5 ms·

Interesting that it seems to suggest there is an optimal amount of distancing/lockdown/etc. to lower the peak, but avoid a big "rebound". I don't see a lot of

Interesting that it seems to suggest there is an optimal amount of distancing/lockdown/etc. to lower the peak, but avoid a big "rebound". I don't see a lot of discussion about how to find that optimum amount. It has occurred to me that the planet is essentially conducting a gigantic experiment in virus evolution, by creating a novel viral selection environment never seen before. For example, how does it impact a virus if the strains most likely to send the host to the hospital, actually spread more than the strains most likely to be asymptomatic, because even asymptomatic hosts are in isolation? Unless there is a vaccine or cure coming soon (there isn't), then the end result must be herd immunity, no matter what the policy. It would seem that we should be considering how to select for the healthiest segment of the population to provide that herd immunity, rather than trying to isolate as much as possible in the vain hope that it will die out prior to that point. If that was every possible, it has long since spread way too far to expect that to be possible. There might be cases (e.g. MERS) where you can stomp out a virus before it spreads enough to cause herd immunity, but we have long since passed that point. I don't think most people (including policy makers) are thinking about the endgame properly (as this paper does).

jakeogh 7y ago
Senegal is worth looking at (end of vid): https://youtu.be/iBma_0oAiMI https://youtu.be/iBma_0oAiMI
macintux 7y ago
As far as I can tell, there is one big unknown that makes planning particularly difficult: What are the long-term health effects from being infected? If it turns out that some significant percentage of the population is going to have a negative impact over the course of their lives from this, should we continue to hunker down until a vaccine or better treatments are found?
- irq11 7y ago
  This is not an unknown. We have very good data on outcomes. The media has been diving ever-further into niche stories of bad outcomes in order to drive clicks, but the numbers of cases driving these narratives are vanishingly small. For the vast majority (>98%) of those who are under 60 and otherwise healthy, this disease is on par with the flu. Even amongst those who are more vulnerable, the rate of long-term sequelae is low. It’s the people who end up in the ICU who are experiencing the most long-term effects, and those people are a single-digit percentage of a single-digit percentage of those infected.
  - macintux 7y ago
    This disease has been here for 6 months. The degree of certainty in your assessment seems unwarranted. I want to believe it, but optimism and certainty given the novelty of this virus seem strange bedfellows.
    - xamuel 7y ago
      As rossdavidh correctly pointed out, if we don't get a vaccine soon (which we probably won't), then herd immunity is virtually the only way out anyway. Even if it turns out there are long term health problems, that doesn't really change that calculus. Very few people can completely isolate themselves indefinitely (remember, the virus doesn't just magically not spread in supermarkets), and if everyone did that, most of us would starve and the few who didn't starve would inherit a post-civilization ruin.
      - mlyle 7y ago
        It does change the economic break even point a little bit. If intervention A reduces infection count 10% in the time to a vaccine, whether it's worth it depends upon whether it prevents 20,000 deaths, or 20,000 deaths and 40,000 long term illnesses. The threshold to herd immunity depends upon contact rate. So interventions well short of "lockdown" may not completely prevent the spread of the virus but still reach equilibrium at a lower number of people infected.
        xamuel 7y ago
        You're right, the question of where the break even point is is quite complex. Aside from the numbers you posted, it also depends on the economic side effects of "intervention A": better to be one of the 40,000 with long-term illnesses in a functional society, than to avoid the long-term illnesses but live in a non-functional society because we destroyed the whole economy.
        macintux 7y ago
        The economy is a human construct, subject to redefinition if needed. It’s not some inevitable product of the natural world. Sacrificing lives unnecessarily to “save the economy” is perverse in that the economy is supposed to serve us, not the other way around. I’m not saying we should stay in lockdown forever, but I’d rather our leaders think creatively with a default view of “let’s be cautious with a global pandemic that has so far shown great destructive powers when left unchecked”.
- ibejoeb 7y ago
