7 ms·

Two months seems like the minimum. The really hard problem is that even if you reduce spread to near zero, it’s almost guaranteed that cases will continue to sp

Two months seems like the minimum. The really hard problem is that even if you reduce spread to near zero, it’s almost guaranteed that cases will continue to spread among the essential workers who are still active during the lockdown. As long as that’s the case, the end of the lockdown will result in the cycle starting over. It seems to me that what we’re really doing with the lockdown is buying the time to “mobilize,” in the military sense, our healthcare system. If we had the testing capacity to test everyone and contain only the sick, this would be less serious. If we had 10x as many ventilators, and 100x as much protective equipment, this would be less dangerous. If we had an effective treatment (like a Tamiflu for Covid), then this would be less dangerous. Etc. It seems to me unlikely that we will be locked down less than 2-3 months. But after that, I doubt the public will be willing to endure another global lockdown of this magnitude. Thus I think everything we’re doing now is really about delaying the inevitable long enough for us to get a coherent response in place. To the extent that anyone is a “winner” in a pandemic, it certainly appears to be Taiwan and South Korea, who responded fast enough to the first wave to keep it from requiring an authoritarian response (or, at least thus far).

danieldk 7y ago
If we had 10x as many ventilators, and 100x as much protective equipment, this would be less dangerous. Only up to some point, then you run out of specialized personnel who know how to properly treat each patient (including controlling said ventilators). (Re-)training personnel probably takes months to years.
- SpicyLemonZest 7y ago
  The value of specialized personnel isn't as large as I think you're expecting. Most hospital care boils down to "put them in bed and deliver medication and food at the appropriate times", and patients who need more are likely to die no matter what care they get. It's tragic that some people will die who could have been saved with intensive specialized intervention - but once everyone can be intubated, there's probably no "overload threshold" where lots of people die when they would have otherwise left in good health.
  - adrianN 7y ago
    Most hospital care is not ICU care. There are special ICU nurses for a reason I assume.
  - ADefenestrator 7y ago
    It's not just intubation but varying other protocols for treating sepsis, ARDS, etc depending on the exact set of symptoms. Even the ventilator itself is far from "hook it up and leave it" - there has to be a careful and up-to-date balance between getting enough oxygen into the bloodstream and not damaging the lungs more than absolutely necessary. The people on a nasal cannula of oxygen probably only need limited skilled intervention and supervision, but once they're intubated it's pretty intensive.
roywiggins 7y ago
The worst part of this to me is that we could have used the time that China bought with their lockdown to mobilize ourselves. Instead, we didn't. Also, the US's lockdown seems liable to be more porous than China's.
- DataWorker 7y ago
  We had more important stuff going on like an impeachment, Democrat primaries and the Super Bowl. And our vaunted journalists were busy crushing rumors that the virus would spread beyond China, or be worse than the flu. Thanks to those compelling news pieces on xenophobia and how travel bans don’t work, how masks don’t work, how we should eat out in Chinatown to combat trump’s white nationalist agenda (pbs I’m looking at you) thanks to the media and their focus on how masks don’t work and how travel bans don’t work, thanks to all that we squandered the chance we had. We were too busy morning Kobe Bryant cause that’s what nbc told us was important.
- ericjang 7y ago
  Having this level of foresight and the guts to risk millions of unemployed workers for a "maybe scenario" is rare. If you were running the country, or were the governor of a coastal state like NY/CA, at what precise date would you have started ramping up ventilator&mask production? Would you have instituted a statewide lockdown when there were 1-2 cases in California? Would you be willing to trade certain unemployment and economic unproductivity for 2+ months, in exchange for the possibility that you might end up like Italy instead of Taiwan/South Korea? The last datapoint we had was SARS-Cov-1, which ended up not becoming a huge pandemic. Of course, the disease characteristics for SARS-Cov-2 are different, but without the benefit of hindsight, was the decision really that clear? Incompetent US administration aside, the financial markets - which can be thought of as an expensive forecasting computer - certainly did not price in what would happen, so I'm not sure we can expect policymakers to arrive at far-superior decision making. Considering that China is not completely out of the woods yet either, and the US/Italy lags about 1 month behind them in pandemic progression, how would you advise the US act now, with the knowledge of what China is doing?
  - 7y ago
CJefferson 7y ago
Actually, it's unclear how much benefit ventilators are -- https://www.npr.org/sections/health-shots/2020/04/02/826105278/ventilators-are-no-panacea-for-critically-ill-covid-19-patients https://www.npr.org/sections/health-shots/2020/04/02/8261052...
- biesnecker 7y ago
  In two if the three studies a third of the people who survived were able to come off ventilation. It’s not a panacea as the article says, but I suspect without ventilators the death rate would be more like 100%, and I’ll take my chances with 1/3 versus 0 any day.
  - swiley 7y ago
    I think I’d personally rather die than go through that but that’s just me.
    - asdfasgasdgasdg 7y ago
      You'd rather die than spend a week or two sedated on a ventilator? I don't feel the same.
    - roywiggins 7y ago
      That's not unreasonable. Being intubated, by all accounts, sucks. A lot. But it matters that you'd have the choice.
    - adrianN 7y ago
      Now is the time to put that in writing so that somebody else might get your ventilator.
      - swiley 7y ago
        Yup, it's in writing here.
avigront 7y ago
I'm skeptical that the public can endure a single 2-3 month lockdown to begin with. But a lot can change in 2 months, so it is far from certain the lockdown will last that long. For example - a treatment might be found which reduces the fatality rate, making it a less dangerous disease - widespread testing might show that a significant portion of the population already had it and were asymptomatic, thus we have herd immunity sooner than expected in places like New York and Spain/Italy - antibody testing might become mainstream, so if there was a certificate for people who have already gotten it, that subset of the population can return to a normal life. - the public support for the lockdown evaporates if it goes on for too long and unemployment skyrockets, so the government might move to a more moderate measure - e.g.: only lock down the people at risk, and let everyone else return to a normal life. - rapid and cheap tests because widespread, so perhaps you can just get tested before boarding a plane, or entering a shopping mall, etc.
- bambax 7y ago
  Sure, many positive developments may happen, but we should prepare for the likely possibility of not one of those things happening. What if we don't find a cure and a vaccine takes 3 years? Cheap, fast testing is almost there but I don't see how that actually helps... What do we do with people who didn't yet get the virus? Should they stay at home? Since they're a majority, it's not very different from the current situation. Or should they go out and "chance it"? Are you willing to do that in the absence of a cure?
  - SpicyLemonZest 7y ago
    Yes, I'm willing to do that in the absence of a cure. I wouldn't like, go to a packed stadium, but I'll happily invite friends over or eat at a restaurant once it's permitted again.
  - avigront 7y ago
    Simply put, yes - staying at home all day isn't living, it's just existing. And giving up 3 of the best years of my life isn't a price i'm willing to pay, even if there is no cure or vaccine.

