Ask HN: Is UK government insane or genius? | Hacker News Reader

Ask HN: Is UK government insane or genius?

524 pointsTheAlchemist741 comments

While virtually all countries adopt the lockdown strategy to eliminate the virus spread, UK is apparently going on with 'herd immunity' strategy. It's pretty well explained in this tweet: https://twitter.com/iandonald_psych/status/12385183716516495...

Basically, the idea is to get the young infected, as the virus seems to be relatively inoffensive for young people, and thus becoming immune. Once the country reach a threshold percentage of immune population, the virus cannot spread effectively anymore, hence protecting the vulnerable ones.

My gut feeling is that this is the rational thing to do, however only in theory. In practice, people won't be disciplined about isolating vulnerable ones in the first phase, thus leading to disaster.

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Their reasoning is that if the only things you can do are China-style lockdown or nothing, then the disease will just resume exponentially growing the second lockdown ends, so it's pointless to do it at all.

While that may be technically right (under some optimistic, unverified assumptions, e.g. no reinfection), it's a false dichotomy. Singapore, Hong Kong, and South Korea aren't under lockdown, they're stopping the spread by just having good testing and case tracking capacity, and good hygiene. And the longer things go on, the better they're getting at doing that. If things are getting out of hand, a temporary lockdown is effective (as it was in China), to get the numbers down while building up this kind of capacity. But lockdown doesn't have to last forever; China has already lifted restrictions in most cities.

The UK seems to be ignoring this, and I don't understand why. I suspect the real logic, as some government officials have outright said, is that a completely failed response would free up money for the NHS by killing off "bed blockers".

The social signalling around it is "prudent caution", in the sense that they are talking slowly and confidently while using big words. This gives some people the gut feeling that this must be the "rational" thing to do, but it's just window dressing. The plan is neither prudent nor cautious; it's recklessly endangering millions of lives. Experts in the UK are horrified; there's an hours-old petition against this with hundreds of academics already signed on [0]. The WHO has condemned it, and half the people I know studying abroad in the UK have fled the country over it.

0: http://maths.qmul.ac.uk/~vnicosia/UK_scientists_statement_on...

Also, the more time you win, the closer we get to a cure, vaccin or way to deal with it better.

Indeed, you buy up time to get more medical supplies or figure out more effective treatments. For example, China is now getting over it, but is still producing ridiculous amounts of medical equipment, which will soon get delivered across the world -- even if you must have a peak, you want that peak to be after you get this equipment, not before.

I think the development of a vaccine in a few months is unlikely. I think however the identification of somewhat effective antivirals in a few months is probable. There are already two antiviral candidates in trials, which are simpler to run than vaccine trials: remdesivir and lopinavir+ritonavir. Also, "transmitted immunity" is being (re)developed:

https://www.nbcnews.com/health/health-care/doctors-push-trea...

Antivirals won't stop the outbreak but they could save thousands of lives.

Dead on, the vaccine will just be a novelty, this will be over by then after 70-90% of the population has caught it and is mostly immune to it or dead.

the problem is that because it takes a year or two to get a vaccine out that this will all be over unless it mutates into something completely different.

But where is South Korea going with its strategy - are they going to keep doing that forever? And whats China's long term strategy? Wuhan is still locked down.

Wuhan had the great majority of cases in the entire world. The other provinces of China are more analogous to individual European countries. They locked down for a few weeks and have already come back up.

The long term strategies for Korea and China are the same: carefully identify new cases as they come in from outside, find their contacts, and isolate them as soon as possible. Temporarily lock down small regions on an individual basis if necessary. They've already been doing that with some new cases coming in from Italy.

> Wuhan had the great majority of cases in the entire world.

That was true a day or two ago, but that's a bit outdated now: Wuhan at most has had a bare majority of total cases in the world now, and probably a minority. In any event, it'll be a minority in a few hours.

What I don't understand is... Won't this just flare up again in another city the size of Wuhan at some point?

Yes, but hopefully they'll identify the flare-up much more quickly and be able to contain it with more targeted measures, before things get to the level they reached in Wuhan in late January.

>But where is South Korea going with its strategy

drawing the infections out so that the hospital system can stay stable and thus minimizing the amount of people who die from the disease. Not to mention that there will likely be a vaccine within 12-24 months and medication approved within the next few months.

Mind you this is in addition to South Korea having ~13 hospital beds per 1000 people, compared to ~8 in Germany and 2.5(!) in the UK. This strategy in the UK to let the virus eat through the population is insane.

Long term they are working on a vaccine and anti-virals.

Once you remove community spread, you only need to deal with international travel, which can be dealt with much more cost-effectively.

THe strategy in Asia seems to keep the virus under control but people in those countries are much more disciplined than European, not sure the measures they take would be as much effective in Europe.

The strategy of UK seems valid as long as you protect the more vulnerable, which they don't do.

What is the strategy after a lock down? You go back to work? It needs only one person infected to get the virus propagating again...

> The strategy of UK seems valid as long as you protect the more vulnerable, which they don't do.

The UK and devolved governments signaled on Thursday that the plan is for the vulnerable to be self-isolating for a long period; and based on the briefings to UK jornos on twitter - it'll be 16 weeks of self isolation for over 70s and those with underlying health conditions (they've not said what conditions yet) - I've seen it referred to as 'cocooning' by some.

I think the UK was doing a really good job, and has been doing a good job with this - I do think they've really misspoken when they've talked about herd immunity and have been trying to walk the term back.

You've got to bare in mind, that they aren't doing the politically easy things here. It would be easy to close the schools. Based on people I've spoken to, its going to happen soon - but I suspect they want this to happen after the over 70s and the vulnerables are into self-isolationg, and not shouldering childcare responsibilities. None of this is easy, we can't magic this virus away.

I think there's a lot behavioural science going on with the strategy here as well. A lot of the UK public now seem to realise this is serious and have automatically changed behaviour without government mandating it. Long term, that's a big win, people are bought in (seemingly) of their own volition and there is huge value in that.

The schools issue is very tricky as a lot of NHS staff will not be able to work if their children need to stay home. I can see them going to a softly, softly approach - parents working from home will be able to keep kids out of school with no consequence and they will probably extend all the school holidays a bit as well.

I can't believe this government wants to kill off the elderly out of choice, it forms a good section of their voter base, if nothing else.

I think overall it's good long term strategy, though very risky, which is never going to be perfect, but seems to have a lot of science and rationale behind it, even if not obvious at first.

I'm not sure how people will react by say, week 4 of isolation. I've been cooped up indoors for a week and it's already taking a toll on my well being.

You will invariably have people breaking quarantine after a few weeks, especially if there is a sense of the threat subsiding.

With entertainment venues being shuttered as “non-essential” at the same time as people are worried about both their health and livelihoods, there’s a very real risk of widespread morale problems as this crisis evolves.

>A lot of the UK public now seem to realise this is serious and have automatically changed behaviour without government mandating it.

I had no choice but go out and to do my weekly food shopping yesterday. This was definitely not what I experienced at all. Families crowding out in the supermarket with small children and grandparents abound. People coughing openly, not maintaining distance and so on.

People still have no sense of urgency to change their behaviour, and this is the critical time that we need to mobilise. Any success would be down to pure luck rather than their strategy.

To be fair, if all the "take it seriously people" stay at home as much as possible, you'll be far less likely to encounter them and 90% of the people you'll encounter in public are the people who don't change their behaviour.

If that's the case, I would also encounter a lot less people than usual in my weekly food shoping. That didn't happen. There's no need to bring all out your extended family out to Waitrose, Tesco or Costco. People are still doing it, nothing's changed.

The plan to protect the vulnerable is four months of quarantine: https://www.itv.com/news/2020-03-14/elderly-to-be-quarantine...

It’s almost Swiftian in its satire... oh wait, they’re serious. Strange that it may be quite a few of their own voters who die. I know Boris idolizes the mayor from Jaws who says the beach is safe to keep businesses open so maybe they are that dumb or maybe they’ll be really lucky. Risking an extra 2% of 50M dead (or even 20% of that) is a big gamble. How many allies died in Normandy? 200k? Hope it’s worth it.

I’m guessing that when things start getting Wuhan level crazy people will isolate anyway and they’ll get the worst of all results.

4400 confirmed dead on D-Day (Allied)

The capture of Normandy didn't take a single day - it took over a month with ~120,000 Allied casualties:

https://en.wikipedia.org/wiki/Invasion_of_Normandy

What better plan for vulnerable people is there than isolating them? You also seem to be under the impression that the plan is for no lockdown. The government has already said that there will be increasingly tight measures over the next few weeks.

I despise the current government, and have no idea if this plan is better than alternatives, but please if you want to criticise it, do so for what it actually is, not a straw man of your own construction.

I truly wish you good luck. Planning for the virus to expand (rapidly) through the younger less vulnerable population to protect businesses and provide herd immunity is what was described. I understand they're trying to walk that back now... good idea! https://politicshome.com/news/uk/health-and-care/illnesstrea...

The actual plan and how to isolate the almost 20% of the population at high risk is not outlined here or anywhere I've seen. If you know (or anyone in the government knows) what it is, please provide a description or link. I've only seen hope... and undefined "measures".

I watched the press conference where they launched the plan. That is emphatically not what was described.

A lot of people seem confused... granted it's the Guardian, but how did so many hear the same thing incorrectly?

The idea that a "second wave" can even be avoided or that infection prevents reinfection is not known. https://www.theguardian.com/commentisfree/2020/mar/15/epidem...

Yes, now that there is a released plan... worst messaging ever.

The U.K.’s Coronavirus ‘Herd Immunity’ Debacle. https://www.theatlantic.com/health/archive/2020/03/coronavir...

What could the government realistically do to protect the vulnerable? It's ultimately up to the people to be disciplined and protect vulnerable people. That will only be done by educating the people, which has been done.

The problem with this reasoning is that your measure is not a direct measure of infection rates. For South Korea, they tested a large number initially, and now fewer. We don’t know if it’s actually under control without more systematic testing and therefore data on infection rates.

The other issue is that of getting the leak at the wrong time. If the UK manages to partly control it, but then realises containment will fail in say November, the peak will occur at the worst possible time in winter.

By controlling the spread and aiming for summer, best medical care can be achieved given limited resources.

This logic is not true for equatorial countries such as Singapore due a lessened seasonal effect, so they should continue with their current Methodology. I suspect others will move to the UK approach once initial social distancing process inadequate (assuming they are that is).

> We don’t know if it’s actually under control without more systematic testing and therefore data on infection rates.

Death and Active cases are a good measure. Both of these are under control in SK vs. still growing in Italy/Spain.

But the original comment said SK is now testing fewer people, so how do we know the active case numbers are under control?

> Singapore, Hong Kong, and South Korea aren't under lockdown, they're stopping the spread by just having good testing and case tracking capacity, and good hygiene.

You forgot Taiwan, who is faring much better than all three of the countries you mentioned.

And they did it all without closing their airports!

What mostly helped was lack of mainland Chinese people entering the country. Also Taiwanese wear their face masks religiously and are used to obeying the rules set by the government.

Finally (AFAIK) they have a very good health care system which handled the cases quickly and efficiently.

>What mostly helped was lack of mainland Chinese people entering the country

If the whole world closed their borders to China back in early Jan (and followed up with tracing and quarantine), we would be seeing this right now. Unfortunately, China was lobbying heavily against it.

Now China, being a massive exporter, has a global demand problem in addition to the local supply problem of shutting down their country for 8 weeks.

face masks don't help unless you've got covid19 and are using it to prevent spreading. If you have flu like symptoms you should be staying home anyway.

I wonder if this is in fact working - Not so much to protect oneself from getting it, but preventing the no-symptom/mild symptom carriers from spreading to others.

please distinguish between surgical masks and N95 masks.

N95 masks, fitted properly, do help prevent catching the virus. For a mask to be called N95 it has to be approved by the CDC. It’s specifically designed to block >95% of airborne particles. That’s why they’re recommended for caretakers at hospitals and frontline workers dealing with infected patients. Replaced every ~3 hours and worn in combination with goggles and ear protection, they minimize the risk of infection through mucosal membranes. They have also been in short supply.

Surgical masks do not prevent catching the virus, but they help sick people not to spread it due to the mask catching some of the spray droplets when they cough / sneeze

> Surgical masks do not prevent catching the virus, but they help sick people not to spread it due to the mask catching some of the spray droplets when they cough / sneeze

That's not true at all. There is a reason why surgical masks are used by surgeons, but for the protection level needed by medical professionals, it is used as a part of a wider system.

Used casually it prevents much of the droplets in the air from entering your respiratory system, as well as preventing a lot of touching of the face. There are studies that indicate wearing a mask decreases virus respiratory several-fold.

All the health experts I’ve heard from (and two of my immediate family members work at hospitals) have said that surgical masks do not prevent catching infections. You breathe by suction. Your diaphragm create a pressure difference by increasing the volume of the thorax and the air rushes into your lungs to compensate.

The reason the N95 filters work is because when the air is sucked in, it must pass through the filter before entering your respiratory system, and that filter is designed to filter >95% of airborne particles (and often times even higher). For the surgical masks, the air just gets sucked in from the side, the path of least resistance. So the airborne particles would also just get sucked in from the side. The masks may cause changes in behavior that lead to lower infection probability (such as reminding you not to touch your face), but dipping your hand in glitter would be just as effective.

Given the incubation period is > 14 days, and more than just a few of the patients don't show symptoms at all, you'd be spreading the virus before you know it without a face mask.

They instituted a 14-day quarantine for travellers from mainland China on the 24th of February and soon after for Korea, Italy and Iran. These were all already in place while other countries were pretending everything was OK and advising people arriving from Italy to go to work.

Taiwan's extremely successful strategy combines thorough testing and tracing with other measures to slow down the spread, much like what the WHO is recommending but no one else seems to be doing.

Very early on they instituted a 14-day quarantine period for anyone arriving from mainland China (later expanding this to Hong Kong and Macau), Korea, Italy and Iran. As of today, this now applies to the entire Schengen area (i.e., most of the EU).

The government has also taken over mask production (increasing capacity) and distribution (with a rationing system and an online map of where they can be bought).

Their website is very informative, with very transparent information about how many have been tested, confirmed, recovered, etc.: https://www.cdc.gov.tw/En

I haven't checked too closely, but surely the age distribution of conservative voters is such that if they are so callous as to treat corona as a convenient boomer remover, they torpedo their own re-election chances.

So, _even if_ you ascribe to the current UK government a conspiracy-esque, cold as nails approach to just effectively _murder whole boatloads of older folks_, it doesn't actually make sense: Who would they be so cold as to just casually acquiesce to a solution that results in a lot of death, but they are still human enough to care about the country first and are willing to sacrifice the electoral future of their party?

I'm on 'do not attribute to malice that which can be explained by stupidity', modifying it slightly to 'incompetence'.

The Conservative party is fresh off one of the greatest electoral landslides in history, and is 5 years away from the next election. So perhaps they think that people will have come around to their point of view by then? I'm just grasping at straws here, it's almost incomprehensible.

Replace “boomer remover” with “working-class-boomer remover” and the strategy makes more sense.

Personally, I don’t think Johnson and his cronies are deliberately targeting this or that group. They just don’t care. They are scared like everyone else, and are prioritizing the survival of their immediate circles and their social status - i.e. they keep the economy working, keep an appearance of order, and ensure people they care about are “cocooned”, ready to come out when the worst is over. That is their priority. Working-class lives are not priority, that’s all. Health-service capacity woes are relatively unimportant, because people “who matter” will be prioritized anyway.

If they go to full-lockdown, they risk upsetting the existing social order (economy tanks even harder, unemployed people start rioting, etc). That is their worst fear; consider that we’ve had actual riots in London only a few years ago. Saving a bunch of working-class grandpas is clearly not worth the risk of upsetting the current social order, from Johnson’s position. He’d rather have a functioning elite ruling over rubbles, than risk the very own existence of such elite just to save “nobodies”. Add to it a sprinkle of academic Strangeloves, and there you are.

Sufficiently advanced incompetence is indistiguishable from malice

You really have to understand that this government hires "superpredictors". It's not malice, it's just incompetence. They're making decisions based on how "truthy" they sound to them.

> they're stopping the spread by just having good testing and case tracking capacity, and good hygiene

First, there is the best of them all you forgot to mention, Taiwan.

Second, To sum up the difference as I have posted elsewhere, it comes down to The East willing to do Social Distancing AND Wear Mask. The west simply refuse to wear mask.

About those hundreds of academics: about 90% seem to be mathematicians. I checked two at random and none of their top publications were about epidemiology. You can be a scientist, yet know effectively nothing on a specific topic.

In the UK, "maths" is a very broad category. It includes my field of theoretical particle physics, as well as mathematical disease modelling. All of us would be called mathematicians.

Yes, not everybody signing is a specialist in epidemiology, but so what? The point is that a good number are -- there is no clear consensus among UK experts for the UK government's position. And among global experts, there is a clear consensus against their position.

Keep signing petitions from ivory towers. That's not where political pressure on decision makers comes from.

Just in case you were not aware, in the UK any official petition with more than 100,000 signatures gets discussed in parliament [0].

0: https://petition.parliament.uk/help

The plan is supposed to be based on science, not politics, yet here you are telling me this isn't the case?

On a more serious note, petitions and other methods by experts to publicly state a position isn't just about influencing government policy. It's also a political tool in the aftermath of failed policy. Just like the current panel of experts is a political tool employed by the government to justify the biases in its policy.

>there is no clear consensus among UK experts for the UK government's position

Well there is a huge government drive to portray that this is the case right now.

Whenever that happens, it always arouses suspicion that something is not quite right.

As a group, it's hard to imagine that UK experts in Epidemiology and related fields deviates significantly from their peers globally.

https://www.immunology.org/news/bsi-open-letter-government-s...

The British Society for Immunology have also wrote an open letter of concern. They are immunologists and know about immunity.

Interestingly, to my surprise, social distancing appear more effective than lockdown (in part because full lockdowns are impossible). At least according to this simulation:

https://www.washingtonpost.com/graphics/2020/world/corona-si...

The success of Hong Kong and Taiwan look like extensions of the social distancing paradigm to me.

Of course, maybe UK government recognizes that the its citizens are equally incapable of effective social distancing. Whatever the case, this looks like madness.

The labelling in the demo is vapid, insomuch as "social distancing" is merely identifying a percentage of the population to lock down.

HK and SK both have huge amounts of social distancing in effect (notably schools shut down). Singapore is about the only country I'd view as never having used lockdown.

Taiwan did heavy school closures but is now coming back online. Hopefully, things hold up.

Singapore is gradually increasing[1] measures now as more imported cases show up - broader travel restriction, no events of more than 250 people, and enforced WFH, among others.

1. https://www.moh.gov.sg/news-highlights/details/additional-pr...

It's worrying that the US might be doing the same thing but without openly saying it. Little is being done here about the virus. Most people can't get tested. The Senate took a vacation. The Republican Party doesn't want older and unhealthy people depending on social programs. Pray the virus away. Suffering will bring people to God.

"I think it is very beautiful for the poor to accept their lot, to share it with the passion of Christ. I think the world is being much helped by the suffering of the poor people." --Mother Teresa

This is how some people think. It seems like there are no serious people in charge. It's going to be a catastrophe like we have never experienced.

This needs heavy citation.

As Singapore, and Hong Kong are so small do the lessons learnt there actually apply in larger more connected countries?

Singapore and HK are ultraconnected city states. If they can do it larger sparser countries should be able to do it.

Both of them have more than 5 million people so they aren't tiny either.

Taiwan isn't small (~20M) and managed to handle it better than the two you mentioned.

Being an island is definitely a contributing factor though.

> reasoning is that if the only things you can do are China-style lockdown or nothing,

Not nothing, the latter is what #flattenthecurve thingy is. Reducing the exponent thereby keeping the NHS load below maximum.

No, that is almost entirely wrong.

You can certainly disagree with their position but you should at least present it accurately. Their position is that this is a pandemic (i.e. spread too widely to eradicate this year), we have moved from the contain phase to the delay phase, and their plan is to gradually introduce measures up to full quarantine rather than jumping to lockdowns straight away. For example here are the measures planned in coming weeks:

https://www.itv.com/news/2020-03-14/elderly-to-be-quarantine...

If they manage to flatten the curve by timing measures, and if there is a second outbreak this winter, it may well save lives. The Chief Scientific Adviser and other experts are not horrified, they came up with the plan and are defending it, so no, ‘experts’ are not horrified, though some disagree (which is fine).

I’d be more worried living in the US right now given the mixture of denial and bluster which has been the response so far.

Europe right now shows the full spectrum of possible solutions. It is not as if draconian lockdowns are the only alternative. Look at Germany, for example. They've been using testing quite effectively and are also looking at primarily isolating vulnerable people.

It will take some time before we know more about how successful these strategies are. Different countries are at different phases in the infection spread which makes comparisons unfair.

If anything, the politically easy decision would be the lockdowns which shows voters strong leaders capable of "doing something" (even if the value of this "something" is at best unclear).

Europe is a chaotic mess. Germany is preventing exports of urgently needed masks and other medical supplies to Switzerland and Austria, Austria announced that no curfews were coming yesterday and today Tirol is under curfew and harsh curfew-like restrictions will be in place from Monday in all of Austria. I'm not really sure what the strategy is, the WHO recommendations after their China mission have been known for 3 weeks and there is no recommended middle ground.

Not sure I agree with your assessment.

Germany is doing pretty well at just 9 deaths on 4.5k cases. The WHO is not the only or the best source of recommendations, nor is this over in China. I'd be very surprised if they don't see another outbreak there now that this is a pandemic it will spread to Africa for example, which has a huge no of Chinese working there who will bring it back.

Germany is also not reporting deaths from coronavirus if the patients had also other pre-existing conditions just to keep the number artificially low.

Do you have a reference for that?

That's false, all recorded deaths do far were reported to have preexisting conditions.

I'm not sure german successses are anything to do with action on the part of the government. I've been consistently surprised by the abrupt reversals in policy - with border controls or school closures going from 'out of the question' to 'tomorrow' with very little time elapsed.

I think much of Europe is a little bit like this. Germany will probably be relatively well off because German culture is fairly anti-social, Germans are typically very healthy, and the healthcare system is somewhat robust.

However, I haven't seen any sign whatsoever of a consistent or coherent response to the coronavirus. I expect whatever response eventually percolates out will be fairly rational, since german civil servants are well-paid and competent, but so far, it's been all over the place.

Antisocial: Unwilling or unable to associate in a normal or friendly way with other people.

That has not been my experience. How could the culture of an entire country be antisocial? A nation of hostile hermits?

Germany doesn't test well at all. My wife's school in Berlin has been closed since Thursday because of a positive parent who partied in a club the same night as over 16 now infected persons.

Teachers are still waiting for test results and are supposed yo come back to work on Monday.

I can't really explain why there are so few casualties yet in Germany, but I think it's because many young and healthy people got infected (that's the case in Berlin, for instance), so hospitals aren't yet saturated.

I hope it stays that way, but I think we can expect much more deaths in the next days.

Under certain assumptions, young and healthy people getting infected would be the best course of action: http://www.overcomingbias.com/2020/03/expose-the-young.html

Growth in Germany is exponential. It doesn't matter how many people they manage to test if they are still going to wait and see before taking measures to reduce the infection rate.

> Their reasoning is that if the only things you can do are China style lockdown or nothing, then the disease will just resume exponentially growing the second lockdown ends, so it's pointless to do it at all.

Before quarantine we had many people infected not knowing they are infected, spreading the virus around.

After a few weeks of quarantine the ones infected will be known and separated from the rest, so the virus should be stopped. That is assuming the quarantine is strict.

Wow, that's a cynical view. Is this the backdrop for another push to end Obama-care? As in claiming there's going to be death-councils deciding to lives and who dies?

But, I guess this question is just begging for all of us arm-chair quarterbacks, fear mongers and un-informed to jump in with anecdotes and opinions knowing full well that only time will tell which it is.

Personally, I think only a few things are clear.

1) Our society and government is totally unprepared.

2) This is going to be a bad year financially for most of us and a terrible year for many of the poorer among us. I just hope that we don't end up pushed yet another group into homelessness.

3) It seems like most of us don't know some really basic information about disease - like:

Q: How many died in the 2017-2018 flu season?

A: 61,000 in the US.

Source: https://www.cdc.gov/flu/about/burden/index.html. And, nope, that's not 61 people, not 610 or not 6100. That's right, the CDC estimates 61,000 people who died in the US alone in 1 year from the flu.

Which left me wondering why hasn't more been done to stop the spread of the flu?

How many have died from Coronavirus? A: 68 as of today in the US. 3,199 in China. 6,515 WorldWide. 3,213 in China, 1,809 in Italy. Source: https://www.worldometers.info/coronavirus/

Time for an anecdote. My wife had a medical emergency about a month ago - before Coronavirus. The emergency room was swamped. Sick people everywhere. Some not too sick. A bunch who were really sick. The nurses were handling out masks to everyone asking them to wear them to avoid making others sick. It was crazy. I had no idea.

Why now?

Because COVID-19 has a higher infection/transmission rate than the seasonal flu and a higher mortality rate. The economy isn't shutting down because 68 people have died, it's shutting down because 61,000 people died from the flu and COVID-19 has a distinct potential of being significantly worse.

Actually, COVID-19 has lower infection rate than flu, according to WTO.

> hundreds of academics already signed on

So I should listen to a bunch of students, astronomers and others over the Chief scientific officer and health scientist in the country? Riighht....

You could also listen to the Harvard epidemiology department: https://www.theguardian.com/commentisfree/2020/mar/15/epidem...

Or the British Society for Immunology: https://www.immunology.org/news/bsi-open-letter-government-s...

Or the two distinct open letters from UK scientists, which are now hitting 1200 signatures total: http://maths.qmul.ac.uk/~vnicosia/UK_scientists_statement_on... https://sites.google.com/view/covidopenletter/home

If you believe nobody credible opposes the UK government, you've been fed a narrative.

> If you believe nobody credible opposes the UK government, you've been fed a narrative.

That's a complete strawman. You gave a letter signed by a massively padded out list of "academics" (probably intended to scare your average layman) and when pointed out that astronomers and students probably don't have much to offer right now

Look, do you think the 4 links I posted (which are in turn a small selection of many more) indicate credible opposition or not?

I’m going to try and lay out the case in as neutral terms as I can, although to be clear I think they are probably right. They’re going to take an awful lot of stick for it though, and indeed already are.

They believe that there are basically two mitigation strategies. One is to have a very drastic early lockdown that shuts down the virus before it spreads widely. The problem with that is, once you lift the lockdown it will simply start all over again. The problem with this is lockdowns are most effective the first time you do them, and then mostly in the first few weeks of the lockdown. Do it too early, and yes it will be very effective in the short term, but later on when cases become much more prevalent the lockdowns will be less effective.

