5 ms·

I am stuck in my flat in Spain for the 5th week now. Just read they extended it another two, to 8 in total. I am wondering how other countries can be a bit more

by collyw 7y ago

I am stuck in my flat in Spain for the 5th week now. Just read they extended it another two, to 8 in total. I am wondering how other countries can be a bit more relaxed (UK and Belgium are allowed out for an our for exercise), or in the case of Sweeden a lot more relaxed, and are still managing to flatten their curves.

nradov 7y ago
This video has a good explanation of why the Spanish policy is ineffective. https://unherd.com/thepost/coming-up-epidemiologist-prof-johan-giesecke-shares-lessons-from-sweden/ https://unherd.com/thepost/coming-up-epidemiologist-prof-joh...
- WillPostForFood 7y ago
  Can you summarize or link to the time in the video where it is addressed?
  - raphlinus 7y ago
    I recommend watching the whole video, as it is by far the clearest argument in favor of the "herd immunity" approach I've seen. The problem with the approach is that it assumes several things that, shall we say, there is not yet evidence for. 1. The disease is relatively mild, certainly less than an order of magnitude more fatal than influenza. 2. It is possible to protect older people and other vulnerable populations while the disease spreads through most of the rest of society. 3. After people recover from the infection, there is lasting immunity. If these three things are true (and some other things that I'm not going to argue with, including that it will take a long time to get a vaccine), then herd immunity is a reasonable strategy. But let's look at each in turn. 1. The death rate in New York City is already 0.1% of the entire population. Even under very strict assumptions, that we're exactly at the peak of a totally symmetrical curve, and that herd immunity results in 50% of the population being infected, that results in a lower bound of the IFR at 0.4%. Lombardy gives similar results (0.12% of the population directly attributed to Covid-19) 2. Prof. Giesecke admitted that they failed to do so in Sweden. It is not clear how this could be done, as elderly people do not live in a bubble, but rather have lots of workers coming in and out of the facility to help take care of them. 3. SARS-CoV-2 is a new virus, and we just don't have the data yet. You can extrapolate from existing coronaviruses, which suggest that immunity will last at least a year for most people, but there are worrying signs (low antibody production, reports of reinfection that might or might not be testing artifacts). We just don't know. To me, it was a gamble, and we'll know before long whether it pays off. There were some things that bothered me about Prof. Giesecke, such as his dismissal of the experience of China ("it's a different world"), and other things that made a lot of sense. People who want to believe will be citing this video as authoritative support for their beliefs. If these assumptions turn out not to be consistent with evidence, then people will be citing this video as a case study in how smart people can get stuff horribly wrong.
    - jeltz 7y ago
      Yes, that is the main issue with our strategy in Sweden. We failed to keep it away from seniors' homes. The strategy seems to have worked just fine otherwise. It stopped our hospitals from getting overwhelmed, espcially since we managed to contain it in Stockholm for the most part. But we did not have resources to test people working with the elderly.
      - Tarsul 7y ago
        it's even worse than not testing enough in care homes: "Its advice to the care workers and nurses looking after older people such as Bondesson’s 69-year-old mother is that they should not wear protective masks or use other protective equipment unless they are dealing with a resident in the home they have reason to suspect is infected." https://www.theguardian.com/world/2020/apr/19/anger-in-sweden-as-elderly-pay-price-for-coronavirus-strategy https://www.theguardian.com/world/2020/apr/19/anger-in-swede... The responses in the US, UK and Sweden (and probably others) are downright criminal and should put politicians in jail.
    - jacobolus 7y ago
