6 ms·

What is the UK doing different than Italy? Will they just let the old and weak die as part of their plan?

knzhou 7y ago
The idea is that in the long run everybody will get it, so might as well "take it on the chin" now to gain herd immunity, and minimize damage to the economy. There's some rumblings of protecting the old during the summer when this is supposed to happen, though I'm not sure how that's supposed to work when there are millions of active cases at once. I suspect the real reason, as some government officials have outright said, is that it would free up money for the NHS by killing off "bed blockers". Their reasoning is that if the only things you can do are China-style lockdown or nothing, then the disease will just resume exponentially growing the second lockdown ends, so it's pointless to do it at all. While that may be technically right (under some optimistic, unverified assumptions, e.g. no reinfection), I think it's a false dichotomy. Singapore, Hong Kong, and South Korea aren't under lockdown, they're stopping the spread by just having good testing and case tracking capacity, and good hygiene. And the longer things go on, the better they're getting at doing that. If things are getting out of hand, a temporary lockdown is effective (as it was in China), to get the numbers down while building up this kind of capacity. But the UK seems to have just dismissed this option out of hand... which means they seem to be heading blindly to disaster.
- dnautics 7y ago
  > While [all or nothing] is technically right No, it's not. Have you done the math?
  - knzhou 7y ago
    Well, I've done the same back of the envelope estimates they're claiming, but what do you have in mind? If you're saying that their plan is doomed and going to kill millions, I agree.
    - dnautics 7y ago
      I don't think your claim that you need to go all Hubei to slow or curtail the spread of an epidemic is correct. "Herd immunity" is a very well studied concept, but it depends on lots of parameters, like transmission likelihood, social exchange rate, transmissibility window, and we (as in humanity), much less you, don't have a very good idea of what those numbers are (and honestly, orgs like WHO and CDC don't either). Depending on what those numbers are, it could (making some numbers up here) be that a 20% decrease in social contact is sufficient (and the US was never doomed from the start relative to china) or maybe a 40% decrease is sufficient (and the US is probably fine now) or maybe a 90% decrease is necessary (and indeed going all Hubei is required). But given that there haven't been major outbreaks in "china outside of Hubei", I think we have good reason to suspect that maybe full authoritarian clampdown isn't necessary, and voluntary self-quarantine is likely to be effective. But who knows? Don't take my word for it. I'm just a no-longer-in-the-industry chemistry PhD that has studied some autocatalysis differential equations. It's also possible that there are genetic components to these parameters, so what works (or doesn't) in italy might not be the same in thailand.
- dvdhnt 7y ago
  Very informative. Thank you
- mytailorisrich 7y ago
  The problem, if you do the maths, is that this must be done over several years and, thus, the same drastic measures as other countries must be taken now. Having 40+ million cases in the UK this year alone does not seem even remotely manageable for the health services. I don't even see extra hospitals being built or anything at the moment, just threats to schools if they close.
  - knzhou 7y ago
    That's exactly right. The NHS is going to completely collapse before their "plan" is even 1% finished. I suspect that once this happens, they're just going to fold and adopt the same plan as every other country -- but after thousands of unnecessary deaths.
- melling 7y ago
  Strange, I asked about this a few days ago and people thought it was a bad idea: https://news.ycombinator.com/item?id=22542494 https://news.ycombinator.com/item?id=22542494 “ If you’re under 30 without any other health issues, you should be fine? Might not realize you have it? I wonder if it would be easier to create a low dosage vaccine for younger people, thus creating a bit of a firewall so it doesn’t spread as rapidly. I know nothing about medicine so this may be silly.”
  - Johnny555 7y ago
    Maybe people don't understand what a "low dosage vaccine" means? If any vaccine at all can be created in time to help, why not have it be a "full dosage" vaccine and give it to everyone? But starting with young healthy people seems counterproductive, start with those at high risk of catching it (front line healthcare workers) and those at high risk if dying from it.
