I find myself reconsidering the original proposition by England to isolate the most vulnerable for a couple months and let the virus work its course through the less vulnerable population.
If death rate is substantially lower among the under 50 crowd, this could work its way through with a fairly low death toll, and result in a herd immunity within a couple months. This slow burn approach we're doing however seems possibly to be the precise worst way to handle it, leaving the virus in the population for as long as possible, reducing the ability for our vulnerable population to avoid it.
Note I think the best possible solution is a complete lock down for a couple months until the virus is more or less eradicated, as Wuhan did. But I don't think it's a realistic option in our society.
The outcomes aren't just death and recovery. There's also the possibility of long-term heart, lung, and kidney damage. And the blood thinners used to prevent coronavirus blood clots can cause brain bleeding. Those happen in younger people, too.
And realistically there's no way to isolate those over 50. They generally live with, work with, or are cared for by younger people.
Yes, recovery is not binary. Even if you recover fully you've expended some percent of your finite lifetime capacity to heal your organs. It may well have taken years off your life. That's true for other illnesses to. The flu doesn't just cost you a week of productivity.
This feels like fear talking. As more data comes in, we are seeing more people with no affects. Not just mild, but nigh non existent.
It is agreed that something gives people severe cases. Severe includes death and recovered with damage. We don't seem to have data letting you know who or what would land there.
we have absolutely no clue regarding the long-term impacts of exposure to this virus for asymptomatic people or otherwise.
we cannot gamble with our future so carelessly on the basis of preliminary data. here is a vignette to explain why.
once someone is infected with HIV, most people experience flu-like symptoms for a week or two which then resolve either with or without treatment. in some people, the virus is cleared so effectively after the initial infection that they will test negative for HIV. then, over the span of months and years, their immune system is silently and entirely asymptomatically destroyed, leaving them none the wiser until they progress to AIDS and get extremely sick.
COVID hasn't given us any indication of similar activity. but we know so very little that we can't take the risk, especially not with millions and millions of people. i will also note that we are unlikely to rule out these kinds of hypothetical risks anytime soon. so caution is our only defense against disaster.
> hasn't given us any indication of similar activity. but we know so very little that we can't take the risk
There's little reason to believe it's significantly different to any other Coronavirus. Speculating that's it's suddenly going to be aids++ is pointless scaremongering.
The main* reason it was a "big deal" was the lack of common immunity thus leading to potentially rapid spread. Deaths in the vulnerable from the side effects of this kind of thing are perfectly normal and perfectly well understood and there is very little treatment
A garden snake and a cobra are both snakes. Belonging to the same category says nothing about the potency of their bite. We have no idea what kind of snake this is yet.
> COVID hasn't given us any indication of similar activity. but we know so very little that we can't take the risk
We take that risk with other viruses and bacteria literally all the time. If hypothetical but unlikely risks become thejustification for destroying people's livelihoods and the world ecomony, we're all dead anyway.
as a former immunologist, i can assure you that with common viruses and bacteria, we have years and years of knowledge about how they perform, thereby making the risks of exposure calculable.
it is this body of knowledge which allows our society to normally function even during a typical flu season. we understand the upper and lower boundaries of the consequences, and we can make an informed judgment about what we should do to navigate the environment accordingly.
the idea of throwing open the gates to allow everyone to get infected is a dangerous fantasy. at best, it's taking a leap of faith with other people's health without knowing whether there is a long way down or not.
I didn't realize this thread was about throwing open the gates. That said, I think there is an argument for more directed isolation measures for at risk groups. Fearing that there may be other unknowns doesn't seem to allow for any progress.
"isolation measures for at risk groups" sound so easy. First, isolate the obese. Hmm, 30% in America so 98M. Next isolate diabetics. Roughly 35M. After this, isolate those with heart disease and hypertension. 30% in the US, 98M. Old people? 32M. Naturally there's some overlapping in these groups. We'll be generous and say that 98M is the lower bound.
How on earth are you going to isolate 30% of the population?
This is making a lot of assumptions on what the at risk crowd is.