danieldk 7y ago

If we had 10x as many ventilators, and 100x as much protective equipment, this would be less dangerous. Only up to some point, then you run out of specialized personnel who know how to properly treat each patient (including controlling said ventilators). (Re-)training personnel probably takes months to years.

SpicyLemonZest 7y ago
The value of specialized personnel isn't as large as I think you're expecting. Most hospital care boils down to "put them in bed and deliver medication and food at the appropriate times", and patients who need more are likely to die no matter what care they get. It's tragic that some people will die who could have been saved with intensive specialized intervention - but once everyone can be intubated, there's probably no "overload threshold" where lots of people die when they would have otherwise left in good health.
- adrianN 7y ago
  Most hospital care is not ICU care. There are special ICU nurses for a reason I assume.
- ADefenestrator 7y ago
  It's not just intubation but varying other protocols for treating sepsis, ARDS, etc depending on the exact set of symptoms. Even the ventilator itself is far from "hook it up and leave it" - there has to be a careful and up-to-date balance between getting enough oxygen into the bloodstream and not damaging the lungs more than absolutely necessary. The people on a nasal cannula of oxygen probably only need limited skilled intervention and supervision, but once they're intubated it's pretty intensive.

roywiggins 7y ago

The worst part of this to me is that we could have used the time that China bought with their lockdown to mobilize ourselves. Instead, we didn't. Also, the US's lockdown seems liable to be more porous than China's.

