Managing risk during the COVID19 Outbreak
Life in the epicenter of the coronavirus outbreak in the United States ~ Washington State. It could have been worse.
Edit: 3/26/2020: The United States cases grew exponentially the day after I wrote this. A number of states increased testing, which is good news. It was not soon enough but hopefully we can stop it from getting worse. Unfortunately it may have been too late for many people. The U.S. has the most cases in the world as of this date. Also, while many states shut down Washington State remained open. Now our state is on lockdown also but likely due to the delay and people not taking the virus seriously we had a significant increase in cases today — over 600. If your state is not already on lockdown, do it now. A number of cases appeared related to a church in Arkansas, which is seeing rise in cases.
Also, if your state is not testing extensively, you may see a fate like New Jersey. I posted on Twitter on March 19th that about 79% of their cases were positive. They did not immediately increase testing until it was too late. The number of cases in New Jersey and other states that are not performing extensive testing has surpassed Washington. States with a high percentage of positive cases are not performing enough tests based on the results a week later when the cases and deaths increase in those states. You can see tests and results here, and at the time of this writing, these were the states with > 20% of test cases coming back positive.
As of 3/27/2020 Maryland’s tests spiked dramatically.
How many coronavirus cases have been found in each U.S. state
Using data from the COVID Tracking Project, we're following how each state is responding to COVID-19.
Original story below. Feel free to fact-check this information by clicking the links in the story, including those linking to the CDC website, and cross-referencing with other credible sources. False information and flawed logic can cost lives.
This story is not some doomsday blog post about how the numbers are rising in the United States, which is very accurate. We are over 5,000 cases as of today. What I want to explain is how we got to where we are in Seattle, and why it could have been worse. I hope that by sharing what I’ve been tracking and witnessing, it will inspire others to take appropriate actions. By doing so, we can root out this virus and be on a path to recovery quickly. China is already starting to resume normal life. Even as the numbers go up, it is a sign that we are getting better. We are finding it and eradicating it. My mom used to tell me when a cut itches, that’s because it’s healing. Don’t scratch it and make it worse. Let it heal. Trying to hide the facts to make ourselves feel better is only going to prolong the healing process.
I’ve been watching the numbers daily on an alternate Twitter account you don’t want to follow. I post snarky messages, track virus statistics, and sometimes post something scientific, funny, or cute. I am not necessarily seeking followers; it’s a place to stash things I would never put on my cybersecurity account. It would probably annoy some, and I’m amazed that anyone does follow me there. But it’s a place where I can post news stories and track the virus over time. I’ve been watching the virus as it started in China, how it progressed when it hit Seattle, and how it is evolving around the world. I’m no expert in medicine or epidemiology. But I do see the obvious analogies to cybersecurity. I also have a ton of facts and numbers to back up what I am writing here. I’m not just spouting off random thoughts. I look at the numbers and news articles every day — because I want to be informed.
As the coronavirus first entered the United States, I was on a plane from Seattle to Chicago to teach a cloud security class. Those two cities were the first to announce cases of the coronavirus. Sometimes I see the world differently. Anyone who knows me closely will tell you that it is not some sort of an egocentric point of view. Most of the time, it makes my life difficult. I am often at odds with the norm, and being right doesn’t always get you anything. People don’t want you to tell them things they don’t want to hear or fit with their mental picture of the world. Although most people who know may might not believe this, sometimes I don’t say what I really think or want to say. But that’s a topic for another post.
It seemed obvious to me that we should halt flights from China because that was the source of the virus. Someone would get on a plane. The virus would linger on surfaces, or a flight attendant might be infected, and I or others would get sick. Since I was already in Chicago, I presumed there was little risk of a passenger from Chicago already having the virus, so I wasn’t as worried about that for myself for my trip home. But I knew others in Seattle might step onto a plane that had just arrived from China and then fly to other parts of the country. Wasn’t it obvious that would cause the virus to spread?
This same concept is true, as I have written and spoken about many times in relation to network defense and defense in depth in cybersecurity. It is the core premise as to why network security is still so important, even if you have authentication or some other type of endpoint security. Do you want a sick person coming from China and infecting the person checking them at the airport? Or do you want to block that by not letting them travel to the U.S. altogether? It depends on the level of risk that person poses when they get on the plane with all the other people, or when they arrive at the airport. In some cases, you may accept the risk. In other cases, you don’t even want the person to get on the plane.
