3 ms·

When did we switch from 'flattening the curve' to 'trying to keep anyone from getting sick'? I thought we were mostly all going to get it this year, but we did

When did we switch from 'flattening the curve' to 'trying to keep anyone from getting sick'? I thought we were mostly all going to get it this year, but we didn't want everyone getting it in a 1 month period?

paulmd 7y ago
Well, never, but we have 20 ventilators per 100k people, "flattening the curve" so strongly that we can treat everybody was always a bit of a pipe dream. You need to flatten the curve almost to zero to get to a "sustainable" level of disease. They are nearly the same goal. Any non-trivial level of disease that is not controlled will rapidly push you past the "flatten the curve" threshold. And we will certainly be here for longer than 2-3 weeks. It is a little white lie that is important to tell the public to help build compliance, the lower you can push it the fewer people will die, but hospitals simply are going to be overloaded regardless. The choice we can make is one between "very overwhelmed" and "overwhelmed to the point of non-functionality". "shelter for 12-18 months" is a little bit of an exaggeration but not much. Simulations suggest that after an initial harsh quarantine period (up to several months) to get transmission under control, we will need to shelter for about 2/3rds of the time (2 months on, 1 month off) for 12-18 months, and other measures for 100% of the time. The vaccine will be what finally terminates the situation. 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... Even then that may be optimistic (especially if the population is not fully compliant). Italy is not just working from home and social distancing, they are straight up quarantining everyone, and they still have overloaded hospitals and bodies piling up faster than they can cremate them. Presumably the quarantine will slow things down on the order of weeks to months, but right now things are brutal. https://vimeo.com/398334975 https://vimeo.com/398334975 https://mobile.twitter.com/foxmulder22791/status/1240454056419696641 https://mobile.twitter.com/foxmulder22791/status/12404540564... The Chinese strategy of requiring everyone to get a phone app, to track them via GPS, doing widespread testing and then quarantining the people who have been in contact appears to be a much more effective strategy than blind quarantine or social distancing. No app, no uber, no groceries, no public transit, etc. The US citizenry absolutely will not stand for the mark of the beast though. The Korean thing about masks and gloves probably helps too. Too bad the hospitals are down to about 11 days of masks let alone for the citizenry. I'm not trying to be a downer but if chloroquine works that's a really fucking big deal, because that would give us a fairly straightforward alternative to treat cases or even prophylactically treat vulnerable populations. Unless you have a tool in your toolbox we are mostly just moving the deck chairs here and choosing between "really bad" and "oh shit".
- notatoad 7y ago
  The Chinese have an app for this? Why aren't we using that? I'd happily be tracked 24/7, and I'm sure so would many many others, if it meant reducing the spread and getting back to some sense of normalcy a bit quicker.
  - paulmd 7y ago
    https://twitter.com/CarolYujiaYin/status/1239583581325778944 https://twitter.com/CarolYujiaYin/status/1239583581325778944 (deffo not propaganda /s) https://www.nytimes.com/2020/03/01/business/china-coronavirus-surveillance.html https://www.nytimes.com/2020/03/01/business/china-coronaviru... The other thing is that other countries like Iran and Israel are just pulling the data directly from Google Location Services or from telcom location data. I assume the US will probably follow at some point, since that data can be accessed without a warrant since it's third-party-controlled data.
- drstewart 7y ago
  Thinking the entire world will quarantine for 12-18 months is a pipe dream. That will never happen.
  - paulmd 7y ago
    US DHHS: "18 months or longer" https://int.nyt.com/data/documenthelper/6819-covid-19-response-plan/d367f758bec47cad361f/optimized/full.pdf#page=1 https://int.nyt.com/data/documenthelper/6819-covid-19-respon... UK government: "at least a year." https://news.sky.com/story/coronavirus-social-distancing-needs-to-be-in-place-for-most-of-a-year-say-government-advisers-11960920 https://news.sky.com/story/coronavirus-social-distancing-nee... Modelling: "2 months on 1 month off until a vaccine is developed". 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... /shrug It's unprecedented and I tend to agree with you that at some point the economic carnage is going to force alternatives, but right now that's the plan. Not the plan they're telling you publicly, but the real one they're planning for and reacting to. At the end of the day if that's the plan you'll go along with it because the men with guns will make you. As I've commented elsewhere, an approach using contact-tracing via app and GPS data, backed by widespread testing (millions per week) and small-scale isolation of affected, along the lines of China or South Korea, seems to be more effective. https://twitter.com/CarolYujiaYin/status/1239583581325778944 https://twitter.com/CarolYujiaYin/status/1239583581325778944 (deffo not propaganda /s) https://www.nytimes.com/2020/03/01/business/china-coronavirus-surveillance.html https://www.nytimes.com/2020/03/01/business/china-coronaviru... The US population is going to hate hate hate that one. But it's that or stay inside except for going to the grocery store for the next 12-18 months. If we don't choose option A, and we don't choose option B, we implicitly choose option C: 20% of our seniors die in a single year. Choosing not to choose is still making a choice. I believe there's a song about that.

