>Nursing homes should be isolated together with some of the staff until other staff who have acquired immunity can take over
Just this one sentence has a lot to unpack. How do we know that a staff member immune to COVID? My understanding is that an antibody test is correlated but not necessarily indicative of immunity. What does this mean for staff members that aren't immune? Will they be furloughed indefinitely or fired? Should there be financial incentives to deliberately infect yourself?
No. All recent data points to long-lasting immunity. A normal, gradual decline in antibody response is coupled with longer-lasting B- and T-cell response.
To date, there has been one documented case of re-infection. From everything we know, this very rare.
There are many reasons a person with a severe illness might have to return to a hospital (e.g. lung damage from ventilators), but this has no relationship to repeated infection from the same virus.
That's 330 million people, 65% exposed, and 1% death rate.
Keep in mind that 9% of people have suffered a crippling illness that lasts several months. That's 19,305,000 people with a crippling multi-month illness.
1. The mortality rate for children is lower than even the flu, and this is likely to do with age-related ACE2 expression. This is fact, and hopefully it leads to something that can help us lower the mortality rate in older folks, too. [1] They can of course spread it to older folks, though.
2. Mortality rate among the young is in line with the flu.
3. Mortality rate in older folks is terrible, and needs to be managed, but it can be managed. Those folks, and those with immune issues can and must be protected at all costs.
These three things together mean the death rate of such a strategy is nowhere near 1%.
> 330,000,000 ÷ 100 x 65 = 214,500,000
Serology studies pin the number closer to 0.6%, but of course that doesn't make the decision any less difficult -- although that is heavily, heavily age dependent.
What you're neglecting otherwise is the thrust of the article: lockdowns are temporary and the disease won't be stopped by lockdowns. Even under the most optimistic projection for vaccination, we may be hurtling towards the 65% number in the US one way or the other.
This article basically documents Sweden's approach. There hasn't been a COVID death in Sweden since August 24th, and at the moment, they continue to see ~150 new cases per day.
Mortality rate in older folks is terrible, and needs to be managed, but it can be managed.
Yeah...I keep seeing this handwave from the "I should be able to do whatever I want" crowd. How exactly can it be managed? Basically it's "if you have any possible risk factor, you should lock yourself away so me and my friends aren't inconvenienced by your existence". Ignoring the fact (and the associated abdication of responsibility) that there's no established risk assessment beyond "if you're an oldster, stay home", and it's not clear why the many otherwise low risk are getting sick and dying. They are apparently the cost of partying on weekends.
"If you have any possible risk factor, you should lock yourself away so me and my friends aren't inconvenienced by your existence" is how quarantines have worked for hundreds of years.
In a quarantine, "Me and my friends" don't go out partying packed at the bar while the oldsters sequester. Look at how well things are going at every college that's opened up.
For hundreds of years, a 'quarantine' didn't mean "for everyone except us entitled shitstains". It meant for everyone.
We aren't running this how quarantines have worked for hundreds of years.
As opposed to 100% of people locking themselves away? The reality is people won’t do what you’re asking. The evidence is in the infection curve. We have to manage the society/neighbors we have not the people we wish we had. Further, a few months later everyone can come out and play.
> a few months later everyone can come out and play.
I'm not so sure. Governments can't admit that fighting such a contagious virus with non-pharmaceutical interventions is extremely difficult on the long run. You're just buying time for a cure (not necessarily a vaccine: drugs work, too).
The problem is people aren’t doing it so it doesn’t matter what the intention is. You need to tailor the public policy towards what people will actually do not what you wish they would do. Otherwise you’re left with the half measures that achieve absolutely nothing you see today.
If there's literally nothing suitable that would be automatically done, what would you do? Allow people to do whatever at the cost of lives or force them to do what is right?
> Allow people to do whatever at the cost of lives or force them to do what is right?
You're invoking police power to massively disrupt people's lives indefinitely. That's unacceptable.
Let people exercise their inalienable freedoms and assume whatever risk they want.
We saw people preempt the government in avoiding risky behavior as the pandemic started, and we'll see people preempt the government in resuming normal life avoiding risk as they deem fit.
In case of this virus, probably not a vaccine. Or not alone.
And any vaccine would need some period of widespread testing, comparable to how long it took to devise flu vaccines.
This one can jump species, reinfection cases have been described already, and coronaviruses in general are known to cause seasonal infections.
> And any vaccine would need some period of widespread testing
That's what the current Phase III trials are doing (30K people for Pfizer, 30K people for Moderna, ~12K people for Oxford/AstraZeneca). This should be enough to check for efficacy, while probably not enough for potential long-term effects.
