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Protect the vulnerable (no sending Covid positive patients into their living spaces!) while allowing low risk population to develop and overcome the virus. Thi

Protect the vulnerable (no sending Covid positive patients into their living spaces!) while allowing low risk population to develop and overcome the virus. This seems like the most logical way to combat issue, as opposed to hiding and hoping it goes away. Of course proposing it publicly means to be smeared by the media and politicians and twitter blue checks, who always have our best interests in mind. Does this solution cause no pain and death? Of course not! It’s about causing the least amount of pain long term, including the externalities of our actions.

phantom0308 6y ago
There isn't enough evidence of long term immunity to make herd immunity a sensible strategy. It's smeared by the media b/c it's way less preferable than the alternative of containing it like nearly every developed country in the world. https://www.cnbc.com/2020/07/14/immunity-to-covid-19-uk-study.html https://www.cnbc.com/2020/07/14/immunity-to-covid-19-uk-stud...
- ashtonkem 6y ago
  “This strategy would kill over half a million Americans” isn’t even really a smear, it’s an accurate description of why the herd immunity strategy is bad.
  - ed25519FUUU 6y ago
    It's neither a smear nor an accurate description. It's fear mongering.
    - ashtonkem 6y ago
      They said the same about tens of thousands dying; we’re now at 141k dead Americans. If you want to dismiss it as “fear mongering” that’s your prerogative, just don’t be surprised that most people find this unconvincing.
searine 6y ago
>This seems like the most logical way to combat issue, as opposed to hiding and hoping it goes away. Logical if all that matters to you is numbers and money. Lets not hide behind words. This logic mean death. You are conducting a blood sacrifice to ensure people don't have to alter their behavior. If you're so gung-ho to get to herd immunity, how about you volunteer to be on the front lines?
- dexen 6y ago
  The alternative - hiding people in homes until vaccine is widely available - means death. From alcohol & substance abuse, from increased suicides, from domestic violence, and so on. Extended period of being prevented from running your business (or out of employment) without steady income, and bottled up at home is a major stresor and silent killer. The hospitals already reported significantly elevated suicides. There is no magical strategy to stave off all the problems; balancing the risks and managing precautions as our knowledge expands is the correct, if hard to politically sell, way to go.
  - ashtonkem 6y ago
    Opening up without restrictions would kill somewhere between 500,000 and 1,300,000 Americans, assuming that the CFR doesn’t rise above 1% (an optimistic assumption). If you think lockdowns will kill that many Americans, then provide your sources.
    - __blockcipher__ 6y ago
      I think you mean IFR not CFR. The new estimates of HIT factoring in widespread t-cell cross-reactivity in humans that have NEVER been exposed to a SARS-like virus nor anyone who was themselves infected with one, implies that the true HIT is somewhere around 25%. Do the math on the US with an IFR of .3% and an HIT of 25%. That’s what a likely scenario looks like. It means a few hundred thousand dead. As an upper bound do the same math with .9% IFR and 25% HIT. BTW you should also consider the risk that lockdown puts the body into a state where it is more susceptible to bad COVID-19 outcomes, due to vitamin d deficiency, lack of nitric oxide, lack of exercise, reduced sleep, social isolation, unemployment, and an unprecedented environment of widespread fear&hysteria. Also consider the lives we have already lost when calculating the delta between containment versus not practicing containment. IMO containment is a foolish and infantile strategy which makes us perpetually at risk of an outbreak. Population immunity is the stable and logical solution. Banking on a vaccine is an awful idea, doubly so in a country where we can’t mandate a vaccine without plunging ourselves into civil war. Vaccine-attributable herd immunity only works if a bunch of people get vaccinated. Granted the t-cell reactivity findings alter the calculus there, but we would need to vaccinate people who do not demonstrate cross reactivity in order for that fact to change the number of required vaccines.
jkinudsjknds 6y ago
That's not how it works. If you had 100% immunity in the young, the old would still be at relatively similar risk because of homophily in social networks. That is, old people spend most of their time with old people. Herd immunity for the general population requires a homogenous mixture of social interactions across those infected. Keeping the vulnerable protected sounds good and all, but in the case of, say, children, the vulnerable is the teaching staff.
phantom0308 6y ago
Protecting the vulnerable has never actually worked. In theory it's possible, but it would require constantly testing nursing home workers that don't have the money to do this and an administration that hasn't shown the ability to support it. Every area that's had a significant level of spread has had issues where nursing home care workers brought in the virus from the community. The exception is Hong Kong where nursing home residents were quarantined in hospitals for significant periods. This presupposes the leadership to setup a system like this and the willingness of nursing home residents to be isolated for long periods of time. If we had either of those things we'd be able to contain the virus in the broader population.
ashtonkem 6y ago
The problem is that this is incredibly hard to do. It’s much easier to protect the vulnerable if the routes for community transmission are reduced or eliminated; if society is acting as normal it’s really hard to stop those specific transmission vectors. Given that we can’t convince people to wear masks, I’m dubious about any plan that requires more planning and communication. We also have no idea if herd immunity will work, or for how long. Lots of coronaviruses confer either no immunity or a short term one; remember that a lot of common cold cases are coronaviruses too, and you can catch those repeatedly. Also, pursuing herd immunity involves infecting basically 20-50% of the population, a strategy that might kill 500k to 1.5mil Americans (assuming CFR stays at 1%, an optimistic assumption in this scenario) We also have no idea what the health impacts for non-fatal cases are. Lots of patients are surviving with heart & lung damage; long term impacts TBD. Crippling an entire generation from the get go would both be tragic, and would put lie to the idea that not opening schools is “letting them fall behind”.
akamia 6y ago
The problem with this approach is it also assumes that overcoming the virus means a return to 100% health with no long term impact. We're already seeing that it can lead to other long term conditions. I have a friend who is being treated for heart damage after having COVID. I'm in a low risk population but just because I'm not likely to die from it doesn't mean it's completely harmless to me.