paulmd 7y ago

Well, never, but we have 20 ventilators per 100k people, "flattening the curve" so strongly that we can treat everybody was always a bit of a pipe dream. You need to flatten the curve almost to zero to get to a "sustainable" level of disease. They are nearly the same goal. Any non-trivial level of disease that is not controlled will rapidly push you past the "flatten the curve" threshold. And we will certainly be here for longer than 2-3 weeks. It is a little white lie that is important to tell the public to help build compliance, the lower you can push it the fewer people will die, but hospitals simply are going to be overloaded regardless. The choice we can make is one between "very overwhelmed" and "overwhelmed to the point of non-functionality". "shelter for 12-18 months" is a little bit of an exaggeration but not much. Simulations suggest that after an initial harsh quarantine period (up to several months) to get transmission under control, we will need to shelter for about 2/3rds of the time (2 months on, 1 month off) for 12-18 months, and other measures for 100% of the time. The vaccine will be what finally terminates the situation. 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... Even then that may be optimistic (especially if the population is not fully compliant). Italy is not just working from home and social distancing, they are straight up quarantining everyone, and they still have overloaded hospitals and bodies piling up faster than they can cremate them. Presumably the quarantine will slow things down on the order of weeks to months, but right now things are brutal. https://vimeo.com/398334975 https://vimeo.com/398334975 https://mobile.twitter.com/foxmulder22791/status/1240454056419696641 https://mobile.twitter.com/foxmulder22791/status/12404540564... The Chinese strategy of requiring everyone to get a phone app, to track them via GPS, doing widespread testing and then quarantining the people who have been in contact appears to be a much more effective strategy than blind quarantine or social distancing. No app, no uber, no groceries, no public transit, etc. The US citizenry absolutely will not stand for the mark of the beast though. The Korean thing about masks and gloves probably helps too. Too bad the hospitals are down to about 11 days of masks let alone for the citizenry. I'm not trying to be a downer but if chloroquine works that's a really fucking big deal, because that would give us a fairly straightforward alternative to treat cases or even prophylactically treat vulnerable populations. Unless you have a tool in your toolbox we are mostly just moving the deck chairs here and choosing between "really bad" and "oh shit".

notatoad 7y ago
The Chinese have an app for this? Why aren't we using that? I'd happily be tracked 24/7, and I'm sure so would many many others, if it meant reducing the spread and getting back to some sense of normalcy a bit quicker.
- paulmd 7y ago
  https://twitter.com/CarolYujiaYin/status/1239583581325778944 https://twitter.com/CarolYujiaYin/status/1239583581325778944 (deffo not propaganda /s) https://www.nytimes.com/2020/03/01/business/china-coronavirus-surveillance.html https://www.nytimes.com/2020/03/01/business/china-coronaviru... The other thing is that other countries like Iran and Israel are just pulling the data directly from Google Location Services or from telcom location data. I assume the US will probably follow at some point, since that data can be accessed without a warrant since it's third-party-controlled data.
drstewart 7y ago
Thinking the entire world will quarantine for 12-18 months is a pipe dream. That will never happen.
- paulmd 7y ago
  US DHHS: "18 months or longer" https://int.nyt.com/data/documenthelper/6819-covid-19-response-plan/d367f758bec47cad361f/optimized/full.pdf#page=1 https://int.nyt.com/data/documenthelper/6819-covid-19-respon... UK government: "at least a year." https://news.sky.com/story/coronavirus-social-distancing-needs-to-be-in-place-for-most-of-a-year-say-government-advisers-11960920 https://news.sky.com/story/coronavirus-social-distancing-nee... Modelling: "2 months on 1 month off until a vaccine is developed". 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... /shrug It's unprecedented and I tend to agree with you that at some point the economic carnage is going to force alternatives, but right now that's the plan. Not the plan they're telling you publicly, but the real one they're planning for and reacting to. At the end of the day if that's the plan you'll go along with it because the men with guns will make you. As I've commented elsewhere, an approach using contact-tracing via app and GPS data, backed by widespread testing (millions per week) and small-scale isolation of affected, along the lines of China or South Korea, seems to be more effective. https://twitter.com/CarolYujiaYin/status/1239583581325778944 https://twitter.com/CarolYujiaYin/status/1239583581325778944 (deffo not propaganda /s) https://www.nytimes.com/2020/03/01/business/china-coronavirus-surveillance.html https://www.nytimes.com/2020/03/01/business/china-coronaviru... The US population is going to hate hate hate that one. But it's that or stay inside except for going to the grocery store for the next 12-18 months. If we don't choose option A, and we don't choose option B, we implicitly choose option C: 20% of our seniors die in a single year. Choosing not to choose is still making a choice. I believe there's a song about that.