      Every one of the “reports of reinfection” I have seen was along the lines of: tested positive continuously for 2 weeks, then tested negative twice, then tested positive again a couple days later. There is no evidence in any of the cases I saw that the person was exposed to another infected person during that time period. This should not be called “reinfection” (even though there are a bunch of sloppy media headlines calling it that) but rather “poor test sensitivity during the last stages of the infection”.
      - collyw 7y ago
        There have been a lot of unreliable tests, here in Spain at least.
    - glandium 7y ago
      About 1. not even counting death, we don't know what the long term effects on the lung capacity of the people who recovered are. Also, everyone reports "80% of mild cases", with a definition of mild that includes things that reasonable people would definitely not call mild. Essentially, as long as doctors don't tell you you have to be on O2, you have a mild case. People with mild cases may well end up with damaged lungs.
  - nradov 7y ago
    The video is only 15 minutes long. You can just watch it in less time than it would take me to summarize.
- collyw 7y ago
  I didn't watch it, but a couple of the bullet points look pretty untrustworthy. Covid-19 is a “mild disease” and similar to the flu, and it was the novelty of the disease that scared people. It's a fair bit nastier, certainly in some cases, or the hospitals wouldn't be full. The actual fatality rate of Covid-19 is the region of 0.1% How can we be sure until we have widespread testing? At least 50% of the population of both the UK and Sweden will be shown to have already had the disease when mass antibody testing becomes available Again how can we be sure of this? It all seems very speculative.
  - SpicyLemonZest 7y ago
    We won't be sure of such statistics whether or not we have widespread testing. Even for pandemics in the past, we just don't know how many people caught them, not even a single significant digit. The best we can do is make reasoned guesses based on the available evidence.
    - collyw 7y ago
      That's why I am suspicious of the claims it makes.
  - quicklime 7y ago
    >> The actual fatality rate of Covid-19 is the region of 0.1% > How can we be sure until we have widespread testing? I think we can be sure that this is an incorrect number, with the data we have right now. At least 8448 people have died of COVID-19 in New York City, and if only 0.1% of the infected die, then we have 8,448,000 infected New Yorkers. This is the entire population of the city (including those who fled to other states) and would mean that we've reached herd immunity and can stop worrying about it now.
    - ahakki 7y ago
      https://www1.nyc.gov/site/doh/covid/covid-19-data.page https://www1.nyc.gov/site/doh/covid/covid-19-data.page shows a significant drop in caseload. There might be herd immunity effect if you assume a death rate of ~0.2%.
Hamuko 7y ago
Sweden has a pretty high number of COVID-19 deaths, so I'm not sure if I'd like to follow their model.
- collyw 7y ago
  It is expected that 70% of the population will get coronavirus then we will have herd immunity. The lock down is about stopping the healthcare systems getting overwhelmed (that will cause unnecessary deaths). That's the way I understand things. The same number of deaths will occur are likely to occur in the long term unless Sweden's ICU beds get full. If anyone has an alternative interpretation I am open to hearing it.
  - varjag 7y ago
    The eventual arrival of a vaccine may allow the states who are flattening the curve to have lower total amount of casualties.
    - lbeltrame 7y ago
      Or drugs to help the clinical management of the disease (which have a chance - not a certainty - to arrive earlier than a vaccine).
    - collyw 7y ago
      True, but it doesn't sound like it's going to happen any time soon. There was no vaccine for SARS.
      - varjag 7y ago
        SARS was contained relatively quickly however, while the countries doing the mitigation looking potentially into many months of flattening.
  - pnw_hazor 7y ago
    According to healthdata.org (IHME), Sweden has 79 ICU beds. If this is true, it seems that slowing the curve may not be worth it with so few ICU beds available. https://covid19.healthdata.org/sweden https://covid19.healthdata.org/sweden
dazc 7y ago