phantom0308 6y ago

There isn't enough evidence of long term immunity to make herd immunity a sensible strategy. It's smeared by the media b/c it's way less preferable than the alternative of containing it like nearly every developed country in the world. https://www.cnbc.com/2020/07/14/immunity-to-covid-19-uk-study.html https://www.cnbc.com/2020/07/14/immunity-to-covid-19-uk-stud...

ashtonkem 6y ago
“This strategy would kill over half a million Americans” isn’t even really a smear, it’s an accurate description of why the herd immunity strategy is bad.
- ed25519FUUU 6y ago
  It's neither a smear nor an accurate description. It's fear mongering.
  - ashtonkem 6y ago
    They said the same about tens of thousands dying; we’re now at 141k dead Americans. If you want to dismiss it as “fear mongering” that’s your prerogative, just don’t be surprised that most people find this unconvincing.

searine 6y ago

>This seems like the most logical way to combat issue, as opposed to hiding and hoping it goes away. Logical if all that matters to you is numbers and money. Lets not hide behind words. This logic mean death. You are conducting a blood sacrifice to ensure people don't have to alter their behavior. If you're so gung-ho to get to herd immunity, how about you volunteer to be on the front lines?

dexen 6y ago
The alternative - hiding people in homes until vaccine is widely available - means death. From alcohol & substance abuse, from increased suicides, from domestic violence, and so on. Extended period of being prevented from running your business (or out of employment) without steady income, and bottled up at home is a major stresor and silent killer. The hospitals already reported significantly elevated suicides. There is no magical strategy to stave off all the problems; balancing the risks and managing precautions as our knowledge expands is the correct, if hard to politically sell, way to go.
- ashtonkem 6y ago
  Opening up without restrictions would kill somewhere between 500,000 and 1,300,000 Americans, assuming that the CFR doesn’t rise above 1% (an optimistic assumption). If you think lockdowns will kill that many Americans, then provide your sources.
  - __blockcipher__ 6y ago
    I think you mean IFR not CFR. The new estimates of HIT factoring in widespread t-cell cross-reactivity in humans that have NEVER been exposed to a SARS-like virus nor anyone who was themselves infected with one, implies that the true HIT is somewhere around 25%. Do the math on the US with an IFR of .3% and an HIT of 25%. That’s what a likely scenario looks like. It means a few hundred thousand dead. As an upper bound do the same math with .9% IFR and 25% HIT. BTW you should also consider the risk that lockdown puts the body into a state where it is more susceptible to bad COVID-19 outcomes, due to vitamin d deficiency, lack of nitric oxide, lack of exercise, reduced sleep, social isolation, unemployment, and an unprecedented environment of widespread fear&hysteria. Also consider the lives we have already lost when calculating the delta between containment versus not practicing containment. IMO containment is a foolish and infantile strategy which makes us perpetually at risk of an outbreak. Population immunity is the stable and logical solution. Banking on a vaccine is an awful idea, doubly so in a country where we can’t mandate a vaccine without plunging ourselves into civil war. Vaccine-attributable herd immunity only works if a bunch of people get vaccinated. Granted the t-cell reactivity findings alter the calculus there, but we would need to vaccinate people who do not demonstrate cross reactivity in order for that fact to change the number of required vaccines.

jkinudsjknds 6y ago

That's not how it works. If you had 100% immunity in the young, the old would still be at relatively similar risk because of homophily in social networks. That is, old people spend most of their time with old people. Herd immunity for the general population requires a homogenous mixture of social interactions across those infected. Keeping the vulnerable protected sounds good and all, but in the case of, say, children, the vulnerable is the teaching staff.

phantom0308 6y ago

Protecting the vulnerable has never actually worked. In theory it's possible, but it would require constantly testing nursing home workers that don't have the money to do this and an administration that hasn't shown the ability to support it. Every area that's had a significant level of spread has had issues where nursing home care workers brought in the virus from the community. The exception is Hong Kong where nursing home residents were quarantined in hospitals for significant periods. This presupposes the leadership to setup a system like this and the willingness of nursing home residents to be isolated for long periods of time. If we had either of those things we'd be able to contain the virus in the broader population.

ashtonkem 6y ago

The problem is that this is incredibly hard to do. It’s much easier to protect the vulnerable if the routes for community transmission are reduced or eliminated; if society is acting as normal it’s really hard to stop those specific transmission vectors. Given that we can’t convince people to wear masks, I’m dubious about any plan that requires more planning and communication. We also have no idea if herd immunity will work, or for how long. Lots of coronaviruses confer either no immunity or a short term one; remember that a lot of common cold cases are coronaviruses too, and you can catch those repeatedly. Also, pursuing herd immunity involves infecting basically 20-50% of the population, a strategy that might kill 500k to 1.5mil Americans (assuming CFR stays at 1%, an optimistic assumption in this scenario) We also have no idea what the health impacts for non-fatal cases are. Lots of patients are surviving with heart & lung damage; long term impacts TBD. Crippling an entire generation from the get go would both be tragic, and would put lie to the idea that not opening schools is “letting them fall behind”.

akamia 6y ago

The problem with this approach is it also assumes that overcoming the virus means a return to 100% health with no long term impact. We're already seeing that it can lead to other long term conditions. I have a friend who is being treated for heart damage after having COVID. I'm in a low risk population but just because I'm not likely to die from it doesn't mean it's completely harmless to me.