COVID-19 Coronavirus Containment Efforts

[phinds]

In my opinion, in crowded places or places where people gather with strangers, because you don't know who is infected, wearing a mask is a good way to prevent the spread of droplets,

Uh ... that's exactly what I just said. Masks are to keep people from spreading it out, not to keep them from getting it.

 

[vxiaoyu18]

Uh ... that's exactly what I just said. Masks are to keep people from spreading it out, not to keep them from getting it.

I do n’t speak English well. I talk to you using a translation software. If my understanding is wrong, do n’t laugh at me, haha.

 

[wukunlin]

Possibly lost in all of this discussion is what the heck is China going to do about LONG-TERM banning of the domestication and sale of wildlife in cramped wet markets like the one in Wuhan, where animal viruses can pass from animal-to-animal and animal-to-human easily?

After 2003's SARS, the Chinese government lifted their temporary ban and these same behaviors that led to SARS continued taking place and brought about COVID19.

Can the world community do anything (outside of mere political pressure and sanctions) to actually stop China from relaxing their ban again - similar to post-SARS years?

There is a part of me that is simply angry at the situation we all face as humans. The Chinese people are innocent. But, the Chinese government is not here. I wish we could punish the Chinese government.

What can be done to prevent another global catastrophe like this in the future?

From a demand standpoint, this "problem" should solve itself. The type of people who even want to eat them are minorities. Most Chinese under the age of 40 should find those scenes in the wet market revolting as much as you and I. The target consumer is for people who believe in traditional alternative medicine. It is a cultural thing that is dying out, especially with the help of CCP. They were not so proactive after SARS because they didn't think it will happen again in this lifetime, which was unfortunate.

Also, you are not thinking of "punishing" every country that consumes wild life are you? That is most of the world. How about all the countries who chose not to prepare when the outbreak was mainly in China, who's going to punish them?

 

[vxiaoyu18]

We all know that the virus may come from bats, but the source of virus no. 0 has not been found, so from a scientific point of view, we are not sure where the virus came from, there is not enough evidence to prove that the virus originated in the farmers' market in wuhan. Every country's civilization needs a process, and every country's understanding of the world also needs to accumulate experience, just like we can't ban the killing of wild animals in Africa or other areas now, so it needs to be a process of mutual learning and progress. After this outbreak, China will surely seize the time to formulate corresponding laws on wildlife protection, prohibit the slaughter of wild animals, from the root cause of prevention. Very few people in our country kill wild animals for food. I've never eaten any wild animals in my life. Our main meat is chicken, duck, goose and pork.

 

[PeterDonis]

Moderator's note: Everyone please refrain from discussion of unacceptable topics.

 

[chirhone]

https://www.sciencealert.com/paper-...ight-be-slightly-more-susceptible-to-covid-19

Is this true? Time is of the essence. Every day thousands dying so we need to tackle it, the science of it directly.

 

[Astronuc]

The US has one week to enforce social distancing and 'flatten the curve' as the Coronavirus outbreak escalates. Here's why these days are so critical.
https://www.businessinsider.com/us-...l-distancing-flatten-curve-coronavirus-2020-3

The article has a comparison of the trends in Italy and US back to a common 149 cases. This evening the US has at least 8865 confirmed cases and 145 deaths.

US Timeline - https://www.nytimes.com/2020/03/13/science/coronavirus-math-mitigation-distancing.html
Jan. 14 — 0
Jan. 21 — 1
Jan. 28 — 5
Feb. 4 — 11
Feb. 11 — 14
Feb. 18 — 25
Feb. 25 — 59
Mar. 3 — 125
Mar. 10 — 1,004
Tonight ~ 8865

 

[Rive]

Is this true?

At this point not only the hospitals of the affected areas are struggling to keep up but the whole 'peer review' system too. Nobody will be able to answer that question for certain.

 

[atyy]

Right now everyone is in shortage of food and have to line up 1 hour or more just to limited stocks. I don't even have much food. I hope it doesn't end up like Italy.

From what I've read there doesn't seem to be a shortage of food in Italy.
https://www.vox.com/2020/3/18/21180483/italy-coronavirus-lockdown-quarantine-lombardy

 

[chemisttree]

Lombardy is the wealthiest part of Italy.

 

[DennisN]

Meme collection

Thanks for posting!
This one was great.

