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Contact tracing is not needed - identify the people at high risk and protect them from the virus. People at low risk should be expected to circulate the virus a

Contact tracing is not needed - identify the people at high risk and protect them from the virus. People at low risk should be expected to circulate the virus and develop immunity. Contract tracing among low risk defeats the purpose. If we're ever going to get our lives back, and not be on indefinite timeline of "maybe there will be a highly effective vaccine" we actually need the virus to circulate among people who can safely get it, get over it, make antibodies which historically - before the advent of highly effective vaccines - is how pandemics ended. Total isolation policies prevent broad population immunity. We know from decades of medical science that the population develops immunity while acquiring antibodies.

tsimionescu 6y ago
That depends on the disease. Is there any proof that people develop immunity to covid 19 after getting it?
- bad_user 6y ago
  We don't have evidence due to disease being so new, but there's enough reason to suspect we'll develop at least short term neutralizing immunity. But yes, caution is necessary. We don't have enough evidence to push forward a national strategy that's based on people developing immunity without a vaccine. Here's WHO's statement on this matter: https://www.who.int/news-room/commentaries/detail/immunity-passports-in-the-context-of-covid-19 https://www.who.int/news-room/commentaries/detail/immunity-p... "Herd immunity" without a vaccine, as a strategy, is equivalent with doing nothing and let the virus wreak havoc on the population.
  - tomp 6y ago
    Risk vs reward. If there is immunity, then developing herd immunity sooner rather than later is important (even more so if there's immunity but it's only short-term). If there's no immunity, we're, excuse the expression, fucked anyhow. Can vaccines even be developed if there's no natural immunity?
    - orwin 6y ago
      If there is short term immunity yes (diphteria, tetanos is an example, polio too). Being exposed to the same antigen while you have an immunity should reactivate this immunity, that's a reason why a "herd immunity" tactic could work, at least for a time However if the natural immunity w/o reactivation only last a year or less, you will end up with a new outbreak at the end of the period. And if the immunity period is shorter than the recuperation one, you will have a virus that will be a lot more lethal.
  - greedo 6y ago
    What's worrisome is that some people are testing positive again, after being diagnosed as positive. Crew on the CVN-71 Roosevelt have tested positive, been quarantined for 14 days, then tested negative twice (two days apart), but then still testing positive a few days later.[1] The possible scenarios for this I can come up with are: 1. No immunity after initial infection 2. Bad test methodology (contamination etc) 3. Bad tests. The article doesn't mention the test type, so perhaps they were initially misdiagnosed (false positive), then infected upon return to the ship. The implication from this would be that the virus is still prevalent in the crew on board the Roosevelt...
    - deleted 6y ago
      [deleted]
    - standardUser 6y ago
      In South Korea, they discovered that all of the many potential reinfections they had detected were due to faulty (overly sensitive) tests. There are no confirmed cases of reinfection and many thousands of people on 'front line' jobs who have recovered form the disease, returned to work and never been reinfected. In a study done on monkeys, scientists were unable to achieve reinfection. Here is a recent article with some useful links discussing immunity: https://www.sltrib.com/news/2020/05/13/coronavirus-immunity/ https://www.sltrib.com/news/2020/05/13/coronavirus-immunity/
CathedralBorrow 6y ago
Iceland has done quite fine through this with contact tracing as one of the main tools in the toolbox. I think a blanket statement of "not needed" needs something more behind it.
- triyambakam 6y ago
  We have better tools that don't involve invasion of privacy. How many people praised the Patriot Act after 9/11?
  - CathedralBorrow 6y ago
    Iceland does not have the Patriot Act or anything like it, so I'm not sure how that's relevant here.
    - triyambakam 6y ago
      Contact tracing is a world wide privacy issue, and especially in the US. I'm talking more generally here, especially that the overwhelming sentiment here on HN towards contact tracing is indifference or praise. We should not be praising further encroachments on our privacy, especially when contract tracing is hardly an effective way to mitigate the disease
      - CathedralBorrow 6y ago
        I respectfully disagree that "we should" do what you would prefer to happen. Contact tracing is not a privacy issue here.
abraae 6y ago
> Total isolation policies prevent broad population immunity. We know from decades of medical science that the population develops immunity while acquiring antibodies. Look at the bigger picture. In today's immensely innovative world there will almost certainly be a vaccine or anti-viral or some effective treatment within a year or two. The goal for those of us who are lucky enough (in normal times it can be a curse) to live on an island is not to hide out forever - it's to hide out until that treatment is available.
- triyambakam 6y ago
  You're sincerely willing to wait an entire year for a vaccine that may not work when we already have effective treatments? That's insane
  - Reelin 6y ago
    > when we already have effective treatments Please don't spread misinformation.
    - triyambakam 6y ago
      How clever. Yes, we have high confidence that hydroxychloroquine, azithromycin and zinc are very helpful at treating it. We should let the virus circulate among low risk population, isolate/protect the vulnerable, and focus on treatments that we know have been effective in the past or are showing good results now. This perpetual waiting is insane.
      - deleted 6y ago
        [deleted]
      - Reelin 6y ago