The original guidance in the UK was to limit exercise to one hour but the actual law doesn't have a time limit. From what I see, people are generally behaving responsibility regards social distancing and, I assume, this is just a gamble our Govt took? Without making sweeping generalisations also, it isn't so common for young adults to spend much time with parents/grandparents/older relatives. So, I reckon, that's one big risk factor that is less of an issue here?
- chippy 7y ago
  I dont think the guidance ever said an hour, in the UK. it did say once a day though. Other places have the hour rule. https://www.gov.uk/government/publications/full-guidance-on-staying-at-home-and-away-from-others/full-guidance-on-staying-at-home-and-away-from-others https://www.gov.uk/government/publications/full-guidance-on-... "one form of exercise a day"
  - makomk 7y ago
    Some reporter asked Matt Hancock how long was a reasonable length of exercise, and he suggested half an hour to an hour for most people - that's probably where it came from. It's not official guidance and certainly not a hard and fast rule anyway. From what I recall the once a day part is also only a guideline and not actually the law in most of the UK (except Wales).
rhino369 7y ago
There is no evidentiary basis for the extreme lock-down Spain is using. While this disease is pretty contagious, you are pretty unlikely to get it walking around outside or going for a run. Especially if everyone is wearing a mask. It's possible you could catch it by running through a cloud of an infected persons breath, but the risk is low enough that we shouldn't ban outside activities. The vast, vast majority of infections occur from sustained contact (>15min) within a few feet of someone.
- zzzcpan 7y ago
  This is an ancient understanding though, it ignores aerosol transmission. But you are still correct that outside is safe, there is absolutely no need to restrict it at all, it's confined poorly ventilated spaces that are a problem, like almost any building, cars, buses, planes, where the virus can concentrate in the air and close range contact isn't even needed, just breathing such air is bad enough. Wearing a mask is the only thing that helps to not get infected in such situations, but doesn't actually help much when infected people are wearing them, they still contaminate the air with aerosol.
  - jakub_g 7y ago
    Some studies suggest covid spreads more by droplets than aerosols. https://mobile.twitter.com/zeynep/status/1251556084424347649 https://mobile.twitter.com/zeynep/status/1251556084424347649
  - rhino369 7y ago
    There is no significant evidence that suggests aerosol transmission is a statistically significant source of transmission.
  - popcorncowboy 7y ago
    Except it doesn't spread by aerosol. https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations https://www.who.int/news-room/commentaries/detail/modes-of-t...
tachyonbeam 7y ago
If people are having less social interactions per day, on average, it will still slow down the spread compared to everyone behaving as before. There's a continuum between no measures taken and complete lockdown... I'm personally very much looking forward to being able to see friends.
nicoburns 7y ago
If people really stay apart from each other when exercising (anecdotally that does seem to mostly be the case here in the UK), then it's not really going to spread the virus in any meaningful way.
koyote 7y ago
This is something I have not seen discussed or explained anywhere: Spain has such a hard lockdown and yet even after 5 weeks there are still thousands of cases every day. How are so many new people getting infected? The same has been true in Italy.
- recoil 7y ago
  I've wondered this too. I can only assume it's because they send infected patients home, and they spread it to their families. That and hospitals & nursing homes, where infected staff may be spreading it between the patients/residents?
- ssijak 7y ago
  Household infections. Infected person in its infancy of the infection gets locked down with the familly and they get infected too. So you must go through all of that for the numbers to slow down and fall.
- greedo 7y ago
  It's extremely difficult to tell whether the number of cases are increasing, or if testing is revealing more cases. It sounds like a tautology, but unless you have a very strict, consistent testing rubric, the outcomes are hard to measure in terms of growth. At best you can determine total case count.

