I'm watching the UK government decide not to implement 'delay' measures today, ostensibly to protect the economy. It seems there is always a reason not to do the right thing.
I hope they change their mind very soon.
I hope they change their mind very soon.
What was said was - from epidimiology point of view, there's no point in telling everyone to stay at home right now when the spread is in the early stages. It will have a marginal effect, and the spread will continue anyway. By government's own estimates 80% of people in the UK will get infected, and imposing a quarantine right now won't change that. What would help is setting the quarantine for 14-18 weeks, and they know that people won't abide by that, so instead, they clearly said they will impose quarantine just before UK hits the predicted peak infections - to lower the stress on the NHS and to achieve the maximum effect of the quarantine. Like, it all made sense if you watched the actual conference.
But the idea that the "most effective" time is going to be later doesn't make much sense to me. Marginal rate changes in exponential spread are most likely to have the biggest impacts early. It doesn't much change the total volume of people who get sick, but it very likely changes the volume of people who get sick at once, and that can save lives.
This sounds like saying "we can only imagine quarantine working if things get fucked, so we're going to let things get fucked, so that the quarantine will work except for the fact that things are already fucked oh well too late."
In addition, new constellations of people gathering become likely. E.g. children from different schools may play together more in the neighborhoods, opening new pathways for the disease to spread.
So when a quarantine is not expected to help in most cases (because most people are not infected), the drawbacks easily outweigh the benefits.
It seems strange a hospital cannot respond to daycare needs in their own population in a situation like this...
I don’t think hospitals have “emergency daycare” available generally speaking. If it does come down to quarantine, I’m sure efforts will be made. It is still a cost and a negative outcome of the quarantine so my point remains: when the benefit is very small, the costs easily outweigh the benefits.
Social distancing, reduce frequency of contact, stop meeting in large groups. That's the whole ballgame now.
Statistically speaking there is a good chance no-one at your work place has the virus yet. We are still counting infections in the hundreds or the thousands in populations of millions. If all you do is to spend time at home and at work, there are good odds you’re just switching between two disease free spheres. You can’t get sick without meeting sick people. The only thing that will change that steady state is contact with new people (by yourself or your coworkers/family).
The point the government was making in this case, I believe, is that quarantine can in fact cause more novel connections, faster, and perversely increase the velocity of the spread. The people who are at home will not just sit there. They will meet other people and those people may be from outside of their ordinary, currently disease free social sphere. Thus new vectors of infection spread are introduced that would not have existed without the quarantine.
A quarantine can certainly help down the road, it’s a numbers game. But right now they’re doing the math and think it would be a net negative.
An infection travels like a game of 'telephone' passed from one to the next, right across the world.
Quarantine will initially regroup people, but in much smaller groups. If the disease is not yet widespread, then your new cohort will also likely be disease-free. There may be a tiny spike as an infected person in a large group joins a different, small group. But this is a good thing, since that group is smaller, and fewer people will now be at risk.
No, quarantine is the only effective way forward.
All else is not equal. You pull the quarantine lever, you increase social distancing but you also increase local mixing. Costs and benefits. The right choice at any given time depends on the disease spread. Computer modelling and simulation tells us when there is a net benefit.
If that's the case... it seems like it heavily relies on timing, good data & models, and more precisely timed and effective social cooperation, and I'm not sure I'd want to bet on having all those pieces in place, but it is interesting.
But if the disease is spread enough (inside or outside your borders) so that is impossible, the next best thing is to reduce social interaction just before your health system collapses, and just enough to avoid a collapse. That minimizes both the cost and time of isolation.
So if you lock down a few weeks too soon, people start breaking isolation at exactly the point it's most important the lockdown is maintained. All of this was explained in the presentation.
So for example, if we have 100,000 ICU beds in the US and we somehow make them all available for COVID-19 patients (unlikely), how flat do we need to make the curve to not go above 100k ICU patients, and how long will that flattened curve last? A month? Six months? Two years?
Assuming 70% of the adult population gets it, that's roughly 140 million infected. Assuming 5% need ICU beds, that's 7 million ICU patients. And assuming the average ICU stay is 2 weeks, we'd need to therefore spread our ICU patients over 140 weeks, or almost three years. Is that how long we can expect social distancing to last if things go perfectly?
It's not a stalemate, they're still getting new cases at a pace that allows their medical system to cope.
> In the absence of a vaccine
It's a pretty safe bet one will become available pretty soon. Meanwhile, more is being learned about how to handle infections and improve the outcome.
> the aim is to flatten the curve but still get the whole thing over and done with in about 6 months
There are 4000 ICU beds in the country in total, most of which will be in use due to other kind of cases at any one time. [1] But let's assume you can make that number available for coronavirus patients for 6 months. So you have 4k*26 = 104k ICU bed-weeks available. There's been talk of 60% of the population getting infected to build up herd immunity [2] (somehow ignoring that there seems to be a nontrivial reinfection rate [3]), so almost 40 million people. It's not very clear how many infected people end up needing intensive care. In Italy, it was 10% of the people who tested positive [4]. But only the worst cases get tested once the epidemic is widespread, so let's say maybe 0.5% of the infected people need ICU (wild guess here since no country with a large number of infections is testing people with mild symptoms, but I think I'm being conservative). 0.5% of 40 million is 200k patients. If each of them need an ICU bed for 2 weeks, that's 400k bed-weeks.
Basically we're talking about most of the 6 months period of the NHS being overwhelmed and coronavirus having a high mortality rate.
[1] https://www.bbc.com/news/health-51714498
[2] https://www.independent.co.uk/news/health/coronavirus-herd-i...
[3] https://www.reuters.com/article/us-china-health-reinfection-...
[4] https://www.statnews.com/2020/03/10/simple-math-alarming-ans...