Reinfections are, so far, a minuscule number compared to the total cases (2 properly documented cases), so I expect immunity to last at least a year, basing on the current data. Time will tell if I'm wrong, of course.
You don't seem to think very highly of other people. You could also phrase it as "if you have any possible risk factor, you should lock yourself away so me and my friends can build up herd immunity so you don't have to", just as the article said.
We're packed in this bar pounding beers with my dudebros...so we can build up immunity!
I got on my bike and road to Sturgis with 50k other bikers...so we can herd up some immunity!
I'm out here maskless and not social distancing, threatening people for not opening schools and complaining about not getting a haircut...how else can we get immune!
I think my read on other people is pretty spot on.
Again, you're playing to the audience you wish you had instead of the one you actually have. As we have been unable to get people to stay inside, there's no good that will come of continuing to tell people to stay inside while we know they won't. We need to figure out how to minimize harm given what we now know. You're basically arguing for the war on drugs.
"Keep in mind that 9% of people have suffered a crippling illness that lasts several months."
There is no evidence for such a claim. If you're referring to the people who spend time in ICUs, on ventilators, etc., these people represent a small fraction of the most severe examples of known infections (i.e. less than 9%), which themselves represent only about 1/10th-1/20th of the total number of infections:
I think the OP referred to the pneumonia-like consequences (weakened immune system, issues with lungs that can last for months), effects common with certain strong viral infections (chronic fatigue) and other effects (circulatory problems, thrombosis).
Note that the first two categories are not exclusive to this virus at all: treatable diseases like "regular" pneumonia can cause them.
The actual incidence of these effects, which can range from small to very severe, is unknown (given that a lot of cases are still missed). I've never heard about the 9% before, though.
The author missed that the whole narrative around herd immunity is based on very very weak papers. The growth dynamics of COVID-19 is following very precise mathematics. Like any seasonal virus it starts strong - and trickles down slowly.
Not doing containment while it is growing will make the situation a lot worse.
Spreading the virus deliberately to get some immunity will make the situation worse.
Using non-functional lockdowns that only slow down the descend and spread the virus more evenly also make things worse.
This is the same load of horsefeathers that is on display in every popular narrative arguing for herd immunity.
The author writes: "We need to shield older people and other high-risk groups until they are protected by herd immunity." I've read this sentence almost verbatim literally dozens of times over the last few months. Those who promote this meme either offer no explanation for how this can be done, or offer a hand-wavy and anemic explanation of what is really a titanic effort on an untried scale. The oldest members of our society either live with their families or are attended by medical caretakers, who are an obvious source of infection. We can't put our elderly into Bubble Boy-style hospital wards or ship them to Old People Island. If we all go back to work and school, we can't help dramatically increasing the risk to the elderly from increased social mingling and network effects.
The author offers the wan suggestion that the institutionalized elderly could be attended by a rotating cast of medical staff who are somehow certifiably safe. "Immunity passports" have been a conservative meme since the start of the epidemic, when we had zero evidential foundation for such a belief. The body of evidence for COVID immunity remains mixed. Six months in, we are starting to see cases of apparently incontrovertible reinfection. The question whether one can be immune and yet still infectious remains open. The enthusiasm for the "immunity passport" meme among a segment of commentators really feels like a spectator's desire to see some dog-eat-dog competition in the labor force.
But all this, of course, is predicated on a third meme, which is that the effects of COVID are possible death for the very old and "water off a duck's back" for everyone else. No. A number of college athletes are currently grounded with pericarditis, a risky diagnosis with an indefinite time course. Unlike our Swiss cheese understanding of practical COVID immunity, our picture of COVID complications is becoming clearer, and it includes common incidence of dangerous internal inflammation, reduced lung function, and chronic fatigue. If we're concerned about the drag on our economy, let's consider what kind of drag a chronically ill labor force will generate. This is the scenario in third-world countries, where infectious diseases like malaria and AIDS eat into labor productivity and sap the average life expectancy.
In other words, this is a dangerous complex of memes that show up in tandem and aren't particularly affected by gathering evidence. It is externally motivated and could very well endanger each of us individually.
Regarding the so called long term effects: is there any research that tells us how prevalent they are?
A lot of people mention cases like these, I'd like to see some figures, also taking into account that pulmonary problems and fatigue, for one, are common to other diseases (even treatable ones).
To be clear: I have no interest in downplaying severe effects of this infection. But I want to look at the whole picture.
