10 ms·

I'm tired of the "shutdown everything" acting like the underpants gnomes. Gates argues for a 10 week or more shutdown and then says we are ~18 months from a va

by treis 7y ago

I'm tired of the "shutdown everything" acting like the underpants gnomes. Gates argues for a 10 week or more shutdown and then says we are ~18 months from a vaccine. If we are 18 months from the definitive solution shutting down for 10 weeks doesn't solve much. Sure, it might knock the infection load back down to what it was in late January. But then 2-3 months later we will be right back where we are now. What's the plan then? Another 10+ week shut down? Covid-19 is with us for the foreseeable future and we have to figure out how to live a normal life with it. The effort should be focused on getting us to that place. Ubiquitous masks, temperature checks at public places like work, stores, etc. and a culture shift to stay home when you're sick.

dragontamer 7y ago
> I'm tired of the "shutdown everything" acting like the underpants gnomes. Gates argues for a 10 week or more shutdown and then says we are ~18 months from a vaccine. If we are 18 months from the definitive solution shutting down for 10 weeks doesn't solve much. We're a few weeks away from mass-testing in the USA. By shutting down for a few weeks, we will at least give time for test-kit manufacturers to mass produce test kits and get our health-policy experts ahead of the curve on this. For now, the US has the steepest exponential rise in the world and some of the fewest test-kits per capita. It seems like our citizens are not taking the lockdown seriously, and the disease continues to spread far faster than it really should be. ---------- This isn't about "winning against the disease" anymore. Its about stalling for time so that our nurses have enough N95 masks to be safe while treating people again. We're out of supplies. The nationwide stockpile of masks is depleted. Hospitals are running out of equipment. Stalling for a few weeks will help significantly.
- treis 7y ago
  >We're a few weeks away from mass-testing in the USA. Mass-testing isn't a panacea and is only one piece of the puzzle. We can be implementing the other pieces while our testing capability continues to ramp up. >This isn't about "winning against the disease" anymore. Its about stalling for time so that our nurses have enough N95 masks to be safe while treating people again. Barring some manufacturing miracle we won't have enough disposable N95 masks for a long time. There are plenty of reusable N95 or better masks stockpiled around the country to provide one to every health care worker. We just haven't made a national decision to do that. >We're out of supplies. The nationwide stockpile of masks is depleted. Hospitals are running out of equipment. Stalling for a few weeks will help significantly. It's wishful thinking that a few weeks are going to change anything. We will have pretty much the same tools that we do now to fight the disease. The change that is needed is to make use of what we have.
  - dragontamer 7y ago
    > It's wishful thinking that a few weeks are going to change anything When we have mass testing in a few weeks, things will be better. This isn't about "panacea", its about buying time so that our statistics can become more effective. We all know that our testing regime is buckling under the current load. No one trusts the numbers, aside from being a clear and gross underestimation of the overall COVID19 problem. At a minimum, in a few weeks when mass testing is available, we'll have better COVID19 numbers to make decisions off of. --------- We're clearly in a situation where there is more infected people than test kits! Doctors / hospitals are rationing the very few test kits they got and only testing people who they think already are infected AND are at high risk. Under these circumstances, our statistics and decision making framework is almost entirely guesswork. Yes, a few weeks will buy us important time. Important time where we can actually gather proper data (through proper testing). The most immediate goal for policy makers is to slow down the disease to the point where our statistics / data-gathering can catch up to reality. That way we stop relying upon guesswork.
