Now granted there could be a higher spread in these countries that is underreported, but if they had it bad as in Italy or Iran it wouldn’t go unnoticed.
I don’t buy it, with the current level of undertesting. The rhetorical work is being done by the red and dark red areas not reporting many cases, but it seems premature to be sure of that, since many of those are places that don’t have the medical infrastructure to do widespread testing. It looks like Africa has done 400 tests; some people suspect that’s enough for the counts to be accurate, but I wouldn’t bank on it yet.
It’s not obvious we would know about Seattle if some heroes hadn’t tested people for coronavirus despite being told not to, and so it’s not clear the higher number of cases reported in Washington state than New York or California is a true difference or testing artifact. Also, Spain (yellow to orange on the map) has more confirmed cases than the entirety of the US.
I can’t find data for Shiraz (a hot big city in Iran), and amusingly looking for that data took me to this paper (since one of the authors is affiliated with a university there), but that seems like one of the big tests of this theory.
I also think we have more reason to believe humidity matters than temperature, and wonder if adding that to this map makes this look more or less accurate.
Various places got a lot of traffic from Wuhan before it was shut down: Singapore, Thailand, the US, Europe, Korea, Australia, etc. It’s clear that Europe’s outbreak is worse than the US/Australia/Singapore. It seems likely that things are worse in the colder parts of the US (vs. Texas or Florida).
Iran was not testing/reporting. There are many tropical / Southern Hemisphere places that could have had an Iran style outbreak and which had a lot more traffic from Wuhan than Iran does. Why Iran?
(I’m mostly replying to this entire thread rather than Owain’s comment.)
I’m failry confident in the following two claims:
Warm climate slows down transmissions substantially.
But not enough to prevent large outbreaks.
My reasoning being:
As commenters have pointed out, we see striking correlations between countries that report large numbers of cases and cold-ish temperatures.
The alternative hypothesis (poorer testing and detection) seems likely true to me, but not strong enough to overcome this point:
Now granted there could be a higher spread in these countries that is underreported, but if they had it bad as in Italy or Iran it wouldn’t go unnoticed.
That said, I think there is circumstantial evidence for a somewhat large underreported outbreak in Indonesia (avg temperature of 31+ Celsius for the last two months), and maybe also the Philippines (but I haven’t been following the latter at all). For Indonesia I think it’s likely they have upward of 2,500 infections. It seems implausible to me that they’d already be anywhere near Italy or Iran’s level of infections, but if one is really cynical, I admit that it can’t be ruled out completely.
Some relevant data points:
When Indonesia had <20 confirmed diagnoses, 3 Indonesians were tested positive abroad: a married couple in Singapore and an Indonesian woman who travelled to Australia. The Singapore case seems to have been motivated by seeking quality hospital care, which admittedly makes this evidence consistent with a smaller outbreak than if Indonesians who travelled to Singapore for non-health-related reasons had tested positively. Still, I think 2 instances of testing positive abroad at a time when the official count is <20 is quite telling.
Indonesia also reported 4 deaths by now. For the first death, a British woman age 53 with several serious previous health conditions, Indonesian authorities labelled the case “imported” because the woman had only been to Indonesia for a couple of days by the point she died. However, I’m not sure whether I should believe the conclusion because there were reports (US nursing home and one from Italy) of people going from symptomatic to dead in <30h. In any case, 3 further deaths were announced yesterday, and no indication was given that they might be imported cases. Even just 3 deaths usually correspond to true rates of infection well above 1,000. The ratio of confirmed diagnoses to deaths is now exceptionally high in Indonesia. (The same applies even more strongly to the Philippines, but I could imagine that some deaths there were definitely imported.)
There was this entire discussion about expert modelling suggesting that indonesia’s long count of zero diagnoses is evidence for them missing cases throughout February.
(Indonesia was one of the last countries to ban incoming travel from Italy or Iran, I believe.)
According to this tweet, testing in Indonesia was 970 people. Indonesia’s population is >>200 million.
