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The problem is that the shelter-in-place rule is already limited in effectiveness due to a very lengthy list of exceptions plus many people not observing the sp

The problem is that the shelter-in-place rule is already limited in effectiveness due to a very lengthy list of exceptions plus many people not observing the spirit of the rule. Compliance will only drop over time as people see that 1) Their actions are having no obvious impact and 2) There is no clear end in sight. If the primary goal of extending the order is to give local governments time to build out infrastructure, that's fine (though they would do well to communicate this progress to the public). But if the primary goal is to further reduce transmission, I can't see it being successful.

mlyle 6y ago
The stated goal is to decay to 1 infection per million residents so that robust contact tracing works. Back of the envelope math puts that between 6 and 18 months of continued progress of the health order to get it to this level. (60 or so in Santa Clara County ICU == ~6000 infections. ICU occupancy decaying by 40% per month; 0.6^15 months * 6000 = ~3 )
- holler 6y ago
  so you think 6-18 months of SIP is going to work? I think that could lead us to a dire situation. > robust contact tracing works Doesn't that rely on the individual opting in/using it? I have a feeling most people don't want the government tracing their every move (even though it already is geographically).
  - mlyle 6y ago
    > so you think 6-18 months of SIP is going to work? I think that could lead us to a dire situation. No, I don't. I think it's implausible. But this is what those in local public health are calling for. Granted, there's the IMHE model, which somehow fantastically thinks the virus will mostly be gone in Santa Clara County in mid-May, but it's shown very little agreement with the actual data and is nearly as bad as saying the Easter Bunny will take the virus away. > Doesn't that rely on the individual opting in/using it? I have a feeling most people don't want the government tracing their every move (even though it already is geographically). No, if you get the infection count low enough, you can investigate each individual case to death like Singapore has been doing it (though cases are growing beyond Singapore's ability to maintain this).
    - rallison 6y ago
      > Granted, there's the IMHE model, which somehow fantastically thinks the virus will mostly be gone in Santa Clara County in mid-May, but it's shown very little agreement with the actual data and is nearly as bad as saying the Easter Bunny will take the virus away. Yeah, that IHME model.. It's unfortunate that it's become the model most people have become acquainted with. It has its uses, but the down-slope has previously generated critiques. Good Carl Bergstrom thread: https://twitter.com/CT_Bergstrom/status/1250304069119275009 https://twitter.com/CT_Bergstrom/status/1250304069119275009 A few select quotes from that thread: > 6. But this is a mix of two different processes, an acceleration phase prior to control, and a deceleration phase once controls are in place. Given that, why does the model predict symmetric death curves? > 7. The answer is that this is a modeling assumption that the research team has made. They have chosen to fit a particular sigmoidal curve called the Gaussian Error Function (erf function, for short) to the data representing the cumulative number of deaths that have occurred. > 13. The actual trajectory tracks the forecast pretty closely, but then starts to turn around. Once that happens, the back side of the curve is constrained to mirror the front side; the epidemic is predicted to wane quickly. By May 17, the uncertainty range collapses to 0 deaths. > 14. This strikes me as unrealistic. Even ignoring the real-world coupling between states (this is not included in the model), I am not persuaded that the epidemic will necessarily be entirely finished in just over a month. And a very important point he brings up: > 16. In defense of the model, every model is a tool with a purpose. The primary purpose of their model is to predict peak health care need, not the endpoint of the outbreak. That said, people need to be aware of a model's purpose and be cautious when using it for anything else. In other words, it's actually a pretty bad model* for predicting the down-slope. I fully expect that we'll hit 100k deaths for this first wave. *unless the US were to have done a Wuhan-style lockdown.
      - mlyle 6y ago
        Yup, but now #16 is no longer true. IMHE has entered the re-opening fray, and is setting target dates based on when they think we'll be down to fewer than 1 infection per million. It seems that it's driving public policy, and it's kinda ridiculous. Decay seems to be very slow even in the jurisdictions with the strictest controls. (I do think the hardest hit jurisdictions may show something close to symmetry). The disease is probably circulating in some subpopulations with Rt near or even above 1.0. Even if overall we're showing decay, those groups can continue to grow... I also really, really, really don't like that if the peak is in the past, the model webpages claim that it predicted it perfectly; when really the webpage is just looking at the history.
