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> The only way out for us unless we significantly ramp up testing and lockdown is to admit defeat and simply optimize for slowing down the onslaught. This has

> The only way out for us unless we significantly ramp up testing and lockdown is to admit defeat and simply optimize for slowing down the onslaught. This has already happened. “Flatten the curve” takes it as written that most people will be exposed to the virus, and thus aims instead to just spread those exposures over a long enough period to avoid overwhelming the health care system.

smoyer 7y ago
I saw a statistical analysis of the flatten the curve idea but assuming we couldn't ramp up the number of intensive care beds, it took 3600 days to fit everyone in under the "available health care" line. It's still a good strategy for right now because it gives us some extra time to ramp testing and healthcare up.
- dharmab 7y ago
  Presumably not everyone needs a hospital bed. Most are fine to take a few days of bed rest, many who would normally be hospitalized out of caution can be cared for by family at home with teledoc guidance, it's a small percentage at high risk who need hospital care.
  - smoyer 7y ago
    Yes ... it used the current percentage of those who get it and require hospital stays and those who need the IC along with the average number of days that they stay. Unfortunately, 70% of our capacity was full before the Coronavirus arrived so there's simply not that much capacity.
  - bosie 7y ago
    a small percentage of a large number is still a large number. 80% infected within 1 year and ~10% of those require hospitalization. usa: 350m => 80% is 280M => ~30 million hospital/ICU beds for 2-4 weeks. this is on top of regular/ongoing hospitalisation. hence it hitting any african country or india with the same force would be devastating.
    - markhahn 7y ago
      much less than 10% require hospitalization, though.
      - bosie 7y ago
        the beauty of the equation is that you can fiddle with the numbers as much as you want, it will always lead to a collapse of the health care system
  - aqme28 7y ago
    About 10-20% of people need a hospital bed and we have concurrent beds for about a hundredth of that.
- DoofusOfDeath 7y ago
  How would that analysis change if we (optimistically) assume that in 2 years, we have a vaccine that's 90% effective? I would assume that under that scenario, the backlog would disappear shortly after the 2-year mark.
- phkahler 7y ago
  If it's drawn out slow enough, the spread should nearly stop without lockdown once 20-25 percent of the population has recovered. Assuming prior infection offers immunity of course.
  - fuckknows 7y ago
    I think it's a pretty safe prior to have that our immune system will work effectively against this virus post exposure. This isn't the first time a virus has crossed the species barrier in all of our evolutionary history and we've survived so far.
    - shock 7y ago
      I don't know we can count on that at this stage: https://thehill.com/changing-america/well-being/prevention-cures/484942-japan-confirms-first-case-of-person-reinfected https://thehill.com/changing-america/well-being/prevention-c...
      - milanove 7y ago
        The article said the patient showed signs of recovery and then later on started showing signs of the virus again. I don't know if that means they conducted an exit test to confirm that she was negative for coronavirus after her first bout with it. Maybe it died down in her system, but wasn't completely gone when she was deemed healthy again and later on it flared up again for some reason.
        shock 7y ago
        There's another man who tested negative and then again got symptoms and tested positive again: https://www3.nhk.or.jp/nhkworld/en/news/20200315_13/ https://www3.nhk.or.jp/nhkworld/en/news/20200315_13/
  - Engineering-MD 7y ago
    Why do you get 25%? I thought it largely depended on the R0 value
- tonystubblebine 7y ago
  Was this the article you were reading with the 3600 days analysis? I just read it. Not sure what to make of it yet. https://medium.com/@joschabach/flattening-the-curve-is-a-deadly-delusion-eea324fe9727 https://medium.com/@joschabach/flattening-the-curve-is-a-dea...
  - makomk 7y ago
    The "Containment works" part seems questionable. In particular, South Korea almost certainly wasn't "tracking its first 30 cases very well, until patient 31 infected over 1000 others on a church congregation". Patient 31 didn't have any known source of exposure - she hadn't travelled abroad or had any contact with known cases, didn't even meet South Korea's criteria for testing, the most likely place she got Covid-19 is from the congregation. There was an entire thousand-person cluster that had slipped through the net and only got spotted because one person happened to get in a car accident and the doctors tested her on a hunch despite not meeting their testing criteria. If things had gone slightly differently, it's entirely possible that we'd be pointing at Italy as an example of successful containment that South Korea should have followed. They tested and contact-traced and thought they were doing quite well for the first 30 or so cases too, but reality hit them once it was far too late to do anything.
    - roenxi 7y ago
