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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 pursuin

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 7y ago
There's also the goal of slowing down and stalling in hopes of getting a vaccine, better treatments, production to catch up with supply shortages for healthcare facilities, and allowing healthcare facilities to increase capacity, etc.
- elliekelly 7y ago
  Has there been any research on survival rates over time? If given the choice of getting COVID-19 today or two months from now I would much prefer the later infection because that’s two more months of doctors learning how best to treat the disease. Even delaying infection by a week seems like it would offer a better fighting chance. The medical community is learning as much as they can as quickly as they can and that benefits everyone who will eventually get sick.
  - rtkwe 7y ago
    It’s complicated a bit because of limited hospital capacity and related treatment supplies. If where ever you are is still below saturation later is better than now probably but once your local system is in the band where they’re running out of supplies things can get pretty dire.
- treis 7y ago
  Barring a miracle, mass production of a vaccine is at least 9 months away. Likely more like a year+ There's no better treatments coming. We've been fighting viral pneumonia since the dawn of medicine and the tool kit is pretty sparse. Finding anything nearing a cure or even a 20% improvement is wishful thinking. Our health care capacity is adequate. NYC got to ~30% infected and while I'm sure none of the medical workers want to repeat the experience the level of care remained good. Any capacity increase is going to come with only marginally improved outcomes. There's no purpose in extending the lockdown. Either we can get back to something resembling normal life and control the spread or we can't and everyone gets infected. Extending the lockdown is just delaying that day of reckoning.
  - lazyasciiart 7y ago
    We can't control the spread until we can test people for the disease. As multiple leaders have stated, the lockdowns need to continue until we build up testing capabilities. For instance in WA, the governor said they are waiting for "widely-available testing, quick isolation for those who may have the virus, identifying people who came into contact with a positive case and getting them into quarantine."
    - makomk 7y ago
      The only country where this seems to have even vaguely worked is South Korea, and the US is already testing much more people for coronavirus than South Korea even in per-capita terms. Has been for a while. Now, the New York Times editorial board has been pushing the idea that you're behind South Korea because more of your tests are coming back positive - but the way they dropped that number is by using stricter social distancing measures to drop transmission rates, not increasing the number of tests. That doesn't seem to be happening in the US even with a full lockdown, and we don't really know why. Basically, all of the US media reporting around testing has been terrible, misleading, partisan nonsense designed to create an imaginary testing gap that can be blamed on the current president to try and kick him out of office in November. Publications like the Times are quite open about why they're doing it. The UK isn't much better though.
the_watcher 7y ago
> 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 it were remotely possible to precisely control the transmission rate such that we stay just under hospital capacity, there would at least be a coherent argument for this. I'd disagree, since a huge part of slowing the spread is to buy time for other mitigation options, such as therapeutics, contact tracing, etc. That said, it has been immensely frustrating that CA and SFBA leadership hasn't provided more clear guidance on what, exactly, we're waiting for.
ridgeguy 7y ago
IIUC, it's still unknown if having COVID-19 confers either short- or long-term immunity.
- catherd 7y ago
  People keep saying that, but I haven't heard of any clear examples of actual sick people who got it again, just positive tests that seem to be within the error bands for the tests. Not a doctor, this is not a rhetorical question: Shouldn't we have those 2nd-time sick people by now? Shouldn't the null hypothesis be that immunity works like most other colds? Masks weren't "proven to be effective" until well after any reasonably thoughtful person was wishing they had one.
  - lazyasciiart 7y ago
    The null hypothesis is exactly that it acts like other coronaviruses, which don't seem to create immunity in people. https://www.technologyreview.com/2020/04/27/1000569/how-long-are-people-immune-to-covid-19/ https://www.technologyreview.com/2020/04/27/1000569/how-long...
    - catherd 7y ago
      This is an informative link. Summary: - of 4 coronavirus strains in one study (all the type that cause common colds), none gave long term immunity after exposure - of those 4 strains, getting re-infected multiple times in the same year is common - each person tends to have a consistent reaction (weak/strong symptoms the first time through predict a similar experience in any later infections) - infection severity tends to run in families - 6 years after SARS, doctors found T-cells, but no B-cells in humans . Mice re-infected with SARS were protected from the worst effects or SARS by memory T-cells. Specifically related to covid-19: - macaque monkeys were infected by covid-19 and exposed again 4 weeks after recovery. none developed symptoms or had detectable virus in their throats - no reported cases of re-infection in Wuhan in the 5 months since the epidemic started
  - dragonwriter 7y ago
r00fus 7y ago