- deleted 6y ago
  [deleted]
the_watcher 6y ago
What evidence is there that the SIP is limited in effectiveness? The existing evidence I am aware of is starkly contra that assertion. Anecdotes of seeing people too close together in the park are not evidence of an ineffective SIP.
- greendave 6y ago
  It's not that SIP does nothing - it's that past a certain point, the rates are what they are. San Mateo and Santa Clara counties have seen a slight increase in the number of cases last week over the previous week. Other Bay Area counties have seen a slight decrease [1]. I don't see how increased traffic/travel as we're starting to see [2] will do anything other than increase transmissions. [1] https://projects.sfchronicle.com/2020/coronavirus-map/ https://projects.sfchronicle.com/2020/coronavirus-map/ [2] https://www.sfchronicle.com/bayarea/philmatier/article/Bay-Area-stay-at-home-orders-don-t-keep-15225537.php https://www.sfchronicle.com/bayarea/philmatier/article/Bay-A...
  - plorkyeran 6y ago
    The rates staying flat rather than going up is already a success, not a sign that SIP has failed.
    - toasterlovin 6y ago
      But if the rates stay the same, then all we're accomplishing is slowing the rate at which we reach herd immunity. If herd immunity is the strategy we're pursuing, then we should lift restrictions enough to meet hospital capacity, so we can get to herd immunity as quickly as possible and get the economy back to something approaching normal levels of activity. If the strategy is actually suppression and elimination, then the lockdowns are not working (at least not here in Oregon, where daily number of new cases have been flat for about 2 weeks; I'm not sure what things look like in California).
      - Enginerrrd 6y ago
greendude29 6y ago
> The problem is that the shelter-in-place rule is already limited in effectiveness I've mostly read that the "control" we have over covid-19 now is due to the SIP. Can you source your claim?
- greendave 6y ago
  Perhaps badly worded on my part. Limited != none. Clearly SIP has bent the curve. But new cases that are being reported now were transmitted well after SIP came into effect, i.e. are happening despite SIP. And absent other policy changes, we should continue to expect to see more of them. What changes we do see are in the other direction - more traffic, more outside activity, etc. Practically, increase (or non-decrease) in weekly number of cases in San Mateo and Santa Clara counties suggests as much[1]. [1] https://projects.sfchronicle.com/2020/coronavirus-map/ https://projects.sfchronicle.com/2020/coronavirus-map/
  - r00fus 6y ago
    To expect the cases to go down is not realistic. We're in a battle to prevent exponential growth. NlogN is managable. N^2 is not.
- numpad0 6y ago
  SIP being fully effective would mean a monotonic reduction towards eradication, whereas it’s merely giving us a control
- antpls 6y ago
  One way would be to look at Sweden's situation in a few weeks. They didn't impose lockdown on citizens. Granted, lifestyle in Sweden and infrastructure may be different than the rest of the world.
m463 6y ago
The primary goal is to keep the rate of infection under what the health care system can handle. If the rate of infection exceeds it, the whole house of cards starts coming down. Imagine doctors, firemen and policemen starting to succumb.
- fullshark 6y ago
  The stated goals keep changing, if that were the goal they’d start opening things up.
  - lazyasciiart 6y ago
    Why do you think that wouldn't just start a new exponential spread?
    - fullshark 6y ago
      Cause they wouldn't open everything up at once and people have shifted their behavior for the foreseeable future. I imagine a series of flattened curves one after another through the end of the year will be what happens as they open up pieces of the economy, presumably with better testing and tracing to control outbreaks (still to be seen). Bay area new case count is pretty much flat at this point, and I don't see why it would be that much lower in June, the thing is bubbling under the surface and won't go away until a vaccine.
      - lazyasciiart 6y ago
        I'm not sure people's behavior will stay changed, but that aside - that presumed "better testing and tracing" is exactly what we are waiting for before opening up. It doesn't exist yet. Reducing restrictions while we still have up to a two week lag on tracking infections means that we won't know if it's going OK.
        fullshark 6y ago
        Things will always be better in terms of testing / tracing / treatment options in a month, in June if we just wait until July things would be in a better place. Ultimately this is going to be about buying time for as long as is politically and economically possible. If more and more states open up and their situation doesn't look like a disaster because they are not as dense as NYC with almost 4 million people taking subways every day, then it's going to be harder and harder for the bay area politicians to claim we need to stay shut down.

