I'm posting this because of the narrative on this site that all experts agree with the UK's plan. To the extent that there is a consensus, it's a consensus against it.
I was trying to make this argument yesterday and got piles of comments responding exactly this way: "oh, that's only 300 signatures from UK scientists in opposition", "oh, but some of the people who agree with you don't have enough credentials".
The BBC ran a piece designed to explain why the Govt policy was kosher and the logic behind it, it said there were no scientists in disagreement. Then it corrected the article to say no epidemiologists rather were in disagreement, which is ostensibly false as well. Now it says that at the time of publication no UK epidemiologists had spoken out in mainstream media. They basically admit they didn't do any due diligence when they wrote the piece (they were in a rush to give the Govt cover).
I'm not sure there is a consensus against it. I've seen a few articles like this (which is worrying) but articles in favour of the status quo tend to not get so much prominence.
I really hope the government knows what it's doing. They have promised to publish their models, so hopefully that will give some more confidence.
The government has somewhat changed the message and they are now saying that their priority is to save lives, which does sound like contradicting their previous message of rapid herd immunity.
They’ve never had a message of rapid herd immunity, unless by rapid you mean spread out over 6-8 months. The whole point is to avoid either a slow burn (where it comes back at the worst time in winter) or a fast burn (where health services are overwhelmed).
Maybe their models are wrong, maybe other approaches will work better, but I like they are having an honest grown up discussion about it instead of insisting eradication is possible, or that there are no tradeoffs to be made and total global lockdown of society for 6 months is the answer (which apart from being of questionable efficacy would certainly cause another Great Depression and more deaths from poverty).
6-8 months is rapid! That's 40+ million cases during that period and impossible to manage for the health services. This is actually a fast burn. Everyone agrees on that.
Whether eradication is possible or not, the FACT is that 6-8 months is extremely fast and can only lead to a collapse of the health services.
I agree it is far more rapid than we’d like, but the options are not clear cut, there is no good choice with a guaranteed outcome, as this article indicates, experts disagree significantly on how to approach this, and due to a lack of data we will not know till after the fact.
The UK gov and their scientific advisors disagree with you or they’d be taking a different course. This really is not clear cut, if we’re being honest, nobody really knows at this stage, there are too many unknowns.
It is clear cut and the government does not necessarily disagree with me.
Handling that many cases over that short period is simply mathematically impossible considering the health care resources available. That is not an opinion, even the Health Secretary acknowledged that today.
The fact they haven't published their models worries me.
At a minimum, I'd like to know what their models are optimizing for. Is it "Minimum number of deaths" or "Minimum economic cost", or "Minimum economic cost taking into account a cost of $XM per death".
Minimum number of deaths probably isn't a smart metric, because the solution to that is to tell 99% of people to stay home in bed for the rest of their lives. Hard to catch a disease if you never leave bed.
Minimum economic cost (with a factor for cost of a death) is hopefully the model they've used, but it's politically suicide to accept that grandpas life was 'worth' $X.
It's pretty challenging to get a model published in the time span required - I believe that the team at Imperial College are racing to do this, but given the behaviour of the virus is still a topic of research it's unsurprising that they are not out there at this time.
A model can begin as a spreadsheet with a handful of guesstimates in.
You can start making decisions based on such a model.
Then in parallel, you get teams refining the model and making it more accurate, while other teams work on implementing those preliminary decisions, potentially changing course if newer, more refined, models come up with different results.
There's no reason the crude model can't be published 1 hour after it was made.
If anything, publishing the model will help localized branches of government make their own decisions ('hmm, looks like we'll be expecting lots of ambulance use at the end of march, that isn't a good time for the fleet inspection!').
Private companies would also benefit from the model, and can better schedule logistics. Even a hugely inaccurate model is better than "who knows! panic!".
A model has nothing to do with the underlying data. If they thought that the model was good enough to justify the deaths of hundreds of thousands of people they should release it right now, so we all can take a look at that abomination and decide for ourselves if they should be prosecuted for mass murder in a couple of months.
It is new data - the assumptions that were in the model showed that the surge capacity of ICU could cope in a social distancing scenario, but once they factored in the rates from Lombardy they got a different result. The horrible truth is that this thing is going to cause a huge number of deaths, I wish it weren't so.
The health services do make difficult choices like that every day though. NICE (National Institute for Health and Care Excellence) restricts expensive medicines which can save lives for that reason - to spend the money on something else.
Rationing happens and it will be necc. in the coming months in every country, whether that is by patient income or by outcome, I’d prefer it by outcome personally.
Please, try to tell this to uk general public when pretty much 1 people over 2 or 3 has one of their parents killed by the Coronavirus because of boris inaction.
I think what will happen to you will not be a pretty sight.
> fast burn (where health services are overwhelmed).
To reach 'heard immunity', if it is even possible at all for sars-cov-2-- there is good reason to expect that it won't be-- without overwhelming critical care will, unfortunately, take years.
Unfortunately, too great a percentage of cases need critical care.
Even with places trying to mitigate-- with the exception of the few places where it was actually contained-- their ICUs are going to be (or are already being) overrun.
> , but I like they are having an honest grown up discussion about it
There is no evidence of this. Experts have been calling on the UK to publish their models and so far they have declined to do so. I would take a sizable bet that no such models exist which support their initial stance (which they are slowly and quietly backing away from, and moving to a position much more like other western countries).
In wuhan it was eradicated, in South Korea it is well under control, in Italy it’s still exploding as of today even if they locked down everything last week, but in about 1 week we should see the effects of the containment. Uk was two weeks behind Italy, they already could see the future and they decided to throw away that fundamental advantage that they had by not doing anything at all.
I think that a great deal of attention is focused on a few words. The fundamental focus in the UK is on Delay - that is even the title (hence the uppercase) of the reaction phase the UK has entered. From the official plan [1] "If the disease becomes established in the UK, we will need to consider further measures to reduce the rate and extent of its spread. Based on experience with previous outbreaks, it may be that widespread exposure in the UK is inevitable; but slowing it down would still nonetheless be beneficial." and "Action that would be considered could include population distancing strategies (such as school closures, encouraging greater home working, reducing the number of large-scale gatherings) to slow the spread of the disease throughout the population, while ensuring the country’s ability to continue to run as normally as possible. The UK governments’ education departments’ planning assumptions include the possibility of having to close educational settings in order to reduce the spread of infection.
We would consider such measures in order to protect vulnerable individuals with underlying illnesses and thus at greater more at risk of becoming seriously affected by the disease. The effectiveness of these actions will need to be balanced against their impact on society."
Starting on about page 14 - a sizeable majority of USA voters who claim to prefer the GOP or claim to be independent do not think this covid-19 pandemic is a big deal.
As a counter to that, unless proven otherwise, you can assume a significant bias in any article on government policy coming from The Guardian, as in the OP here.
That obviously doesn't mean it's incorrect, but try to be aware of all biases, there are plenty on all sides.
Apparently the government's own (secret) figures suggest around 500,000 deaths, and around 8 million people in need of hospitalisation - in a country which currently has around 4,000 ICU beds, and almost no spare capacity in hospitals.
Even if the peak is spread out over nine months, that still means setting up, equipping, and staffing around a million extra beds over the next few weeks. At a time when existing medical staff are incapacitated.
This is not going to happen. The only way it might be possible is with civil conscription - literally taking people off the street and putting them through basic nursing boot camp. Even then there would be huge issues with supplies of equipment and consumables.
So the reality is that most people who need to be hospitalised in the UK (and probably the US) won't be - at least not effectively. Italy has shown what this means: without adequate care the CFR rises from 1% to 7% or so.
Which in turn means that without aggressive containment measures to slow the spread, the actual death toll will be in the millions, heavily concentrated among the over 65s.
There are around 10 million over 65s in the UK. If these numbers are right, around 10% of them will die.
I'm not trying to downplay the crisis - I'm under no illusions that that is not where we are, but a quick look at that article seems to show stuff already revealed in the news conference the other day, and some misstatements.
Just an observation on your Guardian link, not the numbers you've derived.
In another interview with the BBC, Sir Patrick said: “If you suppress something very, very hard, when you release those measures it bounces back and it bounces back at the wrong time.”
He added: “Our aim is to try to reduce the peak, broaden the peak, not suppress it completely; also, because the vast majority of people get a mild illness, to build up some kind of herd immunity so more people are immune to this disease and we reduce the transmission, at the same time we protect those who are most vulnerable to it.”
So, the U.K. plan is survival of the fittest. I’ve been reading reports that high severity cases cause lung scarring even in young people who survive. Given that high severity cases seem to have the same incident rate in young people, this seems insane.
It is fine to state this is risky, it is. It’s unproven, also true. However the methodology is not survival of the fittest (do nothing). Don’t miss label.
Of course it's not survival of the fittest. We're not shutting down the NHS. People with manageable symptoms are being told to stay at home so the NHS will be able to take care of those who can't manage.
The issue is that they would like to build herd immunity by winter, which is not really broadening the peak because that is impossible to handle by the health services.
So this means letting natural selection do its thing.
Correct. Matt Hancock on the Andrew Marr show this morning:
> Herd immunity is not our policy, it's not our goal. Our goal is to protect life. I want to be absolutely crystal clear that we will do what is necessary to protect life.
I’m anxiously waiting for the news that we will block travel from the UK to my country. If they are deliberately making their people into pathogen spreaders, we can’t let them visit us
Your country (whatever it is) likely already has more carriers than UK, and probably will have more carriers in any moment of time in the future.
Anyway, this comment of yours is just offending to the people of UK, non-informative, fear-mongering and does not contribute anything to the discussion.
I wonder what endgames these other countries are hoping for.
I only see:
1. Eliminate virus entirely. Without a vaccine, almost impossible.
2. Infect 1-1/R of the population, relying on the fact that people who have already had the virus will provide herd immunity.
3. Give a vaccine to 1-1/R of the population.
4. Virus control measures of lockdowns stay in place forever.
As far as I can see, the UK is choosing option 2, while most of the rest of the world seem to be attempting 1, which is probably impossible, therefore will end up doing 4.
In my opinion your comment is the one offending.
They obviously should quarantine every country that has the brilliant objective to make 60% of the population ill.
There’s no objective to make 60% population ill. This is a lie by the media and commenters on HN who read that media instead of original statement by the UK government. Rather, it is the statement of the fact: 60% of population eventually will get infected (unless quarantine stays forever).
Maybe other countries should do travel ban. But the tone of the commenter above (my country, they) is very counterproductive. People of UK are not enemies.
There are a fair few restrictions already and I'm sure they'll ramp up over time. At the moment quite a few countries (eg Singa, OZ, Taiwan) require 14 day self isolation for arriving brits.
Hospitals are already stretched, it takes hours of waiting to treat normal injuries such as broken legs. Waiting list for some operations is years long.
How many people are going to die from other causes, if we shutdown entire country for 6 months? How many of those will be children and young people?
It may sound harsh, but as a younger person I prefer this plan.
Indeed, you realy want the bulk of those who will not have complications to catch it early and leaving schools open, enables that. Over making every parent stay at home to look after their child!
Coz you need to balance out infections and with that manage them, so you will see periodic lockdowns in some parts to throttle back infection and also those most at risk will see themselves issolating for months and however you do things, you want to be doing that anyhow.
So infect, isolating those who high risk and letting others carry on and manage infection rate with hospital numbers as you will get risk people getting infected anyhow, so focusing on managing infection in those you can and getting it out the way, has logic behind it. yes people will die, they are not flowing that up, but equally, they are planning for those longterm to be lower than falling victim to the seasonal waves ala spanish flu and how that went.
Yes it does seem harsh, but as an older person it is the best plan for the whole and I'm high risk.
you seem to believe that the government can control a function exponential in time but with incomplete and delayed information. what could possibly go wrong? you only have to miss one super spreader event and you're left with a runaway transmission that you only get to know about 5-10 days after it happened.
also, if bojo wants to ask old people to stay home for 4 months in a couple weeks, why not ask them now to stay home for 4 and a half months? not enough dead in the calculation or what?
I believe people are going to die, and looking at the long term counts over a short-term mentality and with that, having less deaths overall is a better plan than not.
But if you have a solution to how an entire country can completely isolate and operate in today's times for any European sized country then I'm all ears to hear it as we are talking a year at least until any sort of vaccine is available.