Here's a two-month-old summary of a few studies from JAMA Cardiology.[1] The most-quoted result is the Puntmann, et al., which has been amended after scrutiny, but showed pretty much the same pattern of results. Googling "COVID" + "cardiomyopathy" offers some more leads. For example, [2].
Note that the JAMA editorial acknowledges the need for further studies, because the numbers are very small (compared to the known number of patients):
> We wish not to generate additional anxiety but rather to incite other investigators to carefully examine existing and prospectively collect new data in other populations to confirm or refute these findings.
Which is AFAICS the crux of the matter. No one knows how widespread these problems are.
Not to diminish the need for further research, but [1]. I encourage you to consider the growing number of cases of cardiomyopathy in college athletes, who are presumably in the invincible 18-21 age range and also not particularly numerous as a population.
32 comments
[ 4.5 ms ] story [ 78.8 ms ] threadJust this one sentence has a lot to unpack. How do we know that a staff member immune to COVID? My understanding is that an antibody test is correlated but not necessarily indicative of immunity. What does this mean for staff members that aren't immune? Will they be furloughed indefinitely or fired? Should there be financial incentives to deliberately infect yourself?
This article is riddled with questions.
https://threadreaderapp.com/thread/1285618977654407169.html
https://www.medrxiv.org/content/10.1101/2020.07.14.20151126v...
There are many reasons a person with a severe illness might have to return to a hospital (e.g. lung damage from ventilators), but this has no relationship to repeated infection from the same virus.
Antibody tests are already quite available and easy to get. In the longer term, you'd need to test for T-cell response.
330,000,000 ÷ 100 x 65 = 214,500,000 ÷ 100 = 2,145,000
That's 330 million people, 65% exposed, and 1% death rate.
Keep in mind that 9% of people have suffered a crippling illness that lasts several months. That's 19,305,000 people with a crippling multi-month illness.
Aiming for herd immunity is pure madness.
1. The mortality rate for children is lower than even the flu, and this is likely to do with age-related ACE2 expression. This is fact, and hopefully it leads to something that can help us lower the mortality rate in older folks, too. [1] They can of course spread it to older folks, though.
2. Mortality rate among the young is in line with the flu.
3. Mortality rate in older folks is terrible, and needs to be managed, but it can be managed. Those folks, and those with immune issues can and must be protected at all costs.
These three things together mean the death rate of such a strategy is nowhere near 1%.
> 330,000,000 ÷ 100 x 65 = 214,500,000
Serology studies pin the number closer to 0.6%, but of course that doesn't make the decision any less difficult -- although that is heavily, heavily age dependent.
What you're neglecting otherwise is the thrust of the article: lockdowns are temporary and the disease won't be stopped by lockdowns. Even under the most optimistic projection for vaccination, we may be hurtling towards the 65% number in the US one way or the other.
This article basically documents Sweden's approach. There hasn't been a COVID death in Sweden since August 24th, and at the moment, they continue to see ~150 new cases per day.
[1] https://www.uth.edu/news/story.htm?id=b40ccaec-50c5-465c-b2d...
Yeah...I keep seeing this handwave from the "I should be able to do whatever I want" crowd. How exactly can it be managed? Basically it's "if you have any possible risk factor, you should lock yourself away so me and my friends aren't inconvenienced by your existence". Ignoring the fact (and the associated abdication of responsibility) that there's no established risk assessment beyond "if you're an oldster, stay home", and it's not clear why the many otherwise low risk are getting sick and dying. They are apparently the cost of partying on weekends.
For hundreds of years, a 'quarantine' didn't mean "for everyone except us entitled shitstains". It meant for everyone.
We aren't running this how quarantines have worked for hundreds of years.
I'm not so sure. Governments can't admit that fighting such a contagious virus with non-pharmaceutical interventions is extremely difficult on the long run. You're just buying time for a cure (not necessarily a vaccine: drugs work, too).
Usually in law, number 1 is called negligence.
You're invoking police power to massively disrupt people's lives indefinitely. That's unacceptable.
Let people exercise their inalienable freedoms and assume whatever risk they want.
We saw people preempt the government in avoiding risky behavior as the pandemic started, and we'll see people preempt the government in resuming normal life avoiding risk as they deem fit.
This one can jump species, reinfection cases have been described already, and coronaviruses in general are known to cause seasonal infections.
That's what the current Phase III trials are doing (30K people for Pfizer, 30K people for Moderna, ~12K people for Oxford/AstraZeneca). This should be enough to check for efficacy, while probably not enough for potential long-term effects.
Reinfections are, so far, a minuscule number compared to the total cases (2 properly documented cases), so I expect immunity to last at least a year, basing on the current data. Time will tell if I'm wrong, of course.