The option they are going for is to start the lockdown a little later in the cycle. The hope is this will make the lockdown more effective at a higher point in the spread. Effectively instead of a series of booms and busts, you get one longer slower initial burn and then you’re mostly done. They believe that in the long term this will make it easier to protect those most vulnerable to the virus, because you only have to do it once, at the cost of increased prevalence among people least vulnerable to it. So they see it as a better longer term strategy.

But there's a third strategy that works better than either: don't lockdown, but do effective testing, case tracking, and treatment, well enough so that exponential growth can't happen in the first place. That's the policy of Hong Kong, Taiwan, and Singapore, who are doing great.

That’s a very good point, you’re quite right. However all three of those are relatively very small population centres with very easily controlled borders. Britain does have the advantage of being an island, but it has a large rural hinterland that the virus can ‘hide out’ in, and many dense population centres without borders, so it’s a completely different environment.

Take London. We could introduce a system of tracking and isolation within the M25, and that might work to lock down community transmission within the London population, but millions of people flow into and out of London each week so it would be completely pointless and ineffective. Meanwhile that level of tracking and isolation simply can’t work across the whole British isles. It’s administratively and logistically impractical.

> millions of people flow into and out of London each week so it would be completely pointless and ineffective

Was curious about this point in particular - checked the numbers, and Heathrow has essentially equivalent traffic as Hong Kong International.

There are 5 other international airports that call themselves "London", not just Heathrow. And of course London also has road and train connections.

I was mainly thinking about road and rail traffic into and out of the city, including daily commuters.

The equivalent of the entire population of Glasgow passes through Kings Cross station in the morning rush hour. There are 4 other stations with similar flows. Over 20 million people live within an hour or 30 miles of Piccadilly Circus.

That level of population flow and population density are not as special as you are making them out to be. The transfer station nearest Seoul's most recent cluster (discovered 7 days ago) gets about 25% more annual traffic than King's Cross, according to Wikipedia (125,000 per day at Sindorim Station vs. 34 million at King's Cross annually). Despite the cluster having developed at the beginning of March, Seoul is finding fewer than 100 new patients per day. With masks, reduction in ridership, cancellation of meetings, extensive WFH, extensive testing and isolation measures, this epidemic is not as hopeless as the UK seems to be making it out to be.

I completely agree. I was shocked to hear that only people that present with symptoms that require hospital treatment are now being tested.

That's the policy of Hong Kong, Taiwan, and Singapore, who are doing great.

All of which have tiny populations compared to the UK.

For larger nations, there simply aren't enough tests available, nor enough treatment facilities for those who are likely to become very sick if the virus spreads rapidly through the population.

> For larger nations, there simply aren't enough tests available

Why? If your nation is twice as big, then all else equal, your government has twice as much money, twice as many resources, and hence twice as many tests. China now has more tests than they need and they're the 2nd most populous nation in the world.

No amount of money helps if there aren't enough tests available to buy. What is missing are manufacturing and distribution facilities, which of course are calibrated to the normal levels of work and not to a relatively sudden pandemic outbreak of one particular virus.

China has huge resources but has managed so far to keep the infection mostly contained to one specific area. It's not clear how long they'll be able to sustain that or whether they'd have enough resources to go around if all of China were the same as Hubei.

Of course all of this also assumes that tests are effective and that you can then do something useful if you confirm that a patient is indeed infected.

> All of which have tiny populations compared to the UK.

Is 66 million really that qualitatively different than 24 million?

The honest answer is that I don't know. Perhaps I generalised too readily before, given Taiwan is quite a bit closer to the UK in population than the other two.

Even so, assuming that strategies that appear to have been relatively successful in a smaller, more densely populated country will necessarily also work in a larger and less densely populated one seems to be dubious. We know that we don't have the resources we'd need to implement that strategy in the UK right now, and I haven't personally seen any experts arguing that it's a viable option for us, so I'm cautious about extrapolating too much here.

China doesn't have a small population and has it under control. I don't think it's a population size thing.

China does seem to be on of the most interesting cases so far.

The quarantine measures, once introduced, do seem to have been viewed favourably by the experts and do seem to have been remarkably effective. This assumes we trust the reported statistics, which I acknowledge as a possible risk in this instance.

On the other hand, it may be that China has been able to achieve that in part by pulling resources from all over to focus on the main region affected. That isn't necessarily an option that will be open to other nations, particularly if their outbreaks are distributed across their whole area almost immediately.

Taiwan population is smaller, but not really "tiny" compared to UK's.

and much denser populations, with a lot of international travel. which have a huge culture of eating food in hawker centres which would really seem to make a big threat to containment yet they appear to be doing well.

Taiwan is 23 million people. The UK is 67 million people. The level of confidence of your comment does not seem to be warranted by your level of knowledge.

Please don't make comments like this on HN. They lower the tone and add nothing of value to the discussion.

We have explored a little whether the population of Taiwan being somewhat closer to the UK's than the other two named countries was significant in a sibling thread.

In addition, in the UK, which is the subject of this discussion, it is certainly the case that we do not currently have sufficient resources to cope with a widespread, uncontrolled outbreak. There have been a number of further announcements today regarding how the government is hoping to acquire new space for treatments, acquire essential equipment like ventilators on a much larger scale than is currently available, and bring in more trained staff to make use of these resources to help treat coronavirus patients. Even if these plans work out as is hoped, all of them will require at least several weeks to make a large difference. This isn't my opinion, it's coming straight from senior government figures and their senior medical and scientific advisors.

I'd like to ask you to not make comments like the one you did — confident assertions about things you know nothing about, that you haven't made even the most trivial effort to verify, whether that's the population of Taiwan or the general relationship between country size and testing kits per capita. Regardless of how politely you make them, statements unconnected to any concern for truthfulness lower the signal to noise ratio, and they add nothing of value to the discussion. On the contrary, calling out such recklessly false statements does add something of value to the discussion.

Instead of criticizing my tone, which was in fact fairly restrained, you should thank me for taking the time to correct you. For instance: https://news.ycombinator.com/item?id=22580049 https://news.ycombinator.com/item?id=22569806 https://news.ycombinator.com/item?id=22529609 https://news.ycombinator.com/item?id=22505631 https://news.ycombinator.com/item?id=22504690 https://news.ycombinator.com/item?id=22370446

It is true that the UK does not have sufficient resources to cope with a widespread, uncontrolled outbreak, lacking for example one to two orders of magnitude in ventilator capacity; but, as should be obvious, this is not a result of the UK being a large country — the UK is much smaller than China, slightly smaller than Japan, the same size as South Korea, and slightly larger than Taiwan. But this conversation would be of higher quality if, instead of containing such your obviously false assertion and also fact-based rebuttals such as these, you had not posted the assertion in the first place (perhaps because you had read enough to see that it was false), so no rebuttal would be necessary.

Continuing to adopt such a hostile tone still doesn't further the discussion. I am happy to debate this subject, but I will not reply further if you continue to make unnecessary personal attacks in your comments.

Is it your contention that the countries you mentioned do have sufficient tests and treatment facilities available to successfully implement the "third strategy" advocated by knzhou in the comment I first replied to? I can see little evidence that would support such a claim so far, in this discussion or otherwise.

China's recent official statistics may not be entirely trustworthy: they showed the expected exponential growth curve earlier on, but then levelled off remarkably quickly. In any case, its strategy has so far been primarily one of containment, with resources focussed on one specific area, Hubei, where the outbreak was also concentrated at the start. It is not known whether China has an effective testing or tracking regime in operation at this point, nor whether it has sufficient resources to treat large numbers of people if they became seriously ill in the absence of that containment, as may yet happen when the heavy quarantine measures are eventually lifted.

Japan's official statistics have also attracted scepticism, with the suspicion that they aren't testing widely enough to get an accurate picture of how the virus is spreading.

South Korea has had possibly the most successful response so far in terms of credible raw numbers and as such it is certainly worth looking at, but the strategy there has also been primarily one of containment. Again, that doesn't tell us anything about whether SK has the resources to look after much higher volumes of intensive care patients than usual if those containment efforts fail, or if heavy lockdown measures were not attempted and instead that "third strategy" of test, track and treat were used.

The UK isn't just "slightly larger" than Taiwan, it has almost 3x the population and almost 7x the land area. As I already acknowledged in the other thread long before you replied to me, I may have chosen too strong a word when I described three countries including Taiwan as having populations that were tiny compared to the UK, but my fundamental point stands in that we should not assume a strategy that could work at the scale of Taiwan would necessarily also work at the scale of the UK.

You argue for fact-based rebuttals, but where is the evidence that your examples are countries that do have sufficient testing and treatment facilities available to employ that test, track and treat strategy rather than the stronger quarantine measures that most countries are attempting?

There are quite a few difference.

HK, Taiwan and Singapore all acted extremely early on, to the point where HK knew before the news broke out in China. And the culture allows you to wear mask, which seems to be something most western nation are completely against.

Most part of Europe and UK reacted very late in the cycle. Since the Virus has an extremely long stable period before any symptoms appeared or to the point where you could be infected but showing no symptoms at all. It highly likely they are already in wide spread. 500 people each inflecting two, do that 11 times and we have 1 million infected.

Then there is the death rate, at least so far it seems to be extremely mild for anyone below 50.

Not saying I totally agree with Herd Immunity, but judging from the current data and situation it is possibly the best route to go.

Isn’t that the whole point of a lockdown? After ~6-8 weeks you get the new infection rates down low enough that you basically reset the clock and have a second chance at responding like Hong Kong and keeping it in the containment phase. Then you have to keep that up for hopefully 9 months until a vaccine is available.

It’s certainly not easy, but it seems possible and it’s not clear this would be much worse on the economy in the long run. Plus it saves half a million lives, so it seems like a moral imperative to at least try.

>Isn’t that the whole point of a lockdown?

You will need a Lockdown AND Mask, or you will simply just need Mask and not even lockdown. I would argue social distancing only is not enough. But somehow even people in Italy refuse to wear mask. So I think a culture issue is also a problem there.

I don’t think masks are as effective as you think. WHO says only wear a mask:

If you are healthy, you only need to wear a mask if you are taking care of a person with suspected 2019-nCoV infection. Wear a mask if you are coughing or sneezing. Masks are effective only when used in combination with frequent hand-cleaning with alcohol-based hand rub or soap and water. If you wear a mask, then you must know how to use it and dispose of it properly.

https://www.who.int/emergencies/diseases/novel-coronavirus-2...

Except we have clear evidence with all the countries listed above, SK, HK, Singapore, Taiwan that wearing a mask is effective. Even in many cases without social distancing. There are little working from Home in majority of the business in those cities, They have a much higher population density that has a higher chance of being infected with coronavirus.

The mask also protects you from bad actors who are not doing any standard hygiene procedures such as washing your hands.

We don't have enough masks in Europe, and those few are needed for professionals.

Besides that, I think that especially in times like this, it is important to stick to the recommendations of experts. Here in Germany, the expert recommendation is akin to the parent comment. These recommendations are crafted by people with a lot of expertise on the subject and who care for the health of people, and I think it is not productive to fundamentally questions their advice.

>We don't have enough masks in Europe, and those few are needed for professionals.

That is the only valid argument I could possibly understand. Although I would argue we could have ramp up production line. And Medicals get priority with Mask.

>I think it is not productive to fundamentally questions their advice.

I dont know, but Japan, South Korea, Taiwan, Hong Kong, ( We exclude China for comparison ) 200M+ Population together has far fewer death than just Italy with a population of 60M. Let alone Europe. And people are dying.

But hey, I guess as long as the people in Germany and Italy and UK are happy with what is being done then that is fine.

It's not only this reason. Even N95 masks are rated only to .3 micron. COVID-19 is .1 micron. It will prevent droplets from those already infected but I don't see how it would help in the healthy much. Maybe it slows down the air breathing out? But I don't see that helping a lot.

Arh. I see it now. When ever Mask is mentioned in the context of CJK, it meant medical mask with 95% PFE, VFE and BVE mask. Stopping size of 0.1 Micron.

Sorry I wasn't being clear enough. We knew very early on N95 doesn't work.

> It’s certainly not easy, but it seems possible

If your population already has lived through similar outbreaks, sure.

But look at the US. There is a sizable portion of the population who thinks this thing is a hoax, who simply don't believe in this pandemic. How do you lock down those people? They're going to completely ignore government recommendations, and they'll scream bloody murder when government cancels events and restricts travel and assembly.

But let's say you manage to lock down the US to contain the current wave, and that you manage to ramp up testing so that you can be more sure about actual infection rates. Once it dies down in the US, then what? Ease the lock down? What about other countries where it's still rampant? What if it flares up again in the US? Go into a second lock down? You've already spent an enormous amount of political capital getting the first one through, good luck getting a second one.

> Plus it saves half a million lives

You pulled this number right out of your ass by multiplying a guesstimated death rate as measured in China, where the virus spread unchecked through an entire province, and where the medical system wasn't prepared, and you're assuming that the demographics of the people catching the virus in the UK is going to be the same.

But if your medical system is prepared, if you're quarantining vulnerable people, if you have good testing, then letting the virus roll thorough the remaining un-quarantined population won't lead to the same death rates, or the same hospitalization rates, because all the underlying factors are different.

It's far too early to say whether they're doing great. Several months too early. Their lockdowns are preventing virus spread now, but at some point, the lockdowns will end, and then there is a vulnerable population waiting to be infected by a carrier coming from abroad. Will they be able to keep carriers out? Will they be able to respond to further outbreaks with more lockdowns indefinitely? Will there be a vaccine soon enough that they can protect everyone and then end the lockdowns before it all goes wrong?

I don't know enough to say that the UK strategy is correct (i hope it is - i live here, and more importantly, so do my parents). But i think the situation isn't cut and dried.

Hopefully, we will get a lot more detail in the next few days, and then the real experts can come to a consensus.

I would rather have the spread stopped/slowed domestically with aggressive measures than to do little to nothing to stop the spread thinking it will somehow solve the problem.

The UK approach here is basically just accepting that a majority of the population is going to get infected by design. That's fine. It might even be true. (It obviously will be if you don't do anything to stop it, but even in aggressive lockdowns I mean)

But it benefits nobody to have it spread quicker. Maybe life in the UK gets back to normal a little faster for people who are not at-risk or aren't treated at risk but we live in a very global society and if everyone else is locked down then it's hard to see much benefit for the UK itself.

And your parents and the portion of the population who are most vulnerable are more at risk.

An imperfect defense is better than not even trying.

There won't ever be a consensus of experts. That whole concept is one I've really come to hate over the years. When it comes to decisions about what to do, versus the outcome of replicable experiments on nature in lab conditions, there is always disagreement and there always will be. The idea that any decision can be resolved by a bunch of scientists sitting in a committee beard stroking doesn't reflect how people really work.

Amongst other problems, the term "expert" is ill defined (see discussion above about mathematicians) and there's always value in contrarianism for people who aren't directly making decisions. If they're wrong nobody will remember and there's nearly no reputational impact. If they're right, they can win fame and glory.

Do you have sources for these claims?

> The problem with that is, once you lift the lockdown it will simply start all over again.

Well, no, because the world at the end of the lockdown is not the same as the world before the disease started spreading. Some differences:

- People now know there is a dangerous disease and how to act and sanitize to mitigate its spread.

- Manufacturing and other logistics for medical providers have had the time of the lockdown to ramp up.

- Testing has had the time of the lockdown to ramp up.

- A vaccine is that much further along--which is the only viable long-term strategy.

- And most important, scientific understanding of the disease has had that much longer to develop.

Britain's "expose the youngsters" strategy has a terrible flaw, which is that we don't know if the disease is actually safe for young people! All we know are some basic statistics about messy data that was reported by overwhelmed medical systems with spotty testing.

There are reliable reports of a) some young people getting very sick from this disease, b) people who seem to have recovered going back into decline and in some cases death, and c) long-term lung damage among those who did not die.

The ideas that this disease is somehow safe for young people, and that contracting it once confers long-term immunity, are ideas that are yet to be scientifically proven. They are, for now, at best heuristics to aid triage.

Do you have some links with reliable reports of young people getting sick and other cases you told?

Singapore has had a handful of cases of children getting it. A six-month old caught it and took nearly three weeks to recover:

https://co.vid19.sg/cases/singapore-case-28-6-month-old-male...

A 5 year-old was in hospital for six days, but has been discharged today:

https://co.vid19.sg/cases/singapore-case-160-5-year-old-male...

A 17-year old evacuated from Wuhan tested positive, but never showed any symptoms during the 3 weeks he was quarantined despite having the virus:

https://co.vid19.sg/cases/singapore-case-23-17-year-old-male...

(There's more cases that can be explored on the Singaporean website.)

This is nothing like the parent implied.

Also, if an affected region locks down well enough and long enough (cf. Hubei: https://miro.medium.com/max/6812/1*pwPIo7U6pBahMZhopHYbMw.pn...), the number of actual new cases per day may fall to the point where containment becomes feasible again.

Exactly this. I don’t have published numbers to back the following, but we expect them after the weekend. Over half of ICU admitted covid-19 patients in the Netherlands are <50 years old. I get this information from friends and colleagues working in several hospitals. If this turns out to not be a fluke, the young are much more affected by this corona virus vs normal flu.

The distribution of age of corona patients on the ICU is NOT the same as the age distribution of all corona patients vs. disease severity. It could be and quite possibly is the case that many people below the age of 50 are infected but never reach an ICU. Most get better without severe symptoms, so looking at ICU admission stats is misleading if you extrapolate the data to the whole population.

I hate that this fact is spreading in the Netherlands without a proper explanation.

It seems like trying to time the stock market. You can make an educated guess, but in the end it's still a guess.

Unless, oh I don't know, you test for the disease.

Please don't post duplicate comments to HN (https://news.ycombinator.com/item?id=22577808). It strictly lowers the signal/noise ratio and makes merging threads a nightmare.

Merging threads?

Sometimes there are two (or more) threads for what is essentially the same story. When this happens, Dan (or one of the other moderators) frequently chooses one thread to keep, and copies the comments from the thread(s) to be deleted into the thread to be kept. If commenters have already posted the same comment to both threads, this requires more manual cleanup by the moderators. There's a lot of moderation that happens behind the scenes here to keep the site as usable as it is.

As nkurz said. See also:

https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que...

Why would operating as normal and mostly ignoring the problem cause a "slower initial burn"?

It won't. This is nonsense of the most obvious kind, because we're already past the stage where the virus is spreading quickly.

In fact the reverse is likely to be true. Lockdown minimises the number with the disease, but that number is not zero.

Which means that if immunity is possible (questionable for a CV, but let's pretend), immunity will spread wider and wider in each lockdown wave - and the health system won't be swamped.

This plays for time, raising the odds that a vaccine or some other treatment will appear.

Successive lockdowns will do exactly what they're supposed to do - spread out the peaks, minimise casualties over time, and minimise health system stress. (Although it will still be very high.)

What they won't do is keep businesses afloat. Mass bankruptcies are going to be a huge problem throughout the entire global economy.

Other countries understand this, and are stepping in with financial measures to help. Presumably the UK doesn't want to do this.

The tell is the fact that the government has plans to quarantine for four months - i.e. place under house arrest - over-70s who are infected. Without access to intensive care - it won't be available if the NHS is swamped - the mortality rate in this demographic is going to be higher than that of any other developed country. It could easily be twice the nominal 15% CFR for this demo in China.

It's hard to avoid the conclusion that the real plan is to cull the old and sick while pretending that's not happening.

They're not operating as normal: they're telling anyone with a cough to self-isolate for seven days. And the plan isn't to quarantine over 70s who are infected: it's to quarantine them all, when they're not infected.

I believe the current UK Gov’s huge majority and long remaining term allow them to make decisions that many other countries would not be able to make at this time. I think they’re right, not that this makes things any easier, both my parents are in their mid 70’s and have health problems.

As far as I know, they did not communicate an overall strategy or comprehensive action plan. The basis of this thread are a series of tweets making assumptions about what the government strategy could be (given a lack of measures taken as a basis).

I do not understand how not communicating a comprehensive action plan is meant to be the harder choice ("a decision many other countries [...] not able to make") when contrasted with messures such as declaring national emergencies and widespread lockdowns of public life.

They held a press conference live streamed on YouTube where the PM and the two chief scientific advisors answered questions and explained their strategy for nearly an hour. The answer to one question alone took over ten minutes. You may not be aware of their communication about their strategy but it's on YouTube waiting for you.

That hour long press conference, that I’ve seen live, can be condensed in don’t do anything at all, let’s get 60% of the population infected so we’ll have herd immunity.

The lockdown as implemented by Italy and France aims at slowing down the spreading of the virus. It is not meant as a strategy to overcome the virus. It is meant to flatten the curve of the exponential growth of infection to minimize overloading the health system and to provide more time for preparation and for the acquisition of best practices regarding the situation. There is no disillusion that this might somehow stop the virus. The expected total infected percentage of population, with lockdowns is still in the range of 50-60%. Italy went into lockdown on March 9th when # of new cases reached 1791 and total deaths was 463. This does not seem to qualify as a very drastic early lockdown, as stated by parent.

Given everything we know regarding exponential spread, the high percentage of cases requiring icu treatment, and the mortality rate, I fail to see how the absence of any measures to mitigate the spreading of the virus makes sense.

The assumption that there are only two viable strategies, lockdown & no measures, is a plain wrong oversimplification. There is a wide range of intermediary steps that can be taken in between to attempt to slow down the virus.

Attempting to minimize the degree of overload on the health system by applying such measures in a coordinated fashion is meant to reduce casualties caused by system overload.

Those are good points. Because Italy was hit hardest first they had very little time to prepare. The UK has had about an extra month, which puts us in a different strategic position, so we might be able to afford an approach not viable for Italy.

How does the UK have an extra month, exactly ?

It did not take Italy 1 month to to go from 1,143 (today's UK number) positives to 21,157 (today's Italy number, per https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.h...), did it ?

Testing in Italy was far less, the totals for there need to be inferred from the deaths and cases and the amount of testing!

Italy had 21 deaths on the 28th feb, so 2 weeks ago.

But the response will be less pronounced here with knowledge, self isolation and a lack of kissing when greeting. A month is probably a better guess than 2 weeks, but not a single person knows is rather the point...

It takes a long time to acquire respirators and to train anesthesiologists.

You can read some of the rationale behind the plan here:

https://assets.publishing.service.gov.uk/government/uploads/...

I'll be honest, I watched the announcement on Friday in open mouthed horror. I can't claim I have a concrete refutation for either the broad logic or the specific evidence underlying it, but even the best case scenario is a disaster of historic proportions. I wish us luck. I wish the rest of the world luck if it turns out we're right and they're wrong.

You could think of this as the advantage of a decentralized world with every country making decisions and experimenting independently. Maybe the UK's approach is the right one, maybe it isn't. If it turns out to be more effective we'll learn something useful for future pandemics. If not then only the UK goes down the drain and we'll still learn something from it. Best of luck.

Well surely the advantage here would be for us to be able to observe and exploit the hard won knowledge of countries out ahead of us, but that doesn't appear to be what we're doing.

The thing is, what the UK is doing is truely experimental compared to what China, SK, and Italy have already done. And we won't know for sure what the full effects are until the end of the current pandemic. If the UK copied the lockdown and trace playbook already implemented, once this pandemic is over we'll have no data point for the quarantine old people only strategy to plan for the next pandemic with. How can you observe whether the UK strategy will work when nobody's done it before?

Just a note that this document is from 2011. I know you did not claim otherwise, but I had assumed from your comment it was a document prepared in response to the current situation.

Indeed, although I’m not sure what the utility of a preparedness plan prepared only after an outbreak has started would be, especially one created at the speed of the Civil Service. You can read more context (including the ethical framework and the individual studies used as evidence to underlie the plan) here:

https://www.gov.uk/guidance/pandemic-flu

There is no proof immunity will happen, the UK Gov is thinking in economic terms and worried about GDP.

https://www.theguardian.com/education/2020/mar/13/coronaviru...

Exactly. We have huge debts and our "economy" runs on the assumption that, if very little goes wrong, we might be able to stay afloat.

The time for creating choice on the cornonavirus response was during the last 20 years. They chose rampant financialisation, leveraging future income.

The UK has no energy security. No food security. I feel the corner we have painted ourselves into makes a prolonged shutdown far, far harder.

Genuinely curious about where you read that the UK has no energy security? It's not something I've read about before, but is something I'm pretty invested in as a UK citizen.

The one source I could find was https://www.globalenergyinstitute.org/energy-security-risk-i... which placed the UK in the top 3 countries for energy security (many years running).

Do let me know if you have some data that would change my mind! (and ditto for food security)

I mean to say we are a net importer of energy

https://www.theguardian.com/money/2019/sep/01/uk-energy-pric...

And food

https://www.businessinsider.com/no-deal-brexit-percentage-br...

I fear that when the PM said that his decisions are driven by science, he means economists, not virologists.

If immunity doesn’t occur, then a vaccine is also useless.

It's two different things

No it isn't. Vaccines create immunity, that's the point. Also, what diseases that don't kill you also don't result in immunity? "There's no evidence of immunity" seems an absurd statement, we can literally see the antibodies people create in response to the infection. That seems like just looking for an excuse to attack the UK.

do you ever heard of plague?

What's plague got to do with it? Plague vaccines exist that give up to a year of immunity:

https://contagions.wordpress.com/2012/02/25/generating-immun...

Flu vaccine has to be taken every year.

That's because flu isn't a single disease, it's a category of diseases, like cancer. People do build immunity to specific flu variants.

The NHS makes a huge difference. As a single entity it can pivot in a way that I wonder if other countries can come close to.

My daughters dentist commented yesterday that all her surgeries (and her team usually do 50 a week) had been cancelled. The reason? All the anaesthesiologist had been requisitioned as they will be required to do ventilation. All elective surgeries had been cancelled, and her paeds specialists sent on refresher courses for adult patients.

We're in uncertain territory here, the NHS's response may not be 100% perfect and a lot of people will argue that some minutiae could be done better, but I believe it has the huge advantage.

I wonder if other countries, and particularly the US, can manage such a coordinated healthcare response?

It's definitely at an advantage over systems like the US, but the NHS is far more federalised under the hood than you might imagine and there are lots of countries where the government or other regulators can take control of private healthcare when needed so it's not as much of an advantage as you might think.

Thinking about it from where I am right now, I don't think it is crazy.

Let's think about it again: China, Japan, South Korea, Hong Kong and Taiwan. They are countries which are very connected to each other; and yet, somehow, they managed to contain it. It's 'herd responsibility'. The people are applying social distancing and hygiene rules, that's why it's working.

It's possible, as a knowledgeable politician, that you recognize that it's impossible to implement such measures in your country. The reasons are beside the technical abilities of your government: Your citizen are not committed enough to the hygiene. And that's not because Asians are cleaner or superior, they have been exposed to these viruses before and thus they are already trained to deal with them.

