7 ms·

But there's a third strategy that works better than either: don't lockdown, but do effective testing, case tracking, and treatment, well enough so that exponent

by knzhou 7y ago

But there's a third strategy that works better than either: don't lockdown, but do effective testing, case tracking, and treatment, well enough so that exponential growth can't happen in the first place. That's the policy of Hong Kong, Taiwan, and Singapore, who are doing great.

simonh 7y ago
That’s a very good point, you’re quite right. However all three of those are relatively very small population centres with very easily controlled borders. Britain does have the advantage of being an island, but it has a large rural hinterland that the virus can ‘hide out’ in, and many dense population centres without borders, so it’s a completely different environment. Take London. We could introduce a system of tracking and isolation within the M25, and that might work to lock down community transmission within the London population, but millions of people flow into and out of London each week so it would be completely pointless and ineffective. Meanwhile that level of tracking and isolation simply can’t work across the whole British isles. It’s administratively and logistically impractical.
- Marsymars 7y ago
  > millions of people flow into and out of London each week so it would be completely pointless and ineffective Was curious about this point in particular - checked the numbers, and Heathrow has essentially equivalent traffic as Hong Kong International.
  - dmurray 7y ago
    There are 5 other international airports that call themselves "London", not just Heathrow. And of course London also has road and train connections.
  - simonh 7y ago
    I was mainly thinking about road and rail traffic into and out of the city, including daily commuters.
  - willyt 7y ago
    The equivalent of the entire population of Glasgow passes through Kings Cross station in the morning rush hour. There are 4 other stations with similar flows. Over 20 million people live within an hour or 30 miles of Piccadilly Circus.
    - endogui 7y ago
      That level of population flow and population density are not as special as you are making them out to be. The transfer station nearest Seoul's most recent cluster (discovered 7 days ago) gets about 25% more annual traffic than King's Cross, according to Wikipedia (125,000 per day at Sindorim Station vs. 34 million at King's Cross annually). Despite the cluster having developed at the beginning of March, Seoul is finding fewer than 100 new patients per day. With masks, reduction in ridership, cancellation of meetings, extensive WFH, extensive testing and isolation measures, this epidemic is not as hopeless as the UK seems to be making it out to be.
      - willyt 7y ago
        I completely agree. I was shocked to hear that only people that present with symptoms that require hospital treatment are now being tested.
Silhouette 7y ago
That's the policy of Hong Kong, Taiwan, and Singapore, who are doing great. All of which have tiny populations compared to the UK. For larger nations, there simply aren't enough tests available, nor enough treatment facilities for those who are likely to become very sick if the virus spreads rapidly through the population.
- knzhou 7y ago
  > For larger nations, there simply aren't enough tests available Why? If your nation is twice as big, then all else equal, your government has twice as much money, twice as many resources, and hence twice as many tests. China now has more tests than they need and they're the 2nd most populous nation in the world.
  - Silhouette 7y ago
    No amount of money helps if there aren't enough tests available to buy. What is missing are manufacturing and distribution facilities, which of course are calibrated to the normal levels of work and not to a relatively sudden pandemic outbreak of one particular virus. China has huge resources but has managed so far to keep the infection mostly contained to one specific area. It's not clear how long they'll be able to sustain that or whether they'd have enough resources to go around if all of China were the same as Hubei. Of course all of this also assumes that tests are effective and that you can then do something useful if you confirm that a patient is indeed infected.
- AlchemistCamp 7y ago
  > All of which have tiny populations compared to the UK. Is 66 million really that qualitatively different than 24 million?
  - Silhouette 7y ago
    The honest answer is that I don't know. Perhaps I generalised too readily before, given Taiwan is quite a bit closer to the UK in population than the other two. Even so, assuming that strategies that appear to have been relatively successful in a smaller, more densely populated country will necessarily also work in a larger and less densely populated one seems to be dubious. We know that we don't have the resources we'd need to implement that strategy in the UK right now, and I haven't personally seen any experts arguing that it's a viable option for us, so I'm cautious about extrapolating too much here.
ksec 7y ago
There are quite a few difference. HK, Taiwan and Singapore all acted extremely early on, to the point where HK knew before the news broke out in China. And the culture allows you to wear mask, which seems to be something most western nation are completely against. Most part of Europe and UK reacted very late in the cycle. Since the Virus has an extremely long stable period before any symptoms appeared or to the point where you could be infected but showing no symptoms at all. It highly likely they are already in wide spread. 500 people each inflecting two, do that 11 times and we have 1 million infected. Then there is the death rate, at least so far it seems to be extremely mild for anyone below 50. Not saying I totally agree with Herd Immunity, but judging from the current data and situation it is possibly the best route to go.
- cactus2093 7y ago
  Isn’t that the whole point of a lockdown? After ~6-8 weeks you get the new infection rates down low enough that you basically reset the clock and have a second chance at responding like Hong Kong and keeping it in the containment phase. Then you have to keep that up for hopefully 9 months until a vaccine is available. It’s certainly not easy, but it seems possible and it’s not clear this would be much worse on the economy in the long run. Plus it saves half a million lives, so it seems like a moral imperative to at least try.
  - ksec 7y ago
    >Isn’t that the whole point of a lockdown? You will need a Lockdown AND Mask, or you will simply just need Mask and not even lockdown. I would argue social distancing only is not enough. But somehow even people in Italy refuse to wear mask. So I think a culture issue is also a problem there.
    - lukevdp 7y ago
      I don’t think masks are as effective as you think. WHO says only wear a mask: If you are healthy, you only need to wear a mask if you are taking care of a person with suspected 2019-nCoV infection. Wear a mask if you are coughing or sneezing. Masks are effective only when used in combination with frequent hand-cleaning with alcohol-based hand rub or soap and water. If you wear a mask, then you must know how to use it and dispose of it properly. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks https://www.who.int/emergencies/diseases/novel-coronavirus-2...
twic 7y ago
It's far too early to say whether they're doing great. Several months too early. Their lockdowns are preventing virus spread now, but at some point, the lockdowns will end, and then there is a vulnerable population waiting to be infected by a carrier coming from abroad. Will they be able to keep carriers out? Will they be able to respond to further outbreaks with more lockdowns indefinitely? Will there be a vaccine soon enough that they can protect everyone and then end the lockdowns before it all goes wrong? I don't know enough to say that the UK strategy is correct (i hope it is - i live here, and more importantly, so do my parents). But i think the situation isn't cut and dried. Hopefully, we will get a lot more detail in the next few days, and then the real experts can come to a consensus.
- hellotomyrars 7y ago
  I would rather have the spread stopped/slowed domestically with aggressive measures than to do little to nothing to stop the spread thinking it will somehow solve the problem. The UK approach here is basically just accepting that a majority of the population is going to get infected by design. That's fine. It might even be true. (It obviously will be if you don't do anything to stop it, but even in aggressive lockdowns I mean) But it benefits nobody to have it spread quicker. Maybe life in the UK gets back to normal a little faster for people who are not at-risk or aren't treated at risk but we live in a very global society and if everyone else is locked down then it's hard to see much benefit for the UK itself. And your parents and the portion of the population who are most vulnerable are more at risk. An imperfect defense is better than not even trying.
- thu2111 7y ago
  There won't ever be a consensus of experts. That whole concept is one I've really come to hate over the years. When it comes to decisions about what to do, versus the outcome of replicable experiments on nature in lab conditions, there is always disagreement and there always will be. The idea that any decision can be resolved by a bunch of scientists sitting in a committee beard stroking doesn't reflect how people really work. Amongst other problems, the term "expert" is ill defined (see discussion above about mathematicians) and there's always value in contrarianism for people who aren't directly making decisions. If they're wrong nobody will remember and there's nearly no reputational impact. If they're right, they can win fame and glory.