As for `super spreaders` that's a given, just the same way Europe has easy access to heroin and cocaine that are all imported - you can't stop things spreading even with best intentions and efforts and viruses are much smaller than smuggled drugs. So given that, people who spread this will happen and how would you ever stop that? Sure isolate from the vulnerable and at risk and those groups are already on the case, heck the amount of old people I know and saw 2 weeks ago buying a years worth of toilet roll - well, they are already self isolating and no need to be told by some PM they may or may not respect when they have a lifetime of common sense and experience to draw upon and effectively kick into war-mode mentality lockdown. Though many will learn that over the comming year as this is a world war, only it's the entire world this time fighting a virus. Looking at how the spanish flu went, the real fear is not the hear and now, but the winter to come.
my plan would be pretty much what my country is trying to do (I hope) and what South Korea has successfully done already: tell everyone to sit on their asses while massively scaling up testing capabilities so that everyone can test every few days. follow up on every positive case, quarantine carrier and all contacts. test everyone (literally) crossing the border, quarantine as above. this allows to open the country back up while waiting for a vaccine in 12-18 months... or however long it takes.
South Korea can test about 10,000 patients a day. Their total population is about 50 million. They've primarily been relying on contact tracing to target their testing, I think.
As Mike Tyson once said, "everyone has a plan until they get punched in the mouth".
These cool (and callous) calculations will be forgotten the second the hospitals get overwhelmed and there is chaos everywhere. When the country is on fire, the government will be pissing on fires.
That is why they are already planning for overload and with that, having extra buffer layers. Hotels, emergency hospital bed spaces from army, etc etc, already being put in place. Then need for ventilators, many companies been contacted to step up and see if they can make more as many will be needed beyond what any country has. So plans are afoot.
Cool calculations involving the facts that people will die, happen more often in many walks of life without being questioned. Kinda how insurance policies work.
If those calculations show less people die overall then how can that be bad - yes it's involving human life but you have to look at the big picture and not just yourself. I'm about 50% likely to die from this given my health and age, if I'm one of those stats that is in the death count, then so be it, I'll die I certainly won't be blaming the current planned approach by the UK and has much going for it, time will tell but hey - worst case We are an Island so you can all set up navigation warning buoys if it all goes pete tong (sorry British Humour included and slang "pete tong" sames as going pear shaped, going wrong...).
You realize your hospitals are going to be swamped by coronavirus cases and people are going to start dying from other treatable conditions - the exact thing you're worried about. Your logic appears to be backwards.
I spoke with one doctor neighbor from England who now lives in the US. He said he felt much more optimistic about the UK plan because the government was doing a better job of consulting experts. He seems to think the US plan is "satire." But let's not get too political.
That's roughly three weeks from now. Once ICU capacity is saturated it goes downhill very fast. In Italy that took less than three weeks because their population skews elderly, so in the UK it might take a bit longer.
It’s not an exponent, it’s a logistic. That may or may not change the outcome but you can’t just ignore the part of the trace line that doesn’t fit the scare narrative right?
UK will survive, UK's economy will survive, they are consciously sacrificing many of their elders and weaker people - who are in most part a mere cost for the society - in favour of young and productive individuals. They are rationally addressing the consequencies of Brexit by doing so, taking an advantage over EU, who is likely to fall into recession. UK traded their moral for their economy.
Well, then they're idiots. Plenty of people under 50 will end up in intensive care, roughly half of them survive, the remainder will have a good chance of lung issues for the rest of their lives.
But aren't their elder people highly likely to be conservative voters, and also voting in large percentages. If those people do not vote in the next elections, won't the tories lose by a large margin?
The government may not be moral, but I don't know if any government makes plans for losing election in a landslide. Is there something I am missing here?
The conservatives have just come out of the largest win in modern UK parliament history. They also posses an uncanny ability to be able to not see beyond the next year. They won't be concerned with the next election yet.
A conservative would probably answer that any conservative is happy to give his life for god, queen and country. And the Tories might say that winning an election is less important than the future of Britain.
I certainly hope "how can we avoid our voters dying and kill of those of the other party" isn't a factor in the decisions.
Electors have extremely short-time memory and are in most part deeply ignorant. Moreover, at the time the next UK elections will come, there will be enough "fresh" new elder people to fool. BTW they can still blame China, Italy, for the disease. At that time, people will believe them. Look at what Trump did with the US. If the mayority in 320 million believed Trump then there is no way the mayority in 66 million could not believe Johnson.
At the very least it's morally repugnant. The majority of the politicians are in vulnerable demographics, so at least they'll pay the price like everyone else.
That's a false dichotomy: GDP is correlated with life expectancy, so you can't really choose one without the other. It's a question of which method saves more lives in the long-term, and UK appears have made their choice. Note that they most likely have much better understanding of the resources and capacity of NHS than U.S. scientists have.
I think they're clueless and are about to take down the NHS in self imposed DDOS. Death rates will go from 1% to in the neighborhood of 5% when people can't get medical care.
The number of ICU beds and respirators in the UK is public knowledge. It's also enough for less than 1% of the tsunami of cases I expect to swamp the NHS over the next sixty days.
Conspiracy theory : maybe the government wants to have nhs to collapse as a way to turn the public against it, then when the crisis is over nobody will object to its privatization? In a post-Brexit world with Trump in the whitehouse it would not be so irrealistic as a theory but without some hard facts it remains a theory...
It's actually a pretty common thing for big corporations: this decision was publicly taken by a government, so it couldn't end up unnoticed so easily, but this lack of morality is the standard way of doing. Take for example when big companies decide about the lives of third world countries within their board of directors, in private.
i'm quite sure there are folks in the high risk group that are insulted by your writing and people deploying this policy either put their parents in bunkers or don't have them anymore. this is the biggest gamble i've ever seen in my life.
Insulted by my writing? they should be insulted by their government. It's been Boris Johnson that said "prepare to loose loved ones before their time", not me.
Sir Patrick Vallance, England’s chief scientific adviser, said the government was looking “to build up some kind of herd immunity so more people are immune to this disease and we reduce the transmission.” [1]
Britain’s chief scientific adviser ... said that about 40m people in the UK could need to catch the coronavirus to build up “herd immunity” and prevent the disease coming back in the future. [2]
Sir Patrick told Sky News that experts estimated that about 60 per cent of the UK’s 66m population would have to contract coronavirus in order for society to build up immunity. [2]
for reference, at this moment there are 21,157 (according to john hopkins map) confirmed cases in Italy, which probably translates to anything between 50k-500k infections total. lombardy healthcare is near collapse and there's 1.5k people dead already. multiplying by 80-800 (best-worst case to get to 40M) left as an exercise to the reader. at that point the government might not only buy all ventilators on the market but also all diggers.
But if the UK government can managed to isolate elder people, and can get those 40M to contain almost exclusively younger people, won't the fatality rate be far lesser?
I'm not an expert on this, but based on what has been published my understanding is:
1) Fatality rate is based on hospital care being available for people who do get sick. This will include some nonzero percentage of otherwise healthy young people. Some of these patients will need advanced support, including ventilators.
2) Assuming you could contain to 40M young people (likely impossible), if even .5% of them need hospitalization, the UK hospital system will be overrun. (Not even accounting for all the other people who need hospitalization.)
3) Therefore: the low fatality rate assumption in #1 would likely not hold.
TL;DR; the absolute numbers are too big relative to health system capacity.
- Pick your own fraction as to how many are currently available
- pick your own fraction of 40mm that will require hospitalization
- pick your own fraction of 40mm that will require ventilation
- Make your assumptions fit the # of hospital beds and ventilators
I haven't done all the arithmetic, but my gut says you will end up assuming that people in the "young" bucket are all essentially immune to severe forms of the disease. This is at odds with evidence in e.g. France, which would indicate a problem with your assumptions.
This is at odds with what anyone that is remotely looking at the numbers is thinking. It’s really a joke that so many people here are defending the suicidal choice of boris that is going to produce 1M deaths in the best scenario that I can think of unless it changes everything from YESTERDAY, not from now.
From the figures, it looks like 10% of young are still severe pneumonia’s [0]. Not all of those require respirators or ITU, but quite a few will.
The figures depend _hugely_ on the number of sub clinical/mild infections. The UK experts have public ally said they believe the overall mortality rate is at or below 1%. Given a global mortality of ~3% it appears they are assuming two thirds are so mild they didn’t present for testing. You must assume this is based on some evidence not available to the rest of us, or from some simulation based on other findings.
> From the figures, it looks like 10% of young are still severe pneumonia’s [0].
Sorry, where do you see that in [0]? Table 3 has a pneumonia diagnosis but isn’t broken down by age, Table 1 is broken down (somewhat) by age but only differentiates between nonsevere and severe “disease”?
If you look at table one it gives you numbers and severity by age. Ignore the percentages quoted (that’s percentage of patients by age in certain groups which isn’t very useful) and look at the raw data. 67/550 in the 19-50 age range are severe. So >10% of those in the study. What isn’t known is the proportion of mild cases not included in the study group.
If you look in methodology (search for severity), severity is defined by severity of the pneumonia according to American criteria. So these columns refer to how bad the pneumonia is.
There are roughly 167,000 hospital beds in the UK of any type. At .5%, you'd need 200,000 beds for just covid19 patients, since the numbers for hospital care have been more in the 5-15% range.
"The professor of intensive care medicine, who himself heads the ICU of the Rotterdam Erasmus MC, emphasizes that it is not only the elderly who are affected by the corona virus. 'What has mainly made the news is that older people die faster. This is about 2.5% of the entire population, while about 15% of the elderly die. But _more_than_half_ of those patients are under fifty years old. It also includes young people."
> if the UK government can managed to isolate elder people
You also have to isolate young people with preexisting comorbidities such as cardiovascular disease, diabetes, chronic respiratory disease, and oncological diseases.
There is also no guarantee that the immunity will last. You can catch common cold (which incidentally is also caused by a coronavirus) multiple times. We don't know if that's true for Covid-19 as well.
Common cold is caused by hundreds of different rapidly mutating viruses, sometimes infecting you simultaneously, and it's usually a rhinovirus not coronavirus.
It has been studied and determined most people cannot catch the same cold virus again within a short-medium time frame.
Even if the fatality rate for non-old people is only 0.2% that's still impressive 80k dead
Possibly, the isolation is not going to be purely age based, but young people that are more susceptible to the disease might be isolated, in that case the fatality rate could drop significantly.
The problem is that in many cases it's hard to know whether you're susceptible until it's too late. It can be an undiagnosed pre-existing condition, or caused by stress (e.g. due to the crisis itself). For many working adults it might not be easy choice to self isolate (must provide for family etc) so many might likely downplay their susceptibility.
And this is all just talking about fatality rate while hospitals still function normally.
The 0.2% fatality rate depends heavily on access to sufficient medical care. If you infect 40 million people at once, you won't have enough hospital beds and the morality rate will skyrocket.
That's why you don't infect everyone at once and you undertake social distancing, working from home, behavioural changes like avoiding gatherings and increased hand washing etc etc. Governments have been saying for weeks that we'll need to 'flatten the peak' of the infection to keep health care needs manageable.
The idea is that if the government can infect low risk citizens then they can recover on their own without relying on the healthcare system. It's the high-risk individuals who put load on healthcare, so the proposal is to use the low-risk citizens to build up immunity.
The disparity of death rates among countries has more to do with infrastructure than the virus. Germany and Switzerland are proving this is just a flu, albeit a pretty bad one (0.1-0.5% death rate). More testing will prove this out by increasing the denominator by 10x.
The alarming mortality statistics from Wuhan and Italy turned out to be extremely high due to lack of available testing and mild cases that were never reported.
Statistically there are likely already thousands of unreported cases in Seattle, but nobody can get tested. If you have a fever, people are being asked to stay home and not go to the hospital at all. So they’re not even counted in the official numbers.
This is also showing in UK already, where mortality rate seems to be ~3% now. And it is already announced that people who don't need hospitaliztion won't be tested. So number of confirmed cases will appear relatively low but death rate will go up.
At least in the moment we can still hope that the death-toll in germany will be lower than in the other regions... i think the phrase goes "The hope dies last..."
The number of cases is exponential, like any infectious virus. I’m focused on the denominator, which is increasing with testing. The numerator doesn’t change because deaths are deaths, testing doesn’t change that.
> More testing will prove this out by increasing the denominator by 10x.