      A very important part of the public discourse is how many tests can conducted and at what cost. For something with a long incubation period and potentially mild symptoms (ie, infected might not go to a hospital) only widespread statistical sampling will give a reliable picture of what is happening. When I heard countries talking about 'testing criteria' that involved travel - I think this was in mid/late February - it seemed inevitable that things were going to drift out of control. There was no way that would pick up the mild inbound cases that could spread to become clusters. It probably developed that way because actual monitoring programs were infeasible but it'd be nice to know.
    - JamesBarney 7y ago
      Many countries seemed to operate with the assumption community spread wasn't happening. And due to this assumption didn't test for community spread.
- samatman 7y ago
  The more optimistic way of looking at this is: the 'flatten the curve' scenario has to get so close to R0 < 1, that we may as well put in a bit of extra effort to actually get R0 < 1, like China did. At which point the virus will start to isolate in pools and eventually be extinguished. This is difficult, not impossible. We'll see what actually happens.
  - neuronic 7y ago
    Looking at the people happily strolling around and gathering in public cafes as if nothing was going on, I severely doubt it. (large city in Germany btw)
    - asdfasgasdgasdg 7y ago
      They will get with the program once one or two people they know die.
    - Touche 7y ago
      Those Darwin award winners will be the first to get it.
      - throwaway894345 7y ago
        They’ll be the first, but almost all of them will be fine. They’ll just pass it onto the elderly, cancer patients, etc who won’t be fine. No Darwinian justice here, I’m afraid.
        mathdev 7y ago
        Of course there is.
      - lainga 7y ago
        How does that work? Killing the elderly reduces the support network available to rear your children, and so reduces your ability to sustain your genes?
- jopsen 7y ago
  We'll have vaccine within the 3600 days -- I hope :)
- netsharc 7y ago
  Yeah, I noticed the flatten the curve graphs have a horizontal line about "available beds". It probably also represents available healthcare workers, equipment, etc. Surely this line can be made to move. E.g. when China sent a plane with doctors and equipment to Italy. Or simpler, find suitable buildings and make hospitals out of them (easier said than done, obviously).
  - rtkwe 7y ago
    The issue is the people who need to be hospitalized in the worst cases go on to require ventilation to force air into their lungs and those machines have a limited supply. On top of that people on ventilation require pretty close observation so you need about 3:1 patient to nurse ratio. Those are the numbers that are hardest to increase rapidly, nurses and ventilator equipment.
    - jodrellblank 7y ago
      I heard a radio program about the life of a UK (I think) surgeon who worked in war zones and crisis regions like Syria, and one thing he found in a hospital was an intensive care unit staffed mostly by Skype cameras to a hospital in Washington, so the very few nurses on site could be directed to the patients most in need, and the remote nurses could watch the vital signs of many patients without having to spend time walking around. If that was long enough ago to become part of a biography, it must be even more possible these days to get cameras and connectivity to remote hospitals anywhere on Earth with spare capacity of nurses.
      - rtkwe 7y ago
        That would allow you to move capacity around. Not sure if intubated patients could be monitored remotely though I'm just not sure if they only need vitals monitoring or if they require a present person doing something there. That is a neat thing though I didn't know about. Wonder if hospital networks could handle the feeds properly, getting the equipment setup would take a bit but it should all be doable with consumer grade stuff.
  - 7y ago
- rtkwe 7y ago
  The actual required time is probably much lower than that. Not everyone who gets the virus needs critical care so what we have to do is keep those numbers below the healthcare capacity line.
simonh 7y ago
The UK government is revising its plan. A new simulation estimates that if we allow enough transmission to achieve herd immunity, it would cost about 260,000 lives. That’s not acceptable and would massively overwhelm health services. So it looks like we’re going to go for a strict lockdown strategy, but the problem with that is without a vaccine there’s no way out. If you relax the lockdown, you just get another outbreak. The best you can do is dynamic lockdowns per city or region.
- lozenge 7y ago
  If anybody is interested - report 9 here https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/news--wuhan-coronavirus/ https://www.imperial.ac.uk/mrc-global-infectious-disease-ana...
agumonkey 7y ago
a globalized MOOC on over-capacitated system DDoS

smoyer 7y ago

I saw a statistical analysis of the flatten the curve idea but assuming we couldn't ramp up the number of intensive care beds, it took 3600 days to fit everyone in under the "available health care" line. It's still a good strategy for right now because it gives us some extra time to ramp testing and healthcare up.