mlyle 6y ago

The stated goal is to decay to 1 infection per million residents so that robust contact tracing works. Back of the envelope math puts that between 6 and 18 months of continued progress of the health order to get it to this level. (60 or so in Santa Clara County ICU == ~6000 infections. ICU occupancy decaying by 40% per month; 0.6^15 months * 6000 = ~3 )

holler 6y ago
so you think 6-18 months of SIP is going to work? I think that could lead us to a dire situation. > robust contact tracing works Doesn't that rely on the individual opting in/using it? I have a feeling most people don't want the government tracing their every move (even though it already is geographically).
- mlyle 6y ago
  > so you think 6-18 months of SIP is going to work? I think that could lead us to a dire situation. No, I don't. I think it's implausible. But this is what those in local public health are calling for. Granted, there's the IMHE model, which somehow fantastically thinks the virus will mostly be gone in Santa Clara County in mid-May, but it's shown very little agreement with the actual data and is nearly as bad as saying the Easter Bunny will take the virus away. > Doesn't that rely on the individual opting in/using it? I have a feeling most people don't want the government tracing their every move (even though it already is geographically). No, if you get the infection count low enough, you can investigate each individual case to death like Singapore has been doing it (though cases are growing beyond Singapore's ability to maintain this).
  - rallison 6y ago
    > Granted, there's the IMHE model, which somehow fantastically thinks the virus will mostly be gone in Santa Clara County in mid-May, but it's shown very little agreement with the actual data and is nearly as bad as saying the Easter Bunny will take the virus away. Yeah, that IHME model.. It's unfortunate that it's become the model most people have become acquainted with. It has its uses, but the down-slope has previously generated critiques. Good Carl Bergstrom thread: https://twitter.com/CT_Bergstrom/status/1250304069119275009 https://twitter.com/CT_Bergstrom/status/1250304069119275009 A few select quotes from that thread: > 6. But this is a mix of two different processes, an acceleration phase prior to control, and a deceleration phase once controls are in place. Given that, why does the model predict symmetric death curves? > 7. The answer is that this is a modeling assumption that the research team has made. They have chosen to fit a particular sigmoidal curve called the Gaussian Error Function (erf function, for short) to the data representing the cumulative number of deaths that have occurred. > 13. The actual trajectory tracks the forecast pretty closely, but then starts to turn around. Once that happens, the back side of the curve is constrained to mirror the front side; the epidemic is predicted to wane quickly. By May 17, the uncertainty range collapses to 0 deaths. > 14. This strikes me as unrealistic. Even ignoring the real-world coupling between states (this is not included in the model), I am not persuaded that the epidemic will necessarily be entirely finished in just over a month. And a very important point he brings up: > 16. In defense of the model, every model is a tool with a purpose. The primary purpose of their model is to predict peak health care need, not the endpoint of the outbreak. That said, people need to be aware of a model's purpose and be cautious when using it for anything else. In other words, it's actually a pretty bad model* for predicting the down-slope. I fully expect that we'll hit 100k deaths for this first wave. *unless the US were to have done a Wuhan-style lockdown.
    - mlyle 6y ago
      Yup, but now #16 is no longer true. IMHE has entered the re-opening fray, and is setting target dates based on when they think we'll be down to fewer than 1 infection per million. It seems that it's driving public policy, and it's kinda ridiculous. Decay seems to be very slow even in the jurisdictions with the strictest controls. (I do think the hardest hit jurisdictions may show something close to symmetry). The disease is probably circulating in some subpopulations with Rt near or even above 1.0. Even if overall we're showing decay, those groups can continue to grow... I also really, really, really don't like that if the peak is in the past, the model webpages claim that it predicted it perfectly; when really the webpage is just looking at the history.
deleted 6y ago
[deleted]

the_watcher 6y ago

What evidence is there that the SIP is limited in effectiveness? The existing evidence I am aware of is starkly contra that assertion. Anecdotes of seeing people too close together in the park are not evidence of an ineffective SIP.