Now, I confess I am also making assumptions there. Data would be nice.
My assumptions are we could have saved a sizeable portion by tighter lockdowns on nursing homes. I also suspect we could have done things pre-infection to strengthen lungs of people with pre-existing lung conditions.
More pointedly, I think all of the havoc we have caused by closing schools is likely not amounting to a lot of saved lives. As a risk group, children are basically not at risk of severe cases.
Now, I hasten to add that no policy should be set by some random internet poster. I am hoping we are collecting data and running simulations to give us better data for the future.
Depends what the compromise is. And a lot of my view depends on if I had it. I can't get tested, as that isn't offered here. I definitely had something that made walking pneumonia seem like a cake walk. And whatever I had, it was barely a fever on my kids and wife. That said, I am glad I had my inhaler and access to steroids. Without those, I'm confident I would be much worse off today. (Indeed, my emergency inhaler was empty. Had to call in an emergency refill and was basically bed confined waiting on that.)
Closing schools was pitched at the time with a wide net, granted. Such that I could just be misremembering some of it. As a way of protecting the older workers in there, though, it feels weak. As more evidence comes out that it was wide spread by the time the schools closed, it also feels too late for that aim. (Again, this largely depends on if me and my family had it. If so, it had passed through all of us before closures happened.)
Not sure why you think I am bad faith posting. I am posting mainly from my phone, so I suspect some of my parts are bad quality. But if you think I am twisting your point in bad faith, I do not intend that.
> we cannot gamble with our future so carelessly on the basis of preliminary data. here is a vignette to explain why.
Yes we can, and will. We’re gambling with every choice we make about how to respond to this, and anyone claiming that their plan is 100% “based on science” is full of shit. For example, every country enforcing a lockdown is gambling that it won’t lead to civil war.
Speculation is fine. But we need data to back it. Right now, we don't. Could hypothesize that many being found with damage surviving, had damage going in. Would neatly explain why it hit them so hard.
I'm not speculating about the long term effects of covid19. I'm saying all sickness carries a cost as currently understood according to our theories of cellular senescence. You've missed my point entirely.
I'm saying all sickness comes with a long term cost. It gives you a shove toward the grave. Covid19 falls into that category, regardless of how much or little we know about it.
Now you could argue that sickness and aging don't work that way. I don't think you'd be right, but you can make that argument.
Your argument about the long term effects of covid19 is not relevant to the point I made.
Your point feels vacuous, then. Yes, getting sick can have long term impact. Do you have evidence that that is relevant to our current scenario? More so than it would be for any other sickness that is running rampant?
That is the point of my question. There has been no evidence of damage in non severe cases. Indeed, we are having to get complicated testing to find out many people had it at all.
How about this article [1] (translation at reddit [2]) about german divers who had "mild cases" (no hospitalization, recovered at home) and were found to have suffered permanent lung damage, so severe that they can't dive anymore.
My ability to navigate Reddit is embarrassing. Never found the comment with the translation. Saw some of the discussion, though.
Sounds like a promising lead to go down. I think my other criticisms are still unaddressed. Scarring damage is tough to place in age. Is plausible that they had some pre existing damage already.
Funny to see the comments talk if walking pneumonia. I had that a decade ago. Was cake compared to whatever hit me early March.
I think the fact that they used to dive but now can't kind of places most of the damage as recent.
My link should be a direct link to the comment. The bottom of the comment is hidden by default, but half of it is visible (and you can unhide the rest using the big blue button). I hate the new reddit design.
There have been a number of reports of folks who were diagnosed with otherwise asymptomatic COVID when they had a CT for an unrelated reason that showed their lungs with GGO. And in some cases they have shown no signs of recovery even weeks later.
A link would be awesome. And we would still need to ascertain that they did not have this damage before getting covid. :(. CT scans have a troubled history of seeing damage that preexisted. (See back pains)
Wouldnt that mean quartine would never work because it make sense that those younger people going outside would make those 60 olds sick regardless of the quarantine.