by knzhou 7y ago

simonh 7y ago

That’s a very good point, you’re quite right. However all three of those are relatively very small population centres with very easily controlled borders. Britain does have the advantage of being an island, but it has a large rural hinterland that the virus can ‘hide out’ in, and many dense population centres without borders, so it’s a completely different environment. Take London. We could introduce a system of tracking and isolation within the M25, and that might work to lock down community transmission within the London population, but millions of people flow into and out of London each week so it would be completely pointless and ineffective. Meanwhile that level of tracking and isolation simply can’t work across the whole British isles. It’s administratively and logistically impractical.

Marsymars 7y ago
> millions of people flow into and out of London each week so it would be completely pointless and ineffective Was curious about this point in particular - checked the numbers, and Heathrow has essentially equivalent traffic as Hong Kong International.
- dmurray 7y ago
  There are 5 other international airports that call themselves "London", not just Heathrow. And of course London also has road and train connections.
- simonh 7y ago
  I was mainly thinking about road and rail traffic into and out of the city, including daily commuters.
- willyt 7y ago
  The equivalent of the entire population of Glasgow passes through Kings Cross station in the morning rush hour. There are 4 other stations with similar flows. Over 20 million people live within an hour or 30 miles of Piccadilly Circus.
  - endogui 7y ago
    That level of population flow and population density are not as special as you are making them out to be. The transfer station nearest Seoul's most recent cluster (discovered 7 days ago) gets about 25% more annual traffic than King's Cross, according to Wikipedia (125,000 per day at Sindorim Station vs. 34 million at King's Cross annually). Despite the cluster having developed at the beginning of March, Seoul is finding fewer than 100 new patients per day. With masks, reduction in ridership, cancellation of meetings, extensive WFH, extensive testing and isolation measures, this epidemic is not as hopeless as the UK seems to be making it out to be.
    - willyt 7y ago
      I completely agree. I was shocked to hear that only people that present with symptoms that require hospital treatment are now being tested.