We're packed in this bar pounding beers with my dudebros...so we can build up immunity!
I got on my bike and road to Sturgis with 50k other bikers...so we can herd up some immunity!
I'm out here maskless and not social distancing, threatening people for not opening schools and complaining about not getting a haircut...how else can we get immune!
I think my read on other people is pretty spot on.
These are questionable assumptions. Herd immunity thresholds seem to be closer to 20-40%:
https://arxiv.org/pdf/2008.08142.pdf
https://www.medrxiv.org/content/10.1101/2020.04.27.20081893v...
Moreover, fatality rates are not 1%. Current best estimates are ~0.6%, overall, with a strong dependence on age:
https://www.medrxiv.org/content/10.1101/2020.08.24.20180851v...
https://www.medrxiv.org/content/10.1101/2020.07.23.20160895v...
https://www.thelancet.com/journals/laninf/article/PIIS1473-3...
The young (i.e. those under 30), in particular, are at almost no risk of death:
https://www.franklintempleton.com/investor/article?contentPa...
"Keep in mind that 9% of people have suffered a crippling illness that lasts several months."
There is no evidence for such a claim. If you're referring to the people who spend time in ICUs, on ventilators, etc., these people represent a small fraction of the most severe examples of known infections (i.e. less than 9%), which themselves represent only about 1/10th-1/20th of the total number of infections:
https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/comm...
The vast majority of people have mild illness, akin to a cold.
Note that the first two categories are not exclusive to this virus at all: treatable diseases like "regular" pneumonia can cause them.
The actual incidence of these effects, which can range from small to very severe, is unknown (given that a lot of cases are still missed). I've never heard about the 9% before, though.
Not doing containment while it is growing will make the situation a lot worse.
Spreading the virus deliberately to get some immunity will make the situation worse.
Using non-functional lockdowns that only slow down the descend and spread the virus more evenly also make things worse.
The author writes: "We need to shield older people and other high-risk groups until they are protected by herd immunity." I've read this sentence almost verbatim literally dozens of times over the last few months. Those who promote this meme either offer no explanation for how this can be done, or offer a hand-wavy and anemic explanation of what is really a titanic effort on an untried scale. The oldest members of our society either live with their families or are attended by medical caretakers, who are an obvious source of infection. We can't put our elderly into Bubble Boy-style hospital wards or ship them to Old People Island. If we all go back to work and school, we can't help dramatically increasing the risk to the elderly from increased social mingling and network effects.
The author offers the wan suggestion that the institutionalized elderly could be attended by a rotating cast of medical staff who are somehow certifiably safe. "Immunity passports" have been a conservative meme since the start of the epidemic, when we had zero evidential foundation for such a belief. The body of evidence for COVID immunity remains mixed. Six months in, we are starting to see cases of apparently incontrovertible reinfection. The question whether one can be immune and yet still infectious remains open. The enthusiasm for the "immunity passport" meme among a segment of commentators really feels like a spectator's desire to see some dog-eat-dog competition in the labor force.
But all this, of course, is predicated on a third meme, which is that the effects of COVID are possible death for the very old and "water off a duck's back" for everyone else. No. A number of college athletes are currently grounded with pericarditis, a risky diagnosis with an indefinite time course. Unlike our Swiss cheese understanding of practical COVID immunity, our picture of COVID complications is becoming clearer, and it includes common incidence of dangerous internal inflammation, reduced lung function, and chronic fatigue. If we're concerned about the drag on our economy, let's consider what kind of drag a chronically ill labor force will generate. This is the scenario in third-world countries, where infectious diseases like malaria and AIDS eat into labor productivity and sap the average life expectancy.
In other words, this is a dangerous complex of memes that show up in tandem and aren't particularly affected by gathering evidence. It is externally motivated and could very well endanger each of us individually.
A lot of people mention cases like these, I'd like to see some figures, also taking into account that pulmonary problems and fatigue, for one, are common to other diseases (even treatable ones).
To be clear: I have no interest in downplaying severe effects of this infection. But I want to look at the whole picture.
[1] https://jamanetwork.com/journals/jamacardiology/fullarticle/...
[2] https://www.medpagetoday.com/infectiousdisease/covid19/88060
Note that the JAMA editorial acknowledges the need for further studies, because the numbers are very small (compared to the known number of patients):
> We wish not to generate additional anxiety but rather to incite other investigators to carefully examine existing and prospectively collect new data in other populations to confirm or refute these findings.
Which is AFAICS the crux of the matter. No one knows how widespread these problems are.
[1] https://en.m.wikipedia.org/wiki/Further_research_is_needed