5 ms·

The article does not answer the question, except for "it mutated"

gambiting 7y ago
Does it not? It clearly says that countries like the UK knew full well that the best way to combat the illness was to isolate and quarantine people and cities, but decided not to do it to avoid harming the war effort - resulting in a lot more deaths. How is that not an answer to this question?
- Spare_account 7y ago
  I'm watching the UK government decide not to implement 'delay' measures today, ostensibly to protect the economy. It seems there is always a reason not to do the right thing. I hope they change their mind very soon.
  - gambiting 7y ago
    Have you watched the presentation yesterday? Or just reading the news articles today? Because that's precisely not what they said. What was said was - from epidimiology point of view, there's no point in telling everyone to stay at home right now when the spread is in the early stages. It will have a marginal effect, and the spread will continue anyway. By government's own estimates 80% of people in the UK will get infected, and imposing a quarantine right now won't change that. What would help is setting the quarantine for 14-18 weeks, and they know that people won't abide by that, so instead, they clearly said they will impose quarantine just before UK hits the predicted peak infections - to lower the stress on the NHS and to achieve the maximum effect of the quarantine. Like, it all made sense if you watched the actual conference.
    - empiricus 7y ago
      I watched a part of the presentation, but it was actually unclear to me what is the peak infections mentioned. I mean, in Italy, the numbers are very small compared to 80% of population, and the health system is already not able to cope, and mortality rate is quite high. Does it mean that UK will wait for their numbers to be 10 times the current Italy numbers before starting the quarantine?
      - gambiting 7y ago
        No, it means that UK government knows that it cannot stop the situation getting a lot worse, and a quarantine will be a lot more effective as a tool later on. They seemed to be quite realistic about this, not going " it will be all fine, trust us". They know things will get fucked and a full quarantine is one of the many tools to use against the virus - so let's use it when it's most effective. Otherwise like they said - if we quarantine the entire country right now, it won't stop the spread anyway. So we'll come out of quarantine and then have to do it again in a month - and people will get fed up with it and won't obey a quarantine if it goes on for too long or too frequently. So if the spread is inevitable, let's use the quarantine at the point that prevents the most possible number of infections.
        mistersquid 7y ago
        The UK are not following quarantine and isolation protocols to mitigate the virus because they are trying to protect the economy post-Brexit.
        gambiting 7y ago
        I mean, maybe, but I'm yet to see proof of that. The reaction yesterday seemed perfectly reasonable.
        wwweston 7y ago
        I can see some discussion about trying to figure out which restrictions will work best with the psychology of a given population. But the idea that the "most effective" time is going to be later doesn't make much sense to me. Marginal rate changes in exponential spread are most likely to have the biggest impacts early. It doesn't much change the total volume of people who get sick, but it very likely changes the volume of people who get sick at once, and that can save lives. This sounds like saying "we can only imagine quarantine working if things get fucked, so we're going to let things get fucked, so that the quarantine will work except for the fact that things are already fucked oh well too late."
    - thom 7y ago
      I understand that the approach has some degree of internal consistency, but it requires a huge amount of trust in the underlying models, and in our ability to pull the right levers at the right time in the future. I can totally accept that any approach _must_ address what happens for the entire period from now up until immunity or vaccination - we know we can't keep everything shut down until 2021. But the government is hoping to tap the brakes when the outbreak is going at 100mph, compared to controlling acceleration from the standing start of lockdown. This is an immense and shocking gamble. I hope it works, although would mean every other country appears to be making a huge mistake by shutting down now.
  - deleted 7y ago
    [deleted]
  - codeulike 7y ago
    (deleted)
    - senordevnyc 7y ago
      Has anyone done the math on how long a flattened curve stretches out if you flatten it enough to not overwhelm the medical system? So for example, if we have 100,000 ICU beds in the US and we somehow make them all available for COVID-19 patients (unlikely), how flat do we need to make the curve to not go above 100k ICU patients, and how long will that flattened curve last? A month? Six months? Two years? Assuming 70% of the adult population gets it, that's roughly 140 million infected. Assuming 5% need ICU beds, that's 7 million ICU patients. And assuming the average ICU stay is 2 weeks, we'd need to therefore spread our ICU patients over 140 weeks, or almost three years. Is that how long we can expect social distancing to last if things go perfectly?
      - nicoburns 7y ago
        The UK only has ~4000 ICU beds, and these are mostly already full. We've got no chance.
        senordevnyc 7y ago
        Yeah, just to be clear, I think there's no chance in the US either. I just saw something that said we actually only have 45k beds, and they're mostly already full anyway. Plus there's no chance we're going to be able to keep this clamped down for months. We'll be overwhelmed in weeks.