Source? You're ignoring the fact that the number of deaths lags behind the number of people infected, which means the numerator is also being underestimated. Assume people either will/will not die three days from diagnosis. Then the naive case fatality rate is (for small t)
CFR_naive = [D exp(t - 3)] / [I exp(t)]
with D and I appropriate constants and t the number of days. The corrected CFR becomes
CFR = CFR_naive * exp(3)
That is, in this simple model, the true CFR is underestimated by approx 20.
The numerator is unaffected by testing. When you die, you die, you can’t hide it and can’t hide the cause. If anything, testing may slightly decrease the numerator as at risk individuals may get treatment sooner.
The numerator is underestimated in a way separate from testing. People don't die immediately after they're diagnosed. They die some time after, during which the number of cases increases. Since the naive CFR is just the total number of deaths divided by the total number infected (assuming perfect knowledge of both -- the latter is also underestimated, for reasons you mentioned), this will always underestimate the true CFR until the spread reaches a steady state.
the problem with saying "just a flu" is that you need to also say "but of course, people get vaccinated against flu if they are at risk", which we can't do for this.
> Is everyone in a high-risk group supposed to withdraw themselves from society for six months until they can emerge once the (so far entirely imaginary) second wave has been averted?
OK... but... isn't that what everyone is being advised to do right now? So maybe not a great example of something unrealistic to ask? Since in fact the UK would be asking it of fewer people than... many are saying it needs to be asked of -- although the US government isn't actually telling us to... yet? But that's the alternative those who who think the UK's plan is madness are suggesting, right? Asking everyone to withdraw from society for months?
I can see the desire: Wait, could we just ask high-risk people to withdraw themselves from society for months, instead of asking everyone to do that? Cause that'd be a lot less disruptive to our social and mental health maybe it'd be just as good? (There are real costs to mental health and social functioning of asking everyone to avoid all contact with everyone else; it might be the best option anyway, but it's definitely not without it's own health risks and consequences).
But I'm no expert. It kind of sounds like the experts are saying "not really, that isn't a good idea, everyone has got to do it". Sometimes what we are called upon to do is not easy or pleasant.
One of the frustrating and anxiety-producing things here is that we aren't getting very consistent messaging from the governmental authorities and experts. It seems like really a failure of the kind of consistent and pervasive public health educational messaging that would actually maximize compliance. Instead it's "everyone picks what forwarded chain letter on facebook makes sense to them" and we all know how well that works...
My heuristic is to take a oversimplified idea and express it in an authoritative tone on social/economic/administrative topics. Sign the username with pg and you’re good.
The Norwegian government is prohibiting anyone from staying in cabins [0] because they fear it would overwhelm the small hospitals in rural areas and becomes harder to manage medical resources.
> OK... but... isn't that what everyone is being advised to do right now?
No. What everyone is advised to do right now is not to withdraw from society, it's to perform basic hygiene and social distancing in order to slow down the spread. Social distancing doesn't mean living like a recluse eating spam cooked on a gas burner, it's not getting into large crowds and trying to stay some distance from other people (outside spitting / coughing range). WaPo has an article with a "social distancing" simulator: https://www.washingtonpost.com/graphics/2020/world/corona-si...
"Self quarantining" is closer to what you're talking about, but it's for people who are at risk or likely to have been infected, not the general public.
Of course the latter you start the more it's already spread and the harsher measures have to be. And the more you'll have to ramp them up as you realise your initial measures were not sufficient, or your citizens have decided "freedom or death" is a good choice and decide to just ignore it.
FWIW Taiwan's already reopened its schools and life has gone back to something not entirely dissimilar to normal (people do have to wear masks and get their temperature checked to step into public buildings or businesses but they can move around just fine).
Social distancing is just minimizing contact, not avoiding all contact (self-isolation/quarantining). E.g. try to go out for groceries once a week and pick a time to avoid the crowds.
> what are you supposed to do if you live in Manila? Mumbai? Dhaka?
Rejoice that you are with 99% certainty way under 70 years old.
No, it means don't go to football matches. Don't go to cinema. Don't go to a convention. Don't ride on a train for a leisure trip. That the distancing can't be done 100% perfectly does not mean that all distancing is worthless and therefore that NO distancing should even be attempted. Even slowing the spread of the illness may be worthwhile.
It's not that it's necessarily "spreading panic" but that "believe whoever you want on the internet" is not an effective public health communications strategy.
But that appears to be what we've got.
The shaming approach of "you want to be part of this effort?" (whatever that means) is unlikely to be an effective communications strategy either.
I don't know why I asked, I already had my choice of various opinions on the internet (usually given from a position of moral superiority and judgement).
I seriously don't understand why the U.S. public health infrastructure is failing so horribly here; if you want to maximize compliance, it seems obvious that you should be giving consistent and pervasive instructions, there should be literally a planned "marketting" campaign, with a consistent message. If people are getting different messages from different places of course they will be confused and compliance will be less.
Instead, we have "which chain letter on facebook and/or shaming and blaming comment on HN does my gut tell me seems right?" What the fuck America.
i'll clarify: the effort in question is to stop being a potential carrier of a novel disease for which nobody is immune for and thus has potential to put great many people in a hospital for weeks at a time putting strain onto a system which is hardly idle. you might catch the virus and probably won't be able to tell the difference from common cold or flu. somebody you meet might end up intubated and anesthesiologically paralyzed for a week. or dead.
Link to an established study that says that the virus is not transmitted at all when there are multiple people in close quarters or you are knowingly spreading death.
Metro Manila, a region of 12 million people, entered a month-long lockdown on Sunday as Philippine President Rodrigo Duterte considers a plan to impose a curfew on the area to try to contain the coronavirus outbreak.
Until a day or so ago Boris Johnson advocated for a herd immunity when it was not proved to be true for Corona. So no, it did not call for same social distancing as other countries.
Herd immunity and social distancing aren't exclusive. You want both. Is it true that he called for no social distancing?
Is there a summary of the current recommendations? I mean surely gatherings etc are banned? Football is already cancelled, for example, as in other countries?
He didn’t do anything at all. Football was cancelled independently by the football league or whatever it is called some days later, boris was advocating for no action at all and even football and st Patrick parade where actively encouraged.
No, they said to do nothing different from normal at all, unless you are over 70 or you have cough. Guess who jumped from 10 deaths per day from yesterday to 14 per day today almost doubling the deads for two days in a row?
I think the advisors rational is that we're mostly going to get it anyway so let the young get it and keep the old folk at home.
I think it's unwise for a few reasons, not least that if we delay we may have better treatments. Stuff like chloroquine and keltra seems to work but there haven't really been the proper studies - that sort of stuff shouldn't take that long. And there may be a vaccine. (China rushing vaccine stuff https://www.theaustralian.com.au/nation/china-coronavirus-va...)
Plural anecdotes, but: most folks I’ve seen on social media, Reddit, friends very much have interpreted “social distancing” as withdrawing from society. On the NYC and coronavirus subreddits the consensus seems to be that you’re a selfish piece of garbage if you leave the house for any non-essential reason.
The bully pulpit is supremely important in these situations, and no government so far seems to have used it responsibly to disseminate a consistent message early enough to citizenry. Worse yet, in the US ones politics seems to be particularly predictive of opinion on coronavirus.
My current feeling is that the virus was not taken seriously when action could have mattered, and now the goal of government and citizenry is to reduce the carnage to both medically vulnerable folks (old people) and to economically vulnerable people. The latter risk in particular scares me, as there are many folks in the US who are going to be severely impacted by politicians reacting severely way too late who are too cowardly to protect those vulnerable people adequately.
If I noticed anything in the past months it is that it hardly matters if you are an expert. There never was punishment for being wrong for hypotheticals. People just don't know. The WHO when declaring emergency said: "We don't know the damage this virus can do". Even this week professors in statistics compare the Italy crisis to heart attacks and their models all fall apart within a week.
>although the US government isn't actually telling us to... yet? But that's the alternative those who who think the UK's plan is madness are suggesting, right? Asking everyone to withdraw from society for months?
It doesn't take that much to contain something like this. In no particular order:
(1) Temperature checks outside all major gathering places. Shops, subways, offices, etc. If you're running a fever you don't get in.
(2) Hand sanitizer at the entrance/exit of all major gathering places. Clean your hands before you go in and clean them when you come out. Don't clean them you don't get in.
(3) Wear masks everywhere in major gathering places. No mask, no entry.
(4) Widespread testing and contact tracing for those who have tested positive.
I agree that the West in general is handling this as dumb as possible. Shutting everything down is pointless if you don't use the respite to enact public health measures.
It's estimated that as many as 20% of the infected are asymptomatic, including no fever. A lot of your suggestions would fail to contain the virus.
I do believe that widespread testing and tracing would be effective. Given that we don't yet have access to the scale of testing that is required to maintain public health, I think an immediate quarantine is the only way to save lives.
>t's estimated that as many as 20% of the infected are asymptomatic, including no fever. A lot of your suggestions would fail to contain the virus.
We don't need to stop 100% of the transmissions. Right now, on average, an infected person will pass it on to 2-3 people. The goal is to get that to below 1 and eventually it will fizzle out.
I'm not quite sure what's so controversial about my post. It's what countries in Asia have done and they've all contained the spread.
Manufacturing a hundred thousand 8-ounce bottles of hand sanitizer might be considerably easier than a hundred thousand times as difficult as getting a single one. I mean, have you tried distilling alcohol from fermented mash and mixing it with mucilage?
OK... but... isn't that what everyone is being advised to do right now?
Yes but that's expected to, uh, not work. It's only expected to slow the progression.
One of the frustrating and anxiety-producing things here is that we aren't getting very consistent messaging from the governmental authorities and experts.
The only sane course of action the extreme lockdown we are now seeing in many countries. But politicians, being gutless cowards, are coming up with other ideas until their hand forced ... I hope. The alternative of actually believe this stuff and sticking to it would horrific.
I mean, everyone should be definitely be isolating and doing everyone that they can to slow the infection. But we are going to need much stronger measures than individual action. This is a real war, not like drug or terrorism wars, OK.
The main issue with the UK's approach is approximately 10% of young people need acute medical care (e.g., ventilator access). There aren't enough hospital beds in the NHS system to meet that demand.
The amount of misinformation/unverifiable information going on around internet communities right now is really showcasing a huge problem with our modern society.
There are no facts anymore, because nothing and nobody can be trusted.
I thought 10% of the general population required hospitalization. With a smaller number of people needing ventilators and a even smaller % of young people needing ventilators.
At this point, hospitalization basically implies ventilation. Hospitals are crowded. If they were just going to give you a bed and some pills, they'd have you do that at home.
France reports that half their patients in critical care are under 60, which is supposed to be the "low risk" group.
In the Netherlands there are between 40-50 covid-19 patients in ICU in critical condition. Over half of them are younger than 50. (Youngest is 16yo)
Mortality is much higher for the older group, but hospitalisation happens a lot in the younger age group as well. Obesity is a high-risk factor.
A comment in the reddit post[2] which discusses that article notes that in China the 15-49 age group made up 41% of severe/critical cases.
(The below 50 age group accounts for a bigger part of the population to be sure. I see no data for hospital admission rate as fraction of the age group.)
I think "herd immunity" is a euphemism for: This virus will see community spread of around 30% to 70% and it is long impossible to contain. The U.S. is preparing for 30%, The Netherlands for 50%, and Germany for 70%.
Herd immunity will be hard, since antibodies for coronaviruses last only about 4 months.
Even the strictest quarantines possible in the West don't compare to the mild quarantines in the East. The laws don't allow for contact tracing with GPS coordinates and credit card purchases, like they do in Singapore.
Quarantine methods put selective pressure on the strain types that are more infective and severe, since such mutations and recombinations are the only ones able to escape quarantines.
So the plan seems to be to turn this into a community virus, much like herpes or HIV. Then the selective pressure is for the mortality rate to drop and the disease becomes manageable. It would seem silly to damage your economy with heavy quarantine methods when local community cluster spread continues to pop up.
Of course, the UK government can not come out and straight up say this, but they seem one of the few governments that is realistic about facing this virus and its impossible to contain infection rate. I am guessing they ran the numbers from the Italy quarantines and based their decision on that.
The common cold is a coronavirus that people catch annually. As I understand it, it is because the cold evolves or the immunity doesn't last for some reason. https://www.who.int/health-topics/coronavirus
Some infections that people identify as common colds are coronaviruses. There's dozens of other viruses that cause colds, with most infections being a different family of viruses (rhinovirus [https://en.wikipedia.org/wiki/Common_cold]).