In addition, the incentives for reporting cases diligently seem to be suboptimal, as evidenced by some data points:
Indonesian ministers install even less confidence than Trump. Just one example of communication: About the Australia exported case, the Indonesian health official claimed that the woman most likely got infected in Australia because she had travelled for quite a while and because she also visited a Vietnamese restaurant there (implication: Vietnamese restaurants in Australia are risky). However, the Australian source (link above) says clearly that the woman in question started showing symptoms 2 days after leaving Jakarta (so much for “she travelled for quite a while”), and the only reason a Vietnamese restaurant was mentioned anywhere is because the Australian authorities obviously traced the Indonesian woman’s contacts in order to interrupt a potentially newly started chain.
Maybe the time lag confuses me, but I’m pretty sure there was one time when Indonesia skipped a day of reporting case numbers, and then numbers double and deaths went from 1 to 4. (Could be totally benign if there’s some disorganization during a time of crisis, of course.)
Indonesian officials seem to be under enormous pressure because the economy is doing very poorly already. Some unusual measures have already been taken a while back, such as disallowing shorting and pledges for government-owned companies to buy back shares.
And here’s a concerning but speculative hypothesis:
Singapore doctors gave out a warning that patients who tested positive for Dengue fever with a quick-testing kit actually turned out to have Covid-19. They say the diseases are clinically similar and that the widely used quick-test kits may not have failed isolatedly due to extraordinary circumstances. Indonesia currently has a somewhat large Dengue outbreak (and the same goes for the Philippines).
UPDATE: 18 days after I made this comment, Reuters reports that Jakarta’s funeral count for March was 1,300 funerals higher than any preceding month since 2018. This looks highly statistically significant because the previous record was only 3,100 (compared to 4,400). (And there was no natural disaster or other unusual disease outbreak.)
I wrote the above before checking today’s news: Only 27 further cases, but a government official infected and 1 more death. The article also says that cases were in many different parts of Jakarta, and some in other parts of the country. At the same time, the Indonesian authorities say that the reason why they detected all those cases is because they did “massive contact tracing,” suggesting between the lines that this isn’t yet evidence of even more widespread community transmission than already acknowledged.
Edit2: Australia may have caught another infected person with Indonesia as travel history. (I say may have because there’s a small chance that this refers to the initial case from 5 days ago; however, some of the wording somewhat strongly suggests it’s a second, new case.)
A competing hypothesis (this time I am specifically replying to Owain’s comment) is that it’s easier to catch infected travellers coming from the location where one expects them to come from. Asian countries certainly had it harder in phase 1 when the goal was to detect all the infections with Chinese travel history. However, as soon as even just one country in Europe failed at detection, the traveling dynamics changed and in phase 2 it subsequently became easier for the Asian countries, because they had basically zero incoming travel from Europe by that point. So while everyone was still focused on catching infections with Chinese travel history, Europeans were infecting other places in Europe, but less so places in Asia.
It’s maybe some supporting evidence that the Italy outbreak was connected to the early Germany outbreak, and that it only became clear that many countries were going to lose control of the situation once infected travellers had come from many different places. (At the same time, the Seattle outbreak is evidence against.)
Very hot countries have it easier to do contact-tracing. It’s plausible that the virus deactivates at 30 degrees Celsius (I think I may have read that in the often-cited Lipsitch article). In the hottest countries, public transport can be 30+ degrees and even grocery stores can be that warm. If infections happen primarily in indoor settings (e.g., business contacts or partying or household), contact tracing is easier, giving hot countries an initial advantage at preventing outbreaks early on. However, once contact tracing fails, that advantage shrinks. What remains is only that the r0 is lowered somewhat by heat interrupting certain types of of transmissions, but not all types. It wouldn’t surprise me therefore if hotter countries also need extreme measures to contain the case count from growing exponentionally, even if the doubling time might be generally lower for hot countries.
I agree with the objection regarding Seattle. But I don’t think that a situation as bad as in Iran or Italy would go under the radar, the hospitals there are flooded with COVID patients that show the same symptoms over and over and even in the extremely censored China this kind of information eventually leaked. Spain is only x2 compared to the US right now and this could easily be explained by under testing and proximity to Italy.
Why Iran and Italy and not Thailand and the Philipines?