It's not the same deal for many countries of the west. We didn't have much trouble in the last few decades and thus people have forgotten why we do most of the hygiene measures in the first place.

Also, here is my first reaction, as a citizen, if the government has declared 'herd immunity' as their strategy: STAY AT HOME. I'd also probably warn the closer one and avoid contact with them too.

So the UK might win twice here: Have enough social distancing by fear (and fear is a hell of a thing as you experienced in the last few days); and also have its population adopt strict hygiene and distancing rules making it safer in the future and readier for the next disease.

"that's why it's working"

It's only 'working' while the country is on lockdown, and FYI the country spirals towards economic meltdown.

If they come out of 'lockdown', then 'it stops working'.

See the paradox here?

I really have no clue: maybe we'll develop therapies, a better understanding, maybe a vaccine, but possibly this 'herd immunity' idea at least on some scale. I really don't know.

But coronavirus is not going to disappear in a few weeks, we know that.

> It's only 'working' while the country is on lockdown, and FYI the country spirals towards economic meltdown.

Nope.

> In Taiwan, most residents carry on as normal, with offices and schools open. Many restaurants, gyms, and cafes in the capital, Taipei, are still bustling, although most premises will take temperatures and spray hands with sanitiser before allowing customers in.

Source: https://www.theguardian.com/world/2020/mar/13/how-taiwan-is-...

'Nope'

That Taiwan has 'less lockdown' doesn't respond to the fact that whatever the degree of 'lockdown' whenever it is removed, the contagion will grow again, and that any level of lockdown will have bad economic repercussions.

That Taiwan is getting away with 'less severe' lockdown is not relevant because:

a) They do have a really long list of measures (more than 120 published by their Gov.) that are unsustainable in the long run and

b) It's a selective example - most other nations need more aggressive.

c) Due to the fragility from 'a' and economic downturn around the world due to 'b' a deep recession is guaranteed in Taiwan.

The point remains: there is currently no rational answer to 'how to end the lockdown' while economies go down.

In Hong Kong, the only lockdown we've been in this entire time is forcing people from certain countries to go into quarantine. In fact, most of our cases recently have all been HK residents coming back to HK from places like London, Paris, Madrid and bringing the virus back with them.

I'd point out that the HK government has done an okay job, but by no means were the people happy with how they handled it. There were protests from the Hospital Authority demanding them to close the border to Mainland China and they outright ignored it.

The main reason why these countries are doing a good job is because of the people. You go outside and everyone has a mask on. Why? To protect each other. Everyone has been working from home from day 1 of this virus and, impressively, the panic buying only lasted a week or so. The people are in it together and I can't imagine the same ever really happening in Europe.

https://twitter.com/AdamJKucharski/status/123882151552689766... appears to give a better explanation from the modellers.

The aim is to flatten the curve, any herd immunity is a by-product but not the aim.

I think herd immunity is an integral part of the strategy. If a population never gets herd immunity, it will keep on getting infection breakouts and keep on having to impose lockdowns. The only way to stop doing lockdowns is either to prevent the ingress of the virus, ever, or eventually reach herd immunity.

The virus is everywhere now, it’s part of the landscape, so preventing breakouts is just flat out not possible, at least for large countries with lots of travel and especially with large rural hinterlands like the UK. In this view the only strategies are long term strategies.

There is a way to get herd immunity without an epidemic, and that’s inoculations. However we do not have a vaccine yet and have no idea if or when we might ever get one. So you can bet everything on red 13 and cross your fingers for a vaccine in 6 months, or pick which longer term strategy works best for your country, with its particular demographics and geography.

> However we do not have a vaccine yet and have no idea if or when we might ever get one.

https://www.jpost.com/HEALTH-SCIENCE/Israeli-scientists-In-t...

If I had a dollar for every COVID-19 vaccine that will be ready "soon", I'd have quite a few dollars.

No reputable news outlets are reporting a vaccine breakthrough by the 'Galilee Research Institute'.

Serious estimates are that it will take around 18 months [0]

[0] https://www.bbc.co.uk/news/business-51454859

"Herd immunity is not part of our action plan, but is a natural by-product of an epidemic" - spokesperson for Department of Health and Social Care

https://www.bbc.co.uk/news/science-environment-51892402

> so preventing breakouts is just flat out not possible

Why not?

Because it isn’t possible to screen every single person entering a country like the UK, which means it is inevitable the virus will get in again and you’ll have another outbreak.

However that’s assuming you can eradicate it. That might be possible in an isolated population centre like Singapore, but the UK has an extensive rural area where the virus can hide out, slowly propagating through many different sparse populations until it gets back into an urban centre. It can survive outside the body on some surfaces for 9 days according to recent studies so it can infect someone who has light symptoms, they put it on a new surface, then when they recover up to 9 days later it can up again in someone else. This can go on for months. You might track down some of these smouldering brush fires, but not all. That’s how flu keeps coming back every winter.

> Because it isn’t possible to screen every single person entering a country like the UK

Why not? Personally, if I were put before the choice of not having more people enter my country than I can screen or killing off 1M+ of my electorate, I'd at least seriously consider the first option. Meanwhile the UK government clearly thought that even stopping the flow of people from an epi-center, fleeing quarantine (or at least tracking them) would be a grave over-reaction.

> You might track down some of these smouldering brush fires, but not all

I don't see why you can't keep it reasonably contained even with occasional flare ups. I'm not saying you are wrong, but it is certainly not self evident. Since the Chinese were willing to kiss good bye to something in the vicinity of $1T, presumably they think they can. If you keep perfecting testing and procedures and hold out till you've got a vaccine, I don't see that would not be a winning strategy.

> That’s how flu keeps coming back every winter.

Well, this is way worse than the flu and may get worse still, so we should be very motivated to kill it whilst we can. Also, looks like there'll be more where this one came from. Just taking a big hit to global life expectancy every few years will probably start to add up over the long run.

>> Because it isn’t possible to screen every single person entering a country like the UK

>Why not?

In addition to major airports we also have many minor ones and private airfields. There are 120 commercial ports, and many, many more smaller docks, quays and marinas. We have many islands and remote coastal communities that rely on these for essential supplies and no systematic way to monitor them all. Even then, sealing ourselves completely would have to include stopping goods because goods are carried by people.

Also we now know the virus can survive on cardboard for up to 9 days. We don't have 9 days worth of supplies of everything in the country and don'y have a tracking system for every shipment in or out. We know from the Brexit analysis that we can't track goods enough to tax them, so clearly we can't do the same for medical reasons.

Finally, even if such a lockdown were practically feasible and we developed the logistical and administrative capacity to do it overnight, which we can't, it would destroy our economy. That would inflict massive hardship, particularly on the old and vulnerable, exactly the people we most need to protect. Hardship and poverty kills people, and shutting down all trade and commerce until we have a vaccine, which could be several years or even indefinitely, would take us back to the stone age. It would be far, far worse even than during World War 2, and that's how severe it would have to be to prevent the virus getting in, not just for months but probably for one or more years.

Anyway thats a fantasy, we just don't have the logistical or administrative apparatus to do it fast enough for it to matter.

Here is a rule of thumb that will be familiar to many who manage risk in a professional capacity:

The time to get creative is when you face a capped downside on the one hand, and an uncapped upside on the other. The time to get conservative is when you face the opposite condition.

The reason for this rule is that creative policies almost never work; but when they work, they have a much higher chance of working extraordinarily well than conservative policies do.

The UK is facing a capped upside and a huge potential downside. The UK is choosing to handle this situation with a creative experiment. This experiment will, in all likelihood, not succeed. And unfortunately most values of "not succeed", in this context, map to catastrophic outcomes.

Time, as always, will tell.

(warning: conspiracy theory, but at least an original one)

I'm thinking this only makes sense in the context of Brexit. Brexit will be a massive hit to the competitiveness of British businesses... somebody in government is hoping to counteract this by taking an approach different to the rest of Europe. If the UK's approach works, it will end up economically ahead of all the other European countries, something like the US post-WWII (but to a lesser extent).

.. fewer elderly to take care of?

Although I'm personally offended, being unimaginably (for me) old, this does make some sense. After all, many countries have been angsty about demographic inversion. And SARS-CoV-2 could resolve that within a decade or less.

Apologies for the offense, but I was being serious for the reason you mentioned.

NP. I was mostly joking about the offended part :)

The other interesting factor is how it will impact Gerontocracy which is the norm for most eastern and western governments alike. We see this playing out in in Iran.

> I'm thinking this only makes sense in the context of Brexit. Brexit will be a massive hit to the competitiveness of British businesses

Bad theory. This virus could have been used as an excuse to lock down borders while the rest of Europe got economically destroyed by the virus.

No it already spread to the UK so it was to listen for that

Counter-point: is Brexit Britain actually going to be worst off than post-pandemic EU or what's left of the EU?

I don't think the risk of this pandemic approach is worthwhile, especially given how poorly the EU is doing in general. Terrible economy, catastrophic pandemic response, and the symbolism of countries closing borders on fellow EU states are all quite telling.

By contrast Britain almost seems like it dodged a bullet - although they seem to have jumped in front of a train instead with their pandemic gamble.

the uk is bust - germany is injecting 600 billion in the economy, while the uk a mere 30. the uk NEEDS people to work so they keep the country afloat.

The UK can raise as much cash as Germany so it is a choice they are making.

Only the EU economy has been doing pretty well - much better than the UK has been.

I think that their strategy is more smoke and mirrors - they're looking for the massive uproar so that the public understands that what we're facing is the real deal and will accept the harsh restrictions to freedom better once they have to be made.

The damage caused by an extra day or two of waiting will be small in comparison to the benefits of good compliance.

Plus don't forget that it's the weekend. No schools. The schools won't be open on Monday.

Dominic Cummings and his team are sharp and extremely good at manipulating the exact group of unthinking idiots who would otherwise ignore curfews and restrictions..

I should also add: all of the other Western countries are doing the same thing, UK included. Do whatever is possible to keep the health system working until. Eventually you get herd immunity either via people getting it or a vaccination.

Britain reminds me of the drunk guy who falls down a flight of stairs and then rolls back onto their feet unharmed.

That seems like the exact gamble. IMO, the US has taken the right approach. Keep things going until it starts to replicate in the community, then get aggressive before the hospitals are overrun.

Some communities will have too many cases, but most will hopefully be ok. And we will have a first step of Hurd immunity, concentrated on people most likely to transmit later like package delivery, restaurant workers, drivers etc.

The US should have had testing procedure set up early to relieve stress for citizens.

> Keep things going until it starts to replicate in the community, then get aggressive before the hospitals are overrun.

How is that not a bad strategy? By this point the disease will have some sort of transmission inertia, so establishing containment just before hospitals are overrun pretty much guarantees they will be overrun.

We won’t know for 2 weeks. If the hospitals are overrun, that is a massive policy problem. If they aren’t, it’s a massive policy success.

Math was known and the results fall on our politicians

The US approach has been awful. Things are running completely out of control. The "aggressive before the hospitals are overrun" thing won't work.

Herd immunity means something like 60% of the population get it and maybe 1.3 million Americans die ghastly deaths.

Yeah, it will make Britain Great Again as it gets rid of the old population and increases its competitiveness. It almost feels natural that after getting rid of the migrants it's time to get rid of some less desired locals as well.

In a very dark-humour fashion, it sounds like this would change the balance of brexiters-vs-remainers fairly drastically too. No longer ~50/50. ;)

may be a conspiracy theory, but as the uk gov is injecting only 30 bil in the economy while germany is injecting 600 billion shows the uk is financially in a weak position. if the country stops working the economy is bust. the uk _needs_ to be ahead of europe to stay afloat, so that these measures as a state of war, in which economic sovereignty can be lost unless some people die on the battle front.

You're confusing two different measures.

The UK government has increased spending by £30B, £12B to be spent on tackling COVID 19.

The Bank of England has suggested lending £190B to businesses in need.

The roughly equivalent numbers appear to be 12B and 600B (Euros) for Germany.

https://www.theguardian.com/uk-news/2020/mar/11/budget-2020-...

https://www.bankofengland.co.uk/news/2020/march/boe-measures...

https://www.channelnewsasia.com/news/world/coronavirus-germa...

https://www.pionline.com/markets/germany-lines-600-billion-v...

thanks for the clarification, still a pretty small number considering. all i am saying is these numbers might explain the logic behind going against all scientific advice.

I don't think killing a larger portion of Britons than of Continental Europeans is going to be good for the British economy.

That's ignoring intent they expressed to implement very long isolation measures for the elderly. Thier approach might be flawed, but let's debate it based on what has actually been stated.

They can intend what they please, but the facts show that you can't save the elderly without quarantining and social distancing of the non-elderly. "Stiff upper lip" is such a caricature of Britishness that I wonder if Johnson is doing it as a piece of patriotic method-acting. It is not a medically sensible method to fight COVID-19.

It’s already too late. They’re on the Italy path.

This “herd immunity” thing is nonsense. So much so that doctors and scientists are warning against it:

https://www.theguardian.com/world/2020/mar/14/coronavirus-nh...

It's not "nonsense". It's real. It works for almost every other virus out there (even colds and flu, even though it's imperfect: new seasonal cold and flu strains don't become pandemics, because many people have some immunity from previous infections). If you let a large enough fraction of the UK contract and recover from COVID-19, we have every reason to suspect that the society will develop good enough herd immunity to make further pandemic-scale propagation impossible. This part is good science, and reasonably well understood.

The question is on the impact side. The reason this theory seems to work is that the seeming danger from COVID-19 is all on the elderly and immunocompromised. If you can prevent them from getting the same disease everyone else is, then they'll be protected by the herd -- new clusters won't form and infect them.

So this all comes down to those assumptions:

1. The virus is genuinely of low danger to the young and healthy

2. The vulnerable can be adequately protected during a pandemic of the general population

If either is wrong, we're looking at a staggering disaster. Are they wrong? We have no fucking idea. I'm not even on the continent and I'm terrified.

> It's not "nonsense". It's real. It works for almost every other virus out there (e

You're failing to take in consideration that the virus incubation period is on average 1 to 2 weeks, and those who manage to recover from the disease take about 2 weeks from diagnosis to confirmed cure.

This means that you're comparing 4 weeks of exponential growth with 2 weeks of constant recovery.

Sure, those who survived the disease will be immune afterwards. That's great for herd imunity. But the thing you fail to understand is that as the disease increases exponentially, when that time arrives the whole nation has already become infected, and it's too late by then because health services will be unable to cope with the demand and a lot of people will die due to lack of basic medical care.

> But the thing you fail to understand

No no, I understand that. But the thinking is, and it seems to be backed by data, that the health system will be able to cope with a full-population maximal pandemic, as long as it is limited to the much less vulnerable segments of the population. The ICUs in Italy and Hubei were filled, for the most part, with elderly patients. The math, such as it is, checks out.

The risk management analysis, again, is IMHO batshit crazy. But the theory seems about as sound as it could be given the data we have.

> No no, I understand that. But the thinking is, and it seems to be backed by data, that the health system will be able to cope with a full-population maximal pandemic, as long as it is limited to the much less vulnerable segments of the population.

It really doesn't seem that you're getting it, because the whole point of this exercise is that it's quite patently obvious that no health care service in the world is able to keep 10 to 15% of their population in intensive care, which so far is the expected incidence of cases that require medical care.

If that was the case then no one would be bothered with yet another flu-like viral infection.

What is the age distribution of the ICU requirement? Is it really in the ballpark of 10% for all age groups?

> the expected incidence of cases that require medical care.

Among the general population!

Among people under 50, the best data we have is that the fraction needing ICU care is something like 0.2% (I think, I'd have to look it up again).

The intent is to quarantine the at-risk and let it propagate in the "safe". I genuinely think it's you who's failed to understand the plan. You're arguing against something that is not the stated UK policy.

Thanks for being devil's advocate.

I too think it's too risky, FWIW. I read a while ago there might be permanent damage as well, but maybe that was hocus.

Edit: Business Insider reported HK doctors found some people have 20-30% reduced lung capacity after recovery: https://www.businessinsider.com/coronavirus-recovery-damage-... (n=12)

Do we actually have evidence that this quarantining is possible or working?

> Among people under 50, the best data we have is that the fraction needing ICU care is something like 0.2%

Any chance you remember where you found this statistic? I have been looking for any details on hospitalization rates by age range, but haven't had luck so far.

> 10 to 15% of their population in intensive care

Estimates are closer to 10% of the infected getting severe cases, and some small-ish fraction of those requiring intensive care. (The higher percentage numbers are usually an artifact of low testing rates of infected people.)

Also, epidemiology suggests that 20-70% will get it. So, we’re looking at ~1% of the population in the hospital at once.

The rest of your points stand; we don’t have nearly enough hospital capacity for 1% of the population.

Note that with a two week active phase, the pandemic would have to drag on for 20 weeks to get that number to 0.1%. I doubt there is capacity for that either.

The plan also relies on flattening the curve like other countries' plans. They're just calculating that people won't stay in lockdown for months, and that if they put one in place now people will start emerging just in time to hit the peak of the infections.

Recovery is exponential too - it just lags behind the new cases.

There are 200 Viruses, vaccines only exist for 20 or so. For some you can hardly build immunity (e.g. Dengue fever).

"Sure, those who survived the disease will be immune afterwards." There have been reports of re-infections in China and Japan. This may be mistakes - the never were cured - but this could also point to something more severe. Proceed with caution.

Herd immunity works because:

1. Vaccines, immunitized people don't get sick in the process of imunization, don't need hospitalization, don't die

2. Slow and gradual imunization over multiple years.

Neither of this is uphold all other cases of herd imunization in history I'm aware of always had a massive price in human lives.

Also it only works if the virus doesn't mutate to much, party of the reason the flu is still around even through you would believe we got herd imunization in last many decades since the flu is a think.

> 1. The virus is genuinely of low danger to the young and healthy

Except it's not really that low it's only compared to old people low.

And it's close to practically impossible to only affect young people without having idk concentration camps for young people with strict separation from the older people (like over 20?,30?) for a duration of over a month and still 2 in 1000 or so dying. AND it's anyway to late for that measurements as it's already to widely spread in the UK eitherway.

That is... not a good description of herd immunity at all. It has nothing to do with vaccinations or time scales. Wikipedia's is quite clear: https://en.wikipedia.org/wiki/Herd_immunity

The idea is that once a significant fraction of the population has some immunity to an infection, the ability of an infected person to spread the virus (a term called "R0" in the jargon) is fundamentally impeded by its ability to find infectable targets. So the R0 drops, and so does the exponent to the growth. Once that exponent goes below 1, the number of cases drops over time instead of growing, and new infection clusters can't start.

This works. It's why we don't have things like measles outbreaks (or didn't, until the anti-vax crowd messed things up) and why newly mutated flu strains can't find purchase and become pandemics.

Newly mutated flu strains don't become pandemics because they aren't severe enough for people to care, they certainly proliferate.

You seems to think that people who is against the idea either doesn't understand what herd immunity is, or doesn't understand the plan. We understand both, we just think that the risk analysis is wrong.

Specifically with the GP, his argument is that herd immunity gaining through large percentage of the population being infected in a short amount of time is a bad idea. Normally we got herd immunity via vaccination of the population, since it is much safer than being infected. That's why vaccination was mentioned.

3. the immunity gained through an infection holds for a long enough time (how long would need to be checked with the infection rate), which we do not know yet

Additionally, we know nothing of the long term effects even for the "young and healthy". Mortality rates for people 10-39 is 0.2%, 40-49 it's at 0.4%, 50-59 1.3%, 60-69 at 3.6%. Serious conditions develop in a bigger proportion of cases, so you are looking at 4-10% of under 60 population in ICU with unknown long term effects.

Translation: good luck!

> unknown long term effects

Ultimately, it’s a just a really inconsistent cold. The vast majority of cases are mild. However, if it spreads to the lungs, it’s worse than the flu.

As far as I know, there’s no evidence that it’s any more exotic than that.

There are reports from China of significant lung scarring among patients who had to be hospitalised.

This is the concerning thing for me, as an asthmatic if I stop taking meds I'm already 30% down on lung capacity, adding another 20% on top of that is scary. That 20% can't be mitigated by meds either.

Yes, the idea that only those 70+ are "at risk" is weird. But they probably can't afford to isolate everyone 50+ - both from an economic and herd immunity viewpoint - so they will risk losing 3.6% of people aged 60-69 and 1.3% of people aged 50-59.

According to https://www.statista.com/statistics/281174/uk-population-by-...

8.96 million aged 50-59, 7.07 million aged 60-69.

This ignores the risk of spreading the virus to other populations.

And if the worst case occurs, with millions of elderly and immunocompromised dying, there are billions in potential savings in pensions and old-age healthcare, as well as improvements in housing affordability and overall reductions in national CO2 emissions.

Some are against it, others (such as presumably a majority of those advising the government) are for it. That's just good debate.

> It’s already too late. They’re on the Italy path.

Well, that's pretty much the point of the policy. 'Already screwed this year, let's try to cope, and be less screwed next year'.

I was very critical at first, but I'm more interested/satisfied with the response now, it does seem to be well thought through, even if there are also arguments against (of course there are).

It's basically:

Throw 2 or 3 hounded thousand lives away to have less economical impact next year.

I.e. pure evil IMHO.

especially because there is a non small chance that it will be more like 1-1.5 Million more death then necessary.

That’s a misconception though. Economic depression and deprivation also causes death, and staggering amounts of human misery.

Evil is reserved as a description for gross failures of moral duty. Choosing pragmatically between several terrible options with highly unpredictable outcomes does not meet that standard.

> Economic depression and deprivation also causes death, and staggering amounts of human misery.

Let's quantify things here, for a first world country with a social net.

On the one hand, we have people getting evicted from their homes and having to visit soup kitchens.

On the other hand, we have dead people (more likely, dead poor people).

Evil seems pretty fair.

> On the one hand, we have people getting evicted from their homes and having to visit soup kitchens.

Which translates directly into many years of reduced life expectancy, no?

I understand the point you and GP are trying to make.

I'm saying that the two miseries feel like apples vs oranges, given the context.

You'd have to go pretty far to convince me that (even mass) economic depression is more harmful than widespread, near-term fatalities.

mass economic depression affects certain groups more than others.

Near-term fatalities affect certain groups more than others. Those with access to medical services (or can pay for more of it) will be less affected.

Which side being worse is a determination you have to make for yourself.

That is part of the problem. It is very hard to quantify the consequences of economic depression because it affects everyone at least a little bit, and some more than others. It might cause so and so many more people to have to go through therapy, so and so many families break up over financial hardships, and the children are ever so slightly worse off and the second-order consequences aren't fully realised until 30 years down the line. It's individually (possibly) very small effects, but it hits the entire population.

That's hard to weigh against a concrete number of very concrete deaths and serious recuperation periods.

I have trouble seeing a worse economy for a few months vs a highly optimistic 100,000+ dead having similar numbers of lost lives.

It's not just a few months though; a 0.2% recession (say) quite possibly translates to everyone in the future being 0.2% worse off, forever.

That would be true if annual returns were independent of each other which is definitely not the case.

Funnily enough recessions are associated with lower overall mortality rates.

Something to remember the next time people harp on about GDP being the most important metric for a country's advancement.

https://medicalxpress.com/news/2019-02-recession-greater-dec...

It is basically nothing like that in any way. If it works, it will not be at the expense of extra "sacrificed" lives, that's nonsense. The basic idea is to isolate the vulnerable and eventually protect them with herd immunity. You are allowed to opine that this will fail dismally, but you're not allowed to just make shit up and accuse people of sacrificing lives. Have an ounce of shame.

How are going to isolate the vulnerable population? They also neglect that the vulnerable population clusters. Old people socialize with other old people. A bunch of immune school kids don’t provide much herd immunity to a nursing home.

They might if they were the kids of people working at the nursing home. I am not sure if this strategy will work either but I get it -- every infected and recovered individual is another control rod pushed into the out-of-control atomic pile.

The problem is that most of the people in the nursing home are the residents. If none of them get the disease, The R0 in the nursing home is still going to be well above one. The minute one person who is infected shows up at the nursing home, it races through the whole place.

Meanwhile, in the schools, the intention is to get the rate of kids that are immune as close to 100% as possible. That will be difficult without deliberately inoculating them, because they will develop herd immunity at about 66% in their population and it won't spread in that population anymore.

In the nuclear reactor analogy, it's as if you put in half the control rods, but only the ones on the left side of the reactor. That might make the left side strongly subcritical, but the right side might still be critical, even if with an even distribution of the same number of rods, the whole reactor would be subcritical.

This plan is not going to work and it will kill millions of people in Britain unless Chloroquine or something else ends up being a silver bullet for treatment.

> The basic idea is to isolate the vulnerable and eventually protect them with herd immunity.

so what about those who had to suffer to give this herd immunity? If i were a UK citizen, and i got infected, there's a non-zero chance that i will also need a ventilator. Any, even a tiny misstep will cause the numbers to grow beyond the amount of beds available. That i am asked to take this risk is absurd.

Full isolation and quarantine is a more conservative way - for myself at least. Even if the economic damage is severe.

There was an op ed recently from a former member of the Johnson government that stated "It is time the economists took over from the doctors, before the real pandemic [economic recession] spreads."

So that, told me all I need to know about the cruelty and stupidity of the UK government at this time.

Just to correct this, the statement was made by Omar Hassan, who was head of inward Middle Eastern investment while Boris Johnson was Mayor of London, and was never part of the Johnson government. Here's the article the quote comes from:

https://www.independent.co.uk/voices/coronavirus-deaths-trum...

Thanks, I didn't realize that.

I can see the idea behind that gamble. You take short term pain for long term gain.

Except... A vaccine is expected to be ready in 12 months!

So the long term should be pain free either way!

> such as presumably a majority of those advising the government

Why? Politicians have shown several times that they prefer to listen to a minority of scientists that tell them what they want to hear, rather than a majority that doesn't.

if that is the case, it seems reasonable that it is indeed the majority. under your hypothesis the "majority that doesn't" isn't advising the government in the first place.

Worse, politicians (particularly Health ministers) have disporportionately high infection rates.

Not sure why Health ministers are getting shade for testing positive?

I'd rather my top health officials actually have contact with those under them, than sit in a glass bubble.

They don't follow basic advice (e.g. don't shake hands, touch your face, etc), they don't close down mass events, they don't close schools "because we're not at that stage yet". The time to close them is before we reach "that stage".

Number of cases is a trailing indicator, which also only covers those tested.

One point neglected in discussions is the effect of spreading it to other territories that are not adopting a similar strategy. The majority of cases in the English-speaking Caribbean to date have been from persons who traveled to the UK recently.

If the UK government's policy is to deliberately allow widespread infection of the population, the logical response from other countries will be to ban entry to people traveling from the UK.

"I was very critical at first, but I'm more interested/satisfied with the response now"

It sounds more like you're at the bargaining stage now, rationalizing why it might be a good approach because it's happening and you hope for the best.