tinyhouse 7y ago
Your last paragraph is correct. I think that's what Gates is advocating for as well. But it's hard to implement when hospitals are overwhelmed. He's proposing one serious shutdown to calm things down before we gradually go back to normal life.
- treis 7y ago
  Hospitals in the country aren't overwhelmed. The majority of them are seeing lower than normal patient counts as they've canceled elective procedures and people are avoiding the hospital because of Covid. Only a handful of hotspots like NYC, NO, and Seattle are being significantly impacted. >He's proposing one serious shutdown to calm things down before we gradually go back to normal life. The point is we can't go back to "normal life". Going back to normal life gets us back to where we are now 2-3 months after the lock down ends. We have to get to a new normal that will stop the spread.
  - tinyhouse 7y ago
    That's what I meant about gradually moving to normal life. As for hospitals, many are not overwhelmed yet! Based on projections we're not yet at peak hospital resource use at any state. I live in MA where hospitals are still OK. But projections say we will be at peak in 2 weeks and unless the state does something about it (which they do) we will have a serious shortage of beds and equipment. So a serious shutdown for let's say another ~3 weeks should help us passing the peak without major problems.
coldcode 7y ago
Eventually everyone either (1) gets it and has none or mild symptoms, or (2) gets it and requires hospitalization if available and then either recovers or dies, until (3) there is a working vaccine available in quantity for those not yet infected. Dealing with (2) is the biggest issue and that requires masks, gloves and ventilators and universally available free testing. (3) will happen eventually but not right now. Social distancing helps with (2) until we have enough capacity to help them, which is the major problem. But you still have to have food to eat and a place to stay and that requires some measure of assistance, logistics and production and distribution still functioning. Once you can deal with (2) if everyone was careful (which isn't happening) you could function until (3) with some limitations.
DanBC 7y ago
> temperature checks at public places like work, People infected with covid-19 may not ever get a temperature. We've focussed heavily on that because it seems obvious, but it's possible that plenty of people spreading covid-19 have anosmia but no other symptoms. Some people will get temperature, but they can spread covid-19 before their temperature starts and after it's finished.
- treis 7y ago
  We don't need one method to stop all transmissions. Some will be stopped with a temperature check, some by masks, some by symptomatic people staying home, some by washing hands, etc. The goal is for all of those "somes" to add up to infected people, on average, transmitting it to fewer than 1 other person. That will lead to it eventually dying out.
dragonwriter 7y ago
> Gates argues for a 10 week or more shutdown and then says we are ~18 months from a vaccine. If we are 18 months from the definitive solution shutting down for 10 weeks doesn't solve much. It actually does. Theresa a trade-off between shutdown costs and other costs, and the other costs get worse the longer a continuous shutdown is, so the recommendation of pretty much every source I've seen, that treats this as “we need to get to effective vaccine/treatment before full return to normalcy” favors a 2-3 month general shutdown to flatten the curve followed by an extended period where local decisions about the degree of shutdown needed are made based on local capacity and caseload trends, which likely means on-again, off-again shutdown to a certain extent. The strategy is about preventing healthcare system overload while mitigating the adverse effects of extended total shutdown, until you've got vaccine or treatment deployed.

