relief package was not working quickly enough to halt the economic devastation.” It’s almost funny. There is no chain of cause and effect between the stimulus package and unemployment. The unemployment is caused by the virus and the lockdowns, the stimulus package didn’t do anything about either of those things…
The logarithmic graphs continue to flatten and the stock market is soaring. Everyone is kinda surprised. We’re wondering “was that it?” All we had to do was stay at home for a month and this thing is defeated? Currently the assumption is that there will be no second-order effects. The mass unemployment will just go away and no companies or countries will be in real trouble. It all seems a bit naive, but who knows?
Face mask prices are down to $40 for a pack of 50. Their use continues to increase. In my neighborhood more than half the people now wear one. The number of people on the sidewalk is almost back to being normal. Also there are lots of cars on the street, the FDR Drive is busy again. I have no idea where they’re going since offices and stores are still closed. I read the New Yorker from a week ago and it describes a completely empty city, and it feels like it’s from a different world. After my girlfriend got furloughed we took a bike ride to just get out of the house and the only neighborhood that’s completely empty was Chinatown. I don’t know if that’s because people are avoiding it, or if Chinatown is the only neighborhood that’s taking this seriously…
All the measures are still in effect and the conversation is switching to when we can loosen them. Here is what the number of cases looks like right now:
The first thing to notice is how tiny the numbers in the first half of March are. Those are the numbers that used to have us panicked… You might wonder based on this graph why everyone is so confident suddenly, but notice how things stopped accelerating just after April 1st? Where it switches from a curve to a straight line? That’s the reason for the new confidence. Things are still getting worse, but they’re not getting worse faster any more. Apparently this means that we have reached the half way point. On a logarithmic graph this looks great. And other countries that have reached this point didn’t hit a second bump after this. (except for Iran, but everyone ignores that because that second bump is slowing down, too)
With that we’re caught up to the present time. I think to correctly capture the history at this point, I should also write down what the current thoughts about the future are. Otherwise we’ll forget what the mindset was, just as we are already beginning to forget what the mindset was just a couple of weeks ago. (if a bigger crash is coming, the current optimism will quickly be forgotten)
Mainly there is a ton of uncertainty right now. It’s a similar uncertainty as there was at the beginning of the virus. Writing down the history actually makes me realize how similar the situations are. Everyone is weirdly calm, but the mental models also don’t quite fit together. In February the scale of the reaction that we saw in China didn’t fit with the calmness that the West had towards the virus, but we also didn’t have the mental models to figure out where the mismatch came from. (now I can answer that we thought it was not much worse than the flu, and we didn’t understand that it spread more quickly, and sent more people to the hospital, overwhelming the healthcare system quickly) Similarly right now the calm that the stock market is feeling doesn’t fit with the terrible unemployment numbers and the way the government has been acting. The federal reserve has been panicking, acting a little bit like this:
The Fed started off by shooting all of its ammunition at once, then went and found more ammunition and started shooting that off too, as quickly as it could. We also have an unprecedented stimulus package that gives lots of money to unemployed Americans and even more money to companies.
Despite all of that we still don’t have a good plan for how to get the economy back to normal. Currently just over 1% of the population got the virus. (rule of thumb is number of confirmed cases times 10) If the curve flattens out and something like 3% of the population gets it, that leaves us open for a second wave. If we’re not ready to contain it the next time around, the whole thing starts over and things would stabilize at 6% of the population. We can play that game multiple times before the economy is in complete shambles.
Right now part of the lack of concern is that those unemployment numbers are just going to be temporary. It’s not like all the restaurants and bars and stores and airports disappeared. As soon as the virus is gone, people will start using them again. Nobody knows how quickly things will go back to normal, but there is no lack of demand.
Luckily Cuomo’s numbers (40% of the population getting the virus and the lockdown taking several months) are already history. It’s weird how in this time even forecasts made two weeks ago are often completely wrong. That forecast happened three weeks ago, so we can be confident that it’s wrong.