Herd immunity? Is it proven that immunity lasts long enough to provide coverage to the herd? The issue I have is that if we overload our medical system - just go on twitter to see the horror stories posted about ICUs and medical staff in serious depression - then even if you have a totally managable non-COVID acute issue, you could get infected or die by lack of treatment because the system is at or beyond capacity. We are in a fight to keep our current medical system running. If you overload it recovery for that may take longer than the hypothetical herd immunity or vaccine. For curves: Flat = working. exponential = not working.
asdff 7y ago
The strategy is slowing the spread. Elimination was impossible the day the virus left wuhan. We can't lift restrictions to meet hospital capacity because that is an extremely dangerous gamble, especially when all our numbers on the spread of this disease are bound to be underestimates.
- s17n 7y ago
  "Slowing the spread" isn't a strategy, it's a tactic. What is the goal, and why? How are we going to achieve that goal?
  - asdff 7y ago
    The goal is to not overwhelm the medical system. We are achieving that goal currently by not overwhelming the medical system. The strategy is working right now, no reason to balk from it if it's getting desired results as this pandemic runs its course. I'm a little confused about your semantics, so I fell down the hole. A strategy is the plan of action itself to achieve a goal, and the tactic is the action or strategy to achieve the goal. Slowing the spread seems to fit both definitions depending on how you word your sentences.
dragonwriter 7y ago
> But if the rates stay the same, then all we're accomplishing is slowing the rate at which we reach herd immunity. No, we're still avoiding surging past healthcare capacity, which shoots the fatality rate for both the disease itself and anything else that competes for resources with it way up. That's the point. It's true that on some places we may not need SIP to remain in the safe zone, but one of the big problems is that we don't have the kind of surveillance that lets us even be clear what the likely course is, because we're still mostly testing only the very sick because of limited testing availability and infrastructure, which means we have no good future window, and we won't be able to restore SIP in time to prevent a surge because by the time we see it in the case numbers the infections that will take us beyond capacity will already have happened. That's one of the reasons establishing better surveillance is one of the keys to reopening identified by (among others) the West Coast group of states coordinating on the issue.
- makomk 7y ago
  That's the trouble - there's evidence the main reason that the fatality rate shot up massively in places like Lombardy and Wuhan with overwhelmed healthcare systems is because the shortage of healthcare resources meant they massively undertested mild cases compared to elsewhere. It's a statistical artifact that was presented as a real thing by the useless media. Also, people aren't getting healthcare right now because of the lockdown and the fear. All over the Western world, cancer screening and treatment is getting skipped, people with strokes and heart attacks are seeking medical care far too late, kids are missing vaccinations...
  - dragonwriter 7y ago
    > That's the trouble - there's evidence the main reason that the fatality rate shot up massively in places like Lombardy and Wuhan with overwhelmed healthcare systems is because the shortage of healthcare resources meant they massively undertested mild cases compared to elsewhere. No,the death rate among those requiring ICU care shot up, too; and there is no question that the reason is that the systems were so overwhelmed that things like ventilators were rationed on criteria beyond medical need, because medical need exceeded supply. (That's also why other conditions became more dangerous, because it didn't matter why you needed, e.g., a ventilator, whether Covid or not, the supply shortage meant you might not get one.)
maccam94 7y ago
With a two-week asymptomatic incubation period, there is basically no way to eliminate the disease just by sheltering. It's impossible to enforce that every person in the world self-isolates for 3 weeks, so as soon as we "return to normal" it will come back. The strategy is basically, in order: 1. Reduce the rate of transmission to avoid overwhelming hospitals (which would increase the fatality of all other illnesses/injuries). When we have no reliable testing infrastructure, the only action we can take is sheltering-in-place as much as possible 2. This buys time to increase medical supply chain capacity and stockpile necessary supplies. This increases the amount of cases the system can handle, which is important when the public policy feedback loop doesn't see new cases until they're in the hospital weeks later 3. At the same time, build testing infrastructure to detect infections before they turn into uncontrollable outbreaks. This will hopefully catch cases before they get to the hospital, shortening the public policy feedback loop 4. At this point, we should be able to resume some moderate amount of activity without being completely in the dark. We will likely see a cycle of one week on, one week off, two on, two off, etc as we see how much we can control the rate of spread. This will increase herd immunity, but will likely require months to spread the infection without overwhelming our health system 5. All throughout this time, high risk populations will have to isolate as much as possible, since they cannot be infected safely. Medical companies will be working on a vaccine, but it will probably take closer to a year before they are ready for the market.