Silhouette 7y ago

That's the policy of Hong Kong, Taiwan, and Singapore, who are doing great. All of which have tiny populations compared to the UK. For larger nations, there simply aren't enough tests available, nor enough treatment facilities for those who are likely to become very sick if the virus spreads rapidly through the population.

knzhou 7y ago
> For larger nations, there simply aren't enough tests available Why? If your nation is twice as big, then all else equal, your government has twice as much money, twice as many resources, and hence twice as many tests. China now has more tests than they need and they're the 2nd most populous nation in the world.
- Silhouette 7y ago
  No amount of money helps if there aren't enough tests available to buy. What is missing are manufacturing and distribution facilities, which of course are calibrated to the normal levels of work and not to a relatively sudden pandemic outbreak of one particular virus. China has huge resources but has managed so far to keep the infection mostly contained to one specific area. It's not clear how long they'll be able to sustain that or whether they'd have enough resources to go around if all of China were the same as Hubei. Of course all of this also assumes that tests are effective and that you can then do something useful if you confirm that a patient is indeed infected.
AlchemistCamp 7y ago
> All of which have tiny populations compared to the UK. Is 66 million really that qualitatively different than 24 million?
- Silhouette 7y ago
  The honest answer is that I don't know. Perhaps I generalised too readily before, given Taiwan is quite a bit closer to the UK in population than the other two. Even so, assuming that strategies that appear to have been relatively successful in a smaller, more densely populated country will necessarily also work in a larger and less densely populated one seems to be dubious. We know that we don't have the resources we'd need to implement that strategy in the UK right now, and I haven't personally seen any experts arguing that it's a viable option for us, so I'm cautious about extrapolating too much here.

ksec 7y ago

There are quite a few difference. HK, Taiwan and Singapore all acted extremely early on, to the point where HK knew before the news broke out in China. And the culture allows you to wear mask, which seems to be something most western nation are completely against. Most part of Europe and UK reacted very late in the cycle. Since the Virus has an extremely long stable period before any symptoms appeared or to the point where you could be infected but showing no symptoms at all. It highly likely they are already in wide spread. 500 people each inflecting two, do that 11 times and we have 1 million infected. Then there is the death rate, at least so far it seems to be extremely mild for anyone below 50. Not saying I totally agree with Herd Immunity, but judging from the current data and situation it is possibly the best route to go.

cactus2093 7y ago
Isn’t that the whole point of a lockdown? After ~6-8 weeks you get the new infection rates down low enough that you basically reset the clock and have a second chance at responding like Hong Kong and keeping it in the containment phase. Then you have to keep that up for hopefully 9 months until a vaccine is available. It’s certainly not easy, but it seems possible and it’s not clear this would be much worse on the economy in the long run. Plus it saves half a million lives, so it seems like a moral imperative to at least try.
- ksec 7y ago
  >Isn’t that the whole point of a lockdown? You will need a Lockdown AND Mask, or you will simply just need Mask and not even lockdown. I would argue social distancing only is not enough. But somehow even people in Italy refuse to wear mask. So I think a culture issue is also a problem there.
  - lukevdp 7y ago
    I don’t think masks are as effective as you think. WHO says only wear a mask: If you are healthy, you only need to wear a mask if you are taking care of a person with suspected 2019-nCoV infection. Wear a mask if you are coughing or sneezing. Masks are effective only when used in combination with frequent hand-cleaning with alcohol-based hand rub or soap and water. If you wear a mask, then you must know how to use it and dispose of it properly. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks https://www.who.int/emergencies/diseases/novel-coronavirus-2...

twic 7y ago

It's far too early to say whether they're doing great. Several months too early. Their lockdowns are preventing virus spread now, but at some point, the lockdowns will end, and then there is a vulnerable population waiting to be infected by a carrier coming from abroad. Will they be able to keep carriers out? Will they be able to respond to further outbreaks with more lockdowns indefinitely? Will there be a vaccine soon enough that they can protect everyone and then end the lockdowns before it all goes wrong? I don't know enough to say that the UK strategy is correct (i hope it is - i live here, and more importantly, so do my parents). But i think the situation isn't cut and dried. Hopefully, we will get a lot more detail in the next few days, and then the real experts can come to a consensus.

hellotomyrars 7y ago
I would rather have the spread stopped/slowed domestically with aggressive measures than to do little to nothing to stop the spread thinking it will somehow solve the problem. The UK approach here is basically just accepting that a majority of the population is going to get infected by design. That's fine. It might even be true. (It obviously will be if you don't do anything to stop it, but even in aggressive lockdowns I mean) But it benefits nobody to have it spread quicker. Maybe life in the UK gets back to normal a little faster for people who are not at-risk or aren't treated at risk but we live in a very global society and if everyone else is locked down then it's hard to see much benefit for the UK itself. And your parents and the portion of the population who are most vulnerable are more at risk. An imperfect defense is better than not even trying.
thu2111 7y ago
There won't ever be a consensus of experts. That whole concept is one I've really come to hate over the years. When it comes to decisions about what to do, versus the outcome of replicable experiments on nature in lab conditions, there is always disagreement and there always will be. The idea that any decision can be resolved by a bunch of scientists sitting in a committee beard stroking doesn't reflect how people really work. Amongst other problems, the term "expert" is ill defined (see discussion above about mathematicians) and there's always value in contrarianism for people who aren't directly making decisions. If they're wrong nobody will remember and there's nearly no reputational impact. If they're right, they can win fame and glory.