by collyw 7y ago

nradov 7y ago

This video has a good explanation of why the Spanish policy is ineffective. https://unherd.com/thepost/coming-up-epidemiologist-prof-johan-giesecke-shares-lessons-from-sweden/ https://unherd.com/thepost/coming-up-epidemiologist-prof-joh...

WillPostForFood 7y ago
Can you summarize or link to the time in the video where it is addressed?
- raphlinus 7y ago
  I recommend watching the whole video, as it is by far the clearest argument in favor of the "herd immunity" approach I've seen. The problem with the approach is that it assumes several things that, shall we say, there is not yet evidence for. 1. The disease is relatively mild, certainly less than an order of magnitude more fatal than influenza. 2. It is possible to protect older people and other vulnerable populations while the disease spreads through most of the rest of society. 3. After people recover from the infection, there is lasting immunity. If these three things are true (and some other things that I'm not going to argue with, including that it will take a long time to get a vaccine), then herd immunity is a reasonable strategy. But let's look at each in turn. 1. The death rate in New York City is already 0.1% of the entire population. Even under very strict assumptions, that we're exactly at the peak of a totally symmetrical curve, and that herd immunity results in 50% of the population being infected, that results in a lower bound of the IFR at 0.4%. Lombardy gives similar results (0.12% of the population directly attributed to Covid-19) 2. Prof. Giesecke admitted that they failed to do so in Sweden. It is not clear how this could be done, as elderly people do not live in a bubble, but rather have lots of workers coming in and out of the facility to help take care of them. 3. SARS-CoV-2 is a new virus, and we just don't have the data yet. You can extrapolate from existing coronaviruses, which suggest that immunity will last at least a year for most people, but there are worrying signs (low antibody production, reports of reinfection that might or might not be testing artifacts). We just don't know. To me, it was a gamble, and we'll know before long whether it pays off. There were some things that bothered me about Prof. Giesecke, such as his dismissal of the experience of China ("it's a different world"), and other things that made a lot of sense. People who want to believe will be citing this video as authoritative support for their beliefs. If these assumptions turn out not to be consistent with evidence, then people will be citing this video as a case study in how smart people can get stuff horribly wrong.
  - jeltz 7y ago
    Yes, that is the main issue with our strategy in Sweden. We failed to keep it away from seniors' homes. The strategy seems to have worked just fine otherwise. It stopped our hospitals from getting overwhelmed, espcially since we managed to contain it in Stockholm for the most part. But we did not have resources to test people working with the elderly.
    - Tarsul 7y ago
      it's even worse than not testing enough in care homes: "Its advice to the care workers and nurses looking after older people such as Bondesson’s 69-year-old mother is that they should not wear protective masks or use other protective equipment unless they are dealing with a resident in the home they have reason to suspect is infected." https://www.theguardian.com/world/2020/apr/19/anger-in-sweden-as-elderly-pay-price-for-coronavirus-strategy https://www.theguardian.com/world/2020/apr/19/anger-in-swede... The responses in the US, UK and Sweden (and probably others) are downright criminal and should put politicians in jail.
  - jacobolus 7y ago
    Every one of the “reports of reinfection” I have seen was along the lines of: tested positive continuously for 2 weeks, then tested negative twice, then tested positive again a couple days later. There is no evidence in any of the cases I saw that the person was exposed to another infected person during that time period. This should not be called “reinfection” (even though there are a bunch of sloppy media headlines calling it that) but rather “poor test sensitivity during the last stages of the infection”.
    - collyw 7y ago
      There have been a lot of unreliable tests, here in Spain at least.
  - glandium 7y ago
    About 1. not even counting death, we don't know what the long term effects on the lung capacity of the people who recovered are. Also, everyone reports "80% of mild cases", with a definition of mild that includes things that reasonable people would definitely not call mild. Essentially, as long as doctors don't tell you you have to be on O2, you have a mild case. People with mild cases may well end up with damaged lungs.
- nradov 7y ago
  The video is only 15 minutes long. You can just watch it in less time than it would take me to summarize.
collyw 7y ago
I didn't watch it, but a couple of the bullet points look pretty untrustworthy. Covid-19 is a “mild disease” and similar to the flu, and it was the novelty of the disease that scared people. It's a fair bit nastier, certainly in some cases, or the hospitals wouldn't be full. The actual fatality rate of Covid-19 is the region of 0.1% How can we be sure until we have widespread testing? At least 50% of the population of both the UK and Sweden will be shown to have already had the disease when mass antibody testing becomes available Again how can we be sure of this? It all seems very speculative.
- SpicyLemonZest 7y ago
  We won't be sure of such statistics whether or not we have widespread testing. Even for pandemics in the past, we just don't know how many people caught them, not even a single significant digit. The best we can do is make reasoned guesses based on the available evidence.
  - collyw 7y ago
    That's why I am suspicious of the claims it makes.
- quicklime 7y ago
  >> The actual fatality rate of Covid-19 is the region of 0.1% > How can we be sure until we have widespread testing? I think we can be sure that this is an incorrect number, with the data we have right now. At least 8448 people have died of COVID-19 in New York City, and if only 0.1% of the infected die, then we have 8,448,000 infected New Yorkers. This is the entire population of the city (including those who fled to other states) and would mean that we've reached herd immunity and can stop worrying about it now.
  - ahakki 7y ago
    https://www1.nyc.gov/site/doh/covid/covid-19-data.page https://www1.nyc.gov/site/doh/covid/covid-19-data.page shows a significant drop in caseload. There might be herd immunity effect if you assume a death rate of ~0.2%.