dharmab 7y ago
Presumably not everyone needs a hospital bed. Most are fine to take a few days of bed rest, many who would normally be hospitalized out of caution can be cared for by family at home with teledoc guidance, it's a small percentage at high risk who need hospital care.
- smoyer 7y ago
  Yes ... it used the current percentage of those who get it and require hospital stays and those who need the IC along with the average number of days that they stay. Unfortunately, 70% of our capacity was full before the Coronavirus arrived so there's simply not that much capacity.
- bosie 7y ago
  a small percentage of a large number is still a large number. 80% infected within 1 year and ~10% of those require hospitalization. usa: 350m => 80% is 280M => ~30 million hospital/ICU beds for 2-4 weeks. this is on top of regular/ongoing hospitalisation. hence it hitting any african country or india with the same force would be devastating.
  - markhahn 7y ago
    much less than 10% require hospitalization, though.
    - bosie 7y ago
      the beauty of the equation is that you can fiddle with the numbers as much as you want, it will always lead to a collapse of the health care system
- aqme28 7y ago
  About 10-20% of people need a hospital bed and we have concurrent beds for about a hundredth of that.
DoofusOfDeath 7y ago
How would that analysis change if we (optimistically) assume that in 2 years, we have a vaccine that's 90% effective? I would assume that under that scenario, the backlog would disappear shortly after the 2-year mark.
phkahler 7y ago
If it's drawn out slow enough, the spread should nearly stop without lockdown once 20-25 percent of the population has recovered. Assuming prior infection offers immunity of course.
- fuckknows 7y ago
  I think it's a pretty safe prior to have that our immune system will work effectively against this virus post exposure. This isn't the first time a virus has crossed the species barrier in all of our evolutionary history and we've survived so far.
  - shock 7y ago
    I don't know we can count on that at this stage: https://thehill.com/changing-america/well-being/prevention-cures/484942-japan-confirms-first-case-of-person-reinfected https://thehill.com/changing-america/well-being/prevention-c...
    - milanove 7y ago
      The article said the patient showed signs of recovery and then later on started showing signs of the virus again. I don't know if that means they conducted an exit test to confirm that she was negative for coronavirus after her first bout with it. Maybe it died down in her system, but wasn't completely gone when she was deemed healthy again and later on it flared up again for some reason.
      - shock 7y ago
        There's another man who tested negative and then again got symptoms and tested positive again: https://www3.nhk.or.jp/nhkworld/en/news/20200315_13/ https://www3.nhk.or.jp/nhkworld/en/news/20200315_13/
- Engineering-MD 7y ago
  Why do you get 25%? I thought it largely depended on the R0 value
tonystubblebine 7y ago
Was this the article you were reading with the 3600 days analysis? I just read it. Not sure what to make of it yet. https://medium.com/@joschabach/flattening-the-curve-is-a-deadly-delusion-eea324fe9727 https://medium.com/@joschabach/flattening-the-curve-is-a-dea...
- makomk 7y ago
  The "Containment works" part seems questionable. In particular, South Korea almost certainly wasn't "tracking its first 30 cases very well, until patient 31 infected over 1000 others on a church congregation". Patient 31 didn't have any known source of exposure - she hadn't travelled abroad or had any contact with known cases, didn't even meet South Korea's criteria for testing, the most likely place she got Covid-19 is from the congregation. There was an entire thousand-person cluster that had slipped through the net and only got spotted because one person happened to get in a car accident and the doctors tested her on a hunch despite not meeting their testing criteria. If things had gone slightly differently, it's entirely possible that we'd be pointing at Italy as an example of successful containment that South Korea should have followed. They tested and contact-traced and thought they were doing quite well for the first 30 or so cases too, but reality hit them once it was far too late to do anything.
  - roenxi 7y ago