The SK/Taiwan/Chinese/Singapore approach to quarantine has been to isolate people away from their families if they're thought to be sick (i.e., in a hotel or military barracks). That's how you make quarantine actually work.
But that's going to happen anyway because people will catch it until we hit herd immunity. Unless a vaccine comes out before we get there, which seems pretty iffy at this point.
I do think we can plan for the isolation of that population for a couple of months if we have some strong leadership. Unfortunately that seems to be lacking right now.
I was responding to the contents of the parent comment. I agree with you (see a separate branch of the comment tree), but that's not part of what the parent comment was talking about.
Sweden didn't lockdown and might have herd immunity in weeks, according to their chief epidemiologist. It'll be interesting to see how this plays out in the long run.
“In major parts of Sweden, around Stockholm, we have reached a plateau (in new cases) and we’re already seeing the effect of herd immunity and in a few weeks’ time we’ll see even more of the effects of that. And in the rest of the country, the situation is stable,” Dr. Anders Tegnell, chief epidemiologist at Sweden’s Public Health Agency
Tegnell said sampling and modeling data indicated that 20% of Stockholm’s population is already immune to the virus, and that “in a few weeks’ time we might reach herd immunity and we believe that is why we’re seeing a slow decline in cases, in spite of sampling (testing for the coronavirus) more and more.”
I would not really call the Swedish model successful - Czech Republic and Sweden have both about 10 million inhabitants.
Things moved pretty quickly to pretty comprehensive lockdown here in Czech Republic, including mandatory mask wearing. So far this seem to be effective, with combined death toll currently at 210. In comparison Sweden has almost 10x as much, 2010 dead.
Looks like if more has been done less people could have died, not to mention the alarming news about organ damage, virus resurgence and questionable long term immunity.
as others have said, the area under the curve remains the same. The idea with Sweden is, after one year, the deaths will be about the same as everywhere else.
If the hospitals get overcrowded, there will also be more people dying from other causes and suffering from long term consequences, because a percentage of them won't be able to receive adequate care.
I haven't seen any actual data on how big that impact might be, however.
Q is how many are dead when a region has 80% immunity (through vaccination or infection). Those dead should include also deaths due to lack of planned care, cuts in healthcare due to recession, suicides due to unemployment and so on.
Those countries that lock down and stop a first wave with only a few percent infected are basically betting on the arrival of effective treatment or effective containment.
Those that don’t are betting that containment is impossible and effective treatments and vaccines are a year out at least.
It’s impossible to say which scenario is right but I know I’d place my bet the same as the Swedish state epidemiologist.
I don't get it. We have numerous reports of the antibody tests being inaccurate. We have numerous reports suggesting you can get the disease twice => once does not equal immunity. So how exactly are these Swedish scientists testing for immunity?
Sweden hasn't done a government mandated lockdown, but has a lot of social distancing occurring. Also, I wouldn't use Sweden as an example of herd immunity since antibody tests are only coming on line, and many are unreliable. Besides look at Sweden's CFR. Not something I'd like to see in a modern country.
Option 2 can be the most realistic, depending on the outcome of the currently-going clinical trials. There quite a bunch closing by June (although most of these are on repurposed drugs, and with not too large sample sizes).
Yeah, I have less and less hope in a vaccine. We'll likely be well on the way to herd immunity before one is ready.
For #3, I agree. I'd be interested to see the math on how many under-50's need hospitalization, ventilation, and how severe of an additional effect would that have. It may be that it requires less medical capacity to support a high percentage of the healthy population contracting the virus, than a far lower percentage of the general population (including over-50 crowd) contracting it. Or it may require vastly more capacity. I have no idea.
The other thing to take into account is the effect dragging this out has on developing economies. It seems like this is shutting down international supply chains and food shortages could result. So that's what's got me feeling like more aggressive action should be considered.
If we prolong it a lot with all the associated cost and 1 and 2 never happen, we've lost not just a large part of the economy, but also lives without anything to show for it.