It sounds insane. Italy quite literally did the same model. Now they're in the worst of both -- mass quarantine / enormous economic damage AND the brutal human toll.

Well it's not how I'm behaving on an individual level for sure, I'm concerned about unknown long-term effect and don't want it.

But I can see how it might make sense on a wider societal level, assuming everyone doesn't behave like me. (Which they don't, I've observed plenty of people complaining about how it's just 'media scaremongering' and 'just like Brexit'.)

I definitely think we're (almost every country is, save maybe Singapore) past containing it; so I can see how a relatively controlled exposure might actually be a good policy as far as managing resources, economy, and next season...

Nobody thinks it’s a good idea. It’s just nonsense. There is no debate.

https://www.theguardian.com/commentisfree/2020/mar/15/epidem...

Yeah, like, the parents of all the kids will get it and many will die. Others will infect everyone at work.

This seems like a obviously bad idea.

Most parents that have young children aren't in their 70s

But they have parents who are. Maybe in UK this works, different cultures have different degrees of socialization between adult children and their parents.

I'm not sure what your point is here, the comment I replied to said that many of the parents of kids will get infected and die.

cough

https://www.theguardian.com/world/2020/mar/15/uk-coronavirus...

Imagine going ahead with this instead of... doing something.

And no, the NHS doesn’t have the capacity to handle this. So...

“Strategy”.

Here, we can stop “debating” dumb st:

https://www.buzzfeed.com/alexwickham/coronavirus-uk-strategy...

But how can anybody be sure that conservative policy (lockdown, I assume) would work for UK (or any other nation beside China)? They probably have to factor in the chance of success. They can fail in implementing conservative option (which might not be so conservative after all), and ruin the economy as a side effect. I imagine this as a choice between these: - long struggle with uncertain outcome in terms of life lost but with certain economic ruin - short struggle with uncertain outcome in terms of life lost, with small economic ruin

I’m neither epidemiologist nor politician in power, so I can entertain myself with these thought experiments. In the end, I have little choice (and knowledge or firepower), but to do as instructed by local authorities.

The economy is a tool to get people goods and services. It is less important than life & death on a mass scale. 0.1% to 1% of the population unexpectedly dying is huge.

If the government was implementing a plan that they had considered and prepared over a number of years, carefully assessed the evidence and weighed the options? Costs and benefits have been weighed and it is hard to ask for more.

Government has no idea what is happening and it decides to go in and see how bad it is? Not a great time to prioritise the non-essential parts of the economy.

I agree with what you just wrote. But, the premise is wrong, I think; We don’t know if lockdown now vs lockdown later (in UK’s case) will result with 0.1% vs 1% of life lost, respectively.

COVID-19 is rapidly becoming the centre of attention for the entire global medical community and every government on the planet. It threatens the wealth of billionaires and the power of the powerful. I have a remarkable amount of faith that progress on treatments and medical practices will be swift and impressive.

Delaying the pain by a month or two could well be an extremely good move.

You're betting on 1) a therapy being found in that interval, 2) that therapy being highly effective (no significant side effects), 3) easily available 4) affordable 5) you still have medical personnel with which to apply it.

I wouldn't take those odds.

One more, by the way: that the virus doesn’t mutate.

Let's do math!

I'll use US numbers, because I know them.

The current worst case scenarios on the table are between 1% and 5% of the individuals catching the disease dying (there are better numbers, but we're worst casing it). For achieving herd immunity, numbers like 40-70% of the population infected and recovered are bandied about.

So worst case, you're looking at 1.3-11.6 million deaths in the US.

Now, the US government values the lives of its citizens at $7-9 million dollars a piece.

That puts the economic cost of this strategy, in the US, at $9.1-104 trillion dollars.

That dwarfs what is happening in the stock market right now; shutting down the entire US economy for a year makes sense when faced with that magnitude of potential loss.

I assume the math is similar elsewhere.

I don’t understand how we can have reliable mortality/morbidity statistics when it’s only been out for a few months, and many people that get it don’t even get diagnosed with it and so aren’t counted in the survivors. How can there be a representative sample of data available yet?

We work with what we have, and update as more information becomes known.

At the very least, we have a current floor that 0.002% of the total Italian population has died from the disease so far; conversely, we know a minimum of 21,157 have contracted it in the same population, and 1,966 have recovered, so the mortality rate is probably less than 90%.

Now those two numbers are very far apart, so you might be inclined to wait and see whether the final number will lie, but the problem with that is, once the final number is known, it is too late to act.

We either have the option of acting now, as seems best with our current information, and correcting course as the new information reveals itself, or doing nothing at all, and waiting for better information, and our current information says that doing nothing at all is not the best option.

> Now, the US government values the lives of its citizens at $7-9 million dollars a piece.

Wait, where does that figure come from?

I mean, honestly it varies department to department, and when you start talking "lives" versus "YoQL": https://en.wikipedia.org/wiki/Value_of_life#United_States

> The current worst case scenarios on the table are between 1% and 5% of the individuals catching the disease dying (there are better numbers, but we're worst casing it). For achieving herd immunity, numbers like 40-70% of the population infected and recovered are bandied about.

Yes, those numbers apply if it spreads indiscriminately throughout your entire population.

But we know the virus is here, we know who is in the risk group, which means that if you isolate and self-quarantine people in the risk group, and let the virus slowly roll through the rest of the population, you will get a much lower death rate.

There's a ton of variables that determine the death rate, and yet everyone is just staring themselves blind at the first best numbers we have. No. Come on. It depends on the quality of the care available, it depends on the knowledge of doctors who have experience with it, but most importantly it depends on the demographics of the people who get infected.

> shutting down the entire US economy for a year makes sense

Except "the economy" is made up of millions of individuals. Some will still have an ok quality of life, but many people won't. They'll be fired, or their companies will have gone bankrupt, they'll have no money, no food.. Then what? Do you think hungry people won't food riot just because there's a quarantine? Or go stir crazy? Or ignore it? Or spread propaganda that the entire thing is a hoax so that the New World Order can take over?

> Some will still have an ok quality of life, but many people won't. They'll be fired, or their companies will have gone bankrupt, they'll have no money, no food.. Then what?

The point isn't to actually shut down the entire economy.

The point is that when you are talking loss numbers in the trillions, interventions that cost hundreds of billions or even "smaller numbers of trillions" to avert the big losses make economic sense; helicopter dropping a trillion dollars to allow people besides tech workers to self-isolate and socially distance themselves for a few months could be cheap, in the long run.

> The point is that when you are talking loss numbers in the trillions

The main part of my argument above is that you pulled that number out of your ass, you didn't address any of my points against why that number is baseless, yet you continue using the number.

Your number is a worst-case "cost" of doing absolutely nothing and just letting people die, and then you say that your suggested strategy of dumping cash on the population is much cheaper. While true in itself, the error is that you're equating the UK strategy with the worst-case doing-nothing strategy, and that therefore your strategy is better.

The case for the UK strategy is that by letting the virus spread uncontrolled through the not at risk population, health care systems won't ever be overwhelmed, death rates will be much, much lower than current measured ones, and you'll emerge on the other side with a herd immune population, without doing too much damage to your economy, and the at-risk population won't ever get infected in the first place. And by doing that, the total death toll will be lower, than having the virus slowly go through the entire population, at-risk or not.

>letting the virus spread uncontrolled through the not at risk population

Sounds excellent. Did we remember to tell the virus?

Or at the very least, to divide the UK into two non-interacting populations of at-risk and not-at-risk individuals?

> 0.1% to 1% of the population unexpectedly dying is huge.

A lot of people seem to be focusing on mortality rate, but data from China and Italy show that people who get severe symptoms, but survive COVID-19 will live with lifelong scares, that make them vulnerable for say the next flu season.

So while 0.1-1% may die, we are talking about upwards of 10% of people being put out of commission. It's also wrong to say that younger people aren't hurt by this, there are plenty of young people with chronic illnesses, and limited immune systems. And even if they do survive, it may not be worth living.

This is pretty scary. Not only do SARS cause scarring which decrease quality of life, we are on our 3rd ARDS-causing outbreak in the past 2 decades. So potentially tens of millions worldwide with lifelong lung damage and huge risk of getting taken out in the next round.

do you mind sharing some sources regarding the long term effect of covid-19? i am worried about it, especially since i haven't heard much about it so far (might be too early to tell). thanks.

Not OP, but I remember reading about this. The summary was it's too early to establish long term damage. The scarring is present, but its bound to be on patient who recovered a mere few weeks ago.

> The economy is a tool to get people goods and services. It is less important than life & death on a mass scale.

It's not as simple. GDP per capita is strongly correlated with life expectancy. In other words, people die sooner with worse economy.

or die _even sooner_ with this herd immunity strat.

On an individual level, i would not want this, even if it's "better" for the UK in the long run. As an individual, it's unacceptable for me to take this sort of risk, and i would not agree to it if i had a choice.

> The economy is a tool to get people goods and services. It is less important than life & death on a mass scale.

This just isn’t true. The definition of an economy is a system to determine the production and allocation of scarce resources.

To the extent that those resources include food, shelter, and other elements required to stay alive then the economy literally is the determinant of life and death.

Furthermore, significant contractions of economic activity cause death in measurable predictable ways.

All of this closing down of the economy is — literally — killing people as we speak.

Great point - but - shutting down the economy is not a 'conservative' policy, it's up there with 'extreme risk'.

Many sectors will crumble, it will ripple through the economy like dominos, credit dries up, investment halts, you get into an economic death spiral. There's very real possibility existential meltdown which will indirectly cause a lot of pain and death.

So 'lockdown' is 'conservative' from the viral perspective, from any other perspective, it's 'very risky'.

This is a smart observation. The UK is now taking the conservative view because it's the long term view, that this will likely become a recurring seasonal virus (or a one-time virus that keeps knocking on your door until you get it), and therefore there's not much point in a national "lockdown" to "stop" the virus, because as soon as a nation relaxes its lockdown the virus will simply pick up right where it left off.

Herd immunity is the goal for the UK government; they are explicitly saying they want ~60% of the population to get the virus. The only concern for the UK government is to space out the rate of infection so as to avoid overloading hospitals. So they are banning large gatherings, but not doing a lockdown per se, if that makes sense. Slow the pace, but let it continue. (They may do a strategic lockdown later if necessary to flatten the curve, but right now is certainly NOT the time to do a lockdown, according to their strategy, because at this stage it would be motivated by an attempt to "stop" the virus rather than an attempt to flatten the curve.)

> therefore there's not much point in a national "lockdown" to "stop" the virus, because as soon as a nation relaxes its lockdown the virus will simply pick up right where it left off.

I haven't seen anyone address this concern among the people who think the UK's strategy is insane.

Yes, if you lock down society, you will halt the spread of the virus dramatically.

But for how long? When do you lift the lock down? When it's died out in your country? How long will that take? What if it hasn't died out elsewhere? Are you going into another lock down right on the heels of the first one?

And how do you get people to comply with it? Hell, there's plenty of people in the US who are completely convinced that the coronavirus is a hoax or a conspiracy or something something Trump Democrats Obama Liberal But Her Emails. Less than two weeks ago President Trump called the thing a hoax!

The UK strategy takes this into account and rolls with it. They know it's going to infect a majority of the population eventually, so let's just get it over with as quickly as possible, while protecting the vulnerable in society, and then herd immunity kicks in and after that your country is protected no matter what other countries do.

But no lock down strategy is about halting the virus!

They are about slowing it, so that the load on the health care system isn't too grade.

Current data show that dath ratio in case of slow spread can be reduced to 1%, potential even less. While with overload it's more like 5% and with collapsing overload even potentially more.

Also work slowing the number of total infected people without usable medicine against it can potentially be drastically reduced. Especially if we find some usable but imperfect medicine in the near time which reduces ICU cases.

Also let's remember 1918:

The first wave killed the old, the second wave killed the young, the third wave killed without discrimination.

I.e. we are still in the first wave, it's not impossible that a mutation occurred which makes it especially deadly against the young (through maybe quite unlike). Just consider what happens if that overlaps with the UK plans and they notice it to late. It would be a lost generation.

> They are about slowing it, so that the load on the health care system isn't too grade.

Again, the load on the health care system depends completely on the demographics of the people who get infected.

By isolating and quarantining people in risk groups, the load on the health care system will be much lower.

The gamble is this: By letting the virus spread indiscriminately through the part of the population that is not at risk, the load on the health care system will be manageable, the death rate will be nowhere near the current measured ones, and once the virus has passed, you have herd immunity in your population.

But if you argue for harsh lock down of everything now, you are also gambling. You are gambling that you can delay the spread until there is a vaccine, without knowing how far away a vaccine is. You are gambling that all the other countries get a handle on the virus, without knowing if they will.

Are there any examples of countries isolating vulnerable people (elderly, obese, breathing problems, smokers)? It doesn't seem like that is actually viable at all.

It's an explicit part of the UK's strategy, it's been pointed out throughout this thread.

Also, why would that be less viable than locking down all of society the way for example Italy has done?

Yeah, I know that's the UK strategy, that's why I asked if there are any examples of it being done, because it doesn't seem plausible to me. For starters if everyone is out getting infected rapidly, who will be taking care of the vulnerable people?

Uh huh... is the UK isolating and protecting people in risk groups? Because the last time you could safely get infected, and be guaranteed medical attention, was two weeks ago. The NHS is already at capacity right now. There's certainly no danger of accidentally containing it too much.

> There's certainly no danger of accidentally containing it too much.

Actually, there is. The UK strategy explicitly aims to avoid a peak come autumn/winter, you want it to go through enough of the population before summer ends. Too fast and it overwhelms the NHS right now, too slow and it will overwhelm the NHS in November.

I completely agree that it is a risky strategy, but unlike the general sentiment in this thread, I don't think it's an obviously bad strategy, and I absolutely think that everyone arguing against it are also engaging in a lot of wishful thinking regarding people's willingness to self-quarantine and obey government recommendations aimed at containing it.

Try harsh containment measures in the US, and 20% of the population is going to go "fuck you it's a Democratic hoax/Chinese conspiracy/Deep State population control scheme, nothing's gonna stop me!"

At least the UK strategy takes the unwillingness of the population into accord, locking down all retirement homes is much more doable than locking down everything.

>Too fast and it overwhelms the NHS right now

The NHS is already overwhelmed. Right now. We are firmly in "too fast" territory. There is no amount containment, starting from now, that will be too much - the exponential growth is already getting away.

>They are about slowing it, so that the load on the health care system isn't too grade.

This isn't really a plan, it's mostly wishful thinking. We expect herd immunity to kick in at around 60% prevalence, which in the UK would be ~38 million cases. ~10% of cases require hospitalisation, so that's ~3.8 million hospital admissions. At the last count, NHS England had a grand total of 4123 critical care beds. Unless we remain in isolation for the best part of a decade, the healthcare system is going to be substantially overwhelmed and care will have to be rationed.

We may get a vaccine, but that'll take at least 12 months and we don't know how well it'll work; until we know how rapidly SARS-CoV-2 mutates, we can't assume that a vaccine would end the epidemic. It is a strong possibility that COVID-19 will become a regular seasonal affliction like influenza.

There are no good options and we're not even sure which are the least bad options. Strict isolation measures will kick the problem down the road for a while, but at the risk of a whole bunch of other problems. How long will people tolerate being confined to their homes? How long can the economy withstand a huge reduction in productivity and spending? What happens if the lockdown fails and social unrest occurs just in time for the next winter flu season?

We need a lockdown to buy us some time, but we also need to face up to the reality that a lockdown isn't a solution but merely a stopgap.

> ~10% of cases require hospitalisation

That depends on the demographics that get infected! Stop pulling these numbers out of your asses as if they're universally true!

That number is based on the virus hitting everyone equally, and central to the UK strategy is that you avoid that, that you instead quarantine and isolate the at-risk people, and build herd immunity among the remainder, not among the entire general population.

This entire post and all the comments is one giant "holy crap the UK strategy is bananas!", but it seems no-one understands the rationale behind it!

Come on! There are legit arguments against it, but your argument isn't it!

> We need a lockdown to buy us some time, but we also need to face up to the reality that a lockdown isn't a solution but merely a stopgap.

The whole mad point of the UK strategy is that you'll reach herd immunity without massive hospitalisation and death, and that once you're through it, you're done, the virus will die out in the UK, no matter what the state the rest of the world is in, no matter when a vaccine is finished, no matter if other countries fight intermittent outbreaks or not.

Except if it became seasonal there's going to be vaccines (with my faith in the medical research). And if the death rate is as high, everyone is going to get it. Making the sacrifice that british public is going through now senseless.

Also, it becoming seasonal could also be a self fulfilling prophecy due to its policy.

Yeah this basically reads to me as UK doesn’t give a shit about it’s seniors since death is inevitable.

Once a vaccine that works is out I’m sure most of the world will get it. The lockdown is all about preventing (early) deaths.

That is a complete misreading of what they are trying to do, which is flattening the curve and making sure more people can be treated with the medical resources they can measure and substantiate.

> which is flattening the curve

You are NOT flattening jack shit by having all your young population become infected!! [0]

They are NOT gonna mass transport ALL the elderly population to a far away island and isolate them there, they all are gonna get infected and the NHS is going to collapse because of it

There already have been cases documented of people getting infected because of unsealed bathroom toilet pipes on apartment buildings... [1]

[0] https://youtu.be/C98FmoZVbjs?t=693

[1] https://www.scmp.com/news/hong-kong/health-environment/artic...

A vaccine is 1-2 years away. It's likely the majority will be infected before then.

It is unclear if you can continue playing whack-a-mole with quarantine measures for the next 1-2 years. It's possible but unlikely, at least in the West.

The UK's gambit is that by timing stricter quarantine measures they can cut the head off the peak, while slowing down spread due to some immunity in the population. This may work if the risk groups can indeed self-isolate for 4 months, and if more ventilators can be manufactured at speed.

It will still be devastating.

It will be interesting to see what happens in China after people return to work.

Either way, I think we are looking at bans on international travel to continue for many months to come.

This approach is definitely negligent to the point of criminality. There's no practical way to keep younger and healthy people away from older or less-healthy people and once the virus spreads to the less healthy people it will likely spread further.

(I've been doing the arithmetic for this stuff all day but here goes).

The UK's population is about 66 million. Sixty percent infected is 39,600,000. A 1% death rate (which, per above, you can't escape by "just infect young people" or something, jeesh) implies 396,000 dying. That many people dying, spread out evenly over a year is 1084 people dying per day but 10,840 people arrive sick at hospitals. Which is something the UK surely can't deal with. So with the health care system overwhelmed, the death goes to 5% or more and you have 2 millions deaths, much the WWII casualties etc.

Also, the "herd immunity" reasoning is wrong in the sense that we don't cultivate herd immunity to black plague, Ebola or small pox because they are deadly enough that we containment. Covids is in this special deadly "sweet spot" where it doesn't seem deadly enough to isolate in small area but too deadly to allow to run rampant across a city or nation. The answer that's forced on nation is mass city-by-city quarantine. Harsh but China's Wuhan experience was nowhere near the horrors that this "herd immunity" plan promises.

Herd immunity doesn't happen for Ebola because it's not that infectious compared to covid19. Ebola spreads when an infected person coughs up infected blood over someone. That's pretty easy to contain - people don't walk around spreading Ebola with no symptoms.

Herd immunity in this case isn't something you choose to cultivate or not. With such an infectious disease you're going to get it sooner or later; that's the UK's point. Trying to wipe it out through self isolation won't be globally 100% effective and if it's not it'll just come back. Ultimately only the population carrying lots of antibodies will end transmission for good.

With such an infectious disease you're going to get it sooner or later; that's the UK's point.

I believe it's mistake to claim that the disease will inevitably become endemic in the fashion of the flu. It certainly reach that level but costs would be massively catastrophic in a multitude of fashions. Oppositely, that of the different nations who've contained the infection show that is possible to eliminate it from a region and so a world-wide effort could eliminate it world wide as well.

One factor is that the disease is much more deadly than the early commentators (notably in the Atlantic) believed and aside from making "everyone get infected, OK?" horrific, this gives a strong marker for the disease and a strong incentive to act.

So far nobody has shown it can be eliminated from a region. To show that would require that transitional controls on movement of people end and yet the disease doesn't come back.

This is a disease in which people can be infectious yet show no symptoms. How do you stop infected people moving between regions? Do you think a "world wide effort" is going to successfully encompass places like Africa, central Asia, even Latin America? It's out now, it'll be circulating for a long time.

This is NOT a creative experiment.

It's exactly the same as everything that's being done, no one knows what's best, they are all creative or none are.

We have no idea what the downsides are for massive lockdowns. Look at the deaths that happened over summer in Britain when the heatwave struck. What will happen to the elderly in a lockdown?

Lockdowns are not conservative. They are what the rest of the world's doing so they are politically conservative for weak governments.

Lockdown has been shown to work in wuhan and china, except for the political willingness and population willingness in western democracies.

We don't know that yet. This hasn't even begun. We have another 6 months before we'll understand anything. Wuhan might just break out again.

Following others lead is only political conservative. It's the learned behaviour of risk managers, push responsibility to others even if it's not the best action. They are there to manage internal risk.

Interesting way of managing risk. Curious - Does this rule of thumb have a name?

To add to your risk management analysis, I believe we're looking at more of a capped downside if you consider the timing. It's better to come down with it now, before hospitals are overflowing with the sick. We're just at a point where hydroxychloroquine is gaining traction as a treatment, so we have a viable response. We won't have a definitive cure or vaccine for several months, before which the number of people who are contaminated will skyrocket.

"Nobody ever got fired for buying IBM"

I think you can draw a direct line between the personality of Johnson and adoption of this strategy.

Covid19 will unfortunately kill a lot of people. As a silver-lining, it may also kill populism.

Populism seems to be "democracy that I don't like the result of".

I like tomp's comment from a few days ago, feels like the UK playing a game theory https://news.ycombinator.com/item?id=22555643

1) no pandemic, no action -> government was "right", avoided wasting money -> reelected

2) no pandemic, action -> government was "wrong", wasted a lot of money, damaged the economy, inconvenienced the lives of the population -> voted out

3) pandemic, no action -> government was "wrong", caused loss of lives and damaged the economy -> voted out

4) pandemic, action - this is the trickiest scenario, so let's consider two options:

4a) pandemic, action, it works -> government was "right", saved lives, spared the economy -> reelected

4b) pandemic, action, doesn't work -> government was "wrong", their actions failed, they're incompetent -> voted out

This clip of the political sitcom Yes Minister from the 1980s is making the rounds on our social media, as it explains that thought process succinctly, and hilariously:

https://m.youtube.com/watch?v=qNjFIwRYEIo

A better analogy might be that of Kodos the Executioner from an episode of the original Star Trek series: https://en.wikipedia.org/wiki/The_Conscience_of_the_King. Guess right and be hailed as saving as many lives as one practically could in the face of disaster; guess wrong and be remembered as a mass murderer. Never thought I'd see it happen in real life.

(For Simpsons fans, this character is the one from which Kodos of Kodos & Kang originates.)

What's the title of the show? :D

'Yes Minister'. There is also a follow up series called 'Yes Prime Minister'. Very funny stuff - especially if you have any insight into the public service bureaucracy.

If you haven't heard of them, The Thick of It is basically a modern version of this show. By Armando Ianucci, the man who went on to make Veep (with Julia Louis Dreyfuss). Both series have been praised by insiders who say "The show is just like what happens in reality!".

He's also made the movies "In The Loop", set in the run up to the Iraq War, and "The Death of Stalin".

Zapp Brannigan said it best: "Come back when it's a catastrophe"

https://www.youtube.com/watch?v=jW6xTkivmto

There is already a pandemic, so it isn't a question of pandemic or no pandemic. It's a question of if the medical system gets overwhelmed. It's also hard to judge because spending lots of money and enlisting extreme measures may slow the virus so much it looks as if it wasn't that dangerous to begin with. In which case both sides would be using it as a talking point.

Since there's already a pandemic, I'll assume when you're saying "pandemic" you mean more specifically "epidemic in the UK". Even then, there's some fallacy in your list.

In the best case -- if action is taken and it contains the spread -- then there is no epidemic and it looks like overreaction. Even if it slows the spread allowing the health care system to keep up and keeps the fatality rate fairly low you'll get people claiming it wasn't as big a deal and that whatever action was taken was an overreaction.

This happened with Y2K [1], it happens with hurricane warnings when the storms fizzle out, and despite the glaring evidence of what happens with inaction (China, Italy) there should be little doubt people will be talking about 'overreactions' in any countries that do take action that turns out to be effective.

It's the same problem that nobody goes to a show and says "Wow, the sound technician did a great job, because nobody backstage had a hot mic while they were in the bathroom!"

[1] https://news.ycombinator.com/item?id=22556156

I don't think anyone will accuse any government of overreaction, given the state we're in - there's many countries, acting independently, with different outcomes / progressions of the pandemic ... it will be very easy to look back in a year or so (hopefully) and say precisely which governments did well and which did not, possibly even precisely which actions led to the outcomes

Nah, that was the thinking before the pandemic, when "action" was either close the borders and crash the economy, or not and hope that nothing happens.

Now, I think the following consequences need to be taken into account:

(1) politicians have very little skin in the game (given they have priority access to hospitals, security, flights, ...)

(2) the only skin in the game is next election, which in the UK won't happen for another 5 years, so literally who cares (a.k.a. this won't affect Johnson's decision-making)

(3) capacity - NHS in the case of the UK - of which we (the public) have very little information, and the government (Johnson) has a lot - he might think that if there's even less capacity than in Italy, it makes no sense to even try their strategy

(4) what other countries do - a disaster isn't really a disaster if it's no worse than other countries... and Italy is pretty bad already, so it makes some sense to do something else (can hardly be worse than Italy)... this is also why I think Trump won't fare that bad, as long as the US outcome is better than EU (which is might still be, it's a bigger country with literally more space for people to self-isolate, and banned flights with China a while ago - not sure if that'll have an effect at all but it might) he should be fine

(hope not a problem that I brought up your comment but I liked it much)

This doesn't make sense as the next general election here is in 2024 and however coronavirus is handled will be in the distance by then. Consider that the Labour government started a very unpopular war in 2003 and then won a landslide two years later in 2005 - and they were in the middle of fighting it.

Here is a discussion on Channel 4 on the approach taken by the UK government.

https://youtu.be/C98FmoZVbjs?t=590

Debating are:

- John Edmunds: a professor in the Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine

- Tomas Pueyo: his modelling of the pandemic has gone viral on the web: https://medium.com/@tomaspueyo/coronavirus-act-today-or-peop...

During the debate, Pueyo throws up his hands in horror at what the professor says. Listening to them both, I honestly don't know who is right. You may think a level-headed response is the right approach rather than an emotional one. But there is something cold, clinical and unemotional about the UK's strategy to tackle this pandemic.