Of course, the virus might have had minimal impact. Perhaps it was not as big of a deal as it was in China in the United States for some reason. Maybe it would show up here, the doctors would immediately identify it, and we could easily contain it. However, that did not seem logical to me. Why would it not impact the U.S. the same way it was affecting China? They had taken draconian measures, and the numbers were still rising at that moment. Somehow this virus was spreading rapidly, and I did not see how that would not be the same when it reached the United States.
At this moment, when I was evaluating the circumstances surrounding my flight back to Seattle, it appeared that potentially my health and the health of others were at risk. I called on the airlines on Twitter to stop flights from China. It seemed like the logical thing to do. Stop the spread. Don’t put the airline crew’s lives at risk either. I wasn’t going to freak out or not get on the plane. But I was hopeful the airlines would listen and stop the flights.
I did have someone respond that “you can’t shut down a whole country.” I know many people’s reactions to my comment at that point would be that it was overblown. That’s how many people reacted who did not want to think about logical outcomes. Often in security people get chastised for spreading FUD (Fear, Uncertainty, and Doubt). Sometimes, this is true. But in other cases, the recommendations to secure systems are backed by solid logic and factual insights. Sometimes the reasoning is complex or hard to explain, based on many detailed factors in a person’s mind.
Not wanting to get into an argument, I tabled it (that point where I realize my thinking might not match the majority opinion), but I thought, “Yes, you can.” If a wildfire is spreading, you did ditches to stop it and try to get it under control. This virus was an out of control blaze if I ever saw one. The numbers were multiplying daily. Additionally, the virus seemed to be very contagious. It seemed to have a higher death rate in certain populations of people, which bothered me. I don’t know about everyone else, but I love my parents. For some of you who are younger, which I hate to admit, that would be your grandparents.
Eventually, airlines shut those flights down, and I think that did help. If they didn’t take that step, I believe places like Seattle, where many Chinese people live and return to China periodically, would have been much harder hit. I have a friend who frequently returns and has property there. Individuals do not always make the best risk decisions, and I preferred they did not have the option unless it was an emergency. Case in point: the person who got on a plane while he was waiting to find out if he had coronavirus and found out — on the plane — that he was infected. I also recognized we did not yet have all the information to make accurate decisions. People generally don’t like uncertainty, but it doesn’t bother me. Sometimes you just have to say, “We don’t know. We don’t yet have all the facts.” When you don’t have all the facts in life-threatening circumstances, why wouldn’t you err on the side of caution?
The next thing I noticed that doctors and sick people were complaining they could not get tests. The federal government said not to worry. Some suggested the virus would just go away. I know people were just trying to be reassuring, but sometimes it’s better to have the inconvenient facts. Perhaps the public message could be soothing, but behind the scenes we should be rushing to test people, I thought. How can you know the spread of you can’t get people tested? This was an immediate red flag in my mind. I was mildly concerned, but I wasn’t involved in the testing procedures, so I wasn’t sure what was going on at this point and what was true. As we all know, a lot of false information appears on social media at times. Sometimes a wait and see attitude is best before proclaiming a disaster or hard opinion on anything.
At this point, I was nervous about going to a conference in San Francisco a few weeks later. However, RSA is one of the biggest security conferences in the world. It was an honor to speak there. I had invested a lot of money into the flight and accommodations. My risk-based decision based on a logical conclusion was that chances were good that someone there in a crowd of 40,000 or more people would have the virus, but it had not yet spread widely. I would be extremely careful, wash my hands a lot, and avoid crowds for the most part. For me, I didn’t think I was in the highest risk category, and my small cybersecurity company would benefit from the awareness of its existence. When I got home, I would self-quarantine just to be safe and not infect my elderly parents or other family members. The marketing exposure as a presenter and the on-going views of the video of the presentation would hopefully help my business as it had done in past years, so I felt it was a reasonable risk to take.