        > we have high confidence that hydroxychloroquine, azithromycin and zinc are very helpful at treating it We most certainly do not (https://blogs.sciencemag.org/pipeline/archives/2020/05/04/hydroxychloroquine-update-may-4 https://blogs.sciencemag.org/pipeline/archives/2020/05/04/hy...). No effective treatments are currently known. There's hope that monoclonal antibodies will work, but they come with their own list of caveats (https://blogs.sciencemag.org/pipeline/archives/2020/05/14/monoclonal-antibodies-and-vaccines-a-qa https://blogs.sciencemag.org/pipeline/archives/2020/05/14/mo...). Again, please don't make things up. Stop spreading misinformation! It's already incredibly difficult for laypeople to make sense of the chaotic, frequently changing, and often conflicting reports at this point.
jonahbenton 6y ago
As someone working with large health non profits on COVID tools, whose head is deep into the reporting and news around it, and who has 3 school age kids in NYC, I am of the opinion that there is no low risk population, no "safe to get it" group. There are groups where symptomatic incidence is lower. Sure. But JFC some of those symptomatic cases are awful, with lifelong impact. Someone used the Russian Roulette metaphor early on and it continues to resonate with me. We see over and over again surprising case histories all across the demographic, age, and health history map. Too many that are completely unexpected and for which there are presently no predictive metrics. We are slowly learning more about what this virus can do, and we have a sense of what it will do when presented with a known vulnerable population. It is remorseless. But even for "low risk" populations it is exactly like Russian Roulette. You and 9 others might be at the peak of known clinical health measurements and it may leave those others unscathed- that we know of- while it will destroy your lungs or your liver or cause you to have a stroke. With all respect to the goal of broad population immunity, for my family- we stay carefully isolated and adopt all defensive protocols, we wait for a vaccine, and we advocate for govt entities to provide the liquidity to keep safely running the various life sustaining machines that our interdependent world depends on.
- jonahbenton 6y ago
  It is beyond ironic for this comment to get downvoted.
- nradov 6y ago
  This is a ridiculous comment, totally disconnected from reality. The risk of a seriously bad outcome from SARS-CoV-2 infection are far less than 1/6 (Russian Roulette) for most people. Hiding in our homes until a vaccine appears at some unknown point in the future is obviously not a viable strategy. If we drive the economy into another Great Depression that will kill many people as well. Federal government liquidity injections are not a solution. At some point if people aren't out working to create value then society will disintegrate.
  - triyambakam 6y ago
    > Hiding in our homes until a vaccine appears at some unknown point in the future is obviously not a viable strategy. Yes, this is the point I am trying to make. But most of the demographic here (who already work from home or easily transitioned to doing so) likely don't find it difficult and are mostly unaffected.
andybak 6y ago
The more I learn about this disease, the less happy I am about the idea of getting it. There's a lot we don't know and some worrying signs that it might not just be an brief, acute, occasionally severe, illness.
tsomctl 6y ago
I'm on day 11 of this shit. You really do not want this.
- yborg 6y ago
  I'm on week 8 of this shit. If you're one of the 5% that are going to have it turn into a relapsing form like me you really do not want this.
  - tfigment 6y ago
    I think I have it. Going on 4th week with mild symptoms (severely itchy hands/arms, constant headache, muscle fatigue recently) that don't match published ones. I was probably infected going to grocer 6 weeks ago and took 2 weeks to manifest. The itch/red spots move around like every 8 hours ( I don't scratch it). What happened to you? Did it get in your lungs? What does a relapse behave like? I'm just trying to figure out what might happen.
    - nl 6y ago
      You should go and get tested. If you have it then it is in your lungs (it's a respiratory disease)
      - tfigment 6y ago
        They still wont test until you are near death. CDC and Kaiser tell me to stay home. Plague has at least 2 forms: one if its in your lung and another in the skin. I'm wonder if this might not be similar.
        nl 6y ago
        What country are you in? Surely most places have solved the testing bottlenecks by now? You really should go to a doctor for the skin condition at least. > Plague has at least 2 forms: one if its in your lung and another in the skin. I'm wonder if this might not be similar. There's no evidence of that. There are some very occasional skin conditions associated with COVID but they don't don't sound much like this.
Reason077 6y ago
> "identify the people at high risk and protect them from the virus. People at low risk should be expected to circulate the virus and develop immunity." Well, sure. That is what has been happening anyway. But it's hard to keep the low risk people away from the high risk people all of the time. Or are you really not going to ever visit grandma again, potentially for years? So, even if you're low risk, it helps to know if you've been exposed so you can isolate yourself and protect the high risk people.
postingawayonhn 6y ago
> identify the people at high risk and protect them from the virus Nice idea on theory but in practice it's shown to be very difficult to do.
nl 6y ago
This absolutely does not work. In Australia we tried to keep aged care homes isolated, and it was catastrophic - something like 25% of deaths were from a couple of cases that were undetected and made it into aged care homes. In Sweden this was explicitly their plan and here's what happened: “It’s very difficult to keep the disease away from there,” he said. “Even if we are doing our best, it’s obviously not enough.” But he said: “We are not putting anybody’s lives above everybody else’s lives – that’s not the way we’re working.” Tegnell said in late April that at least half of the country’s deaths had been in nursing homes. “We really thought our elderly homes would be much better at keeping this disease outside of them then they have actually been,” he told Noah https://www.businessinsider.com.au/coronavirus-sweden-lockdown-chief-says-high-death-toll-was-surprise-2020-5 https://www.businessinsider.com.au/coronavirus-sweden-lockdo...