And can you "nudge" people to adopt certain behaviours in one country when the rest of the world is doing the opposite to what you advocate?

> there is something cold, clinical and unemotional about the UK's strategy to tackle this pandemic

I don't see that this is a criticism. This kind of decision-making should be based on expertise, not emotion.

It seems unlikely that they're unconcerned with the harm done. Minimising harm is the entire point of responding to the pandemic, after all.

> you can't "nudge" people to adopt certain behaviours in one country when the rest of the world is doing the opposite to what you advocate.

You've not shown that the nudge-based approach will be ineffective.

Harm to what? The populace, or the bank balances of the cabinet?

I agree that misaligned wealth-incentives for politicians can be a serious issue, but I'm not convinced it's likely to apply here.

Unlike many political issues, this one threatens the nation's leaders personally, and the cabinet presumably has a far higher average age (and therefore vulnerability) than the general population.

As we've already seen with Iran, the people at the top aren't safe from infection.

Look at chart 7 of Pueyos article. He uses this chart to underpin his argument that the lockdown in Wuhan is the way to approach controlling the virus. But note, on that chart it shows that testing only became available to the Chinese authorities 9 days before the lockdown. In all other outbreaks (even the US one) there has been widespread testing - it's just not reasonable to make inferences from that situation to any of the others.

Pueyo doesn't understand the data, worse he has made no effort to understand the data (like actually reading the chart for a start). He's just a lad messing round with numbers.

> In all other outbreaks (even the US one) there has been widespread testing

Can you back up that claim? From what I've read, the opposite seemed to be the case, especially in the USA.

Until late Feb, it was mainly CDC, but in March many more states came into the picture:

https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/test...

Depending on one's view of 'widespread' testing, we have currently about 20K tested, and around 2.4K positively diagnosed.

I think it's about 19K "SPECIMEN" tested, not people. Maybe 8K people tested as of today, but only <1K people tested until about a week ago.

So, yes, I think claiming the US had widespread testing is stretching the truth beyond BS level.

But in China for the equivalent stage of the outbreak there was zero testing. Because there were no tests. The data cannot be compared.

The UK has tested 37,746 times so far. [1]

Italy is 80k +

The testing incidence is going to change the infection confirmation number. The testing protocol will change the confirmation number. The type of testing will change the number (I believe that there are several types of test with a different confusion matrix).

[1] https://www.gov.uk/guidance/coronavirus-covid-19-information...

A more cynical question: can a PM win the next elections or politically survive the next weeks if a lot of people die and he just shrugged his shoulders, when the rest of the world did their best to keep people alive, successfully or not? I bet he'll have to change course pretty soon.

And that’s the real calculus here: how will this be perceived after the dust settles? If the population doesn’t think their leaders did enough, there’s risk of reprisals. If the government does the wrong thing but people think it was right, everything is fine. But if the govt did the right thing and people think it was wrong, correctly or incorrectly, there may be reprisals.

Irrelevant. All that matters is the editorials and vox pops in the months immediately prior to an election. Voters don’t remember where they left their keys, never mind last year - and if the current U.K. gov have shown anything, it is that they can and will win every election until the end of time - they’ve presided over a decade of unmitigated disaster, and their approval just keeps growing.

No, we’ll be talking about how Jeremy Corbyn singlehandedly introduced covid to the U.K. It won’t be “true”, but that is... irrelevant.

Yes, if the Tory press back them up. Brexit has shown that the narrative can be spun in their favor.

The impacts of Brexit are relatively abstract; COVID-19 is piles of dead bodies and 1 in 20 families losing a grandparent. Spinning that positively is mighty challenging.

a lot more than 1 in 20, potentially.

With an overwhelmed health system and shortage of ventilators, mortality can exceed 5% in the general population. If that happens, everyone will loose a loved one.

That's why italy and Germany are desperately sourcing more ventilators: https://www.ft.com/content/5a2ffc78-6550-11ea-b3f3-fe4680ea6...

I don't personally think politics are playing a major role in these decisions. UK elections are 5 years away, that's a lot of time for them to change the narrative if things don't end well.

The Tory party does not require an election to backst— er, replace its leaders.

In terms of realpolitik, I guess it depends on the extent, the speed and the affected population.

If it's a lot of people over a long time, they'll be out. If it's a lot of people over a short time, it'll come down to who dies, and how much time until the next election. The young and middle-aged, and generally "the productive" people die: they're out. If it's the old and those close to retirement age, it will be, quite literally, a rejuvenation for the country, lots of wealth will be passed down, the pension and health system will be unburdened, the job market might open up for the young, that could lead to a strong economic improvement for plenty of people.

The personal economic situation is very important, but you'll need some time between the event and the election. If aunt Mary just died last week, you're maybe not going to vote for the guy in office that is responsible for the policies. If aunt Mary died three years ago, your finances have significantly improved, you've inherited a house and your future looks bright, why experiment with a new leadership?

I'm going to go with the guy who was awarded an OBE for his work in infectious disease control: https://www.lshtm.ac.uk/newsevents/news/2016/leading_infecti...

OBE is a political honour, not a scientific one.

Got the Politit honour for all the scientific work. It's yet another accolade for their recognized expertise.

I'm not sure following honors/awards is always the safest path, but your answer doesn't make sense to me at all: he was awarded for infectious disease control "particularly the Ebola crisis response in West Africa", which sounds to me like valuable experience, and solid ground to claim some knowledge.

Thanks for putting some more meat on your appeal to authority. Seems a little bit more reasonable, but I have little faith in UK institutions in 2020.

The more explicit reason to view him as credible is his body of work. The award was ostensibly given in recognition of that work, so to cite the award in support of his credibility is pretty much the same thing as citing the work, just with an appeal to authority thrown in. Which isn’t necessarily a bad thing, an appeal to authority is as valid as the authority you’re appealing to.

My gripe was that OC made an appeal solely on the OBE rather than his body of work. Such awards should be viewed with suspicion as they can be awarded on the basis of saying the convenient thing as much as the right thing.

I said he was awarded the OBE because of his work in this area, not that an OBE is solely a reason to trust his opinion. He is far more qualified than the growth hacker / marketing guy who has zero expertise in this area as far as I can tell.

Well you probably should have cited a more credible award so

I’ll take the guy who has dedicated a significant amount of his life to being an expert in the relevant area.

>for his work in infectious disease control

That's almost a BBC level of "debate". An expert, plus some dude who disagrees and makes good television. Could they not find an actual qualified person with a different opinion instead of a "SV Tech Executive"?

Reminds me of a stand-up routine by Dara O'Briain, "for the sake of balance, we must now turn to Barry who believes the sky is a carpet painted by God".

Obviously an exaggeration in this case - but here one guy is a recognized epidemiologist and the other is a SV tech guy.

Won't all the Brits be banned from entering all the countries in the world for very very long if they have such a big change of carrying the virus?

If you get it, you're only highly infectious for 7 days, and infectious for 30-60 days. After that, you might have antibodies for (some variants of) the virus, but you won't have the actual virus.

where did you get the 30-60 days from? is that also true if you are asymptomatic?

There is no “UK strategy”, just like the number of cases in the US is much higher than the stats say but there are no tests for ordinary people.

The “UK strategy” is “let old people die”.

That “strategy” will be scrapped in the next day or two. Because it’s dumb.

It’s like some “theoretical” thing that ignores what’s actually happening and what has happened before.

Everyone is going to be Italy. Unless they’re China or South Korea and get it under control.

China was Italy before Italy was Italy. 400M people locked down. But they showed it works.

Told you all:

https://www.buzzfeed.com/alexwickham/coronavirus-uk-strategy...

Well, they are both in agreement that we need to reach herd immunity at minimal cost. They also agree to keep the rate of new infections below NHS's capacity to handle.

They disagree on:

- adherence to lockdown measures over a longer time

- actual rate of spreading the disease

I agree with John Edmunds on these two points, however I am frankly disappointed a third approach is absent from the debate which is to lockdown aggressively now and deliberately infect healthy-age adults to achieve herd-immunity in the healthiest (most active) population.

These types of organized "corona parties" if you will could be medically supervised and coordinated with the NHS's ability. In that case you have controlled (accelerated) spread with 0 viral coefficient and uncontrolled general population spread with a viral coefficient.

That said, it would only be ethical if the government believes it could manage the capacity of the NHS. I think more realistically it's a foregone conclusion that the country health systems will be overrun and that drastic lockdown measures only make sense for a few weeks to make sure herd immunity comes at effectively half the cost in human lives.

If they don't believe they can manage the NHS capacity then the UK governments' policy is by all means the most human and economically effective way to manage it

> These types of organized "corona parties"

What if we gave a corona party and nobody came? Seriously, I don't think forcing people to be infected is ethical in any way whatsoever, unless you are a truly brutal trolley-pushing utilitarian, and very confident that your strategy will work....

Your parent wasn’t advocating for forced infection. It’s my understanding that pox parties were a fairly common way to manage the spread of chicken pox.

If you take some extreme assumptions; everyone will catch this, and you can infect in a totally controlled way where only the ones you wanted to infect were infected, you could definitely argue that controlled infection was the best course of action.

Pox parties are forced infection. Children do not choose to go or understand what is being done to them. Their parents exert power over them to make it happen.

You can argue about the morality of it, but the analogy with adults voluntarily getting infected is false.

Wow, Tomas Pueyo is a self proclaimed „growth hacker“ with no experience in epidemiology. I would prefer to have people weigh in on the issue that actually have more than two weeks experience in this. Everyone can have good ideas but giving people like Pueyo a platform for their self marketing must be an insult for all real experts that work on these issues.

With statements like "the markets are up", and the hyperbole of "so we're saying 'we want to kill 200,000 people'" and "killing everybody", which even the anchor has to reign him in on, Mr Pueyo seems like such a douchebag. he comes of as incredibly unlikeable (at least to me). especially compared to Mr Edmunds, who goes through how herd immunity is a good end-game in a measured and calm manner. to which he seems to offer no counterpoint. they even both agree on lowering the peak, just not on how to do that/when to do it.

edit: it seems reasonable to me to suggest not impose quarantine measures too early, to not drag those measures on for longer than necessary - that just makes it more likely people will disobey it. indeed, because a vaccine is so far off, herd immunity seems like the only plan for now.

Funny thing about this is that they don't disagree on herd immunity. They argue over optimal rate and tradeoffs (where/when measures slider should be moved).

In this rare case Pueyo credentials don't matter much as he pretty much echoes open letter from scientific community coming from Italy.

What is not mentioned is that buying a bit of time also increases a chance for many people to get treatment that is yet to be discovered/approved.

absolutely, although it's a balancing act. there's also a mental health component to isolation/quarantine, and how do you measure that? it's a tough and complex call in any case, and i'm glad i don't have to make the call.

It's so crazy seeing him pop up like this. I used to work with Tomas on viral facebook apps like Astrology and Birthday Cards. Obviously working on viral apps is not the same as epidemiology and growth hacking.

He was quite a character to work with, and I'm not sure how to put this .. on the one hand his doc seems more or less correct and it's good that he was able to present things in a way that drove action, but on the other hand like you allude to one shouldn't necessarily believe things about epidemiology just because he's saying it.

On Facebook I saw Paul Buchheit sharing Tomas Pueyo's medium post. I was stunned that PB would share models created by someone who clearly has so little knowledge of epidemiology.

I was unable to comment and call Paul out on this, due to Paul Buchheit's privacy settings allowing only his Facebook friends to comment, not any arbitrary Facebook followers. It's very frustrating to not have an outlet to comment on and critique what is clear misinformation.

> But there is something cold, clinical and unemotional about the UK's strategy to tackle this pandemic.

You say that as though that’s a good thing. The coldest, most rational view is that the virus will eliminate the weak and elderly, and therefore be of benefit to society.

Given that the current U.K. government have enthusiastically spoken about eugenics, this is essentially the mindset you’re supporting.

So. Would you really still say that cold, clinical, and unemotional is the best way for us to act?

> Listening to them both, I honestly don't know who is right.

Well, I suppose we'll find out.

> But there is something cold, clinical and unemotional about the UK's strategy to tackle this pandemic.

Boris Johnson's chief SPAD recently (this year) employed a known eugenicist, and that person only resigned after considerable public consternation.

I think we (UK) are trying to be too cute about managing the curve, like we can ramp it up to the capacity line then slam on the brakes with the big measures at exactly the right time and keep it ticking along there nicely through the spring and summer and have this thing wrapped up by the end of the year. It could all go very badly wrong.

I get the impression we're being overly influenced by a few gurus of behavioral science, a field which must surely make even experimental psychology look replicationally robust, and in particular by 'nudge theory', for which our politicians have a particular penchant. I also gather we war-gamed this exact scenario two years ago, which may have led to a degree of overconfidence amongst some key players.

I would be on board with the UK plan if it was more proactively protecting the at risk population.

Why aren’t large events stopped? I get one infected person won’t infect a whole stadium... the main thing for me is people from all over go to these large events and so there is a high risk of introducing the virus to new areas by having them.

There should be more testing and local alerting. It would keep people on their toes and help individuals be more aware of potential risk around them.

At risk groups should be making use of social distancing at a minimum.

Even with this it seems risky. That said I understand the approach and reasoning. The implementation - so far - seems half baked and risky as hell.

And now more details of the plan are trickling out - over 70s being advised to stay at home (but not yet), etc.

At every point people will ask, "if cancelling large events/closing schools/WFH would have helped, why didn't you announce it weeks ago instead of now?"

Plus, it isn't as if people are actually keeping calm and carrying on. Their shopping has been disrupted, half their friends are staying home (despite no government advice to do so), they can't visit their doctors in person any more, and everybody is stuck to the news. Productivity in offices has dropped due to the anxiety and uncertainty, and I don't think Boris' "life goes on as normal for now but that may change later" speech late Friday has done anything to prevent that.

> keep it ticking along there nicely through the spring and summer and have this thing wrapped up by the end of the year. It could all go very badly wrong.

It certainly will go badly wrong. If you use all your NHS capacity for treating COVID-19 alone, and expect the majority of the population to get it, and don't want to overload the NHS, then simple estimates that anybody can make indicate that you're going to need to keep it "ticking" for 100 years. Any faster, and you will overload and cause the death rate to soar.

The government surely knows this, so I don't know why they're acting like they don't.

My intuition on this is that any strategy that relies on rather precise targets to hit in terms of infection rates is doomed to fail. There is simply far too much uncertainty about the exact properties of the virus, the behaviour of the community and the effectiveness of the various measures that are employed to try to contain or mitigate the pandemic.

The incubation period is something like 5-6 days on average, it'll probably take at least another day, likely more to get test results. So you're always at least a week behind when you're trying to examine the results of your actions, and the pandemic spreads at an exponential rate if no containment or mitigation measures are preventing it. If you get this kind of strategy wrong, at the point where you're noticing it you will have doomed your healthcare system and your population.

It is the nature of exponential spread that you will have to act before it is obvious, and that if you don't do that it'll be far too late once you notice that.

It looks like to me just a comfort pill for the public. They basically acknowledged that they can't handle the crisis already. So what they gonna do? They want it to appear to be an advice from expert, to persuade the public, rationalize a forced decision.

The uncomfortable truth is, the British government have weighted cost and benefit, and they have decided, the death of thousands or more is not worth the cost of near-absolute lockdown of a country, It might lead to total breakdown of the economy, full-recession, and that may cost more lives anyway. These elder people are old enough anyway, and the death rate for young is just 0.2%. (which rise to 1.3% for people elder than 50, and 6% for elder than 60 according to data from China)

What does those number mean? If you and your partner's parents are elder than 60 years old, there is 25% chance, at least one of them will die. That is, very likely, you're going to hear it from your best friends that one of their parents died from COVID-19. Are you okay with that? (Under the assumption everyone will get infected anyway). And beware, these statistics are not final, and mostly from patients who received some level of medical care, although we do not yet know how many of those heavily-ill patients received intense care. Without medical care, the number could easily double, after all, it takes time to die, that's just how lung disease works.

Our establishment are very detached from the hoi polloi. One need only look at WWI unarmed charges from trenches. Not sure much has changed since this time on their side. On the pleb side I think the assumption that the upper crust are competent has changed.

We've just had years and years of austerity in the UK, imposing a huge toll on the most vulnerable in society. The government repeatedly said there was no money. Then they turn the taps on when it effects them. They clearly do not care about the bulk of people.

Put those two together and you have the ingredients for a big uproar.

>One need only look at WWI unarmed charges from trenches.

when did that happen?

It didn't. Maybe poster was thinking of the Crimean war 60 years earlier where bayonet charges where tried on well defended russian positions.

>Under the assumption everyone will get infected anyway

Under that assumption you presumably have no choice? The question is whether that is a good assumption

Well, with no isolation whatsoever that's an likely outcome, it's not possible to know at this time since we don't really have any other country opt to use such desperate measures, and hence no stats available.

> the deaths of thousands or more

More like a million deaths assuming 50% UK infected and 2% death rate.

50%×2% = 1%. 1%×67.5 million = 675,000.

Which is "like a million".

Both the 50% and the 2% are very conservative.

Especially the 2% figure holds when intensive care is available. But if you plan to let millions get infected at the same time, there won't be any intensive care- there will probably be no care at all.

Death of thousands or more???

You are living in some pleasant fantasy!

Back in reality, the UK wants to infect about a cool 40M people (for the herd immunity!). Last I heard they expect 50% (20M) to get it in a 3 week interval. Meanwhile they have about 4k ICU beds, which are at close to capacity already. Assuming cocooning works so great that only 3% of people need urgent care (rather than a more likely 5-10%) and only for one week on average (again, unlikely!), that's 200k people for 4k beds for a period of 3 weeks. Surely the fatality rate for those 3% is going to be way over 60%. At which point you have close to half a million dead in those 3 weeks alone.

I'd like to see numbers for a realistic scenario where this strategy does not result in something in the millions of deaths.

I guess we'll see, won't we. I mean for all the panic about Wuhan, fewer than 3.2K people died there so far, and when it all winds down, the death toll will likely be below 5K people. Probably fewer than died of flu complications in the same time frame. Given that the vast majority of the cases are not acute, probably most of their metro population was exposed to the virus, which is tens of millions of people.

I know that extreme measures were taken to stop the spread (and such actions are infeasible in the West), but they did contain it: there are very few new cases or deaths.

So no, there won't be "millions of deaths" or anything close to that, especially if older people are isolated.

Of course the death toll in Wuhan/China has been relatively limited BECAUSE they took drastic measures.

When people start to say "all this panic for that..." it means that the measures taken have worked, not that they were unnecessary.

Yup.

The best case scenario is that restrictions are introduced, and they work so well that people complain that they were unnecessary.

And remember folks, when it comes to exponential growth, the best time to act was yesterday.

The issue with that approach though is how do you effectively prevent reinfection of the region when all counter measures are suspended? Another carrier could reinfect the region again and all that previous work came to nothing.

It's never "nothing". For all we know (or don't), the virus might (or not) slow down spread during the warmer months in Europe and the US.

Perhaps it could be effective enough to have multiple 2-week lockdown periods (eg. separated by 2 or 4 weeks non-locked-down periods), just to slow down the spread so health care systems can keep up?

There is so many variables at play, and no simple model could come up with "the best" solution, if there ever is one.

By contact tracing, quarantine of people who are suspect, and social distancing.

Look at taiwan , singapore, hong kong, macau. You can totally slow it down to a reasonable number of new cases daily such that the hospitals can handle. Just don't start like wuhan, iran, italy...

Reverse Tinkerbell Effect

Wuhan disagrees with your argument much more than it supports it. The Chinese response in Wuhan -- after the failure of the initial attempts to suppress any news of the virus -- were swift, draconian, and competent. They locked everything down, heavily restricted travel, erected 16 temporary hospitals (just for that region alone), and pumped a ton of medical supplies in to it.

So the argument that follows from that is, "these are the measures required to achieve fewer than 3200 deaths."

Which is something I explicitly pointed out. Shit like this isn't going to fly even in the UK, let alone in the US, so they seem to be acknowledging this simple fact and thinking of what they realistically can do in the absence of such "draconian" lockdown abilities. Which I think is smart. Especially if you consider that _any_ lockdown can't last for very long for economic reasons. A month or two at most, after which you start over. Lather, rinse, repeat, until you build up herd immunity.

... Only when you enact it at 400 cases (January 23rd) for a city of 15m or region of 55m (couple days later).

Germany and France are at 4000 cases, so even draconian lock-down of the entire country might end up with 32.000 deaths each.

I think you kinda missed the part where the UK is trying very hard to infect the majority of the population and China is trying very hard to stop more infections from taking place. Successfully it seems.

> So no, there won't be "millions of deaths" or anything close to that

I showed you some simple arithmetic, based on official figures from the UK government. Can you come up with better numbers or point out an obvious flaw in my calculation?

There are no reliable estimates of overall fatality of the virus. Only the estimates of how many people _who required treatment_ have died, which the press deliberately misinterprets as the overall fatality rates most of the time, because higher numbers drive more clicks. Watch epidemiologists speak about this: they will go out of their way to point out that we don't know these percentages, and we won't know them for quite some time. Your "numbers" are bogus. You can easily see this if you look at the _initial_ estimates of H1N1, SARS and MERS. While COVID19 does appear to be deadlier, _nobody_ knows what the fatality rates will look like population-wide. Anyone who claims otherwise is full of shit. What we do know is that the numbers we currently have are the very uppermost bound of what's possible.

Not true. These estimates are of overall fatality based on number of people diagnoised. Not based on those who required intensive treatment. That means we have crude estimate on death rate for people showing some symptoms. Crude in a way not everyone in the pool is recovered, or dead for that matter, so it's not possible to be that accurate yet, but it will only be higher not lower.

Wouldn’t we only have a crude estimate on the death rate for people diagnosed with the virus? If we find that many people are not getting tested for the virus and just recover by themselves, then it’s possible for the fatality rate to be lower.

Well, those asymptom case can also infect others. In all likeliness they will infect others, multiple others. So if epidemiological root trauce is done right, we would find those asymptom carrier.

This doesn't mean those cases are "asymptomatic". Most people who get the disease fare about as they would with a flu. I'd also venture to guess that most people do not go to the hospital unless things are really bad (e.g. they can't breathe on their own). Furthermore, because not everyone at the hospital gets tested, I'd also guess that there's a number of cases where deaths are misattributed to plain old flu, too, since it's the flu season still, and some of those who are dying "of coronavirus" would have died regardless.

Well. How is common flu any different? Most people don't get tested and they just recover, if any, a lot more don't. So seeing those two numbers on the same page should mean something, even if you doubt the accuracy based on the assumption a large quantity of people aren't tested.

Nope, SARS and MERS are way deadlier than Covid-19, not just in initial estimates. South Korea tested hundreds of thousands of people and we have the Diamond Princess. That makes it unlikely that we are overestimating CFR by an order of magnitude due to uncounted mild cases. If you have someone reputable who thinks true CFR could be as low as 0.1%, please share! As far as I can tell no one believes it can be significantly below 1% for a country with similar demographics as the UK.

The reason why Covid-19 is scarier than SARS is precisely because it has a lower fatality rate, allowing it to spread instead of killing its host before they can spread it.

And so begins the Great Reaping. Get rid of the old and the sick, so the nation can move on, freed of the burden of caring for an elderly population that consumes but does not produce.

isn't the current government disproportionately voted in by the old? It seems somehow short-sighted this.

They will be replaced by the next set of old. A population can always be segmented, they might just not be as old as before.

The problem is they might reap much more than intended. I'd really like to see estimates of how many economically productive members of society will get caught out by the fact that sadly they can't have life-saving treatment after an accident (or will get a nasty covid infection post-op) because the health system shut down for weeks/months or gets permanently gimped (if it kills off or traumatizes enough doctors and nurses).

Also, what are the chances nearly all of the recovered infected are in near mint condition post-recovery? If it turns out non-trivial numbers now have permanently reduced lung capacity or pregnant women produce a lot of wonky babies, what then?

That's not quite the point though, is it? The point is total breakdown of the economy, full-recession, and that may cost more lives anyway. The idea seems to be that you can decide: do you want thousands of deaths, or do you want thousands of death and an economic collapse?

I find one argument supports the delaying tactic is that lockdown won't work especially troubling: because you are eventually going to lift it, it won't work. Here's thing, it's always a matter of when, not never.

Lockdowns are to buy time for vaccination. That will be the optimal solution. Unfortunately, the time when the vaccination will arrive is unclear, at the earliest time expected is 6 months, but it will more likely to take more than a year. New treatment method are also being tested, like make use of blood from those who have recovered (Apparently I do not mean to drink those like vampires do). The UK government may think it will take much longer fo find effective treatment or vaccination.

Thousands already died in Italy over the last several days with less than 20,000 cases (most of those cases are still active so thousands more will die in the coming days before the lockdown even shows effect, if it is effective). You're looking at millions dead if a significant portion of the population is infected.

> It looks like to me just a comfort pill for the public. They basically acknowledged that they can't handle the crisis already. So what they gonna do?

Well, they could do what every other developed country is doing: implement social distancing measures. Social distancing can't stop the spread of the virus, but it can slow the spread down.