 

[PeroK]

From what I've read there doesn't seem to be a shortage of food in Italy.
https://www.vox.com/2020/3/18/21180483/italy-coronavirus-lockdown-quarantine-lombardy

There is definitely a shortage of food in London. The supermarket shelves are practically empty around where I live. I don't know whether it's a problem with deliveries, a few people continuing to stockpile or a lot of people buying extra.

There's also an ominous sense of suppressed panic.

This is certainly grim already.

 

[DennisN]

There is definitely a shortage of food in London. The supermarket shelves are practically empty around where I live. I don't know whether it's a problem with deliveries, a few people continuing to stockpile or a lot of people buying extra.

I have got the advice to go to the store in the morning instead of later. I don't know if this is of help to you, though.

 

[DennisN]

There is definitely a shortage of food in London. The supermarket shelves are practically empty around where I live. I don't know whether it's a problem with deliveries, a few people continuing to stockpile or a lot of people buying extra.

There's also an ominous sense of suppressed panic.

This is certainly grim already.

And now I suppose it's easy to understand why there can be rationing in e.g. wartime.

 

[russ_watters]

The US has one week to enforce social distancing ...

I keep hearing things like that. It sounds like these predictions ignore the fact that social distancing started a week and a half ago!

 

[kadiot]

PRINCIPLE OF HERD IMMUNITY STRATEGY TO FIGHT THE VIRUS: consists of sacrificing some members of the herd so that the rest of the herd is protected in the future.

In simple terms, "herd immunity" is the application of the natural selection law, i.e., only the strong will survive and the weak will be eliminated.

Did I understand it correctly?

 

[DennisN]

@mfb ,
I just checked the Coronavirus COVID-19 Global Cases (CSSE) page, and I saw they have reported 12,327 confirmed cases and only 28 confirmed deaths in Germany. I am well aware Germany is only in the beginning of this, but it is a bit remarkable that Germany comparatively seems to have so few deaths with respect to number of infections.

Have you heard and/or have any thoughts about why this seems to be the case, e.g. has there been comparatively more tests in Germany?

A comparison between Italy, UK, US, Sweden and Germany:

Italy (2978 / 35713) = 0,083 = 8,3 %
United Kingdom (104 / 2644) = 3,9 %
US: (150 / 9415) = 1,6 %
Sweden: (10 /1301) = 0,77 %
Germany: (28 / 12327) = 0,23 %

Notes:
1. Numbers taken from Coronavirus COVID-19 Global Cases (CSSE) page, 19th March 2020.
2. The calculated percentages have been rounded.
3. These numbers reflect only confirmed cases. Various countries have done different number of tests, and some countries may only test persons for whom it seems more likely they may be infected.

 

[PeroK]

And now I suppose it's easy to understand why there can be rationing in e.g. wartime.

If we are locked down for any length of time, then rationing, in some shape or form, is the only fair solution.

 

[Rive]

Did I understand it correctly?

No. Herd immunity is not a strategy.

A kind of strategy might be to stop caring so herd immunity threshold can be reached faster and order restored sooner - for the price of a completely jammed healthcare system, unnecessary loss of many lives and some really bad months/years ahead.

 

[russ_watters]

PRINCIPLE OF HERD IMMUNITY STRATEGY TO FIGHT THE VIRUS: consists of sacrificing some members of the herd so that the rest of the herd is protected in the future.

In simple terms, "herd immunity" is the application of the natural selection law, i.e., only the strong will survive and the weak will be eliminated.

Did I understand it correctly?

No. Is that a joke?

 

[Dr. Courtney]

Science is about data, not authoritative decrees.

Where is the convincing scientific data that a group of more than 50 people is more dangerous than a smaller group as long as all the other precautions are taken? If the sick people stay home, everyone washes their hands early and often, avoids touching common surfaces, and practices other procedures relative to the spread of respiratory illnesses, what is the problem?

Until I see the data, I'm going to church. Because my faith tells me I should, and the 1st Amendment tells me I can.

Show me the data, or keep your shame to yourself.

There is quite a bit of data supporting the effectiveness of instituting social distancing policies on stopping disease spreads from studies of past pandemics/epidemics, such as the 1918 flu pandemic...