- masklinn 7y ago
  TBF it's probably too late for most countries to stop transmission entirely (SK certainly doesn't though that's in part due to Patient 31). However that doesn't mean you should let the virus run unchecked, because doing that overwhelms the healthcare system which seems to be what ended up happening in Italy: there are too many case requiring intensive care (especially as the system is not really prepared yet), which means not everybody can be treated properly, which means more people die that necessary, from both coronavirus and other IC-requiring issues (e.g. strokes or accidents and whatnot). The nominal death rate of covid-19 seems to be about 0.5% at worst, possibly lower because lots of asymptomatic cases (so the numbers we have right now are likely over-estimates). By comparison the flu is about 0.1% (thought what's also unclear is how much of the population it can spread to before it basically burns itself out, IIRC flu is about 10% but for covid I've seen speculations from 20 to 70%). However if intensive care gets overloaded, it shoots up to 5~7%, possibly even higher. That's a lot of extra and unnecessary deaths. That's going from a single "unavoidable" death to 10 or 15. That's what "flattening the curve" is about, all the social distancing, hygiene, etc…[0] it's about slowing down the spread from its (again nominal) 33% per day or something, to give the healthcare system the time to ramp up to "full capacity" (and habituation) and keep the number of new cases below its capacity. That, incidentally, is also why universal testing is not that useful: people with fragilities or comorbidities and medical personnel need to be checked quickly because that impacts either their care or whether / how they can care for others. For the vast majority, if you think you might have COVID you stay home so you're not a spreader, which is what you'd do if you were a confirmed case. That's about it. Sure knowing would be nice, but even South Korea simply can not test everybody, they can test 10000 people a day out of a population of 51 million, this means it'd take them 14 years to test everybody. That's obviously not useful. It's also why you should absolutely not call (to say nothing of going to) ER for covid. Hopefully your healthcare system has a contact point for covid, look up that number and if you think you need to call these people, not 911 or 112. Also note: outside is safe, you can go out and watch trees or run or bike. In fact I really should. You should just avoid direct contact, stay out of droplets (coughing) range, try to not cough on other people (cough in your elbow or a hankie), wash your hands when you can (especially when you get home). Also treat all doors like they're the worst toilet doors you've ever seen e.g. if you can open them without your hands do so, if you can't then try very hard not to touch yourself until you've sanitised or washed your hands. [0] also masks if the supply is good enough which is not the case in most countries, which is why it's recommended to leave them to medical professionals who can't just stay home because they have to go out and treat cases
CaptArmchair 7y ago
> What is the UK doing different than Italy? They want to avoid a lock-down disrupting normal life. Meaning general restriction of any and all individual movement all together. The trouble is that life as we know it got cancelled in the past few weeks. And the harder society tries to cling to the idea of "business as usual", the worst things are going to get down the line. > Will they just let the old and weak die as part of their plan? In a nutshell: Yes. The idea of "herd immunity" is that if enough people are immune, the virus can't jump from host to host and people can't infect each other. Vaccination is essentially an artificial way of creating herd immunity without making people actually suffer the illness. Of course, we can't vaccinate, so the other scenario is people actually contracting the disease and getting sick. The stark consequences of the U.K. strategy are (a) an exponential increase in sick people who need healthcare (b) the implosion of an overran healthcare system and (c) many more people dying. Not just the old and weak, but literally anyone who requires healthcare (i.e. heart attacks, strokes, other illnesses, accidents,...). Countries such as Italy and Spain enforce a lock-down exactly BECAUSE they want to avoid healthcare systems from collapsing any further. Confining people at home literally slows the spread infections as there are far less opportunities to pass the virus from host to host. Decreasing the rate at which more people get sick buys time for the healthcare system to process those who are already sick. Down the road, people will still contract the disease, but less people will die including the weak and the old as resources will stay available to tend to those who really need them. Remember, when we talk about "old" and "weak" people, we are talking about someone else's family members and loved ones. If you want to show solidarity and at least do some kind of civic service towards your (local) community, then do this: * Work from home if you can / are allowed to. * Don't make unnecessary social calls. * Wash your hands regularly. * Don't touch your face. * Don't visit people at risk if you don't have to. * Keep a fair distance from other people (6 feet). * If you feel sick, or you're coughing: stay the f- at home. * Don't hoard and don't buy from the black market. * Keep calm and carry on. Society isn't helped if you're going to act like The End is Nigh.