greendave 6y ago
It's not that SIP does nothing - it's that past a certain point, the rates are what they are. San Mateo and Santa Clara counties have seen a slight increase in the number of cases last week over the previous week. Other Bay Area counties have seen a slight decrease [1]. I don't see how increased traffic/travel as we're starting to see [2] will do anything other than increase transmissions. [1] https://projects.sfchronicle.com/2020/coronavirus-map/ https://projects.sfchronicle.com/2020/coronavirus-map/ [2] https://www.sfchronicle.com/bayarea/philmatier/article/Bay-Area-stay-at-home-orders-don-t-keep-15225537.php https://www.sfchronicle.com/bayarea/philmatier/article/Bay-A...
- plorkyeran 6y ago
  The rates staying flat rather than going up is already a success, not a sign that SIP has failed.
  - toasterlovin 6y ago
    But if the rates stay the same, then all we're accomplishing is slowing the rate at which we reach herd immunity. If herd immunity is the strategy we're pursuing, then we should lift restrictions enough to meet hospital capacity, so we can get to herd immunity as quickly as possible and get the economy back to something approaching normal levels of activity. If the strategy is actually suppression and elimination, then the lockdowns are not working (at least not here in Oregon, where daily number of new cases have been flat for about 2 weeks; I'm not sure what things look like in California).
    - Enginerrrd 6y ago

greendude29 6y ago

> The problem is that the shelter-in-place rule is already limited in effectiveness I've mostly read that the "control" we have over covid-19 now is due to the SIP. Can you source your claim?

greendave 6y ago
Perhaps badly worded on my part. Limited != none. Clearly SIP has bent the curve. But new cases that are being reported now were transmitted well after SIP came into effect, i.e. are happening despite SIP. And absent other policy changes, we should continue to expect to see more of them. What changes we do see are in the other direction - more traffic, more outside activity, etc. Practically, increase (or non-decrease) in weekly number of cases in San Mateo and Santa Clara counties suggests as much[1]. [1] https://projects.sfchronicle.com/2020/coronavirus-map/ https://projects.sfchronicle.com/2020/coronavirus-map/
- r00fus 6y ago
  To expect the cases to go down is not realistic. We're in a battle to prevent exponential growth. NlogN is managable. N^2 is not.
numpad0 6y ago
SIP being fully effective would mean a monotonic reduction towards eradication, whereas it’s merely giving us a control
antpls 6y ago
One way would be to look at Sweden's situation in a few weeks. They didn't impose lockdown on citizens. Granted, lifestyle in Sweden and infrastructure may be different than the rest of the world.

m463 6y ago

The primary goal is to keep the rate of infection under what the health care system can handle. If the rate of infection exceeds it, the whole house of cards starts coming down. Imagine doctors, firemen and policemen starting to succumb.

fullshark 6y ago
The stated goals keep changing, if that were the goal they’d start opening things up.
- lazyasciiart 6y ago
  Why do you think that wouldn't just start a new exponential spread?
  - fullshark 6y ago
    Cause they wouldn't open everything up at once and people have shifted their behavior for the foreseeable future. I imagine a series of flattened curves one after another through the end of the year will be what happens as they open up pieces of the economy, presumably with better testing and tracing to control outbreaks (still to be seen). Bay area new case count is pretty much flat at this point, and I don't see why it would be that much lower in June, the thing is bubbling under the surface and won't go away until a vaccine.
    - lazyasciiart 6y ago
      I'm not sure people's behavior will stay changed, but that aside - that presumed "better testing and tracing" is exactly what we are waiting for before opening up. It doesn't exist yet. Reducing restrictions while we still have up to a two week lag on tracking infections means that we won't know if it's going OK.
      - fullshark 6y ago
        Things will always be better in terms of testing / tracing / treatment options in a month, in June if we just wait until July things would be in a better place. Ultimately this is going to be about buying time for as long as is politically and economically possible. If more and more states open up and their situation doesn't look like a disaster because they are not as dense as NYC with almost 4 million people taking subways every day, then it's going to be harder and harder for the bay area politicians to claim we need to stay shut down.