A study of the 1918 flu pandemic shows the "flattening the curve" strategy exemplified in studying two cities, Philadelphia (which did not ban public gatherings until late in the epidemic) and St Louis which was early to ban public gatherings and institute social distancing ...

Lets you believe that this is cherry picking data, here's a chart from a study comparing death rates from the 1918 flu in various cities based on when they began to institute government-enforced (not voluntary) responses such as closing schools or instituting social distancing through bans of large gatherings:

No doubt social distancing flattens the curve. The question at hand is how much social distancing is "enough" to flatten the curve, and whether steps that violate 1st Amendment rights on broad geographies (whole states or countries) are necessary. One thing the data shows is that social distancing steps that are not implemented in a specific city until the disease is confirmed IN THAT CITY are sufficient to flatten the curve. One thing that data does not show is that mandatory church closures are needed to flatten the curve in addition to school closures, restaurant and theater closures, widespread working from home, and improved hygiene measures already in place in the current crisis.

Quoting:

Announcements of school, church, and theater closures were linked in most cities, occurring within a span of ≤6 days in the majority, and this near simultaneity of implementation precludes multivariate analysis or strong inference about the relative importance of the individual NPIs. Early bans on public gatherings were also associated with lower peak excess death rates, but the statistical significance of this result depended on the test used [Table 2, CEPID at time of, and Fig. 2 a]. Of the other NPIs considered (closure of dance halls, other closures, isolation of cases, bans on public funerals, and making influenza notifiable), none showed a statistically significant association between the stage of implementation and the peak or cumulative excess death rates (Table 2, CEPID at time of, and Fig. 2).

There is very strong data supporting the effectiveness of government imposition of social distancing (defined by the CDC as "remaining out of congregate settings, avoiding mass gatherings, and maintaining distance (approximately 6 feet or 2 meters) from others when possible") in attenuating the spread of an epidemic/pandemic disease.

Conclusions based on data in study of social distancing in 1918 need to use the same definitions of social distancing in place in 1918, not the CDC definition in 2020. I'm sure we might all have doubts with claims of an apples to apples comparison of data dependent on Newton's definition of mass and data dependent on Einstein's definition.

A scientific colleague pointed out that the rise of social media and the "hook up" culture provide lots of avenues for the spread of COVID-19. The close physical contact of dating and sexual relationships provides lots more opportunity for transmission than maintaining a 6 ft distance, the absence of touching, handwashing, etc. We should probably be shutting down all the dating apps used for one night stands in high risk areas.

Let's try:
In South Korea, most of the cases of Coronavirus come from a single church population. Conservatively, as of this edition of wikipedia, 9,000 of 230,000 members of the church are symptomatic, or 3.9%. That's the best current data we have for your odds of getting the Coronavirus in church if one person in the congregation gets infected and attends church ("spreading" was an odd choice of words, and a mismatch...). Note: that's more than one location, so the members get around.

Annually, 3 million Americans are injured in car accidents. If every American averages one trip per day, including multi-passenger trips, then one trip to Walmart carries roughly a 0.000092% chance of injury in a car accident. Or 0.000046% on the way to Walmart.
https://www.driverknowledge.com/car-accident-statistics/

That's a good start, but it misses lots of information specific to my situation and makes a number of unjustified assumptions. There are only 3 identified cases so far in the relevant county, and none in the relevant town. The data above suggests social distancing is not necessary until the disease is known to be in a specific city. Further, many more protections are in place in the town, county, and specific church that were not in place in the South Korea case. You are assuming that the church I'll attend is like the one in South Korea where the disease was propagated and not like the churches in South Korea where it was not spread.

The fact is, about 75% of the church I plan to attend this Sunday will attend online, leaving only 25% in person. That leaves much more room in a large building to maintain a 6 foot distance. The church has also implemented a careful and well considered plan of specific steps to prevent the spread of infectious disease including insisting that symptomatic people remain home, a safe distance be maintained between attendees, and that attendees refrain from touching. This is in stark contrast to the South Korean case, where

"On 18 February, South Korea confirmed its 31st case in Daegu, a member of the Shincheonji religious organisation. The patient continued to go to gatherings of Shincheonji days after showing symptoms, which are typically held with people in very close proximity and include physical contact of the members."

Here are the CDC recommendations for churches in communities where the COVID-19 transmission is currently "none to minimal."