It's probably not a good idea to make concrete assumptions about a specific virus from the family it belongs to. A good place to look when starting to characterize, not necessarily a complete guide to how the virus will interact with our immune systems.
Over 200 different viruses cause common cold symptoms. Only about 15% are coronaviruses. It's usually considered unrealistic to vaccinate for so many different viruses, although there's been some research into vaccinating against a large proportion of them. The Guardian published a good article in 2017:
The coronaviruses that cause colds (such as CoV-OC43) don't mutate much. Immunity to them doesn't last long for reasons that aren't well understood.
Some other viruses that cause colds escape immunity through mutation, other non-CoV cold causing viruses escape are like CoV and also just have short immunity periods without mutation.
> People regularly become ill with a cold due to a coronavirus and may catch the same one about 4 months later.
> This is because coronavirus antibodies do not last for a long time. Also, the antibodies for one strain of coronavirus may be ineffective against another one.
> The general trend of IgM peaking at ≈1 month after symptom onset and IgG peaking at 2–4 months was consistent among different studies.
> Quarantine methods put selective pressure on the strain types that are more infective and severe, since such mutations and recombinations are the only ones able to escape quarantines.
Mind sourcing this? This seems the exact opposite of what I'd expect. I'd expect quarantines to s left for milder strains that are harder to detect.
I think you agree with the parent comment. “put selective pressure on the strain types that are more infective and severe” does select for milder strains (the pressure is on severe strains to change).
> Human intervention may have placed more severe selective pressure on the L type, which might be more aggressive and spread more quickly.
Harder to detect I would see in a strain that has a longer asymptomatic spread period. The only way for a virus to escape a strong quarantine and survive is to survive on surfaces longer, be asymptomatic longer, cause more severe illness (spread through cough and sneezes, especially in hospitals), linger in the air longer, etc.
on the contrary, more sever illness makes it less likely to spread, no?
You are always spreading germs around, if you have high fever or start coughing blood you'll get isolated but if you just have a runny nose you will keep living normally and the virus will happily keep infecting other people when you shake hands.
During quarantines people are not shaking hands. I am not saying quarantines necessarily select for a higher death rate (a dead host can not spread), but for a more severe disease (the main drivers of a spread are when people ultimately develop severe symptoms).
Community viruses mutate to see a lower mortality, severity, and infectiousness, since there is no selective pressure to have an r0 much higher than 1. For a community virus there is also no selective pressure to mutate to a vastly different strain, so the antibodies for other strains don't help, whereas if the virus is confined inside a city like Wuhan, the only way to reinfect is to mutate to a vastly different strain.
Initial response to isolated infections requires a different response to that you give an entrenched pandemic. When it always comes back from multiple countries and is initially undetectable complete shutdown trace and contain simply won’t work.
It’s a sensible measure to delay the spread, I don’t believe it will be effective in stopping the spread and it will be very damaging to the economy so not sustainable IMO.
> estimated projections of as many as 96 million cases in the US, 4.8 million hospitalizations, and 480,000 deaths associated with the novel coronavirus.
All Western countries moved to fase 2 of epidemic control: Stop testing and contact tracing, since you have many many clusters of local community spread and no idea where it is coming from. They are hesitant to come out and outright say it. Some do, but not with permission of their superiors:
Mild cases continue to spread, and don't self-isolate, because they may not even realize they are infected.
China and South Korea have laws that allow for containment: If you message your friend on WeChat and say you have a cough, then you can expect a visit from the Chinese containment crew. If you buy cough syrup in the drug store with your credit card, then South Korea health officials know this.
Containment is pragmatically impossible with an r0 > 2 in the West. Just slowing down is possible.
In Italy they use old laws for murder when you violate your isolation and infect others.
Australia, NZ, U.S., Italy, they all see sustained local community spread. Australia is still exponentially increasing. Shutting down flights when there is local community spread is show politics, something to point to afterwards and say: We took decisive action. It is purely symbolic.
Sure, U.S. could pass emergency law and use their military surveillance systems to track, tag, and contact trace all of their civilians, as if they were Chinese spies.
But is this desirable in a free society? And what difference does it make when there are 100.000 infections in a single state, of which you will miss a 100 and start all over again 2-3 weeks later, but now with 99.900 angry citizens with guns?
One of the reasons that SARS-CoV is deemed a useable bioweapon is exactly because isolation security methods are very expensive and invasive at scale. The cultural damage would be enormous if people receive letters from the government after they had a private chat on Facebook about symptoms.
I think the UK plan is based on some sobering truths that others are just not prepared to acknowledge (yet):
1. You can't shut down the economy indefinitely. At least not if your goal is to minimize fatalities. And if you don't do that, your "quarantine" is not going to be effective
2. You can't maintain quarantine for more than a month or two, after which your epidemic simply re-starts, and you don't get to re-impose the quarantine then because the first quarantine "failed".
3. Vaccine is over a year out in the best case, assuming it works at all. If it's anything like the flu vaccine, chances of it working reliably on mutated strains are approximately nil.
4. Younger people tolerate the disease much better, and if they build up immunity to it while the senior population self-isolates, the overall number of deaths could be minimized.
5. Due to how widespread and virulent this is, it will just become the "new flu", and it will come back with mutations every year. We can't do what we're doing now every year, at least not if the goal is to minimize deaths.
1. while I'm also skeptical re vaccines, we might well have more effective medical treatment options in a few weeks or months. There are a whole range of different phase 3 trials happeninig right now, some of which have shown anecdotal promise, esp Remisdivir.
2. We learn something new about this disease on a daily basis, meaning that in a few weeks we have diff picture of who exactly is most vulnerable (e. g. folks on ACEinhibitors, or we find ACEi actually are protective and ARBs are an issue etc etc
I'm not convinced we can look to China for any 'truth' in this outbreak. None of the numbers there are verifiable and the Chinese government doesn't exactly have great credibility.
#2: we'll see about that; the UK is betting that China's strategy, even if it could be applied in the West (which it can't be) will be ineffective in the medium to long term
#3: there is: if 60-70 percent of people are equipped to kill the virus, it's the best "quarantine" imaginable for people who are at risk
#4: those who have comorbidities could also self-isolate; it's still much better than telling _everyone_ to self-isolate - that's simply not going to happen unless you weld people's doors shut
Italy is _way_ not out of the woods yet. Their case growth remains exponential. It's too early to tell if their strategy is working at all. Germany is already planning for herd immunity scenario (as per Merkel - she expects 60-70% of Germany's population will be infected, and hundreds of thousands will die). In fact I don't see any difference in the rate of doubling between Italy (which is imposing hardcore containment measures) and the UK where the measures are much less severe. Although I'm sure Italians feel like they're "doing something" and "in control" of the situation, so it should be psychologically easier. But that's not the reality I see in the graphs.
+ treatment plans not well understood, but evolving rapidly
+ not enough face masks
+ not enough sanitizer
+ not enough test kits to identify and isolate outbreaks
All four of those elements are absolutely critical to controlling the virus, and all 4 will be in a much better place 30-60 days from now than they are today.
If you want to go the route of herd immunity, do so when you are at appropriate levels of preparedness.
> 1. You can't shut down the economy indefinitely. At least not if your goal is to minimize fatalities.
It's not a binary choice between life as normal and total shutdown. The whole discussion is about reducing non-essentials to slow down the spread, so the health system can cope with the demand spread over time.
> 2. You can't maintain quarantine for more than a month or two, after which your epidemic simply re-starts, and you don't get to re-impose the quarantine then because the first quarantine "failed".
Again, not a binary situation. Given the degree of individualism and freedom, that's unlikely to work anyway.
> 3. Vaccine is over a year out in the best case, assuming it works at all.
Agreed
> If it's anything like the flu vaccine, chances of it working reliably on mutated strains are approximately nil.
While this is likely -- I'm not an expert, so I'd rather refrain from such categorical statements.
> 4. Younger people tolerate the disease much better, and if they build up immunity to it while the senior population self-isolates, the overall number of deaths could be minimized.
False dichotomy -- younger people can still be better protected by reducing non-essential contacts.
> 5. Due to how widespread and virulent this is, it will just become the "new flu", and it will come back with mutations every year. We can't do what we're doing now every year, at least not if the goal is to minimize deaths.
That's right, but counting primarily on herd immunity while neglecting other measures does NOT minimize deaths.
There's widespread information in the UK concerning symptoms and self-isolation, huge changes in working patterns and people undertaking their own 'social-distancing'.
Information on hand washing is pretty much universally understood and huge numbers of events have been postponed or cancelled. Ordinary citizens, businesses and events are undertaking huge changes. Sports, music and other events are postponed or cancelled for example, and a large percentage of people are looking to work from home.
I have a wide network of friends/former colleagues as a by product of work/charity/previous careers/family spread across a huge swathe of jobs/life in the UK. Massive amount of planning and preparation is taking place and there are huge changes to peoples everyday lives.
Just because a Government hasn't mandated a lock down doesn't mean nothing is happening or people are walking around licking handrails on public transport because there is no threat.
From an African perspective a lot of what you say makes sense. Many people live hand to mouth. We have high unemployment and good number of our population just do not have the money to buy supplies for the month and stay away from work. South Africa has taken some initiatives to limit the spread of the disease but not much in terms of concrete plans coming from sub Saharan Africa.
This simple fact has low penetration into the HN well-to-do bubble. A lot of people here could just stop working for six months or more and assuming that people outside the bubble continue to come to work to stock the grocery store shelves (and make the stuff that's on the shelves), they'd be just fine. The vast majority of the population has to work to make that happen though, and you can't stop it all every time someone in China eats something they probably shouldn't have.
The Guardian is such a rag. Why does it still have readers? Finding academics who will criticise anything this conservative pro-Brexit government does is easy: Johnson could make any announcement at all and within 24 hours the Graun would have found a contemptuous academic to tell their readers why it's stupid and bad.
People can agree or disagree with the British government's logic. Only someone very biased would treat it as inherently absurd.
So let's look past the headline at what this guy is actually saying.
He starts this piece by asserting his authority as an expert. But he isn't revealing any new information or critical analysis that would change anyone's minds. In fact as you read further down you find he's actually agreeing with the government's policies.
The key points of the article are:
• Herd immunity will happen anyway and shouldn't be a goal.
• A second wave may or may not happen, it shouldn't drive policy.
• Be like South Korea and close everything for an unspecified period of time.
• Close the schools! But keep children away from Nana and Grandpa.
The entire article says nothing that hasn't been said elsewhere; the only benefit this guy's epidemiology experience seems to add is credentialism.
But there are also major logic problems in the argument.
Let's start with his last point about children and schools. He obviously realises children shouldn't come into contact with grandparents, but fails to apply the common sense knowledge that many parents can't stop working to take care of them e.g. because they work in the healthcare system, or logistics, or grocery retail, or pharmaceuticals, or government, etc. So those children will all go to their grandparents, assuming they have some: the one place you don't want them to be. This is a point the scientific advisors to the government made in their announcement press conference but he fails to address it. Children need to be kept away from grandparents and in the presence of young, fit, healthy adults. These conditions can be found in schools.
He says:
Second waves are real things, and we have seen them in flu pandemics. This is not a flu pandemic. Flu rules do not apply. There might well be a second wave, I honestly don’t know. But vulnerable people should not be exposed to a virus right now in the service of a hypothetical future.
The belief a second wave is likely has nothing to do with how flu-like the virus is. Saying flu rules don't apply is a non-sequitur. Second wave is a simple observation based on the fact that stopping infected people coming in and out of the country isn't possible, nor will it be possible going forward. International travel isn't going to remain shut down for long, which means even if the government could somehow wipe out COVID-19 purely via social control policies, it would come back the moment those measures ended and normal life returned. The only way to stop it permanently is if most people are immune so it can't spread.
Also, just saying "this might or might not happen, who knows" is a poor basis for policy making. This guy is an expert, where's the probabilities?
He says:
The UK should not be trying to create herd immunity, that will take care of itself
But the UK isn't "trying" to create herd immunity. What would that involve, actually? Encouraging chicken pox style virus parties? It's not doing anything like this.
Believing that requires an especially bad-faith reading of a (perhaps poorly phrased) statement by a fellow scientist. The goverment understands that herd immunity is going to happen sooner or later, it's the only way to end this, and that's why reaching it with as few fatalities as possible is the stated aim.
Finally, his recommendations are useless. He just recommends social distancing and shutdowns without any time frames attached. Does he believe people can self isolate and schools can remain shut ind...
