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Really interesting to watch the evolution of the advice on Behavioural and Social interventions. It is absolutely clear from this that the idea of "flattening t

Really interesting to watch the evolution of the advice on Behavioural and Social interventions. It is absolutely clear from this that the idea of "flattening the curve" rather than completely suppressing an outbreak was being seriously considered until very recently. Luckily, this is not something being pursued anymore and they moved away from it in time but you can certainly understand the attraction when you consider the consequences of the almost total shutdown required to suppress.

deleted 7y ago
[deleted]
JoeAltmaier 7y ago
Flattening is still important at first - gives time to respond, to improve treatment and response plans.
whatshisface 7y ago
>Luckily, this is not something being pursued anymore and they moved away from it in time but you can certainly understand the attraction when you consider the consequences of the almost total shutdown required to suppress. Imperial suggested a very interesting approach, turning the measures on and off as the cases rose above and fell below a couple thresholds. You can't hit R0=1.0 exactly, but you can swap between 3.0 and 0.3 as conditions change. This would allow businesses to have a chance of survival.
- kahnjw 7y ago
  From all appearances this is more or less what China is doing today. Lockdown until the number of new cases in a geographic area is zero, then slowly loosen the grip of suppression and calibrate based on new information. When the second wave starts I'm sure the response will be a little more measured this time.
tpfour 7y ago
Quoting one of their sources: It is a political decision to consider whether it is preferable to enact stricter measures at first, lifting them gradually as required, or to start with fewer measures and add further measures if required. It's not a scientific question in the sense that there _is_ a consensus that methods to "flatten the curve" will reduce the load on the healthcare system, which can easily be overloaded well before the peak. It is also clear that solid scientific data will come only _weeks_ after widespread contagion. What's not clear is how to handle this _politically_, i.e which decisions to make confronted with large uncertainty and relatively short timeframes. This is mainly what Trudeau was criticized for. Sure he might be very well advised by top scientists, but he did not seem particularly interested in solving the issue _politically_. It took a few weeks before he (at least publicly) exhibited any serious interest, and then we went from 0 to 100 over a weekend. The political response to this situation will and has to preface any solid scientific understanding.
- aldoushuxley001 7y ago
  Incidentally the same weekend that Trudeau started caring (last weekend) was just after his wife tested positive.
haunter 7y ago
> It is absolutely clear from this that the idea of "flattening the curve" rather than completely suppressing an outbreak was being seriously considered until very recently Wait I'm out of the loop. The #FlattenTheCurve campaign is already wrong?
- balfirevic 7y ago
  The report from Imperial College [0] indicates that it may be impossible to flatten it enough for it not to overwhelm medical care capacity. It wasn't (and still isn't) wrong to try to flatten it - it's what gives time to investigate the appropriate course of action. But unfortunately it seems like flattening won't be enough and more extreme measures (called "suppression" in the report, whereas flattening strategy is called "mitigation") need to be taken. The report also notes that such extreme measures have never been taken on the timescale they anticipate to be required to successfully suppress the disease (basically until the cure or vaccine is found and widely distributed - at least 18 month and possibly years), so we have no idea how that will turn out. [0] - https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf https://www.imperial.ac.uk/media/imperial-college/medicine/s...
- Mvandenbergh 7y ago
  It's not wrong, necessarily, the issue is that ICU admission rates even in young people are high enough that you need to flatten the curve an incredible amount in order not to overwhelm ICU capacity. (They're not high in absolute terms, but an arithmetically small change in a small number can have massive effects)

deleted 7y ago

[deleted]

JoeAltmaier 7y ago

Flattening is still important at first - gives time to respond, to improve treatment and response plans.

whatshisface 7y ago

>Luckily, this is not something being pursued anymore and they moved away from it in time but you can certainly understand the attraction when you consider the consequences of the almost total shutdown required to suppress. Imperial suggested a very interesting approach, turning the measures on and off as the cases rose above and fell below a couple thresholds. You can't hit R0=1.0 exactly, but you can swap between 3.0 and 0.3 as conditions change. This would allow businesses to have a chance of survival.

kahnjw 7y ago
From all appearances this is more or less what China is doing today. Lockdown until the number of new cases in a geographic area is zero, then slowly loosen the grip of suppression and calibrate based on new information. When the second wave starts I'm sure the response will be a little more measured this time.

tpfour 7y ago

Quoting one of their sources: It is a political decision to consider whether it is preferable to enact stricter measures at first, lifting them gradually as required, or to start with fewer measures and add further measures if required. It's not a scientific question in the sense that there _is_ a consensus that methods to "flatten the curve" will reduce the load on the healthcare system, which can easily be overloaded well before the peak. It is also clear that solid scientific data will come only _weeks_ after widespread contagion. What's not clear is how to handle this _politically_, i.e which decisions to make confronted with large uncertainty and relatively short timeframes. This is mainly what Trudeau was criticized for. Sure he might be very well advised by top scientists, but he did not seem particularly interested in solving the issue _politically_. It took a few weeks before he (at least publicly) exhibited any serious interest, and then we went from 0 to 100 over a weekend. The political response to this situation will and has to preface any solid scientific understanding.

aldoushuxley001 7y ago
Incidentally the same weekend that Trudeau started caring (last weekend) was just after his wife tested positive.

haunter 7y ago

> It is absolutely clear from this that the idea of "flattening the curve" rather than completely suppressing an outbreak was being seriously considered until very recently Wait I'm out of the loop. The #FlattenTheCurve campaign is already wrong?

balfirevic 7y ago
The report from Imperial College [0] indicates that it may be impossible to flatten it enough for it not to overwhelm medical care capacity. It wasn't (and still isn't) wrong to try to flatten it - it's what gives time to investigate the appropriate course of action. But unfortunately it seems like flattening won't be enough and more extreme measures (called "suppression" in the report, whereas flattening strategy is called "mitigation") need to be taken. The report also notes that such extreme measures have never been taken on the timescale they anticipate to be required to successfully suppress the disease (basically until the cure or vaccine is found and widely distributed - at least 18 month and possibly years), so we have no idea how that will turn out. [0] - https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf https://www.imperial.ac.uk/media/imperial-college/medicine/s...
Mvandenbergh 7y ago
It's not wrong, necessarily, the issue is that ICU admission rates even in young people are high enough that you need to flatten the curve an incredible amount in order not to overwhelm ICU capacity. (They're not high in absolute terms, but an arithmetically small change in a small number can have massive effects)