From: Implementation of Mitigation Strategies for Communities with Local COVID-19 Transmission, CDC, 2020.

 

[kadiot]

No. Is that a joke?

I'm serious. The opposing and distinct approach/'treatment alone by the UK and the rest of the countries is a fundamental issue. Why? because the two approaches are incongruent with each other,?in that, time will come, which is not really distant, that when the majority of the countries are done with its lock down strategies and becomes successful, and the Brits are also done with its "just let it flow and roll approach"! and has attained the so called "herd immunity", the problem will still be there because there will still be millions who are asymptomatic and they will infect anew humans and mankind's ordeal will just be repeated all over again and again until the economic engine of the world will stop running... So that itmis imperative that The world must take and pursue one direction on eradicating this deadly pathogen, in that, either all go fo the lock down strategy or let's all take the British model...

 

[Rive]

The world must take and pursue one direction on eradicating this deadly pathogen, in that, either all go fo the lock down strategy or let's all take the British model...

I see no reason for any 'don't care' model at this point. Herd immunity can be reached through vaccination too, and the treatment for the affected is also developing fast. Just by waiting for a few month in a (partial or full) lockdown the difference will be vast - any further outbreak could be mediated far more effectively later on.

 

[PeroK]

either all go fo the lock down strategy or let's all take the British model...

Where did you get the idea that Britain is not on the brink of lockdown? Here's the latest:

https://www.bbc.co.uk/news/explainers-51632801

 

[mfb]

Have you heard and/or have any thoughts about why this seems to be the case, e.g. has there been comparatively more tests in Germany?

Yes, Germany tests a lot. I don't have numbers for tests done per day, but based on the number of test kits they produce for Germany it's a lot. At the level of South Korea in absolute numbers, or ~1/2 to ~2/3 per capita. The deaths per case ratio will go up over time - most cases are still fresh, deaths come later. Maybe it gets similar to South Korea.

@kadiot: I expect the UK to change its strategy after cases go up more. The latest when the hospitals reach their limits.

@Dr. Courtney: Be honest, you start with the conclusion and then try to find arguments for it. This is not a scientific approach.

One thing that data does not show is that mandatory church closures are needed to flatten the curve in addition to school closures, restaurant and theater closures, widespread working from home, and improved hygiene measures already in place in the current crisis.

Yes, it also doesn't show that mandatory theater closures are necessary in addition to all the other measures. It also doesn't show that mandatory restaurant closures are necessary in addition to all the other measures. No single measure has been shown to be necessary if you make the analysis granular enough. But that doesn't mean these measures would be useless, or that things would be fine without them. Suggesting that your church visit is more important than the theater visit of someone else is selfish.

 

[Vanadium 50]

In simple terms, "herd immunity" is the application of the natural selection law, i.e., only the strong will survive and the weak will be eliminated.

Did I understand it correctly?

Not even close.

 

[russ_watters]

That's a good start, but it misses lots of information specific to my situation and makes a number of unjustified assumptions.

I see now that the calculation was a mismatch. The S. Korean data is backwards looking, over the entirety of their outbreak. Something like 2 months. It's the odds two months from now that you will have gotten the disease if you keep going to church throughout the outbreak. So we'll multiply the car injury rate by 60 to match: 0.0028%.

There are only 3 identified cases so far in the relevant county, and none in the relevant town. The data above suggests social distancing is not necessary until the disease is known to be in a specific city.

Does your church not have reach beyond your town? Please be clear: are you suggesting that when someone is identified as having the disease within the radius of your church, you will advocate its closure? Your previous posts did not imply that was under consideration.

The problem with your approach is that it is backwards-looking from a week+ ago. Due to the incubation period and lack of testing you are making decisions for 4 days from now based on how the outbreak looked then.

Further, many more protections are in place in the town, county, and specific church that were not in place in the South Korea case. You are assuming that the church I'll attend is like the one in South Korea where the disease was propagated and not like the churches in South Korea where it was not spread.

I don't know your specifics of course, but once one person in the church gets sick, it is tough to keep the others from getting sick. The only thing I really know is the obvious parallel: both yours and the South Korean church explicitly and uniquely resisted complying with containment efforts. In S. Korea their early success was due to early testing, extensive contact tracing and individual quarantine, which we don't have. We tried, but it never really had much chance of succeeding.