That was an extremely long post to avoid addressing the actual concern - that there aren’t enough hospital beds to support a country that doesn’t aggressively and ruthlessly implement social distancing and contract tracing right now.
It was addressed, along with all the other points.
You are implicitly believing that those measures can last for a long period of time if implemented right now. The government is arguing that there are inherent limits to how long that can go on for and that if they must be used at the right time, when more people are infected than at the moment.
The author of the article makes the same mistake. He writes as if social distancing is something you just switch on, and then the outbreak ends. There's no concept that normalcy must return, and so that there's some kind of planning involved in when and how to ramp it up/back down.
$ grep bed https://news.ycombinator.com/reply?id=22591395&goto=item%3Fid%3D22586451%2322591395
that there aren’t enough hospital beds to support a country that doesn’t aggressively and ruthlessly implement social distancing and contract tracing right now
$
Nope, you definitely didn’t address it and still haven’t.
Look, the key point here is neither you nor the author actually know to what extent "aggressively and ruthlessly implementing social distancing right now" will impact the need for beds, that concept isn't well defined. And you are still ignoring that such measures can't last indefinitely.
OK, so everyone is put under total curfew right now and shot if they're found on the street. The spread slows then stops. After a month life starts getting back to normal, and then case numbers start shooting up again. What then?
The optimal position is for every bed to be taken all the time, as that way the curve is flat at exactly the right point to get everything back to normal as soon as possible by having people build up immunity. We all have no idea when the right time to start asking people to hide in their homes is, or even if asking everyone to do that is a good idea. But we can be pretty sure it can't last forever and the right time for people to be isolating themselves is when most people have it, as that way they're getting sick and recovering at home. It's not at a time when most people don't have it and the home stay does nothing but put off the inevitable for a few more weeks.
Aren't masks and other stuff on short supply? At least Italy didn't have enough and France is restricting exports. Even if it is a good idea to restrict the economy as little as possible, how do they prepare for the moment when there are no masks and nurses will drop out en masse due to being infected?
The problem is the alternative is even less feasible. Containment is very unlikely to work, and slowing the epidemic too much leads to it happening in winter.
The only thing which they should have done is delayed a decision on this. They are a few weeks behind other countries, and could have observed effectiveness of social distancing in arresting spread. If it worked, it could be copied (ina modified form) and if it failed, it would be much easier to sell to the public. Currently it’s a brave (but likely correct) position it would seem.
But then again, what do I know. While I’m a doctor, I’m
No specialist so my opinion is of limited value, and experts seem to disagree with each other. This is what makes this so difficult, no one seems to know what is the best option this current data.
The problem is the alternative is even less feasible. Containment is very unlikely to work, and slowing the epidemic too much leads to it happening in winter.
Containment has worked in Wuhan. Containment is being attempted after-the-fact in Italy. Containment is possible, it's just a matter of how extreme gets. But even the most containment does not look the hundreds of thousands or millions dead that letting everyone be infected looks like.
It's possible to contain it with extreme measures, of course. But what happens when you release the lock down and it's still burning through the rest of the world, especially Africa and India? Do you ban every foreign visitor for the next year?
That’s the bit I don’t get - what’s the end game with the lock down? Are you hoping that everyone actually gets it slowly over the course of being isolated (ish). Otherwise have you not just postponed the issue until you set everyone free again?
For now, but what's going to happen as they go back to work, school and resume travel? Unless they stay locked down until we have a vaccine, which is a year+ away at least. And second waves can be worse than the first.
I don't think anyone knows for sure what strategy is going to work best in the meantime, considering experts disagree and the world is conducting a massive A/B test...
Why? When you have aggressive testing everywhere, eliminating the virus seems quite possible. Moreover, when you move slowly to reopen and test aggressively, you can detect any reappearance and squash it.
A variety of the world's diseases are controlled by testing and surveillance, not by cures - TB, for example.
What does aggressive testing everywhere mean though? People spread it whilst asymptomatic. They don't know they need testing. There aren't enough test kits to literally test everyone over and over, and people wouldn't put up with it anyway.
Most viruses aren't as infectious as this one is, comparison to TB or even previous SARS viruses doesn't work for that reason. You can track people down by them expressing symptoms, then test them, then isolate them and it works. That hasn't worked so far with this.
Except in Hong Kong, Singapore, Taiwan, or (more arguably) Japan. And South Korea, while they had a rougher early outbreak, seems to have gotten a lid on the disease now.
That's not really correct. Containment certainly can work. Whether it will or not is still an open question. Right now no western country has been able to match that. Italy, Spain, France and Germany are probably out of time to try. But the UK is still relatively early on its curve.
So, for that matter, might the UK "infect the herd" trick. The science isn't unsound, though it's not nearly certain. So the risk management is just crazy and I can't understand it either. But... it really might work.
> Except in Hong Kong, Singapore, Taiwan, or (more arguably) Japan. And South Korea, while they had a rougher early outbreak, seems to have gotten a lid on the disease now.
And how long can they keep strict containment in force, and what happens when it lifted? You're speaking as if China or SK are now magically immune from a second wave as soon as they relax their restrictions.
In this case the science is flat out unsound: There are several coronaviruses known to infect humans. None are known to result in lasting immunity, and some are known to not result in lasting immunity. This is one of the challenges in making a vaccine.
Given the observed hospitalization rates, many millions in the UK will require hospitalization due to corona. At the moment, their hospitals could support merely thousands. We know from other cities that the mortality rate (particularly among younger people) is dramatically higher when adequate medical care is not available.
Under the UK's argument, the worst outcome of aggressive mitigation is that you are actually successful at it and achieve containment which just shifts the infection later in time at a high economic cost. Given the existing known infection rates in the UK that seems unlikely at that point, but even if it were to happen it would provide time to ready treatment facilities and allow for the discovery of more effective and/or scalable treatment techniques.
Fortunately, the UK has been backing off from its initial position and has now been recontextualizing their position as 'mitigate as much as possible'-- which is what pretty much all of the west is doing.
>While I’m a doctor, I’m No specialist so my opinion is of limited value, and experts seem to disagree with each other.
Given the state of modern politics, this is a time for people to very carefully consider their opinions, because the unpopularity of Trump and Boris is going to potentially sway decisions irrationally. This includes professionals and key decision makers.
This is not a value judgement regarding any world leaders. It's just a call to be very aware of bias and spitefulness can cloud judgement even in the most rational among us.
I think the comment was alluding to the unpopularity of these figures within the "intelligentsia". This group has been making politicised statements masquerading as authoritative announcements quite often. This group love these interjections and the people that follow them do to. But they have sowed distrust.
The person is making a fair point, but cocking it up a bit.
Well satire is a bit strong. But I think the plan seems unwise, due to unvalidated assumptions (especially that immunity will last during a second wave) and the nature of their health system. If an effective treatment emerges, they will also have made a mistake.
To say the government opted 'to encourage the flames' is disingenuous. Presumably their statistical model indicated they won't be able to contain the spread which is why the current stated aim is to delay the spread[0]. Delay, not encourage.
The article's suggestions seem to be in line with the government's stance. The main difference is timing with Dr William Hanage saying measures should have been adopted weeks ago while the government claims their modelling tells them to adopt measures later.
The government should be challenged by questioning whether it truly is/was impossible to contain the epidemic and what the best time to introduce different measures is. This article, however, adds very little to that debate with hand-waving in place of evidence.
It’s not true, Italy had exactly the same deaths per day two weeks ago. They introduced the complete lockdown what will be tomorrow. They had 2 weeks of advantage compared to Italy, they already knew what the future was going to look like, and they squandered it all without doing anything.
Now uk is going to be in a much worse situation compared to Italy because of this. Just one day of delay in an exponential curve can mean possibly tens of thousands death. Here we are speaking about weeks or months of delay if they really want to infect 60% of the people.
The nazis probably caused less deaths in concentration camps than boris, but we’ll know for sure in a couple of months.
Holocaust involved death of 1-11 million people (depending on sources and who you want to count). Not a fan of government's current approach, but Boris shouldn't grow a pencil moustache just yet.
>> Presumably their statistical model indicated they won't be able to contain the spread which is why the current stated aim is to delay the spread[0].
What statistical model? They're talking of "careful modelling". In the article you link, they don't mention anything about statistics, or, say, a simulation etc. You're assuming too much when you're assuming a statistical model, or anything based on data, or any concrete sort of model at all. "Modelling" can just mean a bunch of officials sitting around having tea and brainstorming potential scenarios.
> "Modelling" can just mean a bunch of officials sitting around having tea and brainstorming potential scenarios.
Good point, but it doesn't seem to be the case. From the Coronavirus action plan[0] published on March 3 2020
> The UK is a world leader in the field of outbreak modelling and data analytics. The NIHR HPRU in Modelling Methodology led by Imperial College London has developed novel analytical and computational tools which exploit novel data streams on infectious diseases such as COVID-19. This group and other leading academic groups have developed tools to prepare for infectious disease outbreaks, which include real time infectious disease models, allowing policy decisions to be made using the best possible data and are actively modelling questions of relevance to dealing with the COVID–19 outbreak.
Well, Imperial is a fine research institution indeed, but this still doesn't cut the mustard. Sure, Imperial boffins may be creating "real time infectious disease models" and those models may "allow" policy decisions to be made, but this tells us nothing about what we really want to know: whether these models were actually used to take the decisions we're discussing, instead of some other process.
Really, the claims of having done "careful modelling" absent any evidence of that modelling (say, a graph or a table of the results) is a really bad sign.
In Norway we just slipped from the 2nd most infected per capita to the 3rd after government warnings. If your country has >= 1 infected, you should follow the advice at fhi.no/en.
> The UK should not be trying to create herd immunity, that will take care of itself.
That's a clear blatant lie.
UK is NOT trying to create a herd immunity. UK is trying to flatten the curve. And UK is admitting that 60% population will get invected. And then the UK will get herd immunity.
Both of these talks were about flattening the curve because of NHS capacity etc etc.
The scientists mentioned herd immunity couple times, but not like they are intentionally trying to create it. It was rather like: herd immunity will happen in several months.
> Cummings may well be evil, but he's not stupid.
Likely he got his information from dishonest journalist articles and started self-promotion.
But it's a shame that smart people on HN continue to retransmit this fake.
Maybe you were quite distracted while watching it. As far as I remember the only advice they gave during that press conference was to stay at home for 7 days only if you have a cough. Does it look like flattening the curve to you? To me it looks like “let’s increase the contagion and the deaths as much as possible” compared to what every other country was doing at the time.
Yes, I remember that. They told to do so because otherwise economy will be hurt and people get tired of self-isolation. Not to intentionally create herd immunity.
It's interesting to contrast the UK approach to -everyone else's approach.
Everyone else is asking _infected_ people to do the socially responsible thing
and self-isolate to protect those around them. The UK is asking (or will be
asking) the _vulnerable_ people to self-isolate to protect themselves.
It is very hard to avoid thinking of it this way but: what happens if a
vulnerable person fails to isolate, for whatever reason (stupidity, ignorance,
accident, etc)? Is the blame on them? They were told to protect themselves and
they failed, so it's their fault?
if I think of it this way it very much sounds like the UK government is
planning to just er, wash its hands of vulnerable people and refuse to take
any responsibility for their fate.
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[ 5.1 ms ] story [ 254 ms ] threadhttps://www.bbc.co.uk/news/science-environment-51874084
and here was the first published version: https://web.archive.org/web/20200313155320/https://www.bbc.c...
I really hope the government knows what it's doing. They have promised to publish their models, so hopefully that will give some more confidence.
Maybe their models are wrong, maybe other approaches will work better, but I like they are having an honest grown up discussion about it instead of insisting eradication is possible, or that there are no tradeoffs to be made and total global lockdown of society for 6 months is the answer (which apart from being of questionable efficacy would certainly cause another Great Depression and more deaths from poverty).
Whether eradication is possible or not, the FACT is that 6-8 months is extremely fast and can only lead to a collapse of the health services.
Handling that many cases over that short period is simply mathematically impossible considering the health care resources available. That is not an opinion, even the Health Secretary acknowledged that today.
They took the course they took knowing that.
At a minimum, I'd like to know what their models are optimizing for. Is it "Minimum number of deaths" or "Minimum economic cost", or "Minimum economic cost taking into account a cost of $XM per death".
Minimum number of deaths probably isn't a smart metric, because the solution to that is to tell 99% of people to stay home in bed for the rest of their lives. Hard to catch a disease if you never leave bed.