      - empiricus 7y ago
        When we saw the Chinese building hospitals in a couple of days, maybe we should have started building all around the world, slower. We had the time... Also build respirators, train ppl. Even now is better than later...
    - deleted 7y ago
      [deleted]
    - 7y ago
  - simonh 7y ago
    Imposing a lockdown to soon does a lot of harm and very little good. In fact it makes things worse, because after a few weeks people get fed up of the lockdown and start breaking isolation. So if you lock down a few weeks too soon, people start breaking isolation at exactly the point it's most important the lockdown is maintained. All of this was explained in the presentation.
- fnord123 7y ago
  I think GP was wondering why the flu was so deadly per person rather than how it racked up a huge body count. The article explains the body count but not why any particular person would die at a higher rate than another strain of flu.
  - gambiting 7y ago
    It does as well - to quote directly from article: "Not only was it shocking that healthy young men and women were dying by the millions worldwide, but it was also how they were dying. Struck with blistering fevers, nasal hemorrhaging and pneumonia, the patients would drown in their own fluid-filled lungs. Only decades later were scientists able explain the phenomenon now known as “cytokine explosion.” When the human body is being attacked by a virus, the immune system sends messenger proteins called cytokines to promote helpful inflammation. But some strains of the flu, particularly the H1N1 strain responsible for the Spanish flu outbreak, can trigger a dangerous immune overreaction in healthy individuals. In those cases, the body is overloaded with cytokines leading to severe inflammation and the fatal buildup of fluid in the lungs."
    - porker 7y ago
      Do we now have drugs to suppress a "cytokine explosion" so if a virus mutates to do this again, we can reduce the number of deaths?
      - gambiting 7y ago
        Yes, we have drugs which reduce the effectiveness of the immune system, preventing this from happening. Of course you don't want to weaken the immune system too much, it's a difficult balance to strike I'm sure.
        throwanem 7y ago
        This is false. Clinical management of the syndrome is purely supportive. There is ongoing work toward a variety of possible treatments - cytokine release syndrome can also result from a garden-variety flu, and as a side effect of some other therapies - but there's nothing outside an early experimental stage thus far.

Does it not? It clearly says that countries like the UK knew full well that the best way to combat the illness was to isolate and quarantine people and cities, but decided not to do it to avoid harming the war effort - resulting in a lot more deaths. How is that not an answer to this question?

Spare_account 7y ago
I'm watching the UK government decide not to implement 'delay' measures today, ostensibly to protect the economy. It seems there is always a reason not to do the right thing. I hope they change their mind very soon.
- gambiting 7y ago
  Have you watched the presentation yesterday? Or just reading the news articles today? Because that's precisely not what they said. What was said was - from epidimiology point of view, there's no point in telling everyone to stay at home right now when the spread is in the early stages. It will have a marginal effect, and the spread will continue anyway. By government's own estimates 80% of people in the UK will get infected, and imposing a quarantine right now won't change that. What would help is setting the quarantine for 14-18 weeks, and they know that people won't abide by that, so instead, they clearly said they will impose quarantine just before UK hits the predicted peak infections - to lower the stress on the NHS and to achieve the maximum effect of the quarantine. Like, it all made sense if you watched the actual conference.
  - empiricus 7y ago
    I watched a part of the presentation, but it was actually unclear to me what is the peak infections mentioned. I mean, in Italy, the numbers are very small compared to 80% of population, and the health system is already not able to cope, and mortality rate is quite high. Does it mean that UK will wait for their numbers to be 10 times the current Italy numbers before starting the quarantine?
    - gambiting 7y ago
      No, it means that UK government knows that it cannot stop the situation getting a lot worse, and a quarantine will be a lot more effective as a tool later on. They seemed to be quite realistic about this, not going " it will be all fine, trust us". They know things will get fucked and a full quarantine is one of the many tools to use against the virus - so let's use it when it's most effective. Otherwise like they said - if we quarantine the entire country right now, it won't stop the spread anyway. So we'll come out of quarantine and then have to do it again in a month - and people will get fed up with it and won't obey a quarantine if it goes on for too long or too frequently. So if the spread is inevitable, let's use the quarantine at the point that prevents the most possible number of infections.