Here are the CDC recommendations for churches in communities where the COVID-19 transmission is currently "none to minimal."

And you are explicitly stating your intent to violate the key recommendation!

No doubt social distancing flattens the curve. The question at hand is how much social distancing is "enough" to flatten the curve...

Does logic not tell you that more=better? Particularly in the face of the unknown?

One thing that data does not show...

We all know that data is tough here. But what you are doing is inserting faith, instead of logic, where data is thin.

A scientific colleague pointed out that the rise of social media and the "hook up" culture provide lots of avenues for the spread of COVID-19. The close physical contact of dating and sexual relationships provides lots more opportunity for transmission than maintaining a 6 ft distance, the absence of touching, handwashing, etc. We should probably be shutting down all the dating apps used for one night stands in high risk areas.

Not that I'm advocating it, but that doesn't really follow, since a "hook up" is a 1-on-1 activity, so it only has the potential to infect 1 other person at a time. But if you'd like to go after kids, go after Spring Breakers:
https://www.foxnews.com/travel/spring-break-backlash-amid-coronavirus-outbreak

 

[Vanadium 50]

No. Is that a joke?

I'm serious.

And wrong.

Given that you don't know what "herd immunity" even means, and didn't bother to look it up, why should we take anything you say seriously? "Looking it up" is not a crazy high burden.

You have to decide if you want to be part of the solution or part of the problem.

 

[Vanadium 50]

Is this true?

First, how the heck can we tell? You don't seem to actually want science. You wan scientists to tell you what "truth" is.

Second, there is already a thread on this: https://www.physicsforums.com/threads/coronavirus-infection-rate-outcomes-versus-bloodtypes.985717/ It would have taken you all of 5 seconds to look for it.

Third, I am skeptical of the result, for reasons expressed in that thread.

 

[anorlunda]

NJ.com (Avalon Zoppo)

reports: Two weddings in Lakewood were broken up by police Tuesday night as state officials continued to warn against large gatherings amid the Coronavirus outbreak.

People have a right to get married, but not the right to have a big gathering for the wedding. Similarly, people can be religious without big gatherings of people in a church. Restricting religious activities is not synonymous with restricting practice of the religion. There is ample case law supporting that.

I am well aware Germany is only in the beginning of this, but it is a bit remarkable that Germany comparatively seems to have so few deaths with respect to number of infections.

Have you heard and/or have any thoughts about why this seems to be the case, e.g. has there been comparatively more tests in Germany?

A comparison between Italy, UK, US, Sweden and Germany:

Everything in this crisis is necessarily done hastily. That applies to record keeping and data reporting also. There is not even enough time to process bodies in the morgue in some places. There is certainly no time to audit data handling practices. There is no time for journalists to double check reports before publishing. So I think all the numbers we hear from all sources anywhere in the world are less reliable than the norm.

 

[Ygggdrasil]

I keep hearing things like that. It sounds like these predictions ignore the fact that social distancing started a week and a half ago!

It's important to remember that the https://annals.org/aim/fullarticle/2762808/incubation-period-coronavirus-disease-2019-covid-19-from-publicly-reported of the virus is about 5 days, so we don't expect to see new cases subside until about a week after imposition of social distancing methods. In some locations, distancing measures (like closing schools, restaurants and theaters) were not imposed until the beginning of this week.

Edit to add: also remember that testing is becoming more available, so we should see US numbers go up just from increased testing.

 

[Dr. Courtney]

I see now that the calculation was a mismatch. The S. Korean data is backwards looking, over the entirety of their outbreak. Something like 2 months. It's the odds two months from now that you will have gotten the disease if you keep going to church throughout the outbreak. So we'll multiply the car injury rate by 60 to match: 0.0028%.

Does your church not have reach beyond your town? Please be clear: are you suggesting that when someone is identified as having the disease within the radius of your church, you will advocate its closure? Your previous posts did not imply that was under consideration.

I would advocate for their voluntary closure according to the CDC guidelines that call for that once the presence of COVID-19 in their community is "substantial." There is a very high level of voluntary church closures (I estimate 80%) in the county based simply on governmental requests. There is a significant reduction in attendance (I estimate 75%) in the churches that remain open. Due to online offerings, churches remaining open are drawing from a much smaller radius. As the virus numbers increase within the draw radius of the church, I would hope they have options which might include: 1) Reducing the draw radius - not allowing people to attend from areas where the virus has been identified. 2) Modifying the service format. A nearby church only has the pastors and worship team in physical attendance and the rest attending online. This seems like a viable approach before complete closure. I discussed how to disinfect the equipment with the worship leader there yesterday. (We're fishing buddies and both worship leaders in the county.) They have a sound plan to minimize transmission probabilities.