    A very important part of the public discourse is how many tests can conducted and at what cost. For something with a long incubation period and potentially mild symptoms (ie, infected might not go to a hospital) only widespread statistical sampling will give a reliable picture of what is happening. When I heard countries talking about 'testing criteria' that involved travel - I think this was in mid/late February - it seemed inevitable that things were going to drift out of control. There was no way that would pick up the mild inbound cases that could spread to become clusters. It probably developed that way because actual monitoring programs were infeasible but it'd be nice to know.
  - JamesBarney 7y ago
    Many countries seemed to operate with the assumption community spread wasn't happening. And due to this assumption didn't test for community spread.
samatman 7y ago
The more optimistic way of looking at this is: the 'flatten the curve' scenario has to get so close to R0 < 1, that we may as well put in a bit of extra effort to actually get R0 < 1, like China did. At which point the virus will start to isolate in pools and eventually be extinguished. This is difficult, not impossible. We'll see what actually happens.
- neuronic 7y ago
  Looking at the people happily strolling around and gathering in public cafes as if nothing was going on, I severely doubt it. (large city in Germany btw)
  - asdfasgasdgasdg 7y ago
    They will get with the program once one or two people they know die.
  - Touche 7y ago
    Those Darwin award winners will be the first to get it.
    - throwaway894345 7y ago
      They’ll be the first, but almost all of them will be fine. They’ll just pass it onto the elderly, cancer patients, etc who won’t be fine. No Darwinian justice here, I’m afraid.
      - mathdev 7y ago
        Of course there is.
    - lainga 7y ago
      How does that work? Killing the elderly reduces the support network available to rear your children, and so reduces your ability to sustain your genes?
jopsen 7y ago
We'll have vaccine within the 3600 days -- I hope :)
netsharc 7y ago
Yeah, I noticed the flatten the curve graphs have a horizontal line about "available beds". It probably also represents available healthcare workers, equipment, etc. Surely this line can be made to move. E.g. when China sent a plane with doctors and equipment to Italy. Or simpler, find suitable buildings and make hospitals out of them (easier said than done, obviously).
- rtkwe 7y ago
  The issue is the people who need to be hospitalized in the worst cases go on to require ventilation to force air into their lungs and those machines have a limited supply. On top of that people on ventilation require pretty close observation so you need about 3:1 patient to nurse ratio. Those are the numbers that are hardest to increase rapidly, nurses and ventilator equipment.
  - jodrellblank 7y ago
    I heard a radio program about the life of a UK (I think) surgeon who worked in war zones and crisis regions like Syria, and one thing he found in a hospital was an intensive care unit staffed mostly by Skype cameras to a hospital in Washington, so the very few nurses on site could be directed to the patients most in need, and the remote nurses could watch the vital signs of many patients without having to spend time walking around. If that was long enough ago to become part of a biography, it must be even more possible these days to get cameras and connectivity to remote hospitals anywhere on Earth with spare capacity of nurses.
    - rtkwe 7y ago
      That would allow you to move capacity around. Not sure if intubated patients could be monitored remotely though I'm just not sure if they only need vitals monitoring or if they require a present person doing something there. That is a neat thing though I didn't know about. Wonder if hospital networks could handle the feeds properly, getting the equipment setup would take a bit but it should all be doable with consumer grade stuff.
- 7y ago
rtkwe 7y ago
The actual required time is probably much lower than that. Not everyone who gets the virus needs critical care so what we have to do is keep those numbers below the healthcare capacity line.

simonh 7y ago

The UK government is revising its plan. A new simulation estimates that if we allow enough transmission to achieve herd immunity, it would cost about 260,000 lives. That’s not acceptable and would massively overwhelm health services. So it looks like we’re going to go for a strict lockdown strategy, but the problem with that is without a vaccine there’s no way out. If you relax the lockdown, you just get another outbreak. The best you can do is dynamic lockdowns per city or region.

lozenge 7y ago
If anybody is interested - report 9 here https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/news--wuhan-coronavirus/ https://www.imperial.ac.uk/mrc-global-infectious-disease-ana...

agumonkey 7y ago

a globalized MOOC on over-capacitated system DDoS