      - mistersquid 7y ago
        The UK are not following quarantine and isolation protocols to mitigate the virus because they are trying to protect the economy post-Brexit.
        gambiting 7y ago
        I mean, maybe, but I'm yet to see proof of that. The reaction yesterday seemed perfectly reasonable.
      - wwweston 7y ago
        I can see some discussion about trying to figure out which restrictions will work best with the psychology of a given population. But the idea that the "most effective" time is going to be later doesn't make much sense to me. Marginal rate changes in exponential spread are most likely to have the biggest impacts early. It doesn't much change the total volume of people who get sick, but it very likely changes the volume of people who get sick at once, and that can save lives. This sounds like saying "we can only imagine quarantine working if things get fucked, so we're going to let things get fucked, so that the quarantine will work except for the fact that things are already fucked oh well too late."
  - thom 7y ago
    I understand that the approach has some degree of internal consistency, but it requires a huge amount of trust in the underlying models, and in our ability to pull the right levers at the right time in the future. I can totally accept that any approach _must_ address what happens for the entire period from now up until immunity or vaccination - we know we can't keep everything shut down until 2021. But the government is hoping to tap the brakes when the outbreak is going at 100mph, compared to controlling acceleration from the standing start of lockdown. This is an immense and shocking gamble. I hope it works, although would mean every other country appears to be making a huge mistake by shutting down now.
- deleted 7y ago
  [deleted]
- codeulike 7y ago
  (deleted)
  - senordevnyc 7y ago
    Has anyone done the math on how long a flattened curve stretches out if you flatten it enough to not overwhelm the medical system? So for example, if we have 100,000 ICU beds in the US and we somehow make them all available for COVID-19 patients (unlikely), how flat do we need to make the curve to not go above 100k ICU patients, and how long will that flattened curve last? A month? Six months? Two years? Assuming 70% of the adult population gets it, that's roughly 140 million infected. Assuming 5% need ICU beds, that's 7 million ICU patients. And assuming the average ICU stay is 2 weeks, we'd need to therefore spread our ICU patients over 140 weeks, or almost three years. Is that how long we can expect social distancing to last if things go perfectly?
    - nicoburns 7y ago
      The UK only has ~4000 ICU beds, and these are mostly already full. We've got no chance.
      - senordevnyc 7y ago
        Yeah, just to be clear, I think there's no chance in the US either. I just saw something that said we actually only have 45k beds, and they're mostly already full anyway. Plus there's no chance we're going to be able to keep this clamped down for months. We'll be overwhelmed in weeks.
    - empiricus 7y ago
      When we saw the Chinese building hospitals in a couple of days, maybe we should have started building all around the world, slower. We had the time... Also build respirators, train ppl. Even now is better than later...
  - deleted 7y ago
    [deleted]
  - 7y ago
- simonh 7y ago
  Imposing a lockdown to soon does a lot of harm and very little good. In fact it makes things worse, because after a few weeks people get fed up of the lockdown and start breaking isolation. So if you lock down a few weeks too soon, people start breaking isolation at exactly the point it's most important the lockdown is maintained. All of this was explained in the presentation.
fnord123 7y ago
I think GP was wondering why the flu was so deadly per person rather than how it racked up a huge body count. The article explains the body count but not why any particular person would die at a higher rate than another strain of flu.
- gambiting 7y ago
  It does as well - to quote directly from article: "Not only was it shocking that healthy young men and women were dying by the millions worldwide, but it was also how they were dying. Struck with blistering fevers, nasal hemorrhaging and pneumonia, the patients would drown in their own fluid-filled lungs. Only decades later were scientists able explain the phenomenon now known as “cytokine explosion.” When the human body is being attacked by a virus, the immune system sends messenger proteins called cytokines to promote helpful inflammation. But some strains of the flu, particularly the H1N1 strain responsible for the Spanish flu outbreak, can trigger a dangerous immune overreaction in healthy individuals. In those cases, the body is overloaded with cytokines leading to severe inflammation and the fatal buildup of fluid in the lungs."
  - porker 7y ago
    Do we now have drugs to suppress a "cytokine explosion" so if a virus mutates to do this again, we can reduce the number of deaths?
    - gambiting 7y ago
      Yes, we have drugs which reduce the effectiveness of the immune system, preventing this from happening. Of course you don't want to weaken the immune system too much, it's a difficult balance to strike I'm sure.
      - throwanem 7y ago
        This is false. Clinical management of the syndrome is purely supportive. There is ongoing work toward a variety of possible treatments - cytokine release syndrome can also result from a garden-variety flu, and as a side effect of some other therapies - but there's nothing outside an early experimental stage thus far.