by treis 7y ago

dragontamer 7y ago

> I'm tired of the "shutdown everything" acting like the underpants gnomes. Gates argues for a 10 week or more shutdown and then says we are ~18 months from a vaccine. If we are 18 months from the definitive solution shutting down for 10 weeks doesn't solve much. We're a few weeks away from mass-testing in the USA. By shutting down for a few weeks, we will at least give time for test-kit manufacturers to mass produce test kits and get our health-policy experts ahead of the curve on this. For now, the US has the steepest exponential rise in the world and some of the fewest test-kits per capita. It seems like our citizens are not taking the lockdown seriously, and the disease continues to spread far faster than it really should be. ---------- This isn't about "winning against the disease" anymore. Its about stalling for time so that our nurses have enough N95 masks to be safe while treating people again. We're out of supplies. The nationwide stockpile of masks is depleted. Hospitals are running out of equipment. Stalling for a few weeks will help significantly.

treis 7y ago
>We're a few weeks away from mass-testing in the USA. Mass-testing isn't a panacea and is only one piece of the puzzle. We can be implementing the other pieces while our testing capability continues to ramp up. >This isn't about "winning against the disease" anymore. Its about stalling for time so that our nurses have enough N95 masks to be safe while treating people again. Barring some manufacturing miracle we won't have enough disposable N95 masks for a long time. There are plenty of reusable N95 or better masks stockpiled around the country to provide one to every health care worker. We just haven't made a national decision to do that. >We're out of supplies. The nationwide stockpile of masks is depleted. Hospitals are running out of equipment. Stalling for a few weeks will help significantly. It's wishful thinking that a few weeks are going to change anything. We will have pretty much the same tools that we do now to fight the disease. The change that is needed is to make use of what we have.
- dragontamer 7y ago
  > It's wishful thinking that a few weeks are going to change anything When we have mass testing in a few weeks, things will be better. This isn't about "panacea", its about buying time so that our statistics can become more effective. We all know that our testing regime is buckling under the current load. No one trusts the numbers, aside from being a clear and gross underestimation of the overall COVID19 problem. At a minimum, in a few weeks when mass testing is available, we'll have better COVID19 numbers to make decisions off of. --------- We're clearly in a situation where there is more infected people than test kits! Doctors / hospitals are rationing the very few test kits they got and only testing people who they think already are infected AND are at high risk. Under these circumstances, our statistics and decision making framework is almost entirely guesswork. Yes, a few weeks will buy us important time. Important time where we can actually gather proper data (through proper testing). The most immediate goal for policy makers is to slow down the disease to the point where our statistics / data-gathering can catch up to reality. That way we stop relying upon guesswork.

tinyhouse 7y ago

Your last paragraph is correct. I think that's what Gates is advocating for as well. But it's hard to implement when hospitals are overwhelmed. He's proposing one serious shutdown to calm things down before we gradually go back to normal life.

treis 7y ago
Hospitals in the country aren't overwhelmed. The majority of them are seeing lower than normal patient counts as they've canceled elective procedures and people are avoiding the hospital because of Covid. Only a handful of hotspots like NYC, NO, and Seattle are being significantly impacted. >He's proposing one serious shutdown to calm things down before we gradually go back to normal life. The point is we can't go back to "normal life". Going back to normal life gets us back to where we are now 2-3 months after the lock down ends. We have to get to a new normal that will stop the spread.
- tinyhouse 7y ago
  That's what I meant about gradually moving to normal life. As for hospitals, many are not overwhelmed yet! Based on projections we're not yet at peak hospital resource use at any state. I live in MA where hospitals are still OK. But projections say we will be at peak in 2 weeks and unless the state does something about it (which they do) we will have a serious shortage of beds and equipment. So a serious shutdown for let's say another ~3 weeks should help us passing the peak without major problems.

coldcode 7y ago

Eventually everyone either (1) gets it and has none or mild symptoms, or (2) gets it and requires hospitalization if available and then either recovers or dies, until (3) there is a working vaccine available in quantity for those not yet infected. Dealing with (2) is the biggest issue and that requires masks, gloves and ventilators and universally available free testing. (3) will happen eventually but not right now. Social distancing helps with (2) until we have enough capacity to help them, which is the major problem. But you still have to have food to eat and a place to stay and that requires some measure of assistance, logistics and production and distribution still functioning. Once you can deal with (2) if everyone was careful (which isn't happening) you could function until (3) with some limitations.

DanBC 7y ago

> temperature checks at public places like work, People infected with covid-19 may not ever get a temperature. We've focussed heavily on that because it seems obvious, but it's possible that plenty of people spreading covid-19 have anosmia but no other symptoms. Some people will get temperature, but they can spread covid-19 before their temperature starts and after it's finished.

treis 7y ago
We don't need one method to stop all transmissions. Some will be stopped with a temperature check, some by masks, some by symptomatic people staying home, some by washing hands, etc. The goal is for all of those "somes" to add up to infected people, on average, transmitting it to fewer than 1 other person. That will lead to it eventually dying out.

dragonwriter 7y ago

> Gates argues for a 10 week or more shutdown and then says we are ~18 months from a vaccine. If we are 18 months from the definitive solution shutting down for 10 weeks doesn't solve much. It actually does. Theresa a trade-off between shutdown costs and other costs, and the other costs get worse the longer a continuous shutdown is, so the recommendation of pretty much every source I've seen, that treats this as “we need to get to effective vaccine/treatment before full return to normalcy” favors a 2-3 month general shutdown to flatten the curve followed by an extended period where local decisions about the degree of shutdown needed are made based on local capacity and caseload trends, which likely means on-again, off-again shutdown to a certain extent. The strategy is about preventing healthcare system overload while mitigating the adverse effects of extended total shutdown, until you've got vaccine or treatment deployed.