Was I right? Yes. As it turns out, at least two people so far from that conference got infected with the virus. It is not clear they had it at the conference. By the time I found out, it was almost already two weeks later. I didn’t have the symptoms listed for the virus though I had a bit of a sore throat right after. That is typical for me after every conference. The article I linked to suggests that RSA was the “only big conference that didn’t cancel.” To be fair, it was very unclear at that moment if the risk was that great, and only conferences in Asia were canceling. It was just on the edge of when the virus took off. A few large companies backed out, but many people still went, and I believe, at this point, the impact was minimal. RSA told everyone repeatedly to take precautions, and hand sanitizer was available liberally, such as at the bottom of each escalator. They sent messages to people telling them not to shake hands, though sometimes our habitual reactions take over unexpectedly as it has done for many politicians.
At the conference, I did not interact with a vast number of people. I had meetings with a few people. I went to a breakfast and a dinner and didn’t stay long at either. I gave my presentation, and my session on cloud risk. Almost every time I touched a door or interacted with someone I washed my hands. I tried not to touch my face. OK, also, I gave and got a few hugs. It’s hard not to sometimes, and they were brief interactions, followed by immediate hygienic procedures. Overall I kept my distance and didn’t pick up swag or go to too many sessions. I knew I could watch the videos later. I left a day early.
When I got back to Seattle, I self-quarantined for the most part and watched the news. I knew there was a chance someone there had it. I like to get my news off Twitter and Google. I also sometimes listen to the radio in my car. I waited for time to pass and tracked the virus statistics each day. I wasn’t following the virus because I’m frightened I will get it. That is not to say I had no concerns, but rather, that I know it will do no good to waste time worrying about it. That won’t change anything. On the contrary, I want to be informed and to provide helpful messages that enable the eradication of the virus as quickly as possible.
Yes, there’s a chance I could get the virus. The cases are up to 904 as of today on the Washington Department of Health website. I live in King County, though not the most affected part. This update appears to be updated once per day between 2 and 5 p.m. If I do get infected, I will deal with it. I’m not going to spend all day worrying about it. It’s best to carry on and focus on other things. However, I will avoid it if I can, for the sake of myself, my loved ones, and my community. That’s where risk-based decisions come into play. I hope other people will make conscientious decisions as well.
People’s reaction to the virus in the US seem to be as extreme as our politics. The extremes are rarely healthy or beneficial. On the one hand, we have people buying every roll of toilet paper in sight. I joked on FaceBook that the last time I checked, toilet paper doesn’t stop viruses. When you buy all the toilet paper then some elderly or sick person who can only come to the store on a rare occasion shows up and can’t get any. If we all buy rationally, we will have enough when required. Someone also posted this great image which sums the toilet paper obsession up nicely:
The problem is also that the media is making this frenzy worse. I went to the store prior to the virus outbreak to stock up. I bought my usual amount of toilet paper and a few more cans of soup to tide me over if I got sick and didn’t want to or couldn’t go to the store. When I see the media stories with rows of empty toilet paper shelves, it even causes me to have a reaction to want to go buy more. That’s not because I feel it is the rational thing to do, but because of the irrational over-buying of others. When I need some, there might not be any. At this moment, when I go to my local stores, I still see toilet paper, and I’m in King County with one of the highest numbers of cases in the United States. Please stop posting these photos if you are in the media, and if you are buying supplies, please be rational.
The other thing people should know is that soap and water work just as well as sanitizers from all the reports I read. Think about this as well — if you are staying home (until this thing passes), why do you need hand sanitizer? Use soap and leave the hand-sanitizer for the people who can’t stay home. Uber drivers, restaurant works, medical professionals, bus drivers (like the one I saw at the store buying some when this all started), and others all need to go out. If you are staying home, save those for the people who need them. I didn’t buy any. I’m using soap and water.
On the flip side of overreacting, people are using flawed logic to compare the virus to other things that are not truly analogous. Some people just want to believe it will go away. Others think it’s not that big of a deal as the reports say and don’t believe anything published in the media. Others joke that they want to get the virus and get it over with. Being optimistic and positive is helpful in some cases. It can help you to get through tough times and do things other people say can’t be done. I’ve read a lot of books about optimistic people who changed the world by ignoring the naysayers. I love these stories a much as anyone else.