  I can't understand the amount of intrigue surrounding this. It's not some kind of mysterious alien pathogen; there are 6 other coronaviruses that infect humans, and hundreds that infect other animals. There have been numerous outbreaks in the past 20 years. They're very well researched. Still, I'm not holding my breath for a vaccine since these other diseases, like SARS and MERS, are several orders of magnitude more letha. > some significant percentage of the population is going to have a negative impact Is there any evidence at all that this is some kind of feature of this disease? It's even starting to look like most people who become infected never even develop the associated disease.
  - mlyle 7y ago
    This causes a whole lot more people to be hospitalized with severe illness. Severe illness tends to result in morbidity even if you survive. A fair number of people with SARS-CoV-1 ended up with chronic fatigue ailments, etc, afterwards, too. We don't know, but there's almost certainly going to be more lasting morbidity from this epidemic than the common cold. If it's a little bit, it doesn't change the calculation much. If 1/4th of those hospitalized develop significant morbidity though, that sucks.
    - ibejoeb 7y ago
      > This causes a whole lot more people to be hospitalized with severe illness. Sure. And the other ones kill. > If 1/4th of those hospitalized develop significant morbidity Am I wrong, or is it that the overwhelming majority of people who are hospitalized already have a comorbidity? Where does 1/4 come from? Why not 100%?
- rossdavidh 7y ago
  From what I'm reading, the best case for a vaccine is 3 years (both development and production on a large enough scale). By which point, it's a moot point because the vaccine will have gotten to herd immunity levels long before that. In other words, hunkering down won't really change the fact that the vaccine, if it comes at all, won't come in time.
Isinlor 7y ago
Currently we need to learn more about this virus to make informed decisions - there is more we still don't know, than we do know for sure. Trying to slowly contain the virus like in South Korea, Taiwan, New Zealand is a strategy worth a shot for most of the western world, unless we learn something dramatic new about it. There is no need for draconian lock downs after exponential spread is stopped, but we do need good track and trace programs, masks etc. There are very high risks associated with Swedish strategy of either killing a lot of people due to bad separation of vulnerable people, destroying health of the big part of the population (see below), or even just failing to reach herd immunity because social distancing, closure of schools, and ban on mass gathering will be good enough to slow down the spread a lot, but bad enough to kill disproportionate amount of people. For example Sweden has many times more deaths than other Nordic Countries, but similar economical outlooks, and the even the idea of reaching herd immunity is uncertain. It may be that other Nordic countries will have soon less or about the same amount of restrictions as Sweden, but many times less deaths. And regarding the risks, one of the scientists who discovered Ebola [0]: "Many people think COVID-19 kills 1% of patients, and the rest get away with some flulike symptoms. But the story gets more complicated. Many people will be left with chronic kidney and heart problems. Even their neural system is disrupted. There will be hundreds of thousands of people worldwide, possibly more, who will need treatments such as renal dialysis for the rest of their lives. The more we learn about the coronavirus, the more questions arise. We are learning while we are sailing. That’s why I get so annoyed by the many commentators on the sidelines who, without much insight, criticize the scientists and policymakers trying hard to get the epidemic under control. That’s very unfair." Also based on Japanese study on around 100 COVID-19 cases from Grand Princess passengers [1] and some 6 divers all with mild cases from Germany [2] around 50 to 80% of people seem to have damage to the lungs visible on CT scans after mild symptomatic or even asymptomatic infection. Two of the divers had significant oxygen deficiency when doing physical exercise after 5-6 weeks of recovery. The guess of the doctor who was inspecting them is that this is permanent damage that may take years to recover if ever. [0] https://www.sciencemag.org/news/2020/05/finally-virus-got-me-scientist-who-fought-ebola-and-hiv-reflects-facing-death-covid-19 https://www.sciencemag.org/news/2020/05/finally-virus-got-me... [1] https://pubs.rsna.org/doi/10.1148/ryct.2020200110 https://pubs.rsna.org/doi/10.1148/ryct.2020200110 [2] https://translate.google.com/translate?sl=auto&tl=en&u=https%3A%2F%2Fwww.wetnotes.eu%2Ftauchen-nach-covid-19-erkrankung%2F https://translate.google.com/translate?sl=auto&tl=en&u=https...
deleted 7y ago
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jakeogh 7y ago