Why Iran and Italy and not Thailand and the Philipines?
I think it’s too soon to say “not Thailand and the Philippines”; three days ago there were 10 reported cases in the Philippines, then 33, then 49. Italy’s trend at a comparable level was steeper--3 then 9 then 76--and then here we are, two and a half weeks later.
As for “why Italy and Iran first”, there’s both the possibility of “lower spread rate” and the possibility of “weird founder effects.” If a careless Italian healthcare worker made a mistake three weeks ago, and a careless Philippine healthcare worker made a mistake one week ago, we’d see two additional weeks of growth in the Italian numbers and not the Philippine numbers.
The rate of change being exponential is an extremely important point. The original rate of spread in Wuhan was a doubling every 2 days. If we set another area follows the same rate, then the difference between 32 cases and 4096 cases is just waiting 2 weeks.
Brazil looks like it’s also rising pretty quickly, but is especially interesting because both the president and his communications director seem to have it. [Edit: Probably not?]
Looks like he tested positive and then negative? Hopefully that means he doesn’t have it, but I seem to recall these tests can be inaccurate in both ways.
My understanding is that he never tested positive; rather, it was reported that he tested positive, and then that he tested negative. (The link you provide says otherwise, but Telesur is not a reliable source.)
Update: it now appears that Bolsonaro may have tested positive, though the situation is still unclear, at least to me. The main evidence in favor of the hypothesis that the Brazilian president has tested positive, according to thisLondon Review of Books article, is that (1) Fox News claims that this is what his son Eduardo initially told them, that (2) Bolsonaro has refused to make the results of his tests public, and that (3) 25 members of his entourage are confirmed to have the virus.
Note that the article shows some signs of bias, such as calling the impeachment of former president Dilma Rousseff a “coup” and describing Bolsonaro’s economic minister as having studied “at the University of Chile under Pinochet” (Pinochet was the president of Chile, not the president of the University of Chile). So I’m updating only slightly and would like to see this confirmed by more neutral sources.
I don’t buy it, with the current level of undertesting. The rhetorical work is being done by the red and dark red areas not reporting many cases, but it seems premature to be sure of that, since many of those are places that don’t have the medical infrastructure to do widespread testing. It looks like Africa has done 400 tests; some people suspect that’s enough for the counts to be accurate, but I wouldn’t bank on it yet.
It’s not obvious we would know about Seattle if some heroes hadn’t tested people for coronavirus despite being told not to, and so it’s not clear the higher number of cases reported in Washington state than New York or California is a true difference or testing artifact. Also, Spain (yellow to orange on the map) has more confirmed cases than the entirety of the US.
I can’t find data for Shiraz (a hot big city in Iran), and amusingly looking for that data took me to this paper (since one of the authors is affiliated with a university there), but that seems like one of the big tests of this theory.
I also think we have more reason to believe humidity matters than temperature, and wonder if adding that to this map makes this look more or less accurate.
Various places got a lot of traffic from Wuhan before it was shut down: Singapore, Thailand, the US, Europe, Korea, Australia, etc. It’s clear that Europe’s outbreak is worse than the US/Australia/Singapore. It seems likely that things are worse in the colder parts of the US (vs. Texas or Florida).
Iran was not testing/reporting. There are many tropical / Southern Hemisphere places that could have had an Iran style outbreak and which had a lot more traffic from Wuhan than Iran does. Why Iran?
(I’m mostly replying to this entire thread rather than Owain’s comment.)
I’m failry confident in the following two claims:
Warm climate slows down transmissions substantially.
But not enough to prevent large outbreaks.
My reasoning being:
As commenters have pointed out, we see striking correlations between countries that report large numbers of cases and cold-ish temperatures.
The alternative hypothesis (poorer testing and detection) seems likely true to me, but not strong enough to overcome this point:
That said, I think there is circumstantial evidence for a somewhat large underreported outbreak in Indonesia (avg temperature of 31+ Celsius for the last two months), and maybe also the Philippines (but I haven’t been following the latter at all). For Indonesia I think it’s likely they have upward of 2,500 infections. It seems implausible to me that they’d already be anywhere near Italy or Iran’s level of infections, but if one is really cynical, I admit that it can’t be ruled out completely.