However, sometimes it’s better to be rational and leverage facts. I’ve also read that even the most successful entrepreneurs take calculated risks — not every risk. You can use the available information to evaluate chances and outcomes when making decisions. This may save your life, or the lives of others. You may not die from the virus or even have symptoms, but those germs you leave on the bathroom door may affect someone who will. Having the facts and taking appropriate precautions doesn’t mean you are negative. It means you are making a calculated risk-decision based on known facts and possible outcomes.
Some people have been reacting to virus reports by insulting anyone who has concerns. Then they proceed to tell them all in a condescending tone to stop panicking. The mentality that paints someone as weak or mentally inferior who is trying to be realistic and make judgment calls based on known facts is on the same level as filling your basement with toilet paper from my point of view. Neither is logical. They are both emotional reactions. If we are going to make smart decisions about the risks we will take, we need to consider the facts with an open mind.
Others say the coronavirus is the same as the flu. Yes, the flu takes lives also. I will admit that I did not even realize how bad the flu was and how many people it impacts. I am hopeful that now people understand this, they will practice better hygiene and stay home when they are sick and get vaccinated for the flu. Perhaps, the coronavirus outbreak will help reduce flu tragedies as well. If you look at the numbers alone, at this point, the flu does seem worse than the coronavirus, as explained in this article from John Hopkins. But hold that thought, because this type of limited information and not thinking through the big picture is the same type of flawed risk-assessment that occurs at times in cybersecurity.
I am the farthest person from an expert when it comes to medicine, and all the things doctors and scientists do. I learned about scientific research when I hung out with a friend who had a Ph.D. in molecular biology in the labs at Fred Hutchinson Cancer Research Center (or the Hutch as we call it here) when I was younger. It was intriguing, but I know my knowledge only scratches the surface. I also have a friend who is a doctor who tells me lots of stories. These people amaze me. I could never be a doctor. When I was younger, my mom tried to teach me to give a colt a shot while she was on vacation. I couldn’t do it. She had to call a neighbor who was studying to be a veterinarian. When I took chemistry in college, I got an A, but I was afraid I would blow up the lab. I switched over to take a computer programming class the next quarter to fulfill science requirements.
Although I am not an expert in epidemiology, infection diseases, or gene sequencing, I have been studying risk as it applies to cybersecurity for a very long time. I am especially interested in the ability for network security controls to contain cybersecurity threats and the big picture of risk management in organizations. How do you get people to do the right thing — or in other words, governance. I talked about how people assess the risk of blockchain in my RSA presentation, which is oddly related. If you only look at one aspect of the risk, you may be missing the larger picture and all the tangential risks. This type of risk-analysis is also the core theme in a book I just published — Cybersecurity for Executives in the Age of Cloud. I talk about the idea of cumulative risk as it applies to cybersecurity, and I think that concept applies to this virus as well.
One issue with comparing the virus to the flu is that we have the resources in place to deal with the flu. Doctors around the world are warning that they potentially do not have enough ventilators to deal with a massive coronavirus outbreak. The virus coats the lungs, and people need those ventilators to survive. The outcomes are good — if we have the resources to deal with it. So far, the U.S. seems to be able to handle the cases. If you look at the ratio of deaths to cases in the U.S., at this very moment, we are doing better than some other countries. Last time I checked, it was about 1.9%. However, if we have so many cases it overwhelms the health system, that could change. We can take measures to avoid that now.
As for people who compare the virus to car accidents, I find this analogy to be like comparing apples and oranges. Car accidents are not contagious. They are somewhat similar in that you can stop everyone from driving a car, but obviously, that’s not going to happen. There’s a risk tradeoff when you get into a car, and there are things you can do to prevent a car accident. We make people get driver’s licenses. You can drive carefully and defensively. You wear a seatbelt. Avoid drinking and driving.
Here’s another reason why you want to be careful with that logic. How many people are exposed to riding in a car? How many are exposed to the virus? What if we expose everyone that rides in a vehicle to the virus? We don’t know if that statement is true without taking that measure at this point because we don’t know enough about COVID19. Let’s not test it and find out, OK?
The spread of this virus interests me from an intellectual standpoint because it aligns with how computer viruses spread in cybersecurity. The name for malicious software is no coincidence. A malware infection can spread from computer to computer when they exist on the same network. If you can stop the spread of a computer virus, you can lessen the impact and prevent it from infecting other machines. In the same vein, the actions taken by our federal, state, and local governments increase or decrease the risk that the virus spreads. The choices made by businesses and individuals to take precautions to avoid infecting others impacts the outcome for all of us.