Enginerrrd 7y ago

There's also the goal of slowing down and stalling in hopes of getting a vaccine, better treatments, production to catch up with supply shortages for healthcare facilities, and allowing healthcare facilities to increase capacity, etc.

elliekelly 7y ago
Has there been any research on survival rates over time? If given the choice of getting COVID-19 today or two months from now I would much prefer the later infection because that’s two more months of doctors learning how best to treat the disease. Even delaying infection by a week seems like it would offer a better fighting chance. The medical community is learning as much as they can as quickly as they can and that benefits everyone who will eventually get sick.
- rtkwe 7y ago
  It’s complicated a bit because of limited hospital capacity and related treatment supplies. If where ever you are is still below saturation later is better than now probably but once your local system is in the band where they’re running out of supplies things can get pretty dire.
treis 7y ago
Barring a miracle, mass production of a vaccine is at least 9 months away. Likely more like a year+ There's no better treatments coming. We've been fighting viral pneumonia since the dawn of medicine and the tool kit is pretty sparse. Finding anything nearing a cure or even a 20% improvement is wishful thinking. Our health care capacity is adequate. NYC got to ~30% infected and while I'm sure none of the medical workers want to repeat the experience the level of care remained good. Any capacity increase is going to come with only marginally improved outcomes. There's no purpose in extending the lockdown. Either we can get back to something resembling normal life and control the spread or we can't and everyone gets infected. Extending the lockdown is just delaying that day of reckoning.
- lazyasciiart 7y ago
  We can't control the spread until we can test people for the disease. As multiple leaders have stated, the lockdowns need to continue until we build up testing capabilities. For instance in WA, the governor said they are waiting for "widely-available testing, quick isolation for those who may have the virus, identifying people who came into contact with a positive case and getting them into quarantine."
  - makomk 7y ago
    The only country where this seems to have even vaguely worked is South Korea, and the US is already testing much more people for coronavirus than South Korea even in per-capita terms. Has been for a while. Now, the New York Times editorial board has been pushing the idea that you're behind South Korea because more of your tests are coming back positive - but the way they dropped that number is by using stricter social distancing measures to drop transmission rates, not increasing the number of tests. That doesn't seem to be happening in the US even with a full lockdown, and we don't really know why. Basically, all of the US media reporting around testing has been terrible, misleading, partisan nonsense designed to create an imaginary testing gap that can be blamed on the current president to try and kick him out of office in November. Publications like the Times are quite open about why they're doing it. The UK isn't much better though.

the_watcher 7y ago

> 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 it were remotely possible to precisely control the transmission rate such that we stay just under hospital capacity, there would at least be a coherent argument for this. I'd disagree, since a huge part of slowing the spread is to buy time for other mitigation options, such as therapeutics, contact tracing, etc. That said, it has been immensely frustrating that CA and SFBA leadership hasn't provided more clear guidance on what, exactly, we're waiting for.

ridgeguy 7y ago

IIUC, it's still unknown if having COVID-19 confers either short- or long-term immunity.

catherd 7y ago
People keep saying that, but I haven't heard of any clear examples of actual sick people who got it again, just positive tests that seem to be within the error bands for the tests. Not a doctor, this is not a rhetorical question: Shouldn't we have those 2nd-time sick people by now? Shouldn't the null hypothesis be that immunity works like most other colds? Masks weren't "proven to be effective" until well after any reasonably thoughtful person was wishing they had one.
- lazyasciiart 7y ago
  The null hypothesis is exactly that it acts like other coronaviruses, which don't seem to create immunity in people. https://www.technologyreview.com/2020/04/27/1000569/how-long-are-people-immune-to-covid-19/ https://www.technologyreview.com/2020/04/27/1000569/how-long...
  - catherd 7y ago
    This is an informative link. Summary: - of 4 coronavirus strains in one study (all the type that cause common colds), none gave long term immunity after exposure - of those 4 strains, getting re-infected multiple times in the same year is common - each person tends to have a consistent reaction (weak/strong symptoms the first time through predict a similar experience in any later infections) - infection severity tends to run in families - 6 years after SARS, doctors found T-cells, but no B-cells in humans . Mice re-infected with SARS were protected from the worst effects or SARS by memory T-cells. Specifically related to covid-19: - macaque monkeys were infected by covid-19 and exposed again 4 weeks after recovery. none developed symptoms or had detectable virus in their throats - no reported cases of re-infection in Wuhan in the 5 months since the epidemic started
- dragonwriter 7y ago

r00fus 7y ago

Herd immunity? Is it proven that immunity lasts long enough to provide coverage to the herd? The issue I have is that if we overload our medical system - just go on twitter to see the horror stories posted about ICUs and medical staff in serious depression - then even if you have a totally managable non-COVID acute issue, you could get infected or die by lack of treatment because the system is at or beyond capacity. We are in a fight to keep our current medical system running. If you overload it recovery for that may take longer than the hypothetical herd immunity or vaccine. For curves: Flat = working. exponential = not working.