Silhouette 7y ago
The UK's strategy is apparently based heavily on the principle of "flattening the curve". This isn't the approach taken by other nations that have imposed heavy quarantine measures relatively early in their outbreaks, such as Italy. As far as I can see, the following are the fundamental assumptions of this strategy. 1. Much of your population will get infected at some point. This is unavoidable. 2. Heavy quarantine measures as employed in various other countries are not sustainable or effective over the necessary timescales. The quarantine will need to be lifted after a few weeks to avoid all kinds of other negative effects (including those adversely affecting health in other ways) and then the exponential spread will resume anyway. 3. Certain parts of your population are at much greater risk than others, due to age or other complicating conditions. These are the people you most need to protect. Most other people will be able to look after themselves at home with some unpleasantness and inconvenience but relatively little risk of more serious or permanent consequences. 4. Someone who has previously been infected and survived will have a degree of immunity thereafter. 5. There are limited intensive care resources available in the NHS to care for patients in more serious conditions. 6. As time passes, several things improve likely outcomes: 6a. We move past the winter season, which both reduces stress on the NHS generally and also somewhat reduces the effects of the coronavirus. 6b. The NHS is increasing its number of intensive care facilities above normal levels. 6c. Eventually, antiviral medications and vaccines become available, but widespread availability is likely to be at least a year away. So the plan is to allow a degree of natural infection within the general population spread out over time, with the aim of keeping the number of more serious cases at any given time within the capacity of the NHS to treat as well as it can. As this happens, we buy some time for the situation as a whole to improve, and there is also likely to be some degree of herd immunity building among the general population. In the meantime, the priority is to minimise exposure for those most at-risk and to ensure as much as possible that anyone who does get infected with more serious consequences can at least be treated as well as possible. In probably a few weeks, when the level of general exposure and the number of more serious cases have risen and we're in danger of reaching capacity limits in the healthcare system, then we start to deploy the stronger quarantine measures and the like, for the same reasons as everyone else but in the hope that they serve the purposes above in particular. People who understand the science much better than I do seem to be saying that this actually is quite a reasonable strategy and really could work better than what other nations are doing as long as those assumptions are broadly correct, but also that it does have some specific risks, such as the fact that we aren't 100% sure so far that surviving an infection really does confer some degree of immunity, and the possibility of deferring the peak until it hits the more dangerous winter season at the end of this year.

The idea is that in the long run everybody will get it, so might as well "take it on the chin" now to gain herd immunity, and minimize damage to the economy. There's some rumblings of protecting the old during the summer when this is supposed to happen, though I'm not sure how that's supposed to work when there are millions of active cases at once. I suspect the real reason, as some government officials have outright said, is that it would free up money for the NHS by killing off "bed blockers". Their reasoning is that if the only things you can do are China-style lockdown or nothing, then the disease will just resume exponentially growing the second lockdown ends, so it's pointless to do it at all. While that may be technically right (under some optimistic, unverified assumptions, e.g. no reinfection), I think it's a false dichotomy. Singapore, Hong Kong, and South Korea aren't under lockdown, they're stopping the spread by just having good testing and case tracking capacity, and good hygiene. And the longer things go on, the better they're getting at doing that. If things are getting out of hand, a temporary lockdown is effective (as it was in China), to get the numbers down while building up this kind of capacity. But the UK seems to have just dismissed this option out of hand... which means they seem to be heading blindly to disaster.

dnautics 7y ago
> While [all or nothing] is technically right No, it's not. Have you done the math?
- knzhou 7y ago
  Well, I've done the same back of the envelope estimates they're claiming, but what do you have in mind? If you're saying that their plan is doomed and going to kill millions, I agree.
  - dnautics 7y ago
    I don't think your claim that you need to go all Hubei to slow or curtail the spread of an epidemic is correct. "Herd immunity" is a very well studied concept, but it depends on lots of parameters, like transmission likelihood, social exchange rate, transmissibility window, and we (as in humanity), much less you, don't have a very good idea of what those numbers are (and honestly, orgs like WHO and CDC don't either). Depending on what those numbers are, it could (making some numbers up here) be that a 20% decrease in social contact is sufficient (and the US was never doomed from the start relative to china) or maybe a 40% decrease is sufficient (and the US is probably fine now) or maybe a 90% decrease is necessary (and indeed going all Hubei is required). But given that there haven't been major outbreaks in "china outside of Hubei", I think we have good reason to suspect that maybe full authoritarian clampdown isn't necessary, and voluntary self-quarantine is likely to be effective. But who knows? Don't take my word for it. I'm just a no-longer-in-the-industry chemistry PhD that has studied some autocatalysis differential equations. It's also possible that there are genetic components to these parameters, so what works (or doesn't) in italy might not be the same in thailand.