Senegal is worth looking at (end of vid): https://youtu.be/iBma_0oAiMI https://youtu.be/iBma_0oAiMI

macintux 7y ago

As far as I can tell, there is one big unknown that makes planning particularly difficult: What are the long-term health effects from being infected? If it turns out that some significant percentage of the population is going to have a negative impact over the course of their lives from this, should we continue to hunker down until a vaccine or better treatments are found?

irq11 7y ago
This is not an unknown. We have very good data on outcomes. The media has been diving ever-further into niche stories of bad outcomes in order to drive clicks, but the numbers of cases driving these narratives are vanishingly small. For the vast majority (>98%) of those who are under 60 and otherwise healthy, this disease is on par with the flu. Even amongst those who are more vulnerable, the rate of long-term sequelae is low. It’s the people who end up in the ICU who are experiencing the most long-term effects, and those people are a single-digit percentage of a single-digit percentage of those infected.
- macintux 7y ago
  This disease has been here for 6 months. The degree of certainty in your assessment seems unwarranted. I want to believe it, but optimism and certainty given the novelty of this virus seem strange bedfellows.
  - xamuel 7y ago
    As rossdavidh correctly pointed out, if we don't get a vaccine soon (which we probably won't), then herd immunity is virtually the only way out anyway. Even if it turns out there are long term health problems, that doesn't really change that calculus. Very few people can completely isolate themselves indefinitely (remember, the virus doesn't just magically not spread in supermarkets), and if everyone did that, most of us would starve and the few who didn't starve would inherit a post-civilization ruin.
    - mlyle 7y ago
      It does change the economic break even point a little bit. If intervention A reduces infection count 10% in the time to a vaccine, whether it's worth it depends upon whether it prevents 20,000 deaths, or 20,000 deaths and 40,000 long term illnesses. The threshold to herd immunity depends upon contact rate. So interventions well short of "lockdown" may not completely prevent the spread of the virus but still reach equilibrium at a lower number of people infected.
      - xamuel 7y ago
        You're right, the question of where the break even point is is quite complex. Aside from the numbers you posted, it also depends on the economic side effects of "intervention A": better to be one of the 40,000 with long-term illnesses in a functional society, than to avoid the long-term illnesses but live in a non-functional society because we destroyed the whole economy.
        macintux 7y ago
        The economy is a human construct, subject to redefinition if needed. It’s not some inevitable product of the natural world. Sacrificing lives unnecessarily to “save the economy” is perverse in that the economy is supposed to serve us, not the other way around. I’m not saying we should stay in lockdown forever, but I’d rather our leaders think creatively with a default view of “let’s be cautious with a global pandemic that has so far shown great destructive powers when left unchecked”.
ibejoeb 7y ago
I can't understand the amount of intrigue surrounding this. It's not some kind of mysterious alien pathogen; there are 6 other coronaviruses that infect humans, and hundreds that infect other animals. There have been numerous outbreaks in the past 20 years. They're very well researched. Still, I'm not holding my breath for a vaccine since these other diseases, like SARS and MERS, are several orders of magnitude more letha. > some significant percentage of the population is going to have a negative impact Is there any evidence at all that this is some kind of feature of this disease? It's even starting to look like most people who become infected never even develop the associated disease.
- mlyle 7y ago
  This causes a whole lot more people to be hospitalized with severe illness. Severe illness tends to result in morbidity even if you survive. A fair number of people with SARS-CoV-1 ended up with chronic fatigue ailments, etc, afterwards, too. We don't know, but there's almost certainly going to be more lasting morbidity from this epidemic than the common cold. If it's a little bit, it doesn't change the calculation much. If 1/4th of those hospitalized develop significant morbidity though, that sucks.
  - ibejoeb 7y ago
    > This causes a whole lot more people to be hospitalized with severe illness. Sure. And the other ones kill. > If 1/4th of those hospitalized develop significant morbidity Am I wrong, or is it that the overwhelming majority of people who are hospitalized already have a comorbidity? Where does 1/4 come from? Why not 100%?
rossdavidh 7y ago
From what I'm reading, the best case for a vaccine is 3 years (both development and production on a large enough scale). By which point, it's a moot point because the vaccine will have gotten to herd immunity levels long before that. In other words, hunkering down won't really change the fact that the vaccine, if it comes at all, won't come in time.

Isinlor 7y ago

Currently we need to learn more about this virus to make informed decisions - there is more we still don't know, than we do know for sure. Trying to slowly contain the virus like in South Korea, Taiwan, New Zealand is a strategy worth a shot for most of the western world, unless we learn something dramatic new about it. There is no need for draconian lock downs after exponential spread is stopped, but we do need good track and trace programs, masks etc. There are very high risks associated with Swedish strategy of either killing a lot of people due to bad separation of vulnerable people, destroying health of the big part of the population (see below), or even just failing to reach herd immunity because social distancing, closure of schools, and ban on mass gathering will be good enough to slow down the spread a lot, but bad enough to kill disproportionate amount of people. For example Sweden has many times more deaths than other Nordic Countries, but similar economical outlooks, and the even the idea of reaching herd immunity is uncertain. It may be that other Nordic countries will have soon less or about the same amount of restrictions as Sweden, but many times less deaths. And regarding the risks, one of the scientists who discovered Ebola [0]: "Many people think COVID-19 kills 1% of patients, and the rest get away with some flulike symptoms. But the story gets more complicated. Many people will be left with chronic kidney and heart problems. Even their neural system is disrupted. There will be hundreds of thousands of people worldwide, possibly more, who will need treatments such as renal dialysis for the rest of their lives. The more we learn about the coronavirus, the more questions arise. We are learning while we are sailing. That’s why I get so annoyed by the many commentators on the sidelines who, without much insight, criticize the scientists and policymakers trying hard to get the epidemic under control. That’s very unfair." Also based on Japanese study on around 100 COVID-19 cases from Grand Princess passengers [1] and some 6 divers all with mild cases from Germany [2] around 50 to 80% of people seem to have damage to the lungs visible on CT scans after mild symptomatic or even asymptomatic infection. Two of the divers had significant oxygen deficiency when doing physical exercise after 5-6 weeks of recovery. The guess of the doctor who was inspecting them is that this is permanent damage that may take years to recover if ever. [0] https://www.sciencemag.org/news/2020/05/finally-virus-got-me-scientist-who-fought-ebola-and-hiv-reflects-facing-death-covid-19 https://www.sciencemag.org/news/2020/05/finally-virus-got-me... [1] https://pubs.rsna.org/doi/10.1148/ryct.2020200110 https://pubs.rsna.org/doi/10.1148/ryct.2020200110 [2] https://translate.google.com/translate?sl=auto&tl=en&u=https%3A%2F%2Fwww.wetnotes.eu%2Ftauchen-nach-covid-19-erkrankung%2F https://translate.google.com/translate?sl=auto&tl=en&u=https...

deleted 7y ago

[deleted]