tsimionescu 6y ago

That depends on the disease. Is there any proof that people develop immunity to covid 19 after getting it?

bad_user 6y ago
We don't have evidence due to disease being so new, but there's enough reason to suspect we'll develop at least short term neutralizing immunity. But yes, caution is necessary. We don't have enough evidence to push forward a national strategy that's based on people developing immunity without a vaccine. Here's WHO's statement on this matter: https://www.who.int/news-room/commentaries/detail/immunity-passports-in-the-context-of-covid-19 https://www.who.int/news-room/commentaries/detail/immunity-p... "Herd immunity" without a vaccine, as a strategy, is equivalent with doing nothing and let the virus wreak havoc on the population.
- tomp 6y ago
  Risk vs reward. If there is immunity, then developing herd immunity sooner rather than later is important (even more so if there's immunity but it's only short-term). If there's no immunity, we're, excuse the expression, fucked anyhow. Can vaccines even be developed if there's no natural immunity?
  - orwin 6y ago
    If there is short term immunity yes (diphteria, tetanos is an example, polio too). Being exposed to the same antigen while you have an immunity should reactivate this immunity, that's a reason why a "herd immunity" tactic could work, at least for a time However if the natural immunity w/o reactivation only last a year or less, you will end up with a new outbreak at the end of the period. And if the immunity period is shorter than the recuperation one, you will have a virus that will be a lot more lethal.
- greedo 6y ago
  What's worrisome is that some people are testing positive again, after being diagnosed as positive. Crew on the CVN-71 Roosevelt have tested positive, been quarantined for 14 days, then tested negative twice (two days apart), but then still testing positive a few days later.[1] The possible scenarios for this I can come up with are: 1. No immunity after initial infection 2. Bad test methodology (contamination etc) 3. Bad tests. The article doesn't mention the test type, so perhaps they were initially misdiagnosed (false positive), then infected upon return to the ship. The implication from this would be that the virus is still prevalent in the crew on board the Roosevelt...
  - deleted 6y ago
    [deleted]
  - standardUser 6y ago
    In South Korea, they discovered that all of the many potential reinfections they had detected were due to faulty (overly sensitive) tests. There are no confirmed cases of reinfection and many thousands of people on 'front line' jobs who have recovered form the disease, returned to work and never been reinfected. In a study done on monkeys, scientists were unable to achieve reinfection. Here is a recent article with some useful links discussing immunity: https://www.sltrib.com/news/2020/05/13/coronavirus-immunity/ https://www.sltrib.com/news/2020/05/13/coronavirus-immunity/