People seem to have an impression that the case fatality rate (CFR) has some fixed value somewhere between 0.1% and 4%, and that the CFR is set in stone; but obviously there are many confounding factors, such as access to ventilators. If a sizable portion of the UK population contracts the virus all at once, the NHS will be overwhelmed and many otherwise preventable deaths will occur (see the graph near the end of this BBC article [1]). In contrast, social distancing would "flatten the curve", reducing the burden on the NHS (eg, see this interactive Washington Post article [2]).

~~~

[1] https://www.bbc.com/news/explainers-51632801

[2] https://www.washingtonpost.com/graphics/2020/world/corona-si...

>These elder people are old enough anyway, and the death rate for young is just 0.2%

The numbers we're seeing from The Netherlands, Italy and France show that over half the people in the ICU are between 30 - 60 years old. I'm not convinced the 0,2 % is accurate anymore.

Modelling disease spread seems like the kind of scientific endeavour that one can dedicate one's whole life to becoming an expert in, and many people presumably do. Considering that, why should anyone give much credence to a random medium article on the topic by a 'silicon valley tech executive'? (lol)

There are 10's of thousands of scientific research papers [1], by scientists, on COVID-19 already, and this guy is just some tech exec who knows how to play with a jupyter notebook. I see no reason to pay much attention to him.

[1] https://twitter.com/freereadorg/status/1236104420217286658

Because the models the government's epidemiologists are using explicitly don't account for all possible actions.

Back when this was taking off in China, a bunch of epidemiologists came out and said it was completely uncontrollable there. They were wrong, because they hadn't accounted for the extreme actions the Chinese government was willing to take; it was not even a possibility in the models. The same story repeated itself for Hong Kong, Taiwan, Singapore, and South Korea. They defeated the models by taking effective actions that were "out of the training data" for epidemiology. Given these 5 examples, there's no reason other countries can't defeat the models too.

The US we are trying as hard as possible to track the exponential pandemic curve as closely as we can.

Though the US government certainly isn’t communicating those details to the general public. Have you seen the CDC website? Why do I need to go to The NY Times website to get a summary of updates in a timely manner?

You don’t think professional epidemiologists have not thought of these? There are many papers in the literature that discuss this.

Clearly they have. I'm just saying that the word of each individual epidemiologist is not absolute law. They can disagree, because they base models on different assumptions. As a result, many, many predictions shouted far and wide by epidemiologists in the past months have turned out wrong.

We don't know yet how sustainable Chinese actions are. People are still in lockdown. Covid19 could come back when the lockdown is relaxed.

You are missing the fact that it doesnt matter if it "comes back" or not, what matters is that the rate at which it "returns" doesnt overflood the healthcare systems.

This idea, UK policy makes hae will absolutely collapse the NHS.... But who knows, maybe that's their idea all along, to collapse the NHS, and after this is done, they will start passing laws to "reform it" and sell it by the kilo to US private healthcare firms....

These may be legitimate criticisms of the UK government's epidemiologists - I'm not in a position to judge - but I'm not sure it explains why we should be listening to Tomas Pueyo on the matter.

Well, you don't have to. There are plenty of actual epidemiologists unhappy with the government's actions. Just because Pueyo was arbitrarily chosen to represent one side doesn't mean professional support for that side doesn't exist.

Honestly, choosing a bad representative for a position is a classic media tactic for unfairly discrediting that position.

Agreed, it would have been nice for them to invite an actual epidemiologist who disagrees with the UK strategy - there are many of them, some have already publicly stated this - unfortunately this is par for the course in the UK media.

Hey, at least it isn't bringing Nigel Farage on to talk about Coronavirus. (As the BBC did last week.)

I don't understand how Europe+US governments (and epidemiologists!) say things like "It's basically inevitable that 40-70% of our population gets infected overtime". It feels like the Western countries gave up without even trying.

But yet, there's at least temporary evidence among several Asian countries (South Korea, China, Singapore, Taiwan, Hong Kong) that it's possible to get the R0 < 1, the infection rates to shrink, and seemingly be well contained well before any herd immunity effects happen.

In the US we spent only $7B to fight the virus but yet hundreds of billions to manage the economic impact. And yet, our companies/people will still suffer economically and humanitarily.

In an ideal situation, in ~8 weeks, Italy/US/Europe will only have dozens of new cases per day and will try extremely hard to contain these limited new cases and their spread. The only difference between Early Feb and Early May in these places will be that we had 3 months of potentially avoidable economic and humanitarian destruction- just to teach us the problem was serious and give us time to prepare systems to contain.

If the successful Asian countries (specifically Taiwan, Singapore, Hong Kong, but also South Korea) show that this was possible to keep small, the voters in the Western countries should demand accountability from their scientists and government leaders.

The voters have the leaders they deserve

Insane. Here's the key line, from one of the people in charge of that clown car:

"There’s going to be a point, assuming the epidemic flows and grows, as we think it probably will do, where you’ll want to cocoon, you’ll want to protect those at-risk groups so that they basically don’t catch the disease and by the time they come out of their cocooning, herd immunity’s been achieved in the rest of the population."[1]

Here's the thing about this: it's plainly moronic. Because this strategy only works if they can identify the point in question. And there's no universe in which a government can identify that point under incomplete information and exponential growth. It's the sort of thing that only a psychologist who has spent too much time hanging out with Cass Sunstein and other believers in the omnipotence of the administrative state could possibly come up with.

[1] Quoting a psychologist in charge of something called the "behavioral insights team" in https://www.theguardian.com/world/2020/mar/13/herd-immunity-...

Because this strategy only works if they can identify the point in question.

Why wouldn't they, they know the rate of new cases. When it's low enough they lift the quarantine. Out of all the problems this seems the smallest to me.

They don't know the rate of new cases. They know the rate of observed new cases. They don't also know the innumerable little connections that are hard to lock down across and within age groups.

This is the sort of thing that confounds centralized state policy. Read, among other things, James C. Scott's Seeing Like a State

Then start testing people from the population to see who has had it and who is currently infected.

This is the sort of thing that confounds centralized state policy.

The UK isn't America.

I'm pretty confident they'll start copying everyone else in 10-14 days.

They are ignoring any sensible model of this and they won't be able to deal with the uproar once the numbers reach a psychological threshold. Happened last Sunday in Spain BTW.

> They are ignoring any sensible model of this

Meaning what? They've explained their reasoning.

That's an aspiration more than a reasoning IMO. Meanwhile that R0=2.28 is doing its thing and it can't be good for the NHS, meaning many ugly pictures. The thing is when tabloids are going to get hysterical about this.

Doing what someone else does, but a week later doesn't necesarily mean you made a mistake, or that you are a week late in making a decision.

I think it does, you don't wait a week to put out a fire, it gets worse. China has essentially contained it already. Maybe alternating lockdowns and releases we might be able to keep it manageable until there's a vaccine.

This is not hard to model once there are a few cases in a population, again IMO.

> you don't wait a week to put out a fire, it gets worse

I don't think putting out a fire has any major adverse effects, so perhaps not the best comparison.

There's always side effects to everything you do, but if we're being picky about the fire analogy (maybe I'd rather go to the beach than putting out a fire right now), I'd agree I should have used a gangrene one.

How much does every day in lockdown hurt the economy?

Flattening out the infection curve too much means increasing the economic harm by a much larger degree.

Calling a lockdown a week too early, means continuing it a week extra on the other end or you risk a sudden, unmanageable peak.

I don't envy any politician the decision, but pandering to panic and locking down too soon will cause a lot of harm too.

At a larger level, "hurting the economy" may be the best thing to happen in a long time for (1) the environment, e.g. clean air, (2) family time, (3) cutting out some useless activities that go on due to sheer inertia, like formula-1, olympics, auto shows, most conventions, etc., (4) give people and societies a chance to slow down, think through things and refactor a system that was running full speed towards the wall anyway.

Doesn't seem so clear. During a recession, you might have less money for investing green technologies. No one will be able to afford an electric car. You might get more family time but the stress of the main earner being unemployed will mean it's not high quality.

I really wonder why we can't all just slow down the money circulation. There are many business and people endangered by the situation? They can't earn enough money? Well they don't have to pay the full price for basic needs, mortgages etc. People living on this stop gaining money like before? Discounts for them as well, they just keep working for the greater good because we are in a unique situation. Rinse and repeat until we go full circle.

What's the problem here?

The (totally made up number) 15-20% of greedy people who put money first no matter what.

It's really sad.

> No one will be able to afford an electric car.

I realize my opinion may not be the mainstream one, but I think the 2008 financial crisis did more good for the environment than all the "green investments" of the past few decades.

> the stress of the main earner being unemployed

That can indeed be a problem for families. I hope the crisis will bring about some reduction in consumption/travel, downshifting, rethinking of priorities, simpler living.

I'm somewhat puzzled about this doomed economy idea. Many businesses are doomed of course, but some opportunities arise: economy changes, it adapts to the environment. We've been building the perfect tool for this scenario during the last 25 years, if we manage to sustain the logistics the economy won't stop. Had this happened in the early 90s we'd have been in deep trouble.

Reduced spending on leisure, tourism, travel, etc, less decisions made because no meetings, etc., will MASSIVELY outweigh any opportunities.

Even putting aside the sick leave, which will happen either way.

If they do indeed go into lockdown it’s almost certainly a massive mistake.

I am not knowledgeable enough to endorse/criticise the plan. But watching the various statements yesterday by the government/scientists it's clear that they do plan for lockdown, just not yet. But it's fully expected in the coming weeks.

It certainly does if your inaction causes lives to be lost. A week or two here can be thousands of more deaths

Yes, they've already said that they will bring in those measures in a week or two.

The other countries are going for herd immunity too. The goal of all lock-downs and red zones is just to prevent the health system from collapsing.

Merkel apparently is trying to (or tried to), but was more coy about it. But none of the technocratic Asian governments seem to.

Okay so here is my dispassionate take on it.

1) everyone (>= 60% of population) will get it

2) the modelling that’s been done by the British government is probably very good and almost certainly includes more variables than the shut it all down countries

3) we don’t know enough about how the virus operates but we might know enough by the time peak cases occurs in the UK

4) It’s very likely to come back in China et al, they think in the Far East it’s under control but it only takes one person arriving in Beijing to reignite the problem and you’re back to square one

5) they are trying to limit peak deaths including a lot of factors I have to assume that is their strategy

6) do you go with the models that give you a way to return to some normality sooner?

7) what is the best case outcome according to the best scientific models we can get? It’s very easy to just do what everyone else is doing without thinking through the best path.

8) I actually trust the people thinking about this issue, I know it’s hard to believe but I do think the UK government is going with a view that there are more factors than are immediately apparent in this equation.

9) will the UK turn out to be right that stopping this permanently will involve herd immunity. Unfortunately the American/Italian/Western society situation means stopping this virus will be impossible so you then start calculating if you want international travel to continue how can we keep our societies interconnected?

My guess is based on a lack of information and a load of assumptions about this, but I think it’ll prove to be the right decision medium term. We are going to be in this thing for some time, some countries much longer than others.

I strongly disagree with the approach in the UK. We should be following the WHO guidelines and the rest of Europe

It feels like we're the big version of one of those corona-virus cruise ships

The government isn't going with a herd immunity strategy. It's waiting for the most impactful time to lockdown.

The primary reason why other countries go into a lockdown is to prevent their strained healthcare systems from collapsing.

It's not just sick people who can't get a hospital bed. It's everyone else too. People who get heart attacks, strokes, accidents, other illnesses,...

A lock down is NOT meant to stop the virus in its tracks. It's meant to slow the infection rate and avoid hospitals and health care centers from getting swamped.

Any chart about China and Italy published thus far shows how the infection rate thus far grows exponentially. As such, the most impactful time to perform a lock down isn't next week or in 10 days. It is NOW.

The "herd immunity" strategy isn't a strategy. By the time this is over, the population will have achieved "herd immunity" regardless of how this will have played out. What matters is where we would like society to end up 6 months down the line: a relatively preserved, functional society with low mortality; or a dysfunctional one where likely anyone of this forum will have lost loved ones.

This is not updated for March, but here's a chart that disagrees. China's new cases started dropping after the lockdown: https://miro.medium.com/max/9350/1*r-ddYhoUtP_se6x-NOEinA.pn...

From https://medium.com/@tomaspueyo/coronavirus-act-today-or-peop...

That was also around the time that -- according to credible sources -- doctors in China were given a quota of cases that they were allowed to report each day.

I guess we'll see what happens with other countries, and then that can give us a sense of how many patients went unreported in China. Perhaps it was a lot, perhaps it was only a few.

I think the core message of Tomas Pueyo's blog post is sound, but he undermines it completely with the number juggling.

He's not a specialist. He's not an expert. This is an entrepreneur who knows how to create viral content. His previous blogpost was "How to deliver a funny speech".

So, I wouldn't accept the details, the number or the graphs he has cobbled together at face value. This is true for pretty much anything that is published on medium.com and doesn't come from a sources verified by experts or officials.

While people are slightly optimistic about China and South-Korea, I think it's far too soon to try and make any detailed forecasts on how the next few weeks will pan out. We simply don't know enough yet. All we know is that this is an infectious disease spreading at a lightning speed. Stay home, and adhere to WHO and health administration protocols. That's all there is to do right now. Anything else is conjecture until this has played out completely in a few weeks time.

Here is a link to the Coronavirus Action Plan on GOV.UK: https://www.gov.uk/government/publications/coronavirus-actio...

I would suggest anyone read this and other official publications before any Twitter thread to understand the UK government's approach to the virus. Large, complex decisions are hopefully not made off of a few hundred word summary of the situation.

That document says "Published 3 March 2020" - do you know if it still reflects current government thinking?

It is still linked on all of the relevant sites. https://www.gov.uk/guidance/coronavirus-covid-19-information... is a page with more frequent updates.

Specific local health authorities probably have the most up-to-date information for any given geographic area.

One region of Italy is close to their ICU beds limit, despite a full lockdown. And they have more beds per person than the UK. Without a full lockdown, won't they run out of beds very quickly, thus increasing the death rate a lot?

Yes the model they operate on is around 40% of the population will get this. Even with a lower real death rate of say 1% that still leaves over 250k people dead.

Italy is almost a month ahead of most of the world in infections though, their first outbreaks were weeks ago and the source for infecting most of the rest of Europe.

A lot of the UK infections can be traced to Italian holidays, for example.

Even if the government does plan to lock down the UK eventually, every day must cost 10s of millions, you can understand the strategy to wait longer, and even to play it down a bit.

According to the growth rates along the exponential curve, it seems more like a week or two than a month.

The biggest EU countries are 1 to two weeks behind Italy:

https://twitter.com/MarkJHandley/status/1238604695700209664

(mind the log scale)

I just posted today's update: http://nrg.cs.ucl.ac.uk/mjh/covid19/

Denmark and Norway are less than a week behind Italy in terms of confirmed cases per million inhabitants, as is Switzerland. Spain moved closer the last two days as well.

The average age of a fatal case is still north on 80 years.

The UK plan is effectively to get as many people as possible that are young, and thus at a super low risk of needing hospitalization to get infected, so that they can recover and then be immune, thus making it hard for the virus to sweep through again. If 30% or more of the population were immune, it would be much harder to get a new outbreak started. With a lockdown, either the lockdown suppresses spread, in which case ending the lockdown risks re-igniting the epidemic, or it doesn't, in which case it didn't help materially anyway.

If the UK can get 10x or more of the cases with only the same hospitalization numbers, they'll be in better shape than everywhere else.

The core question ends up being whether they're able to effectively inoculate that many young people without it spreading to just everybody.

Flattening the curve preserves medical capacity somewhat, but it also prolongs the epidemic. And since the lockdowns required to do the flattening have their own cost on lives, it's unclear whether the incremental increase in the number of lives that the medical system can preserve will or will not exceed the number of other lives caught short because the disease and also the lockdowns are extended by the extra time.

You might not be saving lives, just changing which people die.

Or you might save some, or you might lose more. Counting in advance is... let's say nontrivial. Even counting afterward will be hard and full of wide error bars.

It's relatively easy to count how many died directly from an illness, difficult to count how many will die because they delayed necessary non-emergency care for 4 months (unrelated to the virus except for the need to preserve hospital capacity or avoid infection risk) instead of 2 months because the outbreak was prolonged, and virtually impossible to count how many die from things like "I lost my job and my life savings at the same time, and I never fully recovered, and now my whole family is much poorer, which gives us higher all-cause mortality"

Everybody's talking about the first group. Occasionally, I see people admit that the second might exist and be non-empty. But, I keep feeling like I'm the only person on HN (and in my regular life) reminding people that the economy actually affects real life in major ways. (I'm probably not the only one, but still...)

Are we sure that you're immune once you've been infected?

Certain? No. Nobody can realistically be certain yet.

There is only one case that I've been able to find of a person who was diagnosed twice that can't easily be explained away as having been discharged while still infected. And even that case might be one like that.

We only know that you are likely to be immune for six month. Whether you will have life time immunity is anyone’s guess.

Citation needed.

No. There might be even opposite effect - antibodies might make subsequent reinfections easier. That happened with some previous coronavirus. As well as with some vaccinations that didn't generate sufficient amount of antibodies - some kids acquired some illness much faster than non-vaccinated ones because the vaccine wasn't strong enough.

Current coronavirus has already multiple distinct strains. Even if they don't mutate further, we would need multiple vaccines. They might also mutate to something more deadly, given the COVID-19 is a mutation of the original SARS with some characteristics of HIV and Ebola.

We are in uncharted territory.

> [...] antibodies might make subsequent reinfections easier. That happened with some previous coronavirus.

I never read about this, can you point me to a source, please?

What exactly is the risk of needing hospitalisation if you are young? Does anybody know?

It's too early to say with reliable data. We will definitely know in 2-3 weeks with data from many European countries. In Italy, it looks like the percentage of younger hospitalised people is 12%, but growing.

https://www.independent.co.uk/news/world/europe/coronavirus-...

That is not 12% of cases. That is 12% of hospitalizations are under the age for 50.

The overall hospitalization rate is difficult to know, due to the huge inaccuracies in the case numbers.

12% of _COVID ICU patients_ in Italy are below 50 years old. Note that this doesn't let us answer the question of how common are ICU cases among young infected people.

And the question was about hospital admissions not ICU admissions anyway.

> The UK plan is effectively to get as many people as possible that are young, and thus at a super low risk of needing hospitalization to get infected

The risk is already not that low at 55-65. These are people that are working and thus very likely to catch it.

51% of patients requiring intensive care in Italy are in the 50-70 range. 12% are younger than 50.

What is your source for those figures? I haven’t been able to find the breakdown.

https://www.epicentro.iss.it/coronavirus/bollettino/Bolletti...

Unfortunately they don't give a more detailed breakdown.

The first ICU patient in Italy was a 38-year old man who ran two half marathons a week before hospitalization. Iranian 22-year old futsal national team member passed away as well. Many young people have damaged lugs for life after surviving on ICU. I am not sure why people downplay the potential of damage for younger and healthier people just because it predominantly targets old and sick people. The virus might also mutate to more deadly strains.

How do you target young people exclusively? You can't.

The only thing that has worked is China/South Korea style careful tracking, rapid and extensive testing and strict quarantine measures. Nothing else so far is working.

A lot of young people still need icu treatments here in italy. If you don't flatten the curve early a lot of younglings too are gonna die and fast considering the very limited number of icu beds and the very high number of early contagions the uk seems to want to reach.

Some will. Possibly more than would have if we spread the illness over time.

But that set of outcomes has risks and costs too.

But regardless, it isn't really clear that the curve-flattening efforts are even effective. Italy is clearly experiencing an utterly uncontrolled outbreak. Despite pretty much the maximum amount of lockdown possible to achieve.

Don't believe that they have only 20k cases, or only 3k new ones today -- even with their increase in testing, they are still strongly test limited; that's why the Italian mortality rate looks so absurdly high -- they still aren't detecting most of the mild cases. (Either that or somehow the Italian version of the virus is about 10x as deadly as the everywhere-else version)

It seems much more likely that the mortality rate everywhere is relatively similar and it is the detection rate that varies. (Notice how all of the places that have really thorough testing all have the lowest -- and similar -- mortality rates? And the places with really high mortality rates are those with known inadequate testing)

To clarify current national-level lockdown effects are expected to be seen starting twelve days from now.

Some or the old red zones which covered the starting point of the infection are currently with 0 new detected cases since 3 days so it seems lockdown works IF u put them in place soon enough. [ https://translate.googleusercontent.com/translate_c?depth=1&... ]

Of course, if you ever let up on the lockdown, the disease will immediately start spreading again.

Exactly, but the government hope is to manage new cases with heavy tracking and testing as south korea is doing, so to keep the future spread far more under control. That's not possible until the current situation is resolved

This strategy is not insane only if there is also a concerted effort to protect those who are vulnerable while the virus spreads. The problem is there isn't one. At all. None. Zip. Zero. Some care homes are, off their own back, banning visitors but apart from that the old and the vulnerable are not being asked to self isolate or engage in social distancing, only those who have symptoms themselves are being told to self isolate, and not members of their households. Social clubs, churches, pubs, cafes, day centres, restaurants etc. where a lot of older people congregate are all still open. None essential home visits have not been curtailed and people are not being advised to socially distance themselves from the vulnerable.

^^^ 2000% this, a large proportion can't change their ways, is not paying attention or simply doesn't care. It's shocking to still tonight walk past a packed pub on a Saturday night

Personally, I'm 30, have no contact with folks over 65, have no co-morbid conditions and so I have no reason to keep away from folks. I'm at zero risk. In fact if I get it now and develop an immunity, all the better. I have to assume the same is true of the folks at the pub -- otherwise it's them who are being irresponsible, not me.

Defense in depth is a thing. Your strategy is only as strong as the weakest link. Only one person between you and someone vulnerable.

Right, but as I personally am not exposing myself to anyone over the age of 31, and I am not sick, I don't see the harm, or myself as contributing.

But if you are in contact with someone under 31 who has no choice but to be in contact with someone over 31... I guess the question you have to consider is how much to blame is each individual who chooses to ignore recommended procedures yet passes the virus on to someone who ends up dying.

Then why are they out? They have no excuse. My parents are older and so I'm not going to visit them, and instead call regularly. That's unfortunate but that's the safest thing to do.

By staying out you are contributing to the spread of a virus that society at large is ill-prepared for. You have no excuse either. This shouldn't be hard for a grown adult to understand.

If your behaviour is only responsible on the assumption that everyone else you meet is behaving responsibly, then your behaviour is irresponsible.

Scenario: Your parents get it from somebody who is acting irresponsibility, who in turn got it (in)directly from you.

Does it really matter that it's "somebody else's fault"?

This is very wrong. While you yourself may not have contact with old people, you can still act as a vector and spread it to someone who does.

Indeed, which is why it's on them not to go out. So long as nobody who has contact with old folks goes out, we're basically doing the UK plan ad-hoc. The rule shouldn't be "nobody go out" the rule should be "nobody with exposure to the vulnerable should go out" -- and if they do, they're being totally irresponsible.

I, however, am not, and I'm supporting the local economy.

Is the pub the only place where you get in contact with other people?

I mean, I'm not allowed into the office and I get my groceries delivered from a CSA box ^_^

This point of view strikes me as incredibly selfish. Some people who have exposure to vulnerable people might need to go out (to get groceries, medication, etc.) and you could still act as a vector to infect them. Surely your social life will survive two weekends away from the pub.

Old people need groceries and medicine, which in many cases they will have to go out for. (Not everyone has delivery available, or can afford delivery). On those trips they are likely to encounter younger people, including the workers at the grocery stores and pharmacies.

Young people also need groceries and medicine, and through the grocery store and pharmacy they are then one step from people who are one step from older people.

It only takes a handful of steps for your "nobody with exposure to the vulnerable" to be close to an empty set.

I’ve seen this attitude quite a lot among younger people lately, it’s just super irresponsible and arrogant. In a situation like this, the responsibility must be shared, no one should consider themselves free from the responsibilities of stopping the spread this virus.

> In a situation like this, the responsibility must be shared

Why not in other situations though? The elites avoid taxes, Boomers have houses, banks are pumping up the asset bubble, while young people have student debt, can't buy a place to live (or even a car), have no assets and, if they're lucky and productive and high-earners, they "enjoy" 20% higher tax rate than owners of capital... Why exactly should anyone now act in a way that is detrimental to themselves, to save some other predators?

You might find T.M. Scanlon's What We Owe to Each Other interesting.[1]

[1] https://www.scribd.com/document/127602229/Scanlon-1998-What-...

I hate the fact that I kinda see your point.

Again, if you don't come into contact with the vulnerable (or anyone else who does) then you aren't putting anyone at risk and you are developing herd immunity which will in time likely end the virus.

The problem is that while you may not deal with old people, the same is not true of all of the people that you deal with.

Remember that it takes an average of no more than 6 steps in your social network to get from any person in the USA to any other person in the USA.

Mr. arcticbull has replied elsewhere that then it's the responsibility of that person (whom he might deal with, and would deal with the vulnerable as well) to quarantine themselves.

To extrapolate, presumably he wouldn't feel any guilt if that vulnerable person died and he was a vector that got the virus to said person.

I wonder what a valid response to this logic is. Maybe: "not all people will be responsible, so it's your duty to be responsible". I guess he'd respond with, "But why should those people be free to enjoy themselves while I'm stuck at home?".

In any case, it's interesting how the sense of community has died.

I'm genuinely not sure where the balance here should be drawn. The UK is making the case that it's the best thing for the community for all the young folks to get the disease to protect the vulnerable so clearly it's not black and white.

While you probably don’t realize it, you have just underscored my point.

I think this as well. The only problem I learned about, is that there seems to be a chance of long-term respiratory damage (e.g. 20% lower lung capacity), which is as of now unlikely to be properly tracked / reported, but likely higher than the reported number of "critical" or "death" outcomes (which indeed are tiny in < 40s)

This is true of other some, but not all other coronaviridae so I suppose it's not a surprise but I also haven't heard any data on this.

You have a .2% mortality chance once you exhibit symptoms, right? That's much greater than no risk.

That 0.2% is in line with the flu, and also, generally is attributable to those with comorbid conditions, especially ones that compromised immunity. If you're young and healthy, it's not 0.2% -- it's much lower. If you're young and unhealthy it's not 0.2% -- it's much higher.

There's no such thing as no risk. I'm putting myself at risk of all sorts of things by leaving the house.

Your reasoning seems off. From what I can find, in your age group, the mortality rate for covid-19 after exhibiting symptoms is 0.2%. This is about equal to the rate for the overall flu mortality rate which includes those who have a higher risk.

Your dismissal of "everything puts you at risk" is common when we're young, but it is misplaced as well. I suspect you know and understand that a lot of background risk is actively reduced by the actions we take, personally and professionally (justice system, laws, streetlights, seat belts etc.) so while you may be speaking what you feel, if you know better you may want to reconsider stating it as though it was a fact.

Your figures are wrong by several orders of magnitude. In the 18-49 age group, the seasonal flu fatality rate is around 0.0018%.[1] 0.2% is already uncomfortable odds: 1 in 500. And that figure assumes proper hospital care as others have also replied. It's much higher if the healthcare system is flooded.

1. https://www.cdc.gov/flu/about/burden/2018-2019.html

(The mortality rate figures given are per 100,000 population, so 1.8 / 1000 yields the percentage for that age group.)