Minimum economic cost (with a factor for cost of a death) is hopefully the model they've used, but it's politically suicide to accept that grandpas life was 'worth' $X.
You can start making decisions based on such a model.
Then in parallel, you get teams refining the model and making it more accurate, while other teams work on implementing those preliminary decisions, potentially changing course if newer, more refined, models come up with different results.
There's no reason the crude model can't be published 1 hour after it was made.
If anything, publishing the model will help localized branches of government make their own decisions ('hmm, looks like we'll be expecting lots of ambulance use at the end of march, that isn't a good time for the fleet inspection!').
Private companies would also benefit from the model, and can better schedule logistics. Even a hugely inaccurate model is better than "who knows! panic!".
https://www.imperial.ac.uk/media/imperial-college/medicine/s...
Because the government already knew that rapid herd immunity would cause a huge number of deaths.
[1] https://www.theguardian.com/world/2020/mar/16/new-data-new-p...
Rationing happens and it will be necc. in the coming months in every country, whether that is by patient income or by outcome, I’d prefer it by outcome personally.
To reach 'heard immunity', if it is even possible at all for sars-cov-2-- there is good reason to expect that it won't be-- without overwhelming critical care will, unfortunately, take years.
Unfortunately, too great a percentage of cases need critical care.
Even with places trying to mitigate-- with the exception of the few places where it was actually contained-- their ICUs are going to be (or are already being) overrun.
> , but I like they are having an honest grown up discussion about it
There is no evidence of this. Experts have been calling on the UK to publish their models and so far they have declined to do so. I would take a sizable bet that no such models exist which support their initial stance (which they are slowly and quietly backing away from, and moving to a position much more like other western countries).
We would consider such measures in order to protect vulnerable individuals with underlying illnesses and thus at greater more at risk of becoming seriously affected by the disease. The effectiveness of these actions will need to be balanced against their impact on society."
[1] https://www.gov.uk/government/publications/coronavirus-actio...
https://www.documentcloud.org/documents/6810602-200149-NBCWS...
That obviously doesn't mean it's incorrect, but try to be aware of all biases, there are plenty on all sides.
https://www.theguardian.com/world/2020/mar/15/uk-coronavirus...
Even if the peak is spread out over nine months, that still means setting up, equipping, and staffing around a million extra beds over the next few weeks. At a time when existing medical staff are incapacitated.
This is not going to happen. The only way it might be possible is with civil conscription - literally taking people off the street and putting them through basic nursing boot camp. Even then there would be huge issues with supplies of equipment and consumables.
So the reality is that most people who need to be hospitalised in the UK (and probably the US) won't be - at least not effectively. Italy has shown what this means: without adequate care the CFR rises from 1% to 7% or so.
Which in turn means that without aggressive containment measures to slow the spread, the actual death toll will be in the millions, heavily concentrated among the over 65s.
There are around 10 million over 65s in the UK. If these numbers are right, around 10% of them will die.
Just an observation on your Guardian link, not the numbers you've derived.
[1] https://www.nytimes.com/interactive/2020/03/13/world/asia/co...
In another interview with the BBC, Sir Patrick said: “If you suppress something very, very hard, when you release those measures it bounces back and it bounces back at the wrong time.”
He added: “Our aim is to try to reduce the peak, broaden the peak, not suppress it completely; also, because the vast majority of people get a mild illness, to build up some kind of herd immunity so more people are immune to this disease and we reduce the transmission, at the same time we protect those who are most vulnerable to it.”
Source: https://www.ft.com/content/38a81588-6508-11ea-b3f3-fe4680ea6...
It is fine to state this is risky, it is. It’s unproven, also true. However the methodology is not survival of the fittest (do nothing). Don’t miss label.
So this means letting natural selection do its thing.
> Herd immunity is not our policy, it's not our goal. Our goal is to protect life. I want to be absolutely crystal clear that we will do what is necessary to protect life.
Anyway, this comment of yours is just offending to the people of UK, non-informative, fear-mongering and does not contribute anything to the discussion.
The UK is pretty high on the charts...
I only see:
1. Eliminate virus entirely. Without a vaccine, almost impossible.
2. Infect 1-1/R of the population, relying on the fact that people who have already had the virus will provide herd immunity.
3. Give a vaccine to 1-1/R of the population.
4. Virus control measures of lockdowns stay in place forever.
As far as I can see, the UK is choosing option 2, while most of the rest of the world seem to be attempting 1, which is probably impossible, therefore will end up doing 4.
They told 60% will get infected eventually and this is very similar to what Angela Merkel said (she said 70%).
Maybe other countries should do travel ban. But the tone of the commenter above (my country, they) is very counterproductive. People of UK are not enemies.
How many people are going to die from other causes, if we shutdown entire country for 6 months? How many of those will be children and young people?
It may sound harsh, but as a younger person I prefer this plan.
Coz you need to balance out infections and with that manage them, so you will see periodic lockdowns in some parts to throttle back infection and also those most at risk will see themselves issolating for months and however you do things, you want to be doing that anyhow.
So infect, isolating those who high risk and letting others carry on and manage infection rate with hospital numbers as you will get risk people getting infected anyhow, so focusing on managing infection in those you can and getting it out the way, has logic behind it. yes people will die, they are not flowing that up, but equally, they are planning for those longterm to be lower than falling victim to the seasonal waves ala spanish flu and how that went.
Yes it does seem harsh, but as an older person it is the best plan for the whole and I'm high risk.
also, if bojo wants to ask old people to stay home for 4 months in a couple weeks, why not ask them now to stay home for 4 and a half months? not enough dead in the calculation or what?
But if you have a solution to how an entire country can completely isolate and operate in today's times for any European sized country then I'm all ears to hear it as we are talking a year at least until any sort of vaccine is available.
As for `super spreaders` that's a given, just the same way Europe has easy access to heroin and cocaine that are all imported - you can't stop things spreading even with best intentions and efforts and viruses are much smaller than smuggled drugs. So given that, people who spread this will happen and how would you ever stop that? Sure isolate from the vulnerable and at risk and those groups are already on the case, heck the amount of old people I know and saw 2 weeks ago buying a years worth of toilet roll - well, they are already self isolating and no need to be told by some PM they may or may not respect when they have a lifetime of common sense and experience to draw upon and effectively kick into war-mode mentality lockdown. Though many will learn that over the comming year as this is a world war, only it's the entire world this time fighting a virus. Looking at how the spanish flu went, the real fear is not the hear and now, but the winter to come.
These cool (and callous) calculations will be forgotten the second the hospitals get overwhelmed and there is chaos everywhere. When the country is on fire, the government will be pissing on fires.
Cool calculations involving the facts that people will die, happen more often in many walks of life without being questioned. Kinda how insurance policies work.
If those calculations show less people die overall then how can that be bad - yes it's involving human life but you have to look at the big picture and not just yourself. I'm about 50% likely to die from this given my health and age, if I'm one of those stats that is in the death count, then so be it, I'll die I certainly won't be blaming the current planned approach by the UK and has much going for it, time will tell but hey - worst case We are an Island so you can all set up navigation warning buoys if it all goes pete tong (sorry British Humour included and slang "pete tong" sames as going pear shaped, going wrong...).
So Germany, with twice as many hospital beds, gets 2.4 days extra of reaction time.
Exponents are terrifying.
Luckily they will not have to live with those issues for very long.
(Sorry, with all the bad news I had a need to lighten up the mood)
Source: https://yougov.co.uk/topics/politics/articles-reports/2019/1... (And anything else I could find by googling gives similar stats)
The government may not be moral, but I don't know if any government makes plans for losing election in a landslide. Is there something I am missing here?
I certainly hope "how can we avoid our voters dying and kill of those of the other party" isn't a factor in the decisions.
At the very least it's morally repugnant. The majority of the politicians are in vulnerable demographics, so at least they'll pay the price like everyone else.
That's a false dichotomy: GDP is correlated with life expectancy, so you can't really choose one without the other. It's a question of which method saves more lives in the long-term, and UK appears have made their choice. Note that they most likely have much better understanding of the resources and capacity of NHS than U.S. scientists have.
The number of ICU beds and respirators in the UK is public knowledge. It's also enough for less than 1% of the tsunami of cases I expect to swamp the NHS over the next sixty days.
Britain’s chief scientific adviser ... said that about 40m people in the UK could need to catch the coronavirus to build up “herd immunity” and prevent the disease coming back in the future. [2]
Sir Patrick told Sky News that experts estimated that about 60 per cent of the UK’s 66m population would have to contract coronavirus in order for society to build up immunity. [2]
Read more:
[1] https://www.nytimes.com/2020/03/13/world/europe/coronavirus-...
[2] https://www.ft.com/content/38a81588-6508-11ea-b3f3-fe4680ea6...
1) Fatality rate is based on hospital care being available for people who do get sick. This will include some nonzero percentage of otherwise healthy young people. Some of these patients will need advanced support, including ventilators.
2) Assuming you could contain to 40M young people (likely impossible), if even .5% of them need hospitalization, the UK hospital system will be overrun. (Not even accounting for all the other people who need hospitalization.)
3) Therefore: the low fatality rate assumption in #1 would likely not hold.
TL;DR; the absolute numbers are too big relative to health system capacity.
- Google the # of hospital beds in the UK
- Google the # of ventilators in the UK
- Pick your own fraction as to how many are currently available
- pick your own fraction of 40mm that will require hospitalization
- pick your own fraction of 40mm that will require ventilation
- Make your assumptions fit the # of hospital beds and ventilators
I haven't done all the arithmetic, but my gut says you will end up assuming that people in the "young" bucket are all essentially immune to severe forms of the disease. This is at odds with evidence in e.g. France, which would indicate a problem with your assumptions.
[0] https://www.nejm.org/doi/full/10.1056/NEJMoa2002032
Sorry, where do you see that in [0]? Table 3 has a pneumonia diagnosis but isn’t broken down by age, Table 1 is broken down (somewhat) by age but only differentiates between nonsevere and severe “disease”?
If you look in methodology (search for severity), severity is defined by severity of the pneumonia according to American criteria. So these columns refer to how bad the pneumonia is.
Well, good luck?
You also have to isolate young people with preexisting comorbidities such as cardiovascular disease, diabetes, chronic respiratory disease, and oncological diseases.
There is also no guarantee that the immunity will last. You can catch common cold (which incidentally is also caused by a coronavirus) multiple times. We don't know if that's true for Covid-19 as well.
This is starting to look like a form of eugenics where the old and weak are simply left to die.
It has been studied and determined most people cannot catch the same cold virus again within a short-medium time frame.
Possibly, the isolation is not going to be purely age based, but young people that are more susceptible to the disease might be isolated, in that case the fatality rate could drop significantly.
The problem is that in many cases it's hard to know whether you're susceptible until it's too late. It can be an undiagnosed pre-existing condition, or caused by stress (e.g. due to the crisis itself). For many working adults it might not be easy choice to self isolate (must provide for family etc) so many might likely downplay their susceptibility.
And this is all just talking about fatality rate while hospitals still function normally.
More testing = lower mortality rate.
The alarming mortality statistics from Wuhan and Italy turned out to be extremely high due to lack of available testing and mild cases that were never reported.
Statistically there are likely already thousands of unreported cases in Seattle, but nobody can get tested. If you have a fever, people are being asked to stay home and not go to the hospital at all. So they’re not even counted in the official numbers.
Do you mean that the limiting factor is e.g. ventilators and that these countries haven’t exhausted their capacity yet?
Source? You're ignoring the fact that the number of deaths lags behind the number of people infected, which means the numerator is also being underestimated. Assume people either will/will not die three days from diagnosis. Then the naive case fatality rate is (for small t)
with D and I appropriate constants and t the number of days. The corrected CFR becomes That is, in this simple model, the true CFR is underestimated by approx 20.OK... but... isn't that what everyone is being advised to do right now? So maybe not a great example of something unrealistic to ask? Since in fact the UK would be asking it of fewer people than... many are saying it needs to be asked of -- although the US government isn't actually telling us to... yet? But that's the alternative those who who think the UK's plan is madness are suggesting, right? Asking everyone to withdraw from society for months?
I can see the desire: Wait, could we just ask high-risk people to withdraw themselves from society for months, instead of asking everyone to do that? Cause that'd be a lot less disruptive to our social and mental health maybe it'd be just as good? (There are real costs to mental health and social functioning of asking everyone to avoid all contact with everyone else; it might be the best option anyway, but it's definitely not without it's own health risks and consequences).