Hamuko 7y ago

Sweden has a pretty high number of COVID-19 deaths, so I'm not sure if I'd like to follow their model.

collyw 7y ago
It is expected that 70% of the population will get coronavirus then we will have herd immunity. The lock down is about stopping the healthcare systems getting overwhelmed (that will cause unnecessary deaths). That's the way I understand things. The same number of deaths will occur are likely to occur in the long term unless Sweden's ICU beds get full. If anyone has an alternative interpretation I am open to hearing it.
- varjag 7y ago
  The eventual arrival of a vaccine may allow the states who are flattening the curve to have lower total amount of casualties.
  - lbeltrame 7y ago
    Or drugs to help the clinical management of the disease (which have a chance - not a certainty - to arrive earlier than a vaccine).
  - collyw 7y ago
    True, but it doesn't sound like it's going to happen any time soon. There was no vaccine for SARS.
    - varjag 7y ago
      SARS was contained relatively quickly however, while the countries doing the mitigation looking potentially into many months of flattening.
- pnw_hazor 7y ago
  According to healthdata.org (IHME), Sweden has 79 ICU beds. If this is true, it seems that slowing the curve may not be worth it with so few ICU beds available. https://covid19.healthdata.org/sweden https://covid19.healthdata.org/sweden

dazc 7y ago

The original guidance in the UK was to limit exercise to one hour but the actual law doesn't have a time limit. From what I see, people are generally behaving responsibility regards social distancing and, I assume, this is just a gamble our Govt took? Without making sweeping generalisations also, it isn't so common for young adults to spend much time with parents/grandparents/older relatives. So, I reckon, that's one big risk factor that is less of an issue here?

chippy 7y ago
I dont think the guidance ever said an hour, in the UK. it did say once a day though. Other places have the hour rule. https://www.gov.uk/government/publications/full-guidance-on-staying-at-home-and-away-from-others/full-guidance-on-staying-at-home-and-away-from-others https://www.gov.uk/government/publications/full-guidance-on-... "one form of exercise a day"
- makomk 7y ago
  Some reporter asked Matt Hancock how long was a reasonable length of exercise, and he suggested half an hour to an hour for most people - that's probably where it came from. It's not official guidance and certainly not a hard and fast rule anyway. From what I recall the once a day part is also only a guideline and not actually the law in most of the UK (except Wales).

rhino369 7y ago

There is no evidentiary basis for the extreme lock-down Spain is using. While this disease is pretty contagious, you are pretty unlikely to get it walking around outside or going for a run. Especially if everyone is wearing a mask. It's possible you could catch it by running through a cloud of an infected persons breath, but the risk is low enough that we shouldn't ban outside activities. The vast, vast majority of infections occur from sustained contact (>15min) within a few feet of someone.

zzzcpan 7y ago
This is an ancient understanding though, it ignores aerosol transmission. But you are still correct that outside is safe, there is absolutely no need to restrict it at all, it's confined poorly ventilated spaces that are a problem, like almost any building, cars, buses, planes, where the virus can concentrate in the air and close range contact isn't even needed, just breathing such air is bad enough. Wearing a mask is the only thing that helps to not get infected in such situations, but doesn't actually help much when infected people are wearing them, they still contaminate the air with aerosol.
- jakub_g 7y ago
  Some studies suggest covid spreads more by droplets than aerosols. https://mobile.twitter.com/zeynep/status/1251556084424347649 https://mobile.twitter.com/zeynep/status/1251556084424347649
- rhino369 7y ago
  There is no significant evidence that suggests aerosol transmission is a statistically significant source of transmission.
- popcorncowboy 7y ago
  Except it doesn't spread by aerosol. https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations https://www.who.int/news-room/commentaries/detail/modes-of-t...

tachyonbeam 7y ago

If people are having less social interactions per day, on average, it will still slow down the spread compared to everyone behaving as before. There's a continuum between no measures taken and complete lockdown... I'm personally very much looking forward to being able to see friends.

nicoburns 7y ago

If people really stay apart from each other when exercising (anecdotally that does seem to mostly be the case here in the UK), then it's not really going to spread the virus in any meaningful way.

koyote 7y ago

This is something I have not seen discussed or explained anywhere: Spain has such a hard lockdown and yet even after 5 weeks there are still thousands of cases every day. How are so many new people getting infected? The same has been true in Italy.

recoil 7y ago
I've wondered this too. I can only assume it's because they send infected patients home, and they spread it to their families. That and hospitals & nursing homes, where infected staff may be spreading it between the patients/residents?
ssijak 7y ago
Household infections. Infected person in its infancy of the infection gets locked down with the familly and they get infected too. So you must go through all of that for the numbers to slow down and fall.
greedo 7y ago
It's extremely difficult to tell whether the number of cases are increasing, or if testing is revealing more cases. It sounds like a tautology, but unless you have a very strict, consistent testing rubric, the outcomes are hard to measure in terms of growth. At best you can determine total case count.