That isn't supported by any facts and is totally wrong. Our ability to treat viral pneumonia is very limited. We aren't saving 60-90% of patients that otherwise would die which your numbers imply. We can move the needle a bit and maybe save 20% of them. As an example, 90% of patients that go on ventilators still die.
Even in a situation where hospitals are getting overwhelmed it won't make much difference. Much of the care that happens is pointless. That 85 year old obese patient with chronic heart failure ain't making it no matter what you do. So if we are getting overwhelmed we can triage and not see much impact on fatality rates because patients like that are dying either way.
> As an example, 90% of patients that go on ventilators still die.
That’s in New York, and probably because they only put the really worst cases on ventilators because there weren’t enough ventilators. In Germany, that number of deaths on ventilators is at around 30%. This shows that this quota is entirely useless to make your argument, and that maybe you should curb your intuition a bit when it comes to estimating percentages of potentially saveable people, especially if those estimates are then used to effectively sentence people to certain death.
Sorry, just saw your request. I'm taking that number from the Robert Koch Intitute daily status reports, which is basically the central official report regarding COVID-19 in Germany.
The interesting table is on page 6, where there's the percentage of ventilated patients on ICU, which is 73%, so we know most ICU patients are ventilated, which means we can treat someone being on ICU as roughly equal to someone being ventilated. Right below is the number of discharges from ICU, and the percentage of deaths, which is 30% of all discharges. Since almost all ICU patients end up being ventilated, we can conclude that these about 30% of deaths mostly happened on ventilation, and most of the 70% recoveries also happened on ventilation.
I know that my calculation doesn't exactly result in the real percentage of deaths on ventilation, but the error range of my estimation does not allow the actual percentage of deaths on ventilation to even come close to 90%.
This is where your logic fails. Most patients in the ICU at this point in time are ventilated. That doesn't (necessarily) mean that most patients that went to the ICU were ventilated. Those that are ventilated will stay in the ICU for weeks. Those that aren't might only be there for a few days.
That uncertainty is why I already considered my calculation to be a rough estimate with a relatively large error window. But it is not large enough to allow the true percentage to even come close to 90%. For that, huge numbers of patients would have to be in ICU for a single day only, which is a ridiculous assumption.
That's a different argument. I'm saying that "lockdown until we have a vaccine or great treatment" might mean "lockdown until 2030". We already see heavy economic damages, civil unrest and riots after 4-8 weeks. Make that 40, 80 or 200 weeks and the world will be very different.
> Also nobody is arguing for "lockdown until we have a vaccine"
Some pepole in Italy were actually arguing for stronger limitations for 18-24 months until a vaccine was ready, and IIRC someone mentioned on HN a similar strategy (2 months closed - 1 months open) suggested for the UK.
So, there are people (in the authority chain) proposing for that. Whether they'll get listened to or not, it is another matter entirely. Personally I hope they don't.
Are you suggesting the riots in the banlieus in France are done by "astroturf protestors"?
And "flattening the curve" to buy time until we get a vaccine or a very successful treatment was literally in the comment I replied to. Not as in "we must lockdown until then", but as a goal we may reach if we continue with strict measures.
It's fine to want that, we just have to be aware that it might not happen (or might not happen soon) and that it isn't free.
Like "wear masks in public to lower transmission probability"? Anything that will let us carry on in a way that's close to normal is fine.
"Flattening the curve" was, at least here, generally translated into "stay at home if possible, keep 2m distance in public, close non-essential stores and offices". And those aren't sustainable, and they come at a price.
I've been making many posts arguing against the efficacy of lockdowns (and been getting shat on by points I find mostly naive). I think something like this is probably the best approach because it minimizes economic harm while also trying to minimize hospitalization rates among the elderly.
But even if we pretend we could implement a perfect bubble for everyone over 50, they're not especially safe when the lockdown is lifted for them. The virus will still exist, and people over 50 tend to spend time with people over 50 (see: homophily). Once it enters the social network, herd immunity doesn't exist because your local community of old people are both super vulnerable to acquiring the disease and few of them have immunity from past exposure because of the lockdown.