CathedralBorrow 6y ago

Iceland has done quite fine through this with contact tracing as one of the main tools in the toolbox. I think a blanket statement of "not needed" needs something more behind it.

triyambakam 6y ago
We have better tools that don't involve invasion of privacy. How many people praised the Patriot Act after 9/11?
- CathedralBorrow 6y ago
  Iceland does not have the Patriot Act or anything like it, so I'm not sure how that's relevant here.
  - triyambakam 6y ago
    Contact tracing is a world wide privacy issue, and especially in the US. I'm talking more generally here, especially that the overwhelming sentiment here on HN towards contact tracing is indifference or praise. We should not be praising further encroachments on our privacy, especially when contract tracing is hardly an effective way to mitigate the disease
    - CathedralBorrow 6y ago
      I respectfully disagree that "we should" do what you would prefer to happen. Contact tracing is not a privacy issue here.

abraae 6y ago

> Total isolation policies prevent broad population immunity. We know from decades of medical science that the population develops immunity while acquiring antibodies. Look at the bigger picture. In today's immensely innovative world there will almost certainly be a vaccine or anti-viral or some effective treatment within a year or two. The goal for those of us who are lucky enough (in normal times it can be a curse) to live on an island is not to hide out forever - it's to hide out until that treatment is available.

triyambakam 6y ago
You're sincerely willing to wait an entire year for a vaccine that may not work when we already have effective treatments? That's insane
- Reelin 6y ago
  > when we already have effective treatments Please don't spread misinformation.
  - triyambakam 6y ago
    How clever. Yes, we have high confidence that hydroxychloroquine, azithromycin and zinc are very helpful at treating it. We should let the virus circulate among low risk population, isolate/protect the vulnerable, and focus on treatments that we know have been effective in the past or are showing good results now. This perpetual waiting is insane.
    - deleted 6y ago
      [deleted]
    - Reelin 6y ago
      > we have high confidence that hydroxychloroquine, azithromycin and zinc are very helpful at treating it We most certainly do not (https://blogs.sciencemag.org/pipeline/archives/2020/05/04/hydroxychloroquine-update-may-4 https://blogs.sciencemag.org/pipeline/archives/2020/05/04/hy...). No effective treatments are currently known. There's hope that monoclonal antibodies will work, but they come with their own list of caveats (https://blogs.sciencemag.org/pipeline/archives/2020/05/14/monoclonal-antibodies-and-vaccines-a-qa https://blogs.sciencemag.org/pipeline/archives/2020/05/14/mo...). Again, please don't make things up. Stop spreading misinformation! It's already incredibly difficult for laypeople to make sense of the chaotic, frequently changing, and often conflicting reports at this point.

jonahbenton 6y ago

As someone working with large health non profits on COVID tools, whose head is deep into the reporting and news around it, and who has 3 school age kids in NYC, I am of the opinion that there is no low risk population, no "safe to get it" group. There are groups where symptomatic incidence is lower. Sure. But JFC some of those symptomatic cases are awful, with lifelong impact. Someone used the Russian Roulette metaphor early on and it continues to resonate with me. We see over and over again surprising case histories all across the demographic, age, and health history map. Too many that are completely unexpected and for which there are presently no predictive metrics. We are slowly learning more about what this virus can do, and we have a sense of what it will do when presented with a known vulnerable population. It is remorseless. But even for "low risk" populations it is exactly like Russian Roulette. You and 9 others might be at the peak of known clinical health measurements and it may leave those others unscathed- that we know of- while it will destroy your lungs or your liver or cause you to have a stroke. With all respect to the goal of broad population immunity, for my family- we stay carefully isolated and adopt all defensive protocols, we wait for a vaccine, and we advocate for govt entities to provide the liquidity to keep safely running the various life sustaining machines that our interdependent world depends on.