Aside from the fact that you may spend a week or more spreading virus all over the place and to potentially dozens or hundreds of other people with this approach, there is at least a 1 in 10 chance that, if infected, you will need hospitalization and serious care. You will contribute to overloading a medical system, without which even your mortality rate would be closer to 5% than the <0.1% you seem to assume. It is simply not the case that this has no effect on the non-elderly; severe pneumonia is a debilitating condition even for the young and fit. For a large fraction of everyone who gets it, this is WAY harsher than any flu you have experienced, and even many in your demographic will need extended hospitalization.

Indeed, "atypical pneumonia" is a killer, you're basically drowning in your own blood and fluids. This can happen to anyone.

> have no contact with folks over 65, have no co-morbid conditions and so I have no reason to keep away from folks. I'm at zero risk.

Until you spread it to someone _with_ contact with the over-65/those at risk.

Several did, and they either reduced the mortality rate or slowed the spread of infection.

Some made the changes during SARS, some did it now.

A large population CAN change it's ways.

I’m not shocked at all that Brit’s still want to get wasted at the weekend regardless of anything. Disclosure: expat Brit!

See "COVID-19: residential care, supported living and home care guidance"[0].

[0] https://www.gov.uk/government/publications/covid-19-resident...

In any case, the health services are not, and will not be, in a position to handle 40 million cases this year.

The curve must be flattened over years.

Scientists have written that much in a letter to the government today.

> only those who have symptoms [...]

Where 'symptoms' includes 'a cough'; not just definitely-COVID-19 symptoms.

> [...] themselves are being told to self isolate, and not members of their households.

That's not true.

From the Guardian on Thurs, quoting Boris Johnson:

“At some point in the next few weeks we are likely to go further, and if someone in a household has those symptoms then we will be asking everyone in that household to stay at home. I want to signal now that this is coming down the track.”

— https://www.theguardian.com/world/2020/mar/12/uk-moves-to-de...

Which would suggest that's not the advice currently. Would be interested to see anything counter to that though if you've links.

> The move to launch “shielding” of the elderly and infirm and “whole family isolation” is an escalation since Thursday, when the government said that only individuals with a persistent dry cough or temperature should stay at home for seven days.

Paywall, sorry, but from:

https://www.thetimes.co.uk/article/coronavirus-death-toll-le...

> the prime minister ordered the government to accelerate plans [...and] is expected to impose the new rules this week

It's not the current advice.

> That's not true.

How so? Everything I've seen from them, including the Gov't site only say to self-isolate. They said that in the near future they may tell households to isolate, but right now only the person with symptoms.

> "people with confirmed or possible coronavirus (COVID-19) infection"

https://www.gov.uk/government/publications/covid-19-stay-at-...

According to Peston: "elderly to be quarantined at home or in care homes for four months, in "wartime-style" mobilisation to combat Coronavirus."

https://twitter.com/Peston/status/1238917834111156231

How do you quarantine them if they need support from nurses and caregivers who aren't quarantined?

Unless the old people homes have live-in staff and are careful with deliveries, then I don't see the difference between a visitor and a staff member. Scary.

Isn't that how all the Native Americans died? The immigrants and imperialists weren't sick and their resistance to cause a herd immunity to the natives because the diseases were still ON THEM and it spread to the natives! This does not protect the vulnerable ones????

I do wonder if this decision doesn't have a Brexit component, the transition period will be over the end of this year, so I guess that is when the real bad stuff from Brexit will start becoming clear, if you mess up your economy the year before by lockdowns then what happens when things go really downhill?

If you don't lockdown, and other countries do, can you somehow benefit? I would say no that doesn't make sense but I somehow have the feeling that the people who currently lead the UK do not share my understanding of what is reasonable in any way whatsoever so maybe they would have a Baldrick level cunning plan in mind?

I think it would be rational if we knew more about the virus, but we really don't know much, given how new it is. There could be long-term health effects from contracting it, but we just don't know. The UK seems to be making a lot of assumptions, which may not bear out. +1 insane.

This is the part people are missing. We don’t know enough about the virus, and due to the extreme nature of the worst case scenarios it’s probably a better bet to act as if the worst case scenarios are true.

We can recover from an economic hit. We’ve done it several times before, and there are several tools that can be used. A major pandemic with mutating viruses is not something we are as prepared for.

It's totally insane and I am amazed more people in politics and the media aren't calling it out. Other countries have already demonstrated it can be contained with rapid testing, tracing and limited lockdowns so why are we doing this?

Lets assume 60% of the population are to catch it, they have said they want the worst of it over by the winter. That's 40 million people. If 5% need an ICU bed and the average ICU stay is 2 weeks (both conservative numbers) and infections are spread out perfectly over the next 8 months we will need 125,000 ICU beds, the NHS has something like 5,000 and most are already used for non-coronavirus patients.

You run our of ICU beds the fatality rate is going to rocket, more like 3-6% then 1-2% and we are looking at deaths of 1.2million - 2.4million, let alone all the deaths that come from a completely over-run NHS.

How can you describe a plan that will allow the collapse of the NHS and the death of millions anything other than insane?

The UK approach is highly interesting. It's assuming that a government telling people to social distance themselves is highly effective. You then direct the elderly to social distance themselves; they are mostly protected from the virus; it runs rampant through the general population; and after a two months of relatively mild, mass cases among the young, you've effectively built a herd immunity firewall around the elderly.

Three possible issues:

1) Telling people to social distance themselves has a weak effect, not a strong one. In that case, the fire burns through the young population and burns through the old population, and you end up with a pile of flaming corpses.

2) I don't know if herd immunity of the young population is enough, epidemiologically, to give herd immunity to an older population. Old people can pass it to each other, and their day to day interactions are disproportionally among the elderly. So you risk an older subgraph all catching it at once still. I don't think this is a big risk compared to 1).

3) Individuals don't develop an immunity. This would be disastrous for this strategy. Then again, it's disastrous for all strategies.

The first issue seems like the biggest issue to me, and I think it's pretty damning. If that's the case, the elderly never have the protection of herd immunity, and you're not flattening the curve but sharpening it.

Another possibility: the government knows it won't work to seriously change the number of deaths, but it also believes all measures possible in Western countries are likely to fail. In that case, you immolate the elderly population as fast as possible and then get used to a new norm instead of spending months in a futile battle. Essentially, it's possible that even with heroic efforts that the curve can only be flattened a bit, so it's just a matter of timing the deaths and how long you want to be enduring terrible economic damage. And if every other country suffers pretty much as much as you do, political impact is limited.

It is indeed highly intellectually interesting to observe... and absolutely terrifying to experience. It will give the world lots of interesting data, in precisely the same sense that the WWII Axis biological experiments did.

God help the British people. I'm so glad I moved out of the UK half a year ago.

I remember when I was a kid, I didn't really understand refrigerators. Like I knew that the cold would eventually leak out, so how was it cold inside if the cold would eventually leak out? How does insulation even work?

So, I eventually figured it out. The insulation slows down the heat transfer. The fridge still has to do work to keep cold, but the insulation means that it can keep up with the losses and spend less energy on that.

The countermeasures to COVID19 are like that. The virus is going to spread, but we still need to slow it down, so that the healthcare system can deal with individual cases, and not a flood.

Some people are going to get it, but that doesn't mean we have to be fatalistic about it. We should take it seriously, but also rationally.

Isn't there a higher likelihood for the virus to mutate if a large population gets it?

I also wonder about the virus laying dormant in the body and reinfecting like shingles or for example.

Is there even conclusive proof that people can be immune from the virus after being infected?

I think I even heard of people getting re-infected after having been cured

Opinions vary. Dr. Amesh Adalja is an infectious disease specialist, who thinks it's more likely that this isn't the case, and that it was just the impression given by false-negatives from the tests. (That is, if you test someone 3 times over 3 weeks, and see Infected, Uninfected, Infected, it could either be a false negative, or a reinfection.)

I'm afraid I don't have a written source, I heard it in this interview podcast: https://samharris.org/podcasts/191-early-thoughts-pandemic/

We have no long term effect data on Covid-19 so it’s absolutely insane to do anything but minimize infection rates.

According to other famous virologists, this is a risky strategy to play. This is an RNA virus, this means that you cannot safely assume that the population will be immune after the first infection.

Could you cite these sources please?

He just means that RNA mutates more than DNA during replication, which you can learn from Wikipedia. That's why flu keeps coming back every year.

Thank you!

I suggested this a few days ago and it was not a popular idea, but if you can enforce a sufficiently strong quarantine for the elderly, I believe this could decrease the total number of deaths (although the total number of infections will be higher than with universal social distancing, the faster it spreads, according to most simulations).

There are already some reports of re-infection. It may be that immunity isn't so easy to build for this virus. Not enough is known about it yet. This is a huge gamble.

What reputable officials are on record regarding re-infection, please?

I don't think there is any evidence of reinfection. What seems to have happened in some cases is that a person's symptoms have dissipated but resurfaced a bit later. In other words, the patient thought they had recovered when they hadn't.

That said, the chief scientific officer has stated that this is likely to be an annual virus: https://www.telegraph.co.uk/news/2020/03/13/coronavirus-outb...

I had the same discussion a few days ago and someone posted https://www.businessinsider.com/wuhan-coronavirus-risk-of-re... [It has a link to a video, but the caption of the video is wrong. The recommendation to the cured patients is not to increasing their physical activity but to enhance their own health safeguards.]

I found two other articles about the same case https://globalnews.ca/news/6623287/coronavirus-multiple-infe... and https://www.reuters.com/article/us-china-health-japan/japane... . t's not 100% clear, but it looks like a continuation of the first infection after a few week of no symptoms. It makes more sense than no immunity (at least at the short time), and a second independent infection.

There are a few suspicious cases but given how human immunity system works, it is very very unlikely that it is due to reinfection (i.e. a cured patient getting infected again).

A far more likely explanation is either poor testing that gave a false "all clear" while the patient was still sick. The tests are not 100%, that you don't detect the virus in the sample doesn't mean that the patient is not infected - it only means your sample didn't contain the virus. Which could happen for all sorts of reasons. That's why multiple tests are usually required - commonly two, in some cases up to eight consecutive tests had to be clean before the patient was discharged.

Or the patient has not been completely treated and the virus became dormant for a while, reappearing again later. This is known to happen with other diseases as well - e.g. ebola virus could stay dormant for weeks in the eyes and cause the disease to return again.

The idea of not testing except the most serious cases, wait for herd immunity is starting to attract criticism from many scientists

https://www.bbc.co.uk/news/science-environment-51892402

I think they’re taking more or less the right approach. I do think they could have gone further and banned big events and told anyone with cold or flu to stay at home for 7 days (instead of with specific symptoms).

It’s already too late to ban travelers, and will do more damage than benefit. Well it’s possible to score political points by closing borders, the damage it will do the economy is not necessary.

Countries like New Zealand and Israel are so isolated from their neighbors they may benefit from closed borders, but tbh it feels like more short term planning when what we need is long term thinking. What happens in 2 weeks when the crisis is still unfolding?

I wouldn’t be surprised if more cases pop up in China in new locations because of the nature of this virus (delayed feedback system)

Most of the big events seem to have decided to shutdown on their own, I'm not sure a ban would make a huge difference now.

I’ll go out on a limb here and say that this sounds “Dr Strangelove” level bad. Like, phenomenally cavalier.

They need to release the data and assumptions they’re basing their simulations on, because this will affect the entire world, not just the UK.

The current numbers have COVID-19 at something like 20x more deadly [than the flu] for people under 50. It’s not nothing. At scale, that’s a lot of people dying. Those numbers are also a reflection of the treatment being done in all the other areas of the world right now. Does their model adjust for an increased mortality rate that would surely occur in an overwhelmed medical system? Are they assuming a nearly perfectly executed quarantine of the elderly?

They need to share their data and assumptions.

One question here: Do we have any scientific way to verify which strategy works? I been waiting for related research that can either proof or disproof the usefulness of the "Lock-down strategy" which China been using in the past couple of months and still not fully lifted.

We had little less than 30 total cases in our city with just over 1 million population, and the city was in lock down mode for few weeks. I can feel the slow rise of living costs during that period of time.

It's quite funny to see how people reacts to this, panic-buying all the face masks for example. Makes me think whether or not it's worth it to go full-out panic, because panic usually creates way more chaos/problems than the problem itself.

There is a huge flaw in this thinking which is that the disease takes about 5 days before symptoms and another 5 before hospitalization.

And many places put the virus doubling time in several days. So the hospital situation will get 5x to 20x worse after they initiate lockdown.

I feel like this is what Sweden is doing without saying it. They have stopped testing anyone except the elderly, severely ill, or healthcare professionals. It kind of seems like they'll just expect most of us to get it with only mild symptoms since it's out there now anyway, and confirming a mild case isn't really going to change treatment. At the same time they are stopping gatherings of over 500 people and telling people to stay home when sick. Many people are now working from home, but schools are still open. But without testing people and proper statistics how do we know when it's safe to resume gathering, or go back to the office?

You can't do this without adequate testing. If you can do tens of thousands of tests per day, and you're testing everyone, then you can potentially control the rate of infection by opening and closing public places and schools, etc. But without testing you won't know and the goal of not putting strain on the NHS will fail.

Places like the US are completely in the dark because of incompetence, but once we have the visibility as to who is sick, and having widespread testing, then I think this might make sense. Heck, if I knew I would have access to a critical care bed if things got bad, I would probably volunteer to get infected now.

lol it sounds more on the insane side to me. you have to have a thought out plan to protect the vulnerable and do exposure in "phases", but has that ever been done ever?

and even if you are young and healthy why would you knowingly expose yourself to something that, while wouldn't kill you could put you in a life threatening situation, regardless. i know there are probably way more statistical higher ways to die, but there's a reason i don't go rubbing my face in a sick co-workers hand. even the flu symptoms are no joke.

i've heard that there's a chance of re-infection, but not sure how accurate that is.

unless the world plans to stay isolated until there is a cure this may be the alternative that doesnt also bankrupt a lot of businesses and put people out of work.

There will be pockets that will see this carry on for years globally. Currently it is mostly prevalent in climates in their winter phase months, and UK just entered spring.

Then there is this virus mutating, could it mutate into something less harmful, or something more harmful.

Past pandemic the spanish flu saw the initial infection decline in the summer and in the winter saw a higher wave of infections and deaths - which would be at a time when health services with climate phases tend to be less able to handle extra volume.

Policy seems to be around accepting people will die, no escaping that or dressing that up and to manage infected and control the spread and managing response/restrictions accordingly. So by managing the effected numbers needing medical intervention and dragging out the first seasonal phase so that the summer months lul can be used to level out the impact down the line.

It is very much more likely that, as it mutates, it will be to a less-deadly virus.

Evolutionary pressure works that way -- as a less-deadly version will spread faster and outcompete a more-deadly version (because it won't kill as many hosts -- dead hosts cease spreading -- and because less-ill hosts are less likely to stay in bed until better, thus encountering more people and thus more spread)

This is why, broadly, endemic diseases like influenza become less lethal over time

It's why severe influenzas are usually those that just mutated to cross over to humans from some other animal -- like swine flu from last decade, which was not that deadly to swine, but remarkably so to humans those first seasons, or avian flus which also have appeared occasionally.

The Spanish Flu was one of those -- an Avian flu that had newly mutated to infect humans.

Spanish Flu mutated into a far deadlier version over time because it spread faster in hospitals and troop transports than on the streets. We may see a similar situation with corona virus if the quarantines and social distancing are too effective. Ideally, we want most cases to be transmitted from the weak cold-like corona virus cases, not the lung-infesting killer cases.

https://en.wikipedia.org/wiki/Spanish_flu#Deadly_second_wave

To quote that article:

In civilian life, natural selection favors a mild strain. Those who get very ill stay home, and those mildly ill continue with their lives, preferentially spreading the mild strain. In the trenches, natural selection was reversed. Soldiers with a mild strain stayed where they were, while the severely ill were sent on crowded trains to crowded field hospitals, spreading the deadlier virus.

Given that, the UK policy seems to make more sense now, thank you.

The problem is that nobody knows whether this virus will behave like that. Flu does, as did SARS. But MERS has no issues with killing people in Saudi Arabia in 50 degrees Celsius.

That this virus is prevalent during winter time is simply a coincidence - it has started in November and most countries affected happen to be in the northern hemisphere where we are coming into spring only now. However, there are documented cases in Australia and New Zealand too - which have late summer now.

Once testing procedures are prevalent, and the curve has been bent, there is no reason why you cannot continue largely as usual well before a cure or vaccine exists.

There is evidence from China and Korea, that you do not build immunity from the disease.

https://archive.is/Gv1iu

This makes the UK response almost as bad as doing nothing at all. Maybe some people will show to have a natural immunity, but many people will die. The UK is in arrears politically and socially. There honestly is no response that would be appropriate, that they could hope to deploy.

> the virus seems to be relatively inoffensive for young people

Not enough is known about the long term effects of this virus. There are reports that those who recover are experiencing reduced lung function [1].

[1] https://www.sciencealert.com/even-those-who-recover-from-cor...

Lockdowns are just to decrease the rate of spreading (and avoid high concentration of virus particles) not to eliminate the virus, so everyone should prepare oneself to face it and get through. Just this.

Some small percentage of population in isolated regions have chances never meet the virus, but hiding is not the stable strategy.

Getting through and become immune is. This is what UK government is saying. Let's face it.

Sounds like you may not have heard about the importance of "flattening the curve" yet

https://www.statnews.com/2020/03/11/flattening-curve-coronav...

As any third-worlder knows perfectly will, everyone is on your own.

Aside from that, there are so many different factors (variables) that this oversimplified model is almost useless.

Every place, except China, which locked down a whole magapolis, will reach overcapacity of hospitals very quickly and UK government advisers know this.

'Flattering the curve' is a nice catchy meme though.

I watched a presentation/session by Norwegian directorate of health that included some comments from Italy [1]. I think they shed some light on the mortality rate - in effect 50% of those intubated died. And they were some percentage of those needing icu care. Assuming the icus are overrun, and all ventilators taken - all of those patients would be dead.

So (given the size of population, and relative lack of ventilators) - in an actual uncontrolled spread, I think we will/would see much higher mortality rates than we've seen so far.

I hope the UK won't be the first to prove that (I suspect the US might be the first to do so). Or indeed, maybe Iran already has.

I heard there was mentioned that in areas hard hit in China, where low(ish) mortality rates were reported, they were also desperately seeking more people for

[1] in English, starts at 4h mark: https://youtu.be/LtWti5prxzg?t=4h

FWIW, I submitted this earlier today:

When an epidemic outbreak such H1N1, Zika or SARS viruses occurs, containment measures may seem to be the most reasonable solution. However, an EPFL study casts doubt on that idea, showing that such measures make a society less resilient and less able to return to pre-epidemic economic and social conditions. The study, published in Nature Scientific Reports, coincides with another publication on the same subject but based on other mathematical models, published in Nature Physics in December. That study also compared the advantages of containment measures with those of non-intervention, and reached the same conclusion: Preventing travel and social interactions is not always the best way to deal with an epidemic outbreak.

https://phys.org/news/2018-01-epidemics.html

and causing the deaths of >80 year olds, thus reducing the costs of dependency on the health system? #consipracy :)

However this age group is also predominantly conservative voting so they would not want to off their core support base.

On the other hand the next election is nearly five years away, by then most of them will have fallen off their perch anyway.

This in a nutshell. The tory party hate spongers.

It's hard to say, especially when you consider that the NHS has had its funding cut for years, and that even with a full lockdown it is likely to struggle even with a modest rise in patients over time.

This might sound dark, but as others have said, it feels like the government would rather see the country overwhelmed over a short amount of time, compared to a prolonged battle where their failures in healthcare will be highlighted.

I won't pretend to be a virologist, but one thing I will say is that it is wishful thinking to assume that the elderly are going to go into lockdown as the rest of the population builds an immunity. There is a level of arrogence and entitlement, mixed with regular doses of misinformation, that will ensure that the UK public will "keep calm and carry on" throughout this entire mess if there is no enforced lockdown.

I think this is really a battle against ignorance. Until people see results in front of them they aren't going to respect these rules without authoritarian measures.

Best is to shut everything down for a month THEN let 40s and under back to work. By then, hospitals will have been overrun but hopefully on the upswing and people will be a lot more sober and willing to listen.

I imagine once the shutdowns happen and reality sets in, people will not want to go out and expose themselves willingly and politicians will rather keep everyone locked up as long as possible, but that is a mistake too. Everything hits with a 2 week lag so it is import to trust the trends and the analysis rather than the current situation - I expect us to be too conservative on the way out just as we have been too cavalier on the way in.

" Until people see results in front of them they aren't going to respect these rules without authoritarian measures."

Doubtful.

Here in Montreal, the streets are bare. Restaurants are at 50% capacity, there is no toilet paper anywhere.

We only have ~100 official infections in 30M people.

People are taking this pretty seriously and at least as far as 'not going out' and 'social distancing' it's going to be relatively easy to enforce.

There are few 'draconian' measures being taken by any government really anyhow.

I think we'll be doing this for 6 months at least.

The UK government is criminally insane to the point that they should be locked up and shot.

For every person who would die in the normal course of the disease, around 3 more needed hospitalization. The Wuhan experience showed that when hospitals are overwhelmed and cannot put them on ventilators, the fatality rate roughly doubles.

The UK course of action is guaranteed to overwhelm local hospitals. At which point even if half the vulnerable population does not get sick, you have as many fatalities in that group as you would have if the rate of spread was reduced.

Worse yet, it is currently unnecessary. Both China and South Korea have demonstrate that aggressive containment and quarantine efforts can result in exponential declines in the disease. As a result we should not yet be giving up hope that the disease can be contained, avoiding mass casualties. And even if we did want to take the UK approach, you could always switch to it after you had demonstrated that you can't contain the disease.

> The UK government is criminally insane to the point that they should be locked up and shot.

This plan may end up with a coup once the body count starts racking up and people get angry.

BTW. this new plan reminds me of the plot of "V for Vendetta" movie.

(spoiler below)

In it, a fascist government took over by causing an epidemic that killed a hundred thousand people, used that to get itself into power, and promptly buried the evidence.

This idea that the primary aim of the UK Government is herd immunity is plain wrong. The primary aim is to flatten the curve with specially timed interventions and any herd immunity is a by product of that. The aim is to flatten the curve so that the systems are able to cope better.

Herd immunity will be a by product in almost every western countries actions today. Ask them and if they are honest they will say the same that it's a long term effect but not the primary driver or the main aim.

The difficult non sound bite criticism is about the flattening of the curve based on their models which basically means they need to get both the timings and the interventions spot on for it to work correctly. Dont let fear win

The Italian strategy is simply to try to prevent running out of ICU beds or at least minimize the number of people that can't get IC in the short-term due to the current uncontrolled spread.

As far as I can tell, what to do long-term is still up to debate, and continuing the lockdown only for higher-risk/older people is certainly an option.

Note however that jumping straight to such a differentiated lockdown seems much less likely to work, because behavior changes are easier in a total lockdown with full media and discourse focusing on it, as well as much easier enforcement since you don't have to distinguish the high-risk people.

A sudden surge of infections will overwhelm the health services, number of available hospital beds, ICU units, and ventilators. This means that many more people will die that would have otherwise survived if the spread of the virus was slower and treatment was available.

Unfortunately there are many who view the countless avoidable deaths of those who are older, have underlying conditions or otherwise could have benefited from proper treatment as an acceptable price to pay for a faster "economic recovery".

If you read the longer version of the UK's strategy that is not what they are doing... They are waiting until their numbers are high enough to justify lockdown and then lockdown as they know the economic shock is huge. So they wait until it is time, lockdown for 30 days, see if they can flatten the curve, then boot things back up.

The media picked up part of the story, but not the entire story. And, Boris played up one part to the detriment of the actual entire white paper.

This is insane. It depends on a bunch of things we don't know turning out to be true: can we develop herd immunity to COVID-19? Can we adequately isolate young/healthy people from old/sick?

IF this turns out to be the UK strategy it will also become imperative for countries trying containment to ban travel from the UK.

I think it's an idiotic brainwave from a bunch of people who have spent way too much time pretending that they are the "smartest people in the room".

Herd immunity and keeping the total infected at any one time to a manageable level is the end game everywhere. I think the difference you are seeing is a difference of opinion over how extreme the measures need to be to keep the total infected from overwhelming the hospitals. It's possible that moderate measures early might be enough clearly if you wait too long more extreme measures definitely seem to be necessary.

There are three things to consider:

1) Even if they contained it inside the UK, it will be imported every day by people returning from the continent/USA. Unlike the quick flu tests, its 2+days for a result in testing

2) Vaccination at scale is a year+ out (as in at least may 2021)

3) flu season is only 7 months away, which means doing this all again, but with a newer version of the virus. This virus might be more mellow, or not.

Look at the infection rates in spain, france, Nederlands and germany. They are in lock step. Containment has failed.

update THe last, possibly most important point is this: the voting base most at risk of this virus is Boris's. Its really not in his interest to let them all die. I find the man abhorrent and selfish, but I doubt he's stupid enough to let his vote base disappear.

update

Given the new data, I'm changing my opinion to insane.

I think we are two weeks away from northern italy in london, but with 1/4 of the equipment.

Letting people past a certain age just die only works if people at that age co-operate. No matter how much the authorities try to spin it, there are more than a few "runners" who don't want to die (yet). https://www.imdb.com/title/tt0074812/?ref_=fn_al_tt_1

Okay about the mortality rate. What about the hospitalization rate? Is it low enough to do not break the health system ? And about the smokers? diabetics ? Cancer patients ? And about the old one already hospitalized ? The kids ? And about the 0.3% that will dye ? How many young people will die in a old population ? And about the doctors and nurses extra exposed to the virus from different people?

Scientifically, yes. Politically, suicide.

Herd immunity is what you hope for once the infection has gone through the population. To the extent that they try to build it by telling people they must be infected with it (questionable, and arguably a misinterpretation of public statements) it will be perceived as an attempt to cull the lower classes for the benefit of the ruling ones.

Except it seems to predominantly affect the elderly, who skew richer and more conservative.

Scientifically, yes? First do we have conclusion that people are immune to coronavirus once infected? Isn't the disease too new to know that? Secondly have we done any experiments and have any evidence that this will work in a smaller scale? Any scale? I thought science is about evidence and repeatability. If anything this will be a large scale human experiment at best without any informed consent given.

Please read the whole comment instead of just the first couple of words.

Herd immunity is particularly insane idea if it's confirmed that you don't, in fact, get immunity:

https://thehill.com/changing-america/well-being/prevention-c...

No it's insane. Because you know viruses do one thing: they mutate.

Also heard immunity takes to long at which point all old people will get potentially infected too.

Also cases to death ratio (and infection to death ratio) are still on a magnitude larger then with the flu. Especially given that somewhat between 10-20% of infected need intensive medical care, all roughly at the same time if you don't slow the spread which likely can't be provided if that should happen increasing death ratio.

With such a strategy we at looking a mostly likely at >350000 deaths. Not unlikely even over 1800000...[]

Through well there is always very, very small chance that it will work. Less because it's a good strategy but because even if you do nothing there is a very very very small change for a virus to "self destruct" (not correct way to describe they effect but it basically similar to a self destruction to a outside observer knowing nothing about virology).