asdff 7y ago

The strategy is slowing the spread. Elimination was impossible the day the virus left wuhan. We can't lift restrictions to meet hospital capacity because that is an extremely dangerous gamble, especially when all our numbers on the spread of this disease are bound to be underestimates.

s17n 7y ago
"Slowing the spread" isn't a strategy, it's a tactic. What is the goal, and why? How are we going to achieve that goal?
- asdff 7y ago
  The goal is to not overwhelm the medical system. We are achieving that goal currently by not overwhelming the medical system. The strategy is working right now, no reason to balk from it if it's getting desired results as this pandemic runs its course. I'm a little confused about your semantics, so I fell down the hole. A strategy is the plan of action itself to achieve a goal, and the tactic is the action or strategy to achieve the goal. Slowing the spread seems to fit both definitions depending on how you word your sentences.

dragonwriter 7y ago

> But if the rates stay the same, then all we're accomplishing is slowing the rate at which we reach herd immunity. No, we're still avoiding surging past healthcare capacity, which shoots the fatality rate for both the disease itself and anything else that competes for resources with it way up. That's the point. It's true that on some places we may not need SIP to remain in the safe zone, but one of the big problems is that we don't have the kind of surveillance that lets us even be clear what the likely course is, because we're still mostly testing only the very sick because of limited testing availability and infrastructure, which means we have no good future window, and we won't be able to restore SIP in time to prevent a surge because by the time we see it in the case numbers the infections that will take us beyond capacity will already have happened. That's one of the reasons establishing better surveillance is one of the keys to reopening identified by (among others) the West Coast group of states coordinating on the issue.

makomk 7y ago
That's the trouble - there's evidence the main reason that the fatality rate shot up massively in places like Lombardy and Wuhan with overwhelmed healthcare systems is because the shortage of healthcare resources meant they massively undertested mild cases compared to elsewhere. It's a statistical artifact that was presented as a real thing by the useless media. Also, people aren't getting healthcare right now because of the lockdown and the fear. All over the Western world, cancer screening and treatment is getting skipped, people with strokes and heart attacks are seeking medical care far too late, kids are missing vaccinations...
- dragonwriter 7y ago
  > That's the trouble - there's evidence the main reason that the fatality rate shot up massively in places like Lombardy and Wuhan with overwhelmed healthcare systems is because the shortage of healthcare resources meant they massively undertested mild cases compared to elsewhere. No,the death rate among those requiring ICU care shot up, too; and there is no question that the reason is that the systems were so overwhelmed that things like ventilators were rationed on criteria beyond medical need, because medical need exceeded supply. (That's also why other conditions became more dangerous, because it didn't matter why you needed, e.g., a ventilator, whether Covid or not, the supply shortage meant you might not get one.)

maccam94 7y ago

With a two-week asymptomatic incubation period, there is basically no way to eliminate the disease just by sheltering. It's impossible to enforce that every person in the world self-isolates for 3 weeks, so as soon as we "return to normal" it will come back. The strategy is basically, in order: 1. Reduce the rate of transmission to avoid overwhelming hospitals (which would increase the fatality of all other illnesses/injuries). When we have no reliable testing infrastructure, the only action we can take is sheltering-in-place as much as possible 2. This buys time to increase medical supply chain capacity and stockpile necessary supplies. This increases the amount of cases the system can handle, which is important when the public policy feedback loop doesn't see new cases until they're in the hospital weeks later 3. At the same time, build testing infrastructure to detect infections before they turn into uncontrollable outbreaks. This will hopefully catch cases before they get to the hospital, shortening the public policy feedback loop 4. At this point, we should be able to resume some moderate amount of activity without being completely in the dark. We will likely see a cycle of one week on, one week off, two on, two off, etc as we see how much we can control the rate of spread. This will increase herd immunity, but will likely require months to spread the infection without overwhelming our health system 5. All throughout this time, high risk populations will have to isolate as much as possible, since they cannot be infected safely. Medical companies will be working on a vaccine, but it will probably take closer to a year before they are ready for the market.