Locking down the country until the virus is eradicated is not a realistic option and its incorrect to think Wuhan has "done" this
> But even if we pretend we could implement a perfect bubble for everyone over 50, they're not especially safe when the lockdown is lifted for them. The virus will still exist, and people over 50 tend to spend time with people over 50 (see: homophily).
The point of the lock down is to prevent the spread of the virus from happening too fast and overwhelming the healthcare system. It is not to prevent people from ever getting it as that's clearly not possible. You seem to be missing that point in your argument.
If the lockdown is ineffective, there's not point in doing it so whatever.
If the lockdown is effective, you kill the exponential spread. This is good, but if there's no exponential spread, you haven't actually infected many people at all. When you lift the lockdown, you're close to the same level of vulnerability as when you began. For a virus like this, you likely cannot 'eradicate it' by keeping the lockdown ongoing.
There's no middle ground where you slowly build up immunity across the population at a level hospitals can support. We can't turn the economy off and on again until the virus has had burst spread either.
The lockdown makes a lot of sense for 3 reasons: to learn more about the disease, to gather more PPE for doctors, and to reformat critical systems to run with a healthier population. It's not a bad idea. But it's utility is going to run lower while the cost gets higher. We need to address that.
Any time I try and make counterpoints to lockdowns or even logical evaluations of them online the downvotes and hate start flowing. There is a huge bias among those in our circles towards locking down as long as possible, because all of us can work from home and aren’t worried about feeding our families.
Arguing it's a matter of bias sidesteps the reasoning for lockdowns. This is like when someone dismisses someone for possessing a political bias---that's not an argument.
And framing it as lockdown vs. being able to feed your family is a false dichotomy. It seems like a waste to even get into the finer details if this is where you're coming from, but keep calling it hate while ignoring the criticism.
No, it's a very real dichotomy. People won't literally starve in the US, but waiting in a bread line for hours is very different than feeding your family through your own money and effort.
The array of options available to society is not "starve" vs. "waiting in a bread line for hours" vs. "feeding your family" as can be seen by countries that have approached this problem differently.
If food prices increase, and people lose jobs, more people will suffer food insecurity. This problem is MUCH worse in poorer countries for obvious reasons.
> I've been making many posts arguing against the efficacy of lockdowns (and been getting shat on by points I find mostly naive).
I skimmed some of your comment history. Your comments aren't as rock solid as you believe, and there are many points either glossing over things or complete ignorance.
> More people will die if the lockdown is lifted, and many of those who would have died anyway will die sooner.
Are you really arguing many would have died anyways? How many? What percent? You're ignoring the reality that in regions with overwhelmed healthcare systems they're having to engage in triage (read: many people are dying who would not have died anyways) since they cannot treat everyone. This isn't just for covid-19, but for people with other treatable conditions.
> Your comments aren't as rock solid as you believe, and there are many points either glossing over things or complete ignorance.
thanks man. I think you're demonstrating complete ignorance too. For instance, that quote of mine which you posted out of context clearly says the opposite of what you think it says. MORE people will die if the lockdown is lifted, and that those who would have died anyway (if it were not lifted) will die SOONER. Both obvious and uncontroversial.
That aside, triaging is very sad, but has a relatively small effect on total deaths, because the people you triage are the most likely to die, given care. This is very very different from random people dying who would not have died anyways. Hospitals that need to deny patients, which as far as I'm aware is just a single region in Italy with one of the oldest most vulnerable populations in the world, are doing so not because they can't actually take more people in for the most basic low level of care, but because there's basically nothing they can do.
If death rate is substantially lower among the under 50 crowd, this could work its way through with a fairly low death toll, and result in a herd immunity within a couple months. This slow burn approach we're doing however seems possibly to be the precise worst way to handle it, leaving the virus in the population for as long as possible, reducing the ability for our vulnerable population to avoid it.
Note I think the best possible solution is a complete lock down for a couple months until the virus is more or less eradicated, as Wuhan did. But I don't think it's a realistic option in our society.