The problem with your approach is that it is backwards-looking from a week+ ago. Due to the incubation period and lack of testing you are making decisions for 4 days from now based on how the outbreak looked then.

I am checking every day for the latest available local information. If there is a significant uptick in cases within the draw radius of the church, I can change my plans. I am capable of extrapolating the data forward to account for the incubation period and new information regarding risks of non-symptomatic carriers.

I don't know your specifics of course, but once one person in the church gets sick, it is tough to keep the others from getting sick. The only thing I really know is the obvious parallel: both yours and the South Korean church explicitly and uniquely resisted complying with containment efforts.

"Uniquely resisted" is an odd description in a county where 20% of the churches remain open. "Resisted" is an odd choice of words for a church that is exceeding recent CDC recommendations applicable to churches given the level of outbreak in the local community (none to minimal).

And you are explicitly stating your intent to violate the key recommendation!

My current intent is to attend. In the recent CDC guidance for churches that I provided above, there is no recommendation to not attend given the level of outbreak in the local community.

Does logic not tell you that more=better? Particularly in the face of the unknown?

No. There is no evidence that a 90% reduction in social contact is insufficient to flatten the curve in a local area currently experiencing the local level of outbreak. Humans are social creatures. We all have limits on how long we can maintain higher levels of isolation. The outbreak and mitigating measures may well stretch into the summer. It is wise to save our limited capacity for total isolation for the more critical time.

We all know that data is tough here. But what you are doing is inserting faith, instead of logic, where data is thin.

Was the CDC acting on faith rather than logic when they issued the above guidelines stating that church meetings need not be completely canceled until the outbreak is "substantial" in a given community? I'm not depending on faith. But yesterday I observed many more people at Walmart and similar retail outlets in closer proximity than are likely to be in church Sunday. "Cabin fever" has already set in, and people's cravings for interaction are pushing them out into the marketplace, since the level of isolation of closed schools, working from home, and only shopping when needed has not even been sustainable for a couple weeks. I'm not too worried about it in a county with minimal cases right now. But it does inform my view that stricter measures will not be sustainable for long. People need outlets for social interaction with minimal opportunity for transmission. Until an outbreak reaches a "substantial" level in a local community, churches operating within the CDC guidelines above can provide some of that. The local boat ramps, golf courses, parks, tennis courts, and shooting ranges remain open also. These provide additional opportunities to satisfy the human need for social interaction with minimal risk of transmission.

Counties in rural Georgia don't need SF Bay style lockdowns at the present time. Areas with none to minimal or minimal to moderate cases don't need to follow the CDC guidelines for higher levels.

 

[Mondayman]

People need outlets for social interaction with minimal opportunity for transmission.

Internet? Phones? People are more connected than ever.

Many of us want to stay safe and not get sick. There's bound to be frustration when a group doesn't go along with the precautions and puts others at risk.

Social isolation? Seems like a small price to pay. Human's can and have endured worse.

 

[vxiaoyu18]

The spread of the virus knows no borders, no principles, and in this time of emergency, the situation will get worse without more effective detection, isolation and treatment. The more you hide the virus, the more people it kills. China, Japan and other countries have controlled the epidemic through surveillance and quarantine measures. Why not learn from the successful cases and do herd immunity tests instead? This experiment needs more life. My friend in the physics forum, I suggest you prepare more food and stay at home for at least a month.

 

[bhobba]

From what I've heard any vaccine will still take a year to develop and produce.

Its already developed, has been tested in animals and human trials will start soon:


It is thought those trials to ensure efficacy and safety will, with an accelerated timeline, be completed by about the end of the year - but its possible it may not - it may take 18 months or longer. What has also been done in Australia is building on work already done with drugs we currently have it has been found some malaria and HIV drugs can kill the virus in already infected patients. To test this at least 50 hospitals in Australia will be trialing them. If true it could significantly slow the spread of this thing. But I think the final answer will be a vaccine.

Thanks
Bill