jonahbenton 6y ago
It is beyond ironic for this comment to get downvoted.
nradov 6y ago
This is a ridiculous comment, totally disconnected from reality. The risk of a seriously bad outcome from SARS-CoV-2 infection are far less than 1/6 (Russian Roulette) for most people. Hiding in our homes until a vaccine appears at some unknown point in the future is obviously not a viable strategy. If we drive the economy into another Great Depression that will kill many people as well. Federal government liquidity injections are not a solution. At some point if people aren't out working to create value then society will disintegrate.
- triyambakam 6y ago
  > Hiding in our homes until a vaccine appears at some unknown point in the future is obviously not a viable strategy. Yes, this is the point I am trying to make. But most of the demographic here (who already work from home or easily transitioned to doing so) likely don't find it difficult and are mostly unaffected.

andybak 6y ago

The more I learn about this disease, the less happy I am about the idea of getting it. There's a lot we don't know and some worrying signs that it might not just be an brief, acute, occasionally severe, illness.

tsomctl 6y ago

I'm on day 11 of this shit. You really do not want this.

yborg 6y ago
I'm on week 8 of this shit. If you're one of the 5% that are going to have it turn into a relapsing form like me you really do not want this.
- tfigment 6y ago
  I think I have it. Going on 4th week with mild symptoms (severely itchy hands/arms, constant headache, muscle fatigue recently) that don't match published ones. I was probably infected going to grocer 6 weeks ago and took 2 weeks to manifest. The itch/red spots move around like every 8 hours ( I don't scratch it). What happened to you? Did it get in your lungs? What does a relapse behave like? I'm just trying to figure out what might happen.
  - nl 6y ago
    You should go and get tested. If you have it then it is in your lungs (it's a respiratory disease)
    - tfigment 6y ago
      They still wont test until you are near death. CDC and Kaiser tell me to stay home. Plague has at least 2 forms: one if its in your lung and another in the skin. I'm wonder if this might not be similar.
      - nl 6y ago
        What country are you in? Surely most places have solved the testing bottlenecks by now? You really should go to a doctor for the skin condition at least. > Plague has at least 2 forms: one if its in your lung and another in the skin. I'm wonder if this might not be similar. There's no evidence of that. There are some very occasional skin conditions associated with COVID but they don't don't sound much like this.

Reason077 6y ago

> "identify the people at high risk and protect them from the virus. People at low risk should be expected to circulate the virus and develop immunity." Well, sure. That is what has been happening anyway. But it's hard to keep the low risk people away from the high risk people all of the time. Or are you really not going to ever visit grandma again, potentially for years? So, even if you're low risk, it helps to know if you've been exposed so you can isolate yourself and protect the high risk people.

postingawayonhn 6y ago

> identify the people at high risk and protect them from the virus Nice idea on theory but in practice it's shown to be very difficult to do.

nl 6y ago

This absolutely does not work. In Australia we tried to keep aged care homes isolated, and it was catastrophic - something like 25% of deaths were from a couple of cases that were undetected and made it into aged care homes. In Sweden this was explicitly their plan and here's what happened: “It’s very difficult to keep the disease away from there,” he said. “Even if we are doing our best, it’s obviously not enough.” But he said: “We are not putting anybody’s lives above everybody else’s lives – that’s not the way we’re working.” Tegnell said in late April that at least half of the country’s deaths had been in nursing homes. “We really thought our elderly homes would be much better at keeping this disease outside of them then they have actually been,” he told Noah https://www.businessinsider.com.au/coronavirus-sweden-lockdown-chief-says-high-death-toll-was-surprise-2020-5 https://www.businessinsider.com.au/coronavirus-sweden-lockdo...