Some relevant data points:
When Indonesia had <20 confirmed diagnoses, 3 Indonesians were tested positive abroad: a married couple in Singapore and an Indonesian woman who travelled to Australia. The Singapore case seems to have been motivated by seeking quality hospital care, which admittedly makes this evidence consistent with a smaller outbreak than if Indonesians who travelled to Singapore for non-health-related reasons had tested positively. Still, I think 2 instances of testing positive abroad at a time when the official count is <20 is quite telling.
Indonesia also reported 4 deaths by now. For the first death, a British woman age 53 with several serious previous health conditions, Indonesian authorities labelled the case “imported” because the woman had only been to Indonesia for a couple of days by the point she died. However, I’m not sure whether I should believe the conclusion because there were reports (US nursing home and one from Italy) of people going from symptomatic to dead in <30h. In any case, 3 further deaths were announced yesterday, and no indication was given that they might be imported cases. Even just 3 deaths usually correspond to true rates of infection well above 1,000. The ratio of confirmed diagnoses to deaths is now exceptionally high in Indonesia. (The same applies even more strongly to the Philippines, but I could imagine that some deaths there were definitely imported.)
There was this entire discussion about expert modelling suggesting that indonesia’s long count of zero diagnoses is evidence for them missing cases throughout February.
(Indonesia was one of the last countries to ban incoming travel from Italy or Iran, I believe.)
According to this tweet, testing in Indonesia was 970 people. Indonesia’s population is >>200 million.
In addition, the incentives for reporting cases diligently seem to be suboptimal, as evidenced by some data points:
Indonesian ministers install even less confidence than Trump. Just one example of communication: About the Australia exported case, the Indonesian health official claimed that the woman most likely got infected in Australia because she had travelled for quite a while and because she also visited a Vietnamese restaurant there (implication: Vietnamese restaurants in Australia are risky). However, the Australian source (link above) says clearly that the woman in question started showing symptoms 2 days after leaving Jakarta (so much for “she travelled for quite a while”), and the only reason a Vietnamese restaurant was mentioned anywhere is because the Australian authorities obviously traced the Indonesian woman’s contacts in order to interrupt a potentially newly started chain.
Maybe the time lag confuses me, but I’m pretty sure there was one time when Indonesia skipped a day of reporting case numbers, and then numbers double and deaths went from 1 to 4. (Could be totally benign if there’s some disorganization during a time of crisis, of course.)
Indonesian officials seem to be under enormous pressure because the economy is doing very poorly already. Some unusual measures have already been taken a while back, such as disallowing shorting and pledges for government-owned companies to buy back shares.
And here’s a concerning but speculative hypothesis:
Singapore doctors gave out a warning that patients who tested positive for Dengue fever with a quick-testing kit actually turned out to have Covid-19. They say the diseases are clinically similar and that the widely used quick-test kits may not have failed isolatedly due to extraordinary circumstances. Indonesia currently has a somewhat large Dengue outbreak (and the same goes for the Philippines).
UPDATE: 18 days after I made this comment, Reuters reports that Jakarta’s funeral count for March was 1,300 funerals higher than any preceding month since 2018. This looks highly statistically significant because the previous record was only 3,100 (compared to 4,400). (And there was no natural disaster or other unusual disease outbreak.)
Malaysia is up to 428 cases now and rising rapidly: https://www.bloomberg.com/news/articles/2020-03-15/malaysia-virus-cases-spike-after-outbreak-at-16-000-strong-event They’ve been averaging 24C with peaks of 36C. Not looking good for the heat hypothesis.
I wrote the above before checking today’s news: Only 27 further cases, but a government official infected and 1 more death. The article also says that cases were in many different parts of Jakarta, and some in other parts of the country. At the same time, the Indonesian authorities say that the reason why they detected all those cases is because they did “massive contact tracing,” suggesting between the lines that this isn’t yet evidence of even more widespread community transmission than already acknowledged.
Edit: On the same day, Singapore gets 2 positive tests with a direct connection to Indonesia.