DataWorker 7y ago
We had more important stuff going on like an impeachment, Democrat primaries and the Super Bowl. And our vaunted journalists were busy crushing rumors that the virus would spread beyond China, or be worse than the flu. Thanks to those compelling news pieces on xenophobia and how travel bans don’t work, how masks don’t work, how we should eat out in Chinatown to combat trump’s white nationalist agenda (pbs I’m looking at you) thanks to the media and their focus on how masks don’t work and how travel bans don’t work, thanks to all that we squandered the chance we had. We were too busy morning Kobe Bryant cause that’s what nbc told us was important.
ericjang 7y ago
Having this level of foresight and the guts to risk millions of unemployed workers for a "maybe scenario" is rare. If you were running the country, or were the governor of a coastal state like NY/CA, at what precise date would you have started ramping up ventilator&mask production? Would you have instituted a statewide lockdown when there were 1-2 cases in California? Would you be willing to trade certain unemployment and economic unproductivity for 2+ months, in exchange for the possibility that you might end up like Italy instead of Taiwan/South Korea? The last datapoint we had was SARS-Cov-1, which ended up not becoming a huge pandemic. Of course, the disease characteristics for SARS-Cov-2 are different, but without the benefit of hindsight, was the decision really that clear? Incompetent US administration aside, the financial markets - which can be thought of as an expensive forecasting computer - certainly did not price in what would happen, so I'm not sure we can expect policymakers to arrive at far-superior decision making. Considering that China is not completely out of the woods yet either, and the US/Italy lags about 1 month behind them in pandemic progression, how would you advise the US act now, with the knowledge of what China is doing?
- 7y ago

CJefferson 7y ago

Actually, it's unclear how much benefit ventilators are -- https://www.npr.org/sections/health-shots/2020/04/02/826105278/ventilators-are-no-panacea-for-critically-ill-covid-19-patients https://www.npr.org/sections/health-shots/2020/04/02/8261052...

biesnecker 7y ago
In two if the three studies a third of the people who survived were able to come off ventilation. It’s not a panacea as the article says, but I suspect without ventilators the death rate would be more like 100%, and I’ll take my chances with 1/3 versus 0 any day.
- swiley 7y ago
  I think I’d personally rather die than go through that but that’s just me.
  - asdfasgasdgasdg 7y ago
    You'd rather die than spend a week or two sedated on a ventilator? I don't feel the same.
  - roywiggins 7y ago
    That's not unreasonable. Being intubated, by all accounts, sucks. A lot. But it matters that you'd have the choice.
  - adrianN 7y ago
    Now is the time to put that in writing so that somebody else might get your ventilator.
    - swiley 7y ago
      Yup, it's in writing here.

avigront 7y ago

I'm skeptical that the public can endure a single 2-3 month lockdown to begin with. But a lot can change in 2 months, so it is far from certain the lockdown will last that long. For example - a treatment might be found which reduces the fatality rate, making it a less dangerous disease - widespread testing might show that a significant portion of the population already had it and were asymptomatic, thus we have herd immunity sooner than expected in places like New York and Spain/Italy - antibody testing might become mainstream, so if there was a certificate for people who have already gotten it, that subset of the population can return to a normal life. - the public support for the lockdown evaporates if it goes on for too long and unemployment skyrockets, so the government might move to a more moderate measure - e.g.: only lock down the people at risk, and let everyone else return to a normal life. - rapid and cheap tests because widespread, so perhaps you can just get tested before boarding a plane, or entering a shopping mall, etc.

bambax 7y ago
Sure, many positive developments may happen, but we should prepare for the likely possibility of not one of those things happening. What if we don't find a cure and a vaccine takes 3 years? Cheap, fast testing is almost there but I don't see how that actually helps... What do we do with people who didn't yet get the virus? Should they stay at home? Since they're a majority, it's not very different from the current situation. Or should they go out and "chance it"? Are you willing to do that in the absence of a cure?
- SpicyLemonZest 7y ago
  Yes, I'm willing to do that in the absence of a cure. I wouldn't like, go to a packed stadium, but I'll happily invite friends over or eat at a restaurant once it's permitted again.
- avigront 7y ago
  Simply put, yes - staying at home all day isn't living, it's just existing. And giving up 3 of the best years of my life isn't a price i'm willing to pay, even if there is no cure or vaccine.