But I'm no expert. It kind of sounds like the experts are saying "not really, that isn't a good idea, everyone has got to do it". Sometimes what we are called upon to do is not easy or pleasant.
One of the frustrating and anxiety-producing things here is that we aren't getting very consistent messaging from the governmental authorities and experts. It seems like really a failure of the kind of consistent and pervasive public health educational messaging that would actually maximize compliance. Instead it's "everyone picks what forwarded chain letter on facebook makes sense to them" and we all know how well that works...
[0] https://www.thelocal.com/20200315/norwegians-told-to-leave-c...
No. What everyone is advised to do right now is not to withdraw from society, it's to perform basic hygiene and social distancing in order to slow down the spread. Social distancing doesn't mean living like a recluse eating spam cooked on a gas burner, it's not getting into large crowds and trying to stay some distance from other people (outside spitting / coughing range). WaPo has an article with a "social distancing" simulator: https://www.washingtonpost.com/graphics/2020/world/corona-si...
"Self quarantining" is closer to what you're talking about, but it's for people who are at risk or likely to have been infected, not the general public.
Of course the latter you start the more it's already spread and the harsher measures have to be. And the more you'll have to ramp them up as you realise your initial measures were not sufficient, or your citizens have decided "freedom or death" is a good choice and decide to just ignore it.
FWIW Taiwan's already reopened its schools and life has gone back to something not entirely dissimilar to normal (people do have to wear masks and get their temperature checked to step into public buildings or businesses but they can move around just fine).
...which presumes you don't live in a place with high-enough urban density that going outside your home immediately puts you into a large crowd.
Like, what are you supposed to do if you live in Manila? Mumbai? Dhaka?
Pretty much the only way to "practice social distancing" in those sorts of places is to never go outside.
> what are you supposed to do if you live in Manila? Mumbai? Dhaka?
Rejoice that you are with 99% certainty way under 70 years old.
I am getting mixed messages, I'm not sure why I think asking for another opinion on the internet will help, but there it is.
But that appears to be what we've got.
The shaming approach of "you want to be part of this effort?" (whatever that means) is unlikely to be an effective communications strategy either.
I don't know why I asked, I already had my choice of various opinions on the internet (usually given from a position of moral superiority and judgement).
I seriously don't understand why the U.S. public health infrastructure is failing so horribly here; if you want to maximize compliance, it seems obvious that you should be giving consistent and pervasive instructions, there should be literally a planned "marketting" campaign, with a consistent message. If people are getting different messages from different places of course they will be confused and compliance will be less.
Instead, we have "which chain letter on facebook and/or shaming and blaming comment on HN does my gut tell me seems right?" What the fuck America.
so don't go if you don't want to be that person.
https://www.bloomberg.com/news/articles/2020-03-15/manila-en...
I thought the UK (and Sweden, Finland etc) differed mostly in not closing schools yet. Are there other significant differences?
Is there a summary of the current recommendations? I mean surely gatherings etc are banned? Football is already cancelled, for example, as in other countries?
What? That sounds insane
(Today's deathcount is of course dependent on policy from weeks ago tough)
I think it's unwise for a few reasons, not least that if we delay we may have better treatments. Stuff like chloroquine and keltra seems to work but there haven't really been the proper studies - that sort of stuff shouldn't take that long. And there may be a vaccine. (China rushing vaccine stuff https://www.theaustralian.com.au/nation/china-coronavirus-va...)
The bully pulpit is supremely important in these situations, and no government so far seems to have used it responsibly to disseminate a consistent message early enough to citizenry. Worse yet, in the US ones politics seems to be particularly predictive of opinion on coronavirus.
My current feeling is that the virus was not taken seriously when action could have mattered, and now the goal of government and citizenry is to reduce the carnage to both medically vulnerable folks (old people) and to economically vulnerable people. The latter risk in particular scares me, as there are many folks in the US who are going to be severely impacted by politicians reacting severely way too late who are too cowardly to protect those vulnerable people adequately.
It doesn't take that much to contain something like this. In no particular order:
(1) Temperature checks outside all major gathering places. Shops, subways, offices, etc. If you're running a fever you don't get in.
(2) Hand sanitizer at the entrance/exit of all major gathering places. Clean your hands before you go in and clean them when you come out. Don't clean them you don't get in.
(3) Wear masks everywhere in major gathering places. No mask, no entry.
(4) Widespread testing and contact tracing for those who have tested positive.
I agree that the West in general is handling this as dumb as possible. Shutting everything down is pointless if you don't use the respite to enact public health measures.
I do believe that widespread testing and tracing would be effective. Given that we don't yet have access to the scale of testing that is required to maintain public health, I think an immediate quarantine is the only way to save lives.
We don't need to stop 100% of the transmissions. Right now, on average, an infected person will pass it on to 2-3 people. The goal is to get that to below 1 and eventually it will fizzle out.
I'm not quite sure what's so controversial about my post. It's what countries in Asia have done and they've all contained the spread.
https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf
It is more effective against viruses.
Yes but that's expected to, uh, not work. It's only expected to slow the progression.
One of the frustrating and anxiety-producing things here is that we aren't getting very consistent messaging from the governmental authorities and experts.
The only sane course of action the extreme lockdown we are now seeing in many countries. But politicians, being gutless cowards, are coming up with other ideas until their hand forced ... I hope. The alternative of actually believe this stuff and sticking to it would horrific.
I mean, everyone should be definitely be isolating and doing everyone that they can to slow the infection. But we are going to need much stronger measures than individual action. This is a real war, not like drug or terrorism wars, OK.
There are no facts anymore, because nothing and nobody can be trusted.
France reports that half their patients in critical care are under 60, which is supposed to be the "low risk" group.
In the Netherlands there are between 40-50 covid-19 patients in ICU in critical condition. Over half of them are younger than 50. (Youngest is 16yo)
Mortality is much higher for the older group, but hospitalisation happens a lot in the younger age group as well. Obesity is a high-risk factor.
A comment in the reddit post[2] which discusses that article notes that in China the 15-49 age group made up 41% of severe/critical cases.
(The below 50 age group accounts for a bigger part of the population to be sure. I see no data for hospital admission rate as fraction of the age group.)
[1] http://www.ad.nl/dossier-coronavirus/40-a-50-nederlandse-cor...
[2] https://old.reddit.com/r/Coronavirus/comments/fj1owh/over_ha...
Herd immunity will be hard, since antibodies for coronaviruses last only about 4 months.
Even the strictest quarantines possible in the West don't compare to the mild quarantines in the East. The laws don't allow for contact tracing with GPS coordinates and credit card purchases, like they do in Singapore.
Quarantine methods put selective pressure on the strain types that are more infective and severe, since such mutations and recombinations are the only ones able to escape quarantines.
So the plan seems to be to turn this into a community virus, much like herpes or HIV. Then the selective pressure is for the mortality rate to drop and the disease becomes manageable. It would seem silly to damage your economy with heavy quarantine methods when local community cluster spread continues to pop up.
Of course, the UK government can not come out and straight up say this, but they seem one of the few governments that is realistic about facing this virus and its impossible to contain infection rate. I am guessing they ran the numbers from the Italy quarantines and based their decision on that.
Sources? And if so why?
It's probably not a good idea to make concrete assumptions about a specific virus from the family it belongs to. A good place to look when starting to characterize, not necessarily a complete guide to how the virus will interact with our immune systems.
https://www.theguardian.com/news/2017/oct/06/why-cant-we-cur...
The coronaviruses that cause colds (such as CoV-OC43) don't mutate much. Immunity to them doesn't last long for reasons that aren't well understood.
Some other viruses that cause colds escape immunity through mutation, other non-CoV cold causing viruses escape are like CoV and also just have short immunity periods without mutation.
> This is because coronavirus antibodies do not last for a long time. Also, the antibodies for one strain of coronavirus may be ineffective against another one.
> The general trend of IgM peaking at ≈1 month after symptom onset and IgG peaking at 2–4 months was consistent among different studies.
- Article on SARS-CoV https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851497/
- Article on Coronaviruses in general https://www.medicalnewstoday.com/articles/256521#symptoms
Mind sourcing this? This seems the exact opposite of what I'd expect. I'd expect quarantines to s left for milder strains that are harder to detect.
Harder to detect I would see in a strain that has a longer asymptomatic spread period. The only way for a virus to escape a strong quarantine and survive is to survive on surfaces longer, be asymptomatic longer, cause more severe illness (spread through cough and sneezes, especially in hospitals), linger in the air longer, etc.
on the contrary, more sever illness makes it less likely to spread, no?
You are always spreading germs around, if you have high fever or start coughing blood you'll get isolated but if you just have a runny nose you will keep living normally and the virus will happily keep infecting other people when you shake hands.
Community viruses mutate to see a lower mortality, severity, and infectiousness, since there is no selective pressure to have an r0 much higher than 1. For a community virus there is also no selective pressure to mutate to a vastly different strain, so the antibodies for other strains don't help, whereas if the virus is confined inside a city like Wuhan, the only way to reinfect is to mutate to a vastly different strain.
I don't understand this.
We just saw what looks like containment in China and South Korea who the WHO praised for their response.
Not sure why every country couldn't do the same to isolate incoming infections.
This isn’t really tenable if you want a functioning economy, and cases will slip through.
And it seems a pretty common sense preventative measure since a 14 day quarantine isn't too onerous.
> estimated projections of as many as 96 million cases in the US, 4.8 million hospitalizations, and 480,000 deaths associated with the novel coronavirus.
All Western countries moved to fase 2 of epidemic control: Stop testing and contact tracing, since you have many many clusters of local community spread and no idea where it is coming from. They are hesitant to come out and outright say it. Some do, but not with permission of their superiors:
https://nypost.com/2020/03/13/ohio-health-officials-believe-...
Mild cases continue to spread, and don't self-isolate, because they may not even realize they are infected.
China and South Korea have laws that allow for containment: If you message your friend on WeChat and say you have a cough, then you can expect a visit from the Chinese containment crew. If you buy cough syrup in the drug store with your credit card, then South Korea health officials know this.
Containment is pragmatically impossible with an r0 > 2 in the West. Just slowing down is possible.
Western countries likely have laws already and even still it isn't hard to pass new emergency, sunsetting ones.
Australia, NZ, U.S., Italy, they all see sustained local community spread. Australia is still exponentially increasing. Shutting down flights when there is local community spread is show politics, something to point to afterwards and say: We took decisive action. It is purely symbolic.
Sure, U.S. could pass emergency law and use their military surveillance systems to track, tag, and contact trace all of their civilians, as if they were Chinese spies.
But is this desirable in a free society? And what difference does it make when there are 100.000 infections in a single state, of which you will miss a 100 and start all over again 2-3 weeks later, but now with 99.900 angry citizens with guns?
One of the reasons that SARS-CoV is deemed a useable bioweapon is exactly because isolation security methods are very expensive and invasive at scale. The cultural damage would be enormous if people receive letters from the government after they had a private chat on Facebook about symptoms.
Also UK: People won't react negatively when hundreds of thousands of people die. Keep Calm and Carry On.
1. You can't shut down the economy indefinitely. At least not if your goal is to minimize fatalities. And if you don't do that, your "quarantine" is not going to be effective
2. You can't maintain quarantine for more than a month or two, after which your epidemic simply re-starts, and you don't get to re-impose the quarantine then because the first quarantine "failed".
3. Vaccine is over a year out in the best case, assuming it works at all. If it's anything like the flu vaccine, chances of it working reliably on mutated strains are approximately nil.
4. Younger people tolerate the disease much better, and if they build up immunity to it while the senior population self-isolates, the overall number of deaths could be minimized.
5. Due to how widespread and virulent this is, it will just become the "new flu", and it will come back with mutations every year. We can't do what we're doing now every year, at least not if the goal is to minimize deaths.
1. while I'm also skeptical re vaccines, we might well have more effective medical treatment options in a few weeks or months. There are a whole range of different phase 3 trials happeninig right now, some of which have shown anecdotal promise, esp Remisdivir.
2. We learn something new about this disease on a daily basis, meaning that in a few weeks we have diff picture of who exactly is most vulnerable (e. g. folks on ACEinhibitors, or we find ACEi actually are protective and ARBs are an issue etc etc
2. China did.
3. So then there isn't any point to herd immunity.
4. Only younger people who are in good health. There are many disabled and sick young people.
5. It could be the new flu. Or it could be like SARS/MERS.
#3: there is: if 60-70 percent of people are equipped to kill the virus, it's the best "quarantine" imaginable for people who are at risk
#4: those who have comorbidities could also self-isolate; it's still much better than telling _everyone_ to self-isolate - that's simply not going to happen unless you weld people's doors shut
And as we've seen in Italy it's absolutely possible to have everyone self-isolate. You just police it.