As I watched the virus numbers grow in Seattle, it seemed perfectly logical to me that large companies should allow their employees to work remotely. I have an autoimmune deficiency. Every time I work in a large corporate environment, and especially if they have a cafeteria, I get sick a lot more than when I work at home. I posted on Twitter that large companies may want to consider letting people work at home. It wouldn’t hurt, and it might help. I don’t know if anyone was paying attention to my tweets. However, that’s how I was thinking about the problem at the time.
We have many very large firms in the area as most big cities do. When someone at Amazon got sick on March 3rd, I posted my message again on Twitter. I’m sure I wasn’t the only one thinking about this. People in Seattle could have blown off this idea and tried to be optimistic. Then Microsoft told Seattle areas to work from home. I wonder if this was at the behest of Bill Gates. He and his wife Melinda have been working to help the spread of infectious diseases all over the world. He wrote about the Ebola outbreak in this article from 2018. Amazon and others like Facebook, Google, and Twitter followed soon after.
I believe that these actions and those of our governor, Jay Inslee, to limit large gatherings, close schools, and other actions taken to limit people from interacting with each other helped mitigate the spread of the virus immensely. We also received a lot of messaging about personal hygiene early on from the Washington State Department of Health. People were also informed of the symptoms so people can rest easy who don’t have the symptoms, and people who do can get tested. The main coronavirus symptoms include a dry cough, fever, and breathing issues. People received guidance on how and when to call their doctor or go to the doctor. It could have been much worse, based on reports from other areas that did not take the same action so quickly.
Here’s a related Twitter post showing two different places in Italy and how a difference in response limited the outbreak:
But why is it so bad here? How come so many people died in our county if we are doing such a good job locking things down? The problem was that the lockdown came after the virus had already spread in the community. It also, unfortunately, got spread through a nursing home facility with a large population that was vulnerable. That happened in part due to people not being tested at the airport who came from China or other places with virus cases. It also had to do with delayed testing. By the point the virus had severely spread to a large population of the nursing home staff and residents, it was already too late.
The other problem in this case is that the virus was new. As I already mentioned, we have the capacity and knowledge to deal with other types of illnesses and accidents. We are aware of the risks, prevention, and in the case of the flu, we have vaccines. Washington state was one of the first places to get hit hard, and some medical professionals may not have known what to do. Now they do, and can share knowledge. If doctors around the country are taking the right steps, rest assured we can prevent this type of spread in other places. However, medical professionals need to the right resources and the authority to do their jobs to their full potential.
Additionally, people need to take the information seriously and do the right thing. If people are still pretending the virus is not a big deal and are not taking the recommendations seriously, such as the person from New York who found out on the plane he was infected, we will have a harder time preventing the spread. If doctors are not able to or do not want to test people with the virus symptoms, then this also may weaken our ability to fight this virus.
John Swartzberg, clinical professor emeritus of infectious diseases and vaccinology in the UC Berkeley-UCSF Joint Medical Program, explains that doctors cannot tell from symptoms alone whether someone has the coronavirus or the flu. They need to test people to know the difference. Unfortunately, some issues with testing early on led to a delayed start in the assessment and mitigations to prevent massive spread in our area.
The CDC started shipping test kits around February 6th, 2020. If these test kits had gone out immediately and worked properly, perhaps more people would have been tested sooner and we would have less cases in Washington, but that would be speculation. Everyone was likely doing the best they could under the circumstances, but unfortunately those test kits were flawed. Here is the transcript from the CDC regarding the malfunctioning kits on February 12th, 2020. It took some time after that point for the CDC to get out new test kits and ramp up testing. Around that time, the FDA changed its policy to allow more research facilities to begin working on their own test kits.
Besides not having working test kits, some researchers and doctors were not allowed to test according to some reports. Luckily, we have some amazing research facilities and doctors in the Seattle area. I know the same is true for other areas of the United States, as well, but these people may have saved many more lives. The way we found one of the first cases of the virus not associated with travel or China, was when a researcher defied regulations and tested a patient in a flu study for the virus. She ran tests for the coronavirus without government approval.