Edit2: Australia may have caught another infected person with Indonesia as travel history. (I say may have because there’s a small chance that this refers to the initial case from 5 days ago; however, some of the wording somewhat strongly suggests it’s a second, new case.)
A competing hypothesis (this time I am specifically replying to Owain’s comment) is that it’s easier to catch infected travellers coming from the location where one expects them to come from. Asian countries certainly had it harder in phase 1 when the goal was to detect all the infections with Chinese travel history. However, as soon as even just one country in Europe failed at detection, the traveling dynamics changed and in phase 2 it subsequently became easier for the Asian countries, because they had basically zero incoming travel from Europe by that point. So while everyone was still focused on catching infections with Chinese travel history, Europeans were infecting other places in Europe, but less so places in Asia.
It’s maybe some supporting evidence that the Italy outbreak was connected to the early Germany outbreak, and that it only became clear that many countries were going to lose control of the situation once infected travellers had come from many different places. (At the same time, the Seattle outbreak is evidence against.)
Another hypothesis:
Very hot countries have it easier to do contact-tracing. It’s plausible that the virus deactivates at 30 degrees Celsius (I think I may have read that in the often-cited Lipsitch article). In the hottest countries, public transport can be 30+ degrees and even grocery stores can be that warm. If infections happen primarily in indoor settings (e.g., business contacts or partying or household), contact tracing is easier, giving hot countries an initial advantage at preventing outbreaks early on. However, once contact tracing fails, that advantage shrinks. What remains is only that the r0 is lowered somewhat by heat interrupting certain types of of transmissions, but not all types. It wouldn’t surprise me therefore if hotter countries also need extreme measures to contain the case count from growing exponentionally, even if the doubling time might be generally lower for hot countries.
I agree with the objection regarding Seattle. But I don’t think that a situation as bad as in Iran or Italy would go under the radar, the hospitals there are flooded with COVID patients that show the same symptoms over and over and even in the extremely censored China this kind of information eventually leaked.
Spain is only x2 compared to the US right now and this could easily be explained by under testing and proximity to Italy.
Why Iran and Italy and not Thailand and the Philipines?
I think it’s too soon to say “not Thailand and the Philippines”; three days ago there were 10 reported cases in the Philippines, then 33, then 49. Italy’s trend at a comparable level was steeper--3 then 9 then 76--and then here we are, two and a half weeks later.
As for “why Italy and Iran first”, there’s both the possibility of “lower spread rate” and the possibility of “weird founder effects.” If a careless Italian healthcare worker made a mistake three weeks ago, and a careless Philippine healthcare worker made a mistake one week ago, we’d see two additional weeks of growth in the Italian numbers and not the Philippine numbers.
The rate of change being exponential is an extremely important point. The original rate of spread in Wuhan was a doubling every 2 days. If we set another area follows the same rate, then the difference between 32 cases and 4096 cases is just waiting 2 weeks.
Brazil looks like it’s also rising pretty quickly, but is especially interesting because both the president and his communications director seem to have it. [Edit: Probably not?]
Note that Bolsonaro does not have the virus.
Looks like he tested positive and then negative? Hopefully that means he doesn’t have it, but I seem to recall these tests can be inaccurate in both ways.
My understanding is that he never tested positive; rather, it was reported that he tested positive, and then that he tested negative. (The link you provide says otherwise, but Telesur is not a reliable source.)
Update: it now appears that Bolsonaro may have tested positive, though the situation is still unclear, at least to me. The main evidence in favor of the hypothesis that the Brazilian president has tested positive, according to this London Review of Books article, is that (1) Fox News claims that this is what his son Eduardo initially told them, that (2) Bolsonaro has refused to make the results of his tests public, and that (3) 25 members of his entourage are confirmed to have the virus.
Note that the article shows some signs of bias, such as calling the impeachment of former president Dilma Rousseff a “coup” and describing Bolsonaro’s economic minister as having studied “at the University of Chile under Pinochet” (Pinochet was the president of Chile, not the president of the University of Chile). So I’m updating only slightly and would like to see this confirmed by more neutral sources.
Ah, good to know!