dvdhnt 7y ago
Very informative. Thank you
mytailorisrich 7y ago
The problem, if you do the maths, is that this must be done over several years and, thus, the same drastic measures as other countries must be taken now. Having 40+ million cases in the UK this year alone does not seem even remotely manageable for the health services. I don't even see extra hospitals being built or anything at the moment, just threats to schools if they close.
- knzhou 7y ago
  That's exactly right. The NHS is going to completely collapse before their "plan" is even 1% finished. I suspect that once this happens, they're just going to fold and adopt the same plan as every other country -- but after thousands of unnecessary deaths.
melling 7y ago
Strange, I asked about this a few days ago and people thought it was a bad idea: https://news.ycombinator.com/item?id=22542494 https://news.ycombinator.com/item?id=22542494 “ If you’re under 30 without any other health issues, you should be fine? Might not realize you have it? I wonder if it would be easier to create a low dosage vaccine for younger people, thus creating a bit of a firewall so it doesn’t spread as rapidly. I know nothing about medicine so this may be silly.”
- Johnny555 7y ago
  Maybe people don't understand what a "low dosage vaccine" means? If any vaccine at all can be created in time to help, why not have it be a "full dosage" vaccine and give it to everyone? But starting with young healthy people seems counterproductive, start with those at high risk of catching it (front line healthcare workers) and those at high risk if dying from it.
masklinn 7y ago
TBF it's probably too late for most countries to stop transmission entirely (SK certainly doesn't though that's in part due to Patient 31). However that doesn't mean you should let the virus run unchecked, because doing that overwhelms the healthcare system which seems to be what ended up happening in Italy: there are too many case requiring intensive care (especially as the system is not really prepared yet), which means not everybody can be treated properly, which means more people die that necessary, from both coronavirus and other IC-requiring issues (e.g. strokes or accidents and whatnot). The nominal death rate of covid-19 seems to be about 0.5% at worst, possibly lower because lots of asymptomatic cases (so the numbers we have right now are likely over-estimates). By comparison the flu is about 0.1% (thought what's also unclear is how much of the population it can spread to before it basically burns itself out, IIRC flu is about 10% but for covid I've seen speculations from 20 to 70%). However if intensive care gets overloaded, it shoots up to 5~7%, possibly even higher. That's a lot of extra and unnecessary deaths. That's going from a single "unavoidable" death to 10 or 15. That's what "flattening the curve" is about, all the social distancing, hygiene, etc…[0] it's about slowing down the spread from its (again nominal) 33% per day or something, to give the healthcare system the time to ramp up to "full capacity" (and habituation) and keep the number of new cases below its capacity. That, incidentally, is also why universal testing is not that useful: people with fragilities or comorbidities and medical personnel need to be checked quickly because that impacts either their care or whether / how they can care for others. For the vast majority, if you think you might have COVID you stay home so you're not a spreader, which is what you'd do if you were a confirmed case. That's about it. Sure knowing would be nice, but even South Korea simply can not test everybody, they can test 10000 people a day out of a population of 51 million, this means it'd take them 14 years to test everybody. That's obviously not useful. It's also why you should absolutely not call (to say nothing of going to) ER for covid. Hopefully your healthcare system has a contact point for covid, look up that number and if you think you need to call these people, not 911 or 112. Also note: outside is safe, you can go out and watch trees or run or bike. In fact I really should. You should just avoid direct contact, stay out of droplets (coughing) range, try to not cough on other people (cough in your elbow or a hankie), wash your hands when you can (especially when you get home). Also treat all doors like they're the worst toilet doors you've ever seen e.g. if you can open them without your hands do so, if you can't then try very hard not to touch yourself until you've sanitised or washed your hands. [0] also masks if the supply is good enough which is not the case in most countries, which is why it's recommended to leave them to medical professionals who can't just stay home because they have to go out and treat cases

CaptArmchair 7y ago