So currently it seems like we’re waiting for a plan that allows things to go back to normal. Politicians have been talking about massively scaling up testing, (Elizabeth Warren was the first as far as I can tell, now democratic presidential candidate Joe Biden is saying the same thing) and companies are starting to check their employee’s temperature. It’s starting to look more like defense in depth. With people also wearing face masks now, we’re almost at the point where Taiwan was from the beginning.
So maybe the confidence is justified. A plan is materializing and maybe we can stop just being passive and reactive. We’re just hoping that there won’t be any second-order effects, like a country or big company being in deep trouble…
I enjoyed reading your blog post about Covid-19. Something to keep in mind though is that incidence rates rates is misleading without corresponding mortality rates. Something that keeps coming up is that the mortality risk is much lower than previously thought. The same thing is being found across many sources: “many infections, few deaths.”
Up to 2.7 Million in New York May Have Been Infected, Antibody Study Finds
Kern County, California ER Doctors Discuss Covid Virus
“California has 0.03% chance of death from Covid-19. Is this enough to justify a lock-down?”
New York’s data consistent with all the others: most people get the infection with no symptoms.
“A New York study seeking to measure the spread of the new coronavirus found that 13.9% of 3,000 people tested across the state had signs of the virus, one of the biggest U.S. reviews to date.
That implies that about 2.7 million residents may have had Covid-19, Governor Andrew Cuomo said. That’s about 10 times more than the official count based on the state’s testing, which covered mostly very sick patients”
Result: With 15,000 fatalities, IFR is 0.5%
I’m still not sure what to think about that. New information is still coming in. The New York Times looked at number of deaths in New York City and found that there were 20,900 deaths more than average in the last few weeks. But there’s only been 16,673 Covid-19 deaths. (only 12,509 if you only count the ones that tested positive) So maybe the actual rate is higher:
Also the doctor is doing very questionable math early in that video. I didn’t watch the entire video, but for your quote of a 0.03% chance of death, he makes the assumption that if 10% of tests are positive, that means that 10% of the population has gotten the virus. Which is just not the case because there haven’t been enough tests. We’ve mostly been testing people who are sick and are likely to have the virus. (and then people they came in contact with)
But let’s say it turns out that about 0.5% of people who get the virus die from it. (as the New York numbers suggest) Then the question is how many people do you expect to get it? Since it was spreading really quickly early on, it was plausible that half the US population might get it, which would have led to more than 800,000 deaths. That still sounds pretty terrible, even if its lower than we thought at first.
Now I actually think it’s probably OK to stop the New York lockdown on May 16th, as planned. The reason is that people’s behavior has changed. A lot more people are wearing masks and are generally being more conscious of what they touch and who they get close to. In early March almost nobody was wearing a mask, and nobody was taking the “flatten the curve” advice nearly as seriously as they are now. So the virus was free to spread like crazy. So I think it’s a lot safer now and we won’t see half the population getting the virus.
Another thing that’s interesting about this virus is that it affected rich areas of the world first. People say it’s because those areas travel more, but in my mind that doesn’t fully explain it. It’s really weird: After the first and second wave (China being the first wave, Iran, South Korea and Italy being the second) the next places were Europe and the US. If you looked at the new cases in early April, they were mostly in rich countries. In fact in the richer part of those countries: Lombardy and Veneto in Italy, New York, California and Washington in the US. Now at this point we’re hitting a fourth wave of the virus, and it’s in Brazil, Turkey, India and Russia. It’s really weird how it spreads from richer countries to less rich countries. For the longest time people thought Russia was faking its numbers because they were so low, but it seems like they really were just hit later. (if this trend continues, a fifth wave might hit poorer countries soon, and indeed the numbers are accelerating in Nigeria, which had been weirdly low for a long time)
Anyways it’ll be interesting to see if the same thing happens within countries: Maybe the rich areas of the US were hit first, but we’ll see a second wave in poorer areas. I still have no idea why the virus seems to follow this trend, so I think it’s a weak model, but it’s currently a nagging concern of mine. (especially with Georgia re-opening first)
So yeah, definitely still mixed feelings about this but at this point I’d err on the side of reopening as planned.