+ treatment plans not well understood, but evolving rapidly
+ not enough face masks
+ not enough sanitizer
+ not enough test kits to identify and isolate outbreaks
All four of those elements are absolutely critical to controlling the virus, and all 4 will be in a much better place 30-60 days from now than they are today.
If you want to go the route of herd immunity, do so when you are at appropriate levels of preparedness.
It's not a binary choice between life as normal and total shutdown. The whole discussion is about reducing non-essentials to slow down the spread, so the health system can cope with the demand spread over time.
> 2. You can't maintain quarantine for more than a month or two, after which your epidemic simply re-starts, and you don't get to re-impose the quarantine then because the first quarantine "failed".
Again, not a binary situation. Given the degree of individualism and freedom, that's unlikely to work anyway.
> 3. Vaccine is over a year out in the best case, assuming it works at all.
Agreed
> If it's anything like the flu vaccine, chances of it working reliably on mutated strains are approximately nil.
While this is likely -- I'm not an expert, so I'd rather refrain from such categorical statements.
> 4. Younger people tolerate the disease much better, and if they build up immunity to it while the senior population self-isolates, the overall number of deaths could be minimized.
False dichotomy -- younger people can still be better protected by reducing non-essential contacts.
> 5. Due to how widespread and virulent this is, it will just become the "new flu", and it will come back with mutations every year. We can't do what we're doing now every year, at least not if the goal is to minimize deaths.
That's right, but counting primarily on herd immunity while neglecting other measures does NOT minimize deaths.
Neglecting what?
There's widespread information in the UK concerning symptoms and self-isolation, huge changes in working patterns and people undertaking their own 'social-distancing'.
Information on hand washing is pretty much universally understood and huge numbers of events have been postponed or cancelled. Ordinary citizens, businesses and events are undertaking huge changes. Sports, music and other events are postponed or cancelled for example, and a large percentage of people are looking to work from home.
I have a wide network of friends/former colleagues as a by product of work/charity/previous careers/family spread across a huge swathe of jobs/life in the UK. Massive amount of planning and preparation is taking place and there are huge changes to peoples everyday lives.
Just because a Government hasn't mandated a lock down doesn't mean nothing is happening or people are walking around licking handrails on public transport because there is no threat.
People can agree or disagree with the British government's logic. Only someone very biased would treat it as inherently absurd.
So let's look past the headline at what this guy is actually saying.
He starts this piece by asserting his authority as an expert. But he isn't revealing any new information or critical analysis that would change anyone's minds. In fact as you read further down you find he's actually agreeing with the government's policies.
The key points of the article are:
• Herd immunity will happen anyway and shouldn't be a goal.
• A second wave may or may not happen, it shouldn't drive policy.
• Be like South Korea and close everything for an unspecified period of time.
• Close the schools! But keep children away from Nana and Grandpa.
The entire article says nothing that hasn't been said elsewhere; the only benefit this guy's epidemiology experience seems to add is credentialism. But there are also major logic problems in the argument.
Let's start with his last point about children and schools. He obviously realises children shouldn't come into contact with grandparents, but fails to apply the common sense knowledge that many parents can't stop working to take care of them e.g. because they work in the healthcare system, or logistics, or grocery retail, or pharmaceuticals, or government, etc. So those children will all go to their grandparents, assuming they have some: the one place you don't want them to be. This is a point the scientific advisors to the government made in their announcement press conference but he fails to address it. Children need to be kept away from grandparents and in the presence of young, fit, healthy adults. These conditions can be found in schools.
He says:
Second waves are real things, and we have seen them in flu pandemics. This is not a flu pandemic. Flu rules do not apply. There might well be a second wave, I honestly don’t know. But vulnerable people should not be exposed to a virus right now in the service of a hypothetical future.
The belief a second wave is likely has nothing to do with how flu-like the virus is. Saying flu rules don't apply is a non-sequitur. Second wave is a simple observation based on the fact that stopping infected people coming in and out of the country isn't possible, nor will it be possible going forward. International travel isn't going to remain shut down for long, which means even if the government could somehow wipe out COVID-19 purely via social control policies, it would come back the moment those measures ended and normal life returned. The only way to stop it permanently is if most people are immune so it can't spread.
Also, just saying "this might or might not happen, who knows" is a poor basis for policy making. This guy is an expert, where's the probabilities?
He says:
The UK should not be trying to create herd immunity, that will take care of itself
But the UK isn't "trying" to create herd immunity. What would that involve, actually? Encouraging chicken pox style virus parties? It's not doing anything like this.
Believing that requires an especially bad-faith reading of a (perhaps poorly phrased) statement by a fellow scientist. The goverment understands that herd immunity is going to happen sooner or later, it's the only way to end this, and that's why reaching it with as few fatalities as possible is the stated aim.
Finally, his recommendations are useless. He just recommends social distancing and shutdowns without any time frames attached. Does he believe people can self isolate and schools can remain shut ind...
You are implicitly believing that those measures can last for a long period of time if implemented right now. The government is arguing that there are inherent limits to how long that can go on for and that if they must be used at the right time, when more people are infected than at the moment.
The author of the article makes the same mistake. He writes as if social distancing is something you just switch on, and then the outbreak ends. There's no concept that normalcy must return, and so that there's some kind of planning involved in when and how to ramp it up/back down.
Look, the key point here is neither you nor the author actually know to what extent "aggressively and ruthlessly implementing social distancing right now" will impact the need for beds, that concept isn't well defined. And you are still ignoring that such measures can't last indefinitely.
OK, so everyone is put under total curfew right now and shot if they're found on the street. The spread slows then stops. After a month life starts getting back to normal, and then case numbers start shooting up again. What then?
The optimal position is for every bed to be taken all the time, as that way the curve is flat at exactly the right point to get everything back to normal as soon as possible by having people build up immunity. We all have no idea when the right time to start asking people to hide in their homes is, or even if asking everyone to do that is a good idea. But we can be pretty sure it can't last forever and the right time for people to be isolating themselves is when most people have it, as that way they're getting sick and recovering at home. It's not at a time when most people don't have it and the home stay does nothing but put off the inevitable for a few more weeks.
The only thing which they should have done is delayed a decision on this. They are a few weeks behind other countries, and could have observed effectiveness of social distancing in arresting spread. If it worked, it could be copied (ina modified form) and if it failed, it would be much easier to sell to the public. Currently it’s a brave (but likely correct) position it would seem.
But then again, what do I know. While I’m a doctor, I’m No specialist so my opinion is of limited value, and experts seem to disagree with each other. This is what makes this so difficult, no one seems to know what is the best option this current data.
Containment has worked in Wuhan. Containment is being attempted after-the-fact in Italy. Containment is possible, it's just a matter of how extreme gets. But even the most containment does not look the hundreds of thousands or millions dead that letting everyone be infected looks like.
I don't think anyone knows for sure what strategy is going to work best in the meantime, considering experts disagree and the world is conducting a massive A/B test...
A variety of the world's diseases are controlled by testing and surveillance, not by cures - TB, for example.
Most viruses aren't as infectious as this one is, comparison to TB or even previous SARS viruses doesn't work for that reason. You can track people down by them expressing symptoms, then test them, then isolate them and it works. That hasn't worked so far with this.
Time is vital.
Except in Hong Kong, Singapore, Taiwan, or (more arguably) Japan. And South Korea, while they had a rougher early outbreak, seems to have gotten a lid on the disease now.
That's not really correct. Containment certainly can work. Whether it will or not is still an open question. Right now no western country has been able to match that. Italy, Spain, France and Germany are probably out of time to try. But the UK is still relatively early on its curve.
So, for that matter, might the UK "infect the herd" trick. The science isn't unsound, though it's not nearly certain. So the risk management is just crazy and I can't understand it either. But... it really might work.
And how long can they keep strict containment in force, and what happens when it lifted? You're speaking as if China or SK are now magically immune from a second wave as soon as they relax their restrictions.
In this case the science is flat out unsound: There are several coronaviruses known to infect humans. None are known to result in lasting immunity, and some are known to not result in lasting immunity. This is one of the challenges in making a vaccine.
Given the observed hospitalization rates, many millions in the UK will require hospitalization due to corona. At the moment, their hospitals could support merely thousands. We know from other cities that the mortality rate (particularly among younger people) is dramatically higher when adequate medical care is not available.
Under the UK's argument, the worst outcome of aggressive mitigation is that you are actually successful at it and achieve containment which just shifts the infection later in time at a high economic cost. Given the existing known infection rates in the UK that seems unlikely at that point, but even if it were to happen it would provide time to ready treatment facilities and allow for the discovery of more effective and/or scalable treatment techniques.
Fortunately, the UK has been backing off from its initial position and has now been recontextualizing their position as 'mitigate as much as possible'-- which is what pretty much all of the west is doing.
Given the state of modern politics, this is a time for people to very carefully consider their opinions, because the unpopularity of Trump and Boris is going to potentially sway decisions irrationally. This includes professionals and key decision makers.
This is not a value judgement regarding any world leaders. It's just a call to be very aware of bias and spitefulness can cloud judgement even in the most rational among us.
The person is making a fair point, but cocking it up a bit.
The article's suggestions seem to be in line with the government's stance. The main difference is timing with Dr William Hanage saying measures should have been adopted weeks ago while the government claims their modelling tells them to adopt measures later.
The government should be challenged by questioning whether it truly is/was impossible to contain the epidemic and what the best time to introduce different measures is. This article, however, adds very little to that debate with hand-waving in place of evidence.
[0]: https://www.gov.uk/government/news/covid-19-government-annou...
What statistical model? They're talking of "careful modelling". In the article you link, they don't mention anything about statistics, or, say, a simulation etc. You're assuming too much when you're assuming a statistical model, or anything based on data, or any concrete sort of model at all. "Modelling" can just mean a bunch of officials sitting around having tea and brainstorming potential scenarios.
Good point, but it doesn't seem to be the case. From the Coronavirus action plan[0] published on March 3 2020
> The UK is a world leader in the field of outbreak modelling and data analytics. The NIHR HPRU in Modelling Methodology led by Imperial College London has developed novel analytical and computational tools which exploit novel data streams on infectious diseases such as COVID-19. This group and other leading academic groups have developed tools to prepare for infectious disease outbreaks, which include real time infectious disease models, allowing policy decisions to be made using the best possible data and are actively modelling questions of relevance to dealing with the COVID–19 outbreak.
[0]: https://assets.publishing.service.gov.uk/government/uploads/...
Really, the claims of having done "careful modelling" absent any evidence of that modelling (say, a graph or a table of the results) is a really bad sign.
(LOL in Norwegian)
Quoting the article:
> The UK should not be trying to create herd immunity, that will take care of itself.
That's a clear blatant lie.
UK is NOT trying to create a herd immunity. UK is trying to flatten the curve. And UK is admitting that 60% population will get invected. And then the UK will get herd immunity.
For example, it is explained (again) in this video: https://www.youtube.com/watch?v=2XRc389TvG8
Feel free to downvote, that's a popular sport here on HN.
They've pulled back a bit from it because they've seen the vehement public reaction to it.
Cummings may well be evil, but he's not stupid.
They did not.
I watched an hour long full press conference by PM and two adisors.
https://www.youtube.com/watch?v=xRadMzCKnCU
I also watched an hour long Chris Witty Q&A for MP following day.
https://www.youtube.com/watch?v=IfJcwDaZrsA
Both of these talks were about flattening the curve because of NHS capacity etc etc.
The scientists mentioned herd immunity couple times, but not like they are intentionally trying to create it. It was rather like: herd immunity will happen in several months.
> Cummings may well be evil, but he's not stupid.
Likely he got his information from dishonest journalist articles and started self-promotion.
But it's a shame that smart people on HN continue to retransmit this fake.
It is very hard to avoid thinking of it this way but: what happens if a vulnerable person fails to isolate, for whatever reason (stupidity, ignorance, accident, etc)? Is the blame on them? They were told to protect themselves and they failed, so it's their fault?
if I think of it this way it very much sounds like the UK government is planning to just er, wash its hands of vulnerable people and refuse to take any responsibility for their fate.