> What is the UK doing different than Italy? They want to avoid a lock-down disrupting normal life. Meaning general restriction of any and all individual movement all together. The trouble is that life as we know it got cancelled in the past few weeks. And the harder society tries to cling to the idea of "business as usual", the worst things are going to get down the line. > Will they just let the old and weak die as part of their plan? In a nutshell: Yes. The idea of "herd immunity" is that if enough people are immune, the virus can't jump from host to host and people can't infect each other. Vaccination is essentially an artificial way of creating herd immunity without making people actually suffer the illness. Of course, we can't vaccinate, so the other scenario is people actually contracting the disease and getting sick. The stark consequences of the U.K. strategy are (a) an exponential increase in sick people who need healthcare (b) the implosion of an overran healthcare system and (c) many more people dying. Not just the old and weak, but literally anyone who requires healthcare (i.e. heart attacks, strokes, other illnesses, accidents,...). Countries such as Italy and Spain enforce a lock-down exactly BECAUSE they want to avoid healthcare systems from collapsing any further. Confining people at home literally slows the spread infections as there are far less opportunities to pass the virus from host to host. Decreasing the rate at which more people get sick buys time for the healthcare system to process those who are already sick. Down the road, people will still contract the disease, but less people will die including the weak and the old as resources will stay available to tend to those who really need them. Remember, when we talk about "old" and "weak" people, we are talking about someone else's family members and loved ones. If you want to show solidarity and at least do some kind of civic service towards your (local) community, then do this: * Work from home if you can / are allowed to. * Don't make unnecessary social calls. * Wash your hands regularly. * Don't touch your face. * Don't visit people at risk if you don't have to. * Keep a fair distance from other people (6 feet). * If you feel sick, or you're coughing: stay the f- at home. * Don't hoard and don't buy from the black market. * Keep calm and carry on. Society isn't helped if you're going to act like The End is Nigh.

Silhouette 7y ago

The UK's strategy is apparently based heavily on the principle of "flattening the curve". This isn't the approach taken by other nations that have imposed heavy quarantine measures relatively early in their outbreaks, such as Italy. As far as I can see, the following are the fundamental assumptions of this strategy. 1. Much of your population will get infected at some point. This is unavoidable. 2. Heavy quarantine measures as employed in various other countries are not sustainable or effective over the necessary timescales. The quarantine will need to be lifted after a few weeks to avoid all kinds of other negative effects (including those adversely affecting health in other ways) and then the exponential spread will resume anyway. 3. Certain parts of your population are at much greater risk than others, due to age or other complicating conditions. These are the people you most need to protect. Most other people will be able to look after themselves at home with some unpleasantness and inconvenience but relatively little risk of more serious or permanent consequences. 4. Someone who has previously been infected and survived will have a degree of immunity thereafter. 5. There are limited intensive care resources available in the NHS to care for patients in more serious conditions. 6. As time passes, several things improve likely outcomes: 6a. We move past the winter season, which both reduces stress on the NHS generally and also somewhat reduces the effects of the coronavirus. 6b. The NHS is increasing its number of intensive care facilities above normal levels. 6c. Eventually, antiviral medications and vaccines become available, but widespread availability is likely to be at least a year away. So the plan is to allow a degree of natural infection within the general population spread out over time, with the aim of keeping the number of more serious cases at any given time within the capacity of the NHS to treat as well as it can. As this happens, we buy some time for the situation as a whole to improve, and there is also likely to be some degree of herd immunity building among the general population. In the meantime, the priority is to minimise exposure for those most at-risk and to ensure as much as possible that anyone who does get infected with more serious consequences can at least be treated as well as possible. In probably a few weeks, when the level of general exposure and the number of more serious cases have risen and we're in danger of reaching capacity limits in the healthcare system, then we start to deploy the stronger quarantine measures and the like, for the same reasons as everyone else but in the hope that they serve the purposes above in particular. People who understand the science much better than I do seem to be saying that this actually is quite a reasonable strategy and really could work better than what other nations are doing as long as those assumptions are broadly correct, but also that it does have some specific risks, such as the fact that we aren't 100% sure so far that surviving an infection really does confer some degree of immunity, and the possibility of deferring the peak until it hits the more dangerous winter season at the end of this year.