Further evaluation led to a report from a researcher at Fred Hutchinson Cancer Research Center and the realization that the virus was spreading in our community. It wasn’t only people getting off planes. Although researchers projecting the number of people who will be infected may have been speculation, the fact that it was here and spreading in our community was not.
If you can’t or don’t test people, you don’t know they have it. They don’t know they have it. Medical facilities cannot quarantine them or they do not self-quarantine. You might not find out before it’s too late to save their lives, or they may spread it to others who are at-risk. So the bottom line is, we need to be able to test as many people as possible. The fact that the numbers are rising should not scare people, because the risk of dying from the virus is low. However, if we are not testing people who are sick, the percentage of people who appear to die from the virus will be high in comparison. The ratio of deaths to cases will be abysmal. The risk of more deaths is also higher because the risk of spreading the virus is more significant. What we should measure, which is more important than the number of cases or deaths, is the number of tests performed on those who have the symptoms or have been in contact with an infected person.
If you look at a report from ourworldindata.org it shows how many tests countries around the world are performing. China, who is now recovering from the virus, performed massive amounts of testing. South Korea, which currently has more cases but less COVID19 deaths than the U.S., also has done massive amounts of testing. I wonder how many tests are being performed in each state here in the United States. Additionally, how does that correlate with the spread and the different hotspots in our country? I have not yet run across those numbers. However, curiously at the time of this writing, West Virginia, which is very close to some other areas with many cases, is the only state in the U.S. that has reported no cases. With almost every state reporting multiple cases, I am curious how many cases they have performed, but perhaps they are just very fortunate.
One of the other amazing things our researches did here at the virology lab by University of Washington Medicine is to develop a test, separate from the one provided by the CDC. The number of cases here in Washington may look scary and high, but part of that is because the ability to test has ramped up to about 1,000 tests per day. Our state is aggressively testing to weed out the virus as quickly as possible. Bill Gates and the Gates Foundation funded home test kits so people could stop spreading germs at doctor’s offices. Amazon offered to help. For all the people who are complaining about big companies in politics, I am sure glad we had some in the Seattle area who were willing to step in when other options were not working very well.
As of yesterday, New York has surpassed Washington for the most number of cases with 1,374 cases at this moment on the map I shared. The report in that article does not match the number of cases in Washington state, which is 904 at the time of this writing. Unfortunately, the numbers in this post will probably go up again (perhaps before I hit the publish button), but I’d rather know what is out there and stop it than bury my head in the sand. If we look at the trend in other countries and compare it to our own, we can be smart and take appropriate actions. I don’t know how accurate this is, but someone posted a report showing how the spread in the U.S. is trending compared to Italy. Regardless of how accurate this particular graph is, we know the numbers are rising. We can wait to see if this becomes a reality, or we can take action now. We have the capability to do something about it.
One of the great things that happen in a time of tragedy is when people come together. Although some aspects of the virus are heartbreaking, like children only allowed to look through the window of the nursing care facility to see their parents, in other ways, our community has pulled together to fight this nasty bug. We have a sculpture called the Fremont Troll under one of the bridges in Seattle, and someone dressed him up in a giant mask.
Almost every attraction or event you can imagine is closed in Seattle, including the Space Needle. Restaurants and bars are shut down. Schools are closed. However, many different organizations are trying to help the community cope and get through this difficult time. The Seattle Symphony is live-streaming free musical performances.
And, as the virus progressed, a new hashtag emerged on Twitter:
This can be taken two ways. Either way, it’s a positive message. Not sure if it was intentionally tongue in cheek or an unintentional double meaning, but people are responding to it and many people in Seattle are helping each other get through this.
Know the facts, so you can make decisions the appropriate risk-based decisions to limit your risk and the risk of those around you. If everyone does their part in this virus outbreak, I am hopeful that we can overcome it quickly. Please try to avoid extreme reactions. Follow the advice of medical professionals. Wash your hands for 20 seconds — sing a song so like Happy Birthday twice so you know you did it long enough. Use social distancing until we are confident we have eradicated this virus from our midst, and doctors have it under control. If you are in an at-risk category, stay home. If you are sick, stay home. If you have clear symptoms, call your doctor and ask for a test. Tests are limited so if you can’t get one, be patient. If you can work from home, please do so. Hopefully, if everyone chips in, we will be back to our Teri Radichel
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