But gambling hundred of thousand lives one it would be insane.

Well except if you have no morals and want to destabilize the country. Through I don't think that's the case, incompetence is more likely.

EDIT: spelling

EDIT: Numbers based on not unlikely infection rate of 60% of population and IDR of 1% (health system not overloaded) and 5% (health system overloaded to some degree).

EDIT: argument based on heard immunity idea not explicitly the UK strategy

It looks like they've either backtracked on the idea or it was misconstrued from the start:

https://www.dailymail.co.uk/news/article-8113011/Downing-Str...

Does anyone have a link to an actual policy document explicitly stating the UK's herd immunity policy? The link is a tweet from a random guy.

Herd immunity is the default, and it's also being pursued by the US, despite statements to the contrary. So I'm not sure there would actually be a document, but maybe it does exist.

We are about 2 weeks behind Italy in death rate, which is the only measure that can be reliably compared between countries, due to differences in test rates and criteria to be tested.

Is 2 weeks "grace period" before implementing a lockdown and starting the heavy measures worth it in the long run? I don't think so.

I'm not really qualified to comment on this strategy, but isn't this going to lead to stronger exposure to virus specimens per individual, i.e. more severe infections and thus higher CFR?

The actual goal of the UK might be to sacrifice a few people to boost the economy while the rest of the world wrecks its economy.

https://philip.greenspun.com/blog/2020/03/14/if-the-british-...

I don't think there's any working strategy for infecting the young and keeping them separate from the old. Many young people have contact with older people (live together, work together, being taught by them etc.), and anybody who claims it might work is IMHO divorced from reality.

I think the main mystery about the UK govts approach can be solved when your realise it is not very clever; just very incompetent. The whole word has been stunned by the herd immunity experiment policy; only to have it denied a week later. We are fools led by clowns.

The UK government is neither genius nor insane. What the UK government is, is pragmatic.

Turns out they were insane: https://www.buzzfeed.com/alexwickham/coronavirus-uk-strategy...

No. It’s dumb asf.

It’ll last like 2 days.

Here’s the EIC of The Lancet:

https://twitter.com/richardhorton1/status/123814984490619290...

I'm not sure I understand how this herd immunity strategy can work in the current world. Albeit the UK is segregated from the rest with water, there are still a lot of people entering your frontiers and that are not immune.

Herd immunity is basically doing nothing right? How is that any different from what happened in the Spanish Flu? I'm sure herd immunity came into play eventually but at the cost of all those lives.

I see lots of praise for Singapore and Taiwan's handling of the crisis.

What about the weather? Is part of the solution for cold dry places to have warm humid weather, which apparently kills the virus?

Insane, but we already knew it thanks to their past decisions. This is just the last confirmation. In the best case we’ll have close to 1M deaths if they succeed with their strategy.

Herd immunity by mass exposure is an interesting, very likely catastrophic, approach. It's interesting that he (of the twitter cite) claims that it is "more refined", as if simply doing nothing and rationalizing your hubris is 4D chess.

Every country realizes it can't be stopped now. Every country realizes that the majority of the population will get it. But as has been cited a thousand times, having hundreds of thousands of vulnerable people, along with a substantial enough number of otherwise healthy people, needing heroic medical care would be disastrous. See: Italy. Their approach wasn't "more refined".

I doubt the outcome is going to be good.

Meanwhile, people returning from the UK to the EU are being tested positive for Covid-19...

So, maybe the strategy (if it is one) works, but the UK is imposing it on everyone else without a care.

It is correct in theory, but Wuhan coronavirus spreads very quickly and easily. I doubt UK has enough hospitals and people to provide proper medical treatments.

All the kids get it, infect their parents, and off it goes.

I expected immunity once you'd had it, but have heard of re-infection occurring (not from official sources).

This sounds like the "bargaining" stage, in the 5 stages:

denial, anger, bargaining, depression and acceptance.

(Acceptance being a China style lockdown of course...)

MMh. is the netherlands then doing the same thing ?

The bit I don’t understand is how you carefully infect the bulk of young people and simultaneously keep the older folks uninflected.

Sounds incredibly risky to me. I suppose if all countries end up crippled anyway then it would be good to be the first to recover.

I think this is the path the USA will be taking as well if not "officially" so the old folks won't freak out.

The title reads like judging a startup founder. I'm not sure if all the startup rules apply to governments.

I feel really torn about this.

The intuitive way of managing this is to try all possible containment methods as long as possible. The benefits of this is that it will give maximum chance for containment, and failing that, maximum time for therapies/vaccines to emerge. What are the chances of this? Containment thus far has already failed. The asymptomatic period make this hard to contain, and even in China with drastic measures new infections are occurring. Even if this worked, it would only take one area not doing this effectively to allow reinfection of these other areas once measures are lifted. The other issue is that an effective vaccine is not going to appear for at least a year. Other repurpose therapies are being trialed, and initial results will be released this month. I’m not aware of any other completely new therapies which may change outcomes. So, it appears the benefit is limited. The main risk of this approach is that containment is initially successful, but then fails in Autumn (fall), leading to a peak in the winter when the health system is already under a large amount of stress. This would be a disaster, and may well be what happens to other countries who try this. So, the UK approach of making occur in summer may make sense for the UK. How appropriate this course of will obviously depend on level of seasonal variability in health care needs. Therefore countries like Indonesia or Singapore will do well to stick to containment initially, as they dont risk a peak occurring in winter.

Doesn’t herd immunity work if reinfection isn’t possible, which is unconfirmed at best at the moment?

As long as the virus does not mutate and start killing young people, which is a definite possibility,

Doesn't herd immunity require like 90% immunity?

Even with 5% of cases requiring hospitalization this is insane.

An interesting experiment is about to be carried out with the British as the control group.

The only thing we know for certain about C19 is we don't know anything for certain. The EU recognise that fact and are playing for time. The UK, on the other hand, is pretending to have a sciencey fix based on some adolescent game theory nerdgasm. Herd immunity can be conferred by both vaccine and disease. But there's a difference between vaccine and disease that seems too subtle for Whitehall to grasp.

The UK is planning for 60% of its population - forty million people - to contract C19. The gamble is that this won't overwhelm the health system. How? Because the government has told the virus not to infect people who might get ill.

In China, healthcare workers were at greater risk than the general population because of elevated exposure. The UK has told the virus not to infect doctors.

The big risk with RNA viruses is mutation: we could develop a vaccine this year that's useless next. Obviously, the larger the infected population, the higher the viral mutation rate. China and the EU are responding by locking down. The UK has told the virus not to mutate.

When declaring a pandemic, the WHO director-general said, “The idea that countries should shift from containment to mitigation is wrong and dangerous.”

Most comments here raise excellent points.

One more in the mix: Many companies in many countries are working on vaccines and cures. So far some are reporting moderate successes; as I understand it, those with the experience to tell seem to think odds are pretty decent there'll be some sort of vaccine available within a span of a year, maybe sooner.

Whether corona infections 'outpace' the time when a vaccine will be generally available depends a lot on how long it'll take to get a vaccine out the door, but presumably a ton of resources (and a lot of leeway on relaxing regulations) are spent on this, as well as exactly how fast corona spreads.

If it spreads very fast, all of this 'planned herd immunity' stuff is nonsense, all the taps you can close should be closed and stay closed and it'll still spread. The UK would be mismanaging this and should be closing more facilities.

If it doesn't, then the UK is probably mismanaging this, in that it'd be better to try to slow the spread because the end game is the vaccine.

Effectively then, they appear to be betting on a creative and untested solution that they more or less have to keep secret because it doesn't work well if it is generally known, which requires accurate forecasts from lethality rates amongst various parts of the public to spread rates in circumstances that are probably unique to the UK then, if they are the only country to go with this plan, __whilst__ betting that the vaccine solution is not going to be fruitful for a long long time.

I'm going with 'insane' on this one.

I do now know what is right, but I am glad humanity has a diverse set of strategies

They've backed away from the herd immunity approach now. Embarrassing

Herd theory works once you have an immunized herd(from recovery from infaction while we have no vaccine) so that infection passes only from an infected person to a vulnerable one. As we sit, the current policy will lead to an exposure to all people - more or less, and then the recovery and formation of the immune herd commences. Thus the IK government has decided to allow unfettered spread = all the casualties that involves to form the herd. This is a million or more people. An isolate into tiny herds-at-home, test symptomatics - treating positive by supportive care = formation of many immunized small herds. This second procedure will kill 50,000 or so. Laters it does not matter if the mini herds mingle as they are all immune. There will be little subsequent spread. UK is deciding to kill a large number of it's citizenry = some sort of class war???

Do you get immunity to cold caused by coronavirus after having it?

So, it sounds like the UK is having a big chicken pox party?

Definitely insane, here's why:

In order to get to herd immunity, you need something around 60% of the population to get infected and thus immunized [0] (there's a big assumption here already, that immunity lasts forever, might well be wrong). The UK's population is 66 million people, so that's about 40 million who need to get sick.

Let's assume 2% of cases require intensive care (it's closer to 10% in Italy right now [1], but we can assume for the sake of this calculation that the UK has the superpower to isolate people over 65 or so perfectly). That's 800000 people who will require intensive care!

There are about 4000 ICU beds in the UK [2]. Let's assume, again highly optimistally, that only 50% are occupied, so 2000 are available for Covid19-patients. Covid19 patients may need to spend 7 days in the ICU [1], which means there can be up to 286 new Covid19 patients starting intensive care each day.

You can see where this is going. At that rate, it would take 2797 days to reach herd immunity. It's utterly nonsensical. We will hopefully have a vaccine way, way before that. What this "herd immunity" strategy is actually going to do is lead to a total break-down of the hospital system in the UK, if the government doesn't change course real soon now.

[0] This is 1-(1/R_0), see https://en.wikipedia.org/wiki/Herd_immunity and unmitigated R_0 is around 3 for SARS-CoV-2, https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndr...

[1] https://www.statnews.com/2020/03/10/simple-math-alarming-ans...

[2] https://www.theguardian.com/commentisfree/2020/mar/03/icu-do...

It’s worth noting that many diseases don’t converge to herd immunity except through very high vaccination rates. Examples include polio, small pox, chicken pox, etc.

So their assumption about outcome seems flawed.

This is utter, utter madness. Assuming UK has 66M people and 2/3 need to be infected, that's 44M people. Coronavirus has, depending on the quality, affordability and accessibility of the healthcare system, a fatality ratio somewhere along 0.7% in best case and 15% (at least!) in old and pre-conditioned people... which means that there is anything possible between 300k and 6.6M (!!) deaths.

tl;dr: absolutely fucking nuts to risk more people than the UK lost in WW2. If BoJo really tries to execute that plan, he has to be stopped.

> If BoJo really tries to execute that plan, he has to be stopped.

But that's the beauty of the plan, it functions as its own dead man's switch.

Important to remember that this person doesn't know what the policy is. They're just tweeting their opinion.

The UK government announced the policy in a press conference with the Prime Minister and the chief scientific advisor.

Here is an interesting follow up interview with the chief scientific advisor: https://www.youtube.com/watch?v=2XRc389TvG8

My personal opinion, after watching the interview, is that the UK government is not doing anything that radical. They will follow the reactions of other countries but want to time the reaction so that it is most effective.

Sure, but this twitter post gets shared a lot.

https://twitter.com/robfordmancs/status/1238882933508919299?...

https://twitter.com/robfordmancs/status/1238816293463228423?...

"An awful lot of people with no background in epidemiology or health, and no access to the government’s policy making process, seem to be pronouncing with very high levels of certainty about what is being done and why. It is not obvious to me how this is helpful"

They didn't word it like the OP. The OP got that from the Twitter account extrapolating the contents of the press conference. The press conference mentions herd immunity but it didn't (like the twitter thread) state that keeping schools open was to ensure young people get infected.

What could possibly go wrong.

A lot. It can potentially wipe out the non young generation.

I said what could go wrong.

They are neither; they are making difficult decisions on the basis of limited information across multiple disciplines. The main aim is to prevent the NHS from being overwhelmed, which would be a humanitarian disaster. A secondary aim is to prevent bringing economic life to an end in the UK, which would also be a humanitarian disaster.

We are at most about five months into this pandemic; to suggest we know what strategies succeeded and failed is very premature. We are just at the beginning.

In another world, we could all spend 2020 in individual seclusion, without any economic, social, familial, cultural, mental, or behavioral concerns. In the world that actually exists, "No man is an island, entire of itself" and so rather annoyingly we must continue to live our lives without being completely governed by epidemiological concerns. SARS-CoV-2 can be transmitted asymptomatically and is basically everywhere at this point, so if your entire strategy is just "don't let anyone get infected, ever", it is surely doomed?

One country did get a legitimate chance to end COVID-19 for all humanity by preventing onward transmission, and they blew it. The next off ramp is global herd immunity (either natural or artificial), which lies years or decades in the future.

It's worth pointing out that the UK already pursues a strategy of herd immunity regarding chicken pox (along with other countries), despite the availability of a vaccine: http://www.ox.ac.uk/research/everything-you-need-know-about-... I disagree with that strategy but I am not qualified to make that decision on behalf of a country, and I'm glad it's not my responsibility to do so.

> the UK already pursues a strategy of herd immunity regarding chicken pox (along with other countries), despite the availability of a vaccine: http://www.ox.ac.uk/research/everything-you-need-know-about-.... I disagree with that strategy but I am not qualified to make that decision on behalf of a country, and I'm glad it's not my responsibility to do so.

The UK does not vaccinate against chickenpox because it judges that the overall public health consequences are worse if you vaccinate than if you don't - it would increase the frequency of shingles which is much worse than chickenpox.

That for me is where the logic breaks down, a comprehensive vaccine programme for shingles would seem far more effective than just hoping the adults come into contact with infected children.

Anti-vaxxers are a thing. If you vaccinate then due to herd immunity the anti-vaxxers don't get exposed to chickpenpox nearly as much and then end up getting shingles.

Also then anti-vaxxer children get chickenpox much later in life when it can be more serious.

If you don't vaccinate everybody gets exposed to chickenpox much more and the proportion of shingles cases ends up being smaller, not only that but anti-vaxxer children don't need to worry about getting their first case of chickenpox at age 30.

> http://www.ox.ac.uk/research/everything-you-need-know-about-...

Thanks for linking to that fascinating article, by far the most enlightening virusy thing I've read.

It is a theoretical solution. That also could backfire fiercely. The more it spreads, the more likely it is to mutate. And not all mutations will be equals. Plus it might make producing a vaccine more complex.

Could also work. Unexplored territory, the truth is we don't know.

"In practice, people won't be disciplined about isolating vulnerable ones in the first phase, thus leading to disaster."

That is the point. One can catch the virus, become asymptomatic then continue to live normally and become even more dangerous to anyone in vicinity ("hug me, I'm safe!"). Eventually most of us will be infected anyway, and some will recover becoming immune (hopefully; this is far from guaranteed), so the correct line of action IMO would be to isolate everyone from everyone to gain time and resources. Nothing would stop them later from making people immune through controlled infection (aka vaccination) when the crisis is over.

To me they don't have a clue and just chose the only option that might paint them as still in control.

More insane than genius.

The government expert on TV was basically saying most people are going to get it eventually so why bother making huge efforts to delay but that kind of ignores that if we delay we may get better treatments or a vaccine. Just fine tuning some of the existing treatments could make a big difference.

The economy wasn't important for Brexit but it somehow is for COVID-19, and we're going to sacrifice half a million people (best case).

I say bring back the guillotine

To be honest, I don’t think this kind of conversation is worthwhile on HN. There are very few facts here, just opinions.

I’m all for posting authoritative information, and interesting side-effects.

But just shooting around opinions is best left for Twitter, Facebook, Reddit.

The dividing line for what's on topic on HN not fact vs. opinion, it's intellectual curiosity (https://news.ycombinator.com/newsguidelines.html). That doesn't limit itself to authoritative information, by definition.

Speculation is inevitable. The question is whether it's curious (thoughtful and fresh) or uncurious (reflexive and predictable).

But ignorant speculation during a crisis can have serious consequences. Look the fools in this thread claiming that the UK government is deliberately culling the sick and elderly. The last thing we need is ideas like that getting widespread acceptance and causing civil unrest and distrust of the authorities who are essential to managing the situation.

It's true. But ignorant speculation forms a chunk of every thread. The solution isn't to try to restrict posting to authorized opinion—that would cause more harm than good and is impossible anyway. The solution—well, there's no solution, but the best we can do—is to let the community respond when it's able to function, and moderate the threads to the extent that it's not.

When I last looked in on this one, it seemed to me that the community was functioning ok—noticeably better, in fact, than in most of the coronavirus discussions, which are highly repetitive. Repetition is bad on HN, not only because it's lacking in intellectual curiosity, but because it leads to flamewars. The mind seems to resort to conflict to amuse itself when nothing new and interesting is available.

This might work. But how many people will die in the process? There are many cases of young people, with seemingly no prior health issues, dying after getting severe issues as a result of the virus.

On top of that, you can't guarantee that young people will only get it. With no travel restrictions, it can easily spread to the elderly.

It kills maybe 1% to 2% of people under 50 with no comorbitities.

If we assume everyone in the UK is under 50 and there are 60m people and we want to infect 60% of them that's 36m people infected, and 1% of that is 360,000 dead.

That's ignoring all the people who do have comorbitieis (diabetes, high blood pressure, etc), and all the people over 50.

It's also ignoring all the people who eg get into road traffic accidents and need an ICU bed, which won't be available if we cram hospitals full of covid-19 patients.

The reported numbers in published papers are more like 0.4% under the age of 50 and 0.2% under 40 and probably lower as there could be a large portion of mild unreported cases.

https://www.worldometers.info/coronavirus/coronavirus-age-se...

>> Death Rate = (number of deaths / number of cases) = probability of dying if infected by the virus (%)

That's not a great way of measuring the death rate during an on-going epidemic. They should be measuring the number of people who died today / number of cases a week ago.

Why a week ago? If it takes longer than a week for victims to die, in a situation with rapidly increasing infections that will give a very distorted number.

The best source I found on the subject -- a disease modeler with CDC who was giving an interview -- said that their current estimates used 5-day doubling, 15-day median time to death, and 1% CFR to do their estimates.

For the modeler, the purpose was estimating the true number of cases (which they estimate as current_deaths * 800 for a first-order approximation) -- but similarly, you could use that to estimate CFR by taking (num_cases / 8) as the denominator. Except, of course, that you can't realistically estimate num_cases. With the exception of Diamond Princess and possibly South Korea, everybody's numbers tell you more about the number of tests they run than the number of infected that exist.

One doctor from John Hopkins, for example, estimated that there are between 50k and 500k cases in the US as of 3 days ago -- and my own admittedly-amateur estimations using CDC numbers for deaths from influenza and all-cause pneumonia could only set an upper bound of ~400k cases as of March 1st

Sure, maybe just one week is too short and it needs to be longer. But that just makes my point stronger, doesn't it?

Using the total number of people infected today means they're including a bunch of people who may go on to die, but they're not including those deaths yet. So they're making the death rate look smaller than it is.

This is the same thing China is doing, except China is also lying about it and saying they have "contained" it with extreme quarantine, in part to trick other nations into doing the same thing to tank their economies while China is going back to work and letting the virus spread.

Good for UK to step up amidst hysteria. Hopefully other democratic nations will follow suit.

I wonder how much of it is just playing the odds. Shutting everything down will very likely have a large, but fixed consequence on the economy, which has huge cost, including in lives and health. Whereas biding your time increases the relatively small risk of catastrophic consequences from coronavirus, but avoids the economic consequences. So it comes down to a choice between accepting a known downside, or taking a gamble on a path with the possibility of very little downside, but also much larger worst-case downside. Leaving the expected values of the choices aside, maybe Boris just likes to roll the dice?

There are other considerations, like how well the president/prime minister’s incentives are aligned with the countries. Donald Trump, through very little fault of his own[1], faces the possibility of a failed presidency due to the economic consequences of shutdown. If possible, a president might think it worth swinging for the fences, if he is down a couple of runs in the ninth? If he strikes out, he is no worse than before, although the country is. And Boris has kinda made himself out to be a guy who tries for home runs, at least in his public persona.

There is also the game theoretic considerations on the country level. If all the other countries are doing everything to stop the spread and paying the economic cost, than U.K. can take the benefit of that sacrifice, and not crash it’s own economy.

[1] of course he is doing his best to compound the external factors.

All of this ignores the moral aspect of sacrificing human lives at the feet of the economy. And, to be fair, it's totally plausible that said leaders are themselves ignoring the moral aspect. But it does matter when we judge them on the actions they decided to take (or not take).

> through very little fault of his own

https://www.snopes.com/fact-check/trump-fire-pandemic-team/

Get out of here with this. We had expert teams and processes in place to combat the possibility of this exact thing and his administration fired them without any replacement.

The virus existing is not his fault, but nearly all of the national consequences rest directly at his feet.

I worded it that way because I think that even if he had done everything right, his re-election would still be in trouble because of factors outside of his control.

The job is literally to be prepared for the future on behalf of the country. If you take active steps that make us less prepared for something and we therefore suffer greater consequences when it happens, I have a really hard time describing that as being something outside of your control.

Under normal circumstances, an exigent crisis such as war would make a President significantly more likely to be re-elected. He tried to start a war with Iran not long ago for this very reason.

If you want to argue about Trump, please find someone else to do it with (or somewhere else to do it).

My comment was not about Trump's response, and I regret even including mention of him, since that one offhand comment has generated uninteresting political arguments, without anybody engaging with what I was actually writing about.

Snopes stopped being a reliable source a long time ago, if they ever were. They give one-sided versions for obviously political reasons.

>Get out of here with this. We had expert teams and processes in place to combat the possibility of this exact thing and his administration fired them without any replacement.

Ah yes, yet another person who looked at the Snopes piece's headline and nothing else. One would think reading only that, or the Twitter thread (!) the piece is based on, that to save money (or because the Trump administration hates science, or something) the entire "US Pandemic Response Team" agency was eliminated and everyone in a large DC office building was fired.

Actually reading the contemporary NBC News https://www.nbcnews.com/politics/politics-news/tom-bossert-t... and Washington Post https://www.washingtonpost.com/news/to-your-health/wp/2018/0... articles the Snopes piece cites in the body, they seem to have been a handful of people in one team in the National Security Council hierarchy, that the new National Security Advisor reassigned to related agencies, as part of a desire to have his own hierarchical structure. Ziemer resigned because he wanted to keep his team the way it was.

COVID19 was not a surprise; that is, it was known to exist in China some time before the first cases appeared in the US. It is not unreasonable for a government to assemble a team to respond to something like a pandemic as needed, as opposed to having people dedicated solely to the purpose and nothing else. And that's exactly what the US did, implementing the ban on non-American travelers who'd been to China in late January, among other things.

You may or may not agree with this. But please don't claim that this is somehow prima facie proof of the Trump administration's malfeasance/evilness.

PS - No, Trump did not "cut the CDC budget" either. https://apnews.com/d36d6c4de29f4d04beda3db00cb46104

No, Trump did not "cut the CDC budget" either.

No, he only proposed cutting the CDC budget. Luckily, saner minds prevailed.

>No, he only proposed cutting the CDC budget. Luckily, saner minds prevailed.

Presidents do not pass the budget; Congress does, under the Constitution. The annual President-proposed budget is just that, a starting point from which to negotiate from. Both the House (currently controlled by Democrats) and Senate (Republicans) have to pass it.

If you criticize the president for starting out with a proposal for cutting the CDC budget (and for most other agencies), why not also praise him for signing the final budget that raised its budget?

I don’t find anything praiseworthy in his actions re this crisis, he has and will continue to handle it really badly IMO.

I really can't believe how stupid this is, I was starting to feel positive about the whole thing, China got it under control, they are sending resources to Italy to help get it under control, cures and vaccines are being developed while people stay indoors and the number of cases drops. WE COULD ERRADICATE THE VIRUS JUST BY STAYING HOME FOR 1 FUCKING MONTH. Literally that's all it would take, a person isn't contagious after a month, if everyone cooperated for the greater good we could have this under control, it's not too late, it's the one and only chance to not make this virus "the norm" of our society, every day it's gonna get much harder... But then you hear a country with 60 million people just isn't gonna do anything about it, throwing in the towel before the fight even started and dooming the whole world with them. It's beyond insane.

I'm sorry but this is just too much, I was hoping we would have the common sense to do our best to contain the spread but seems we just have to travel, go to the gym, go for beers every night and hang out, even though it will kill a lot of people around you. Your fathers, mothers, grandparents, your friend's parents, your neighbour's family, they might as well all die because you can't stay home for a month. Really I expected too much from people and forgot how stupid the average person is. I expect global warming will also go great, kudos humanity.

https://www.scmp.com/news/china/society/article/3074945/coro...

You better hope this isn't true and the virus doesn't have any lasting effects on reproductive health.

paper - https://www.medrxiv.org/content/10.1101/2020.02.12.20022418v...

So let's assume that building immunity is even a possibility even though there is no evidence to support this while there exists substantial evidence to the contrary (people getting reinfected)?

Not happy to be living in the UK if that's really the plan.

> while there exists substantial evidence to the contrary (people getting reinfected)?

No. There are instances of people testing negative and then testing positive again, but the strong consensus is that this probably results from faulty testing and/or changes in how viral material manifests at different stages in a person's infection. The chance is very small that people are truly getting re-infected.

>No. There are instances of people testing negative and then testing positive again, but the strong consensus is that this probably results from faulty testing and/or changes in how viral material manifests at different stages in a person's infection. The chance is very small that people are truly getting re-infected.

This is also why testing everyone and anyone is a bad idea. Half or more of positive tests of people without symptoms being tested because they are in close contact with infected seem to be false positives. https://www.ncbi.nlm.nih.gov/pubmed/32133832 I've seen something else I can't find at the moment that says that only about 10% of those with both potential COVID19 symptoms and a contact history indicative of possible contact are positive. It's both pointless and dangerous to have someone get a false positive reading, perhaps do self-quarantine for 14 days, then go out and promptly get (not re)infected.

The US government (and I think UK too) is getting a lot of criticism for restricting testing to those who meet the requirements of symptoms and contact history, but it's almost certainly because the CDC is aware of this. The Canadian government, too; Prime Minister Trudeau is not being tested, although his wife is positive, because he is asymptomatic. https://www.usatoday.com/story/news/world/2020/03/12/sophie-...

This "strategy" is rebranded "do nothing". The journalist running the country (with his "everyone's had enough of experts" and "fuck business" attitudes) is simply displaying his usual contempt for all the non-privately educated, and is miles out of his depth. This is in a similar vein to how they're also rebranding a no-deal Brexit as an "Australia-style" deal. I don't believe they have a strategy at all - and "herd immunity" means hope for the best (a la "sunlit uplands").

From a PR point of view this is not a clever move. The very phrase 'herd immunity' says a lot about what they think of people. It is also a highly memorable phrase, much like 'shock and awe' and sometimes you just don't need a 'marketing slogan' for something divisive.

It's a technical term.

> The very phrase 'herd immunity' says a lot about what they think of people

...You know they didn't invent the phrase, right? It's a term of art, and has been the standard term for that epidemiological concept for many decades. https://en.wikipedia.org/wiki/Herd_immunity

I did not claim that they invented the words. English is a rich language and some words resonate better. From your article:

> Herd immunity (also called herd effect, community immunity, population immunity, or social immunity).

Community immunity would rhyme and not be received as negatively by those that already hate the government as the herd word. It would also convey community, which is a caring nice word.

The kill rate from economic loss far exceeds the virus atm.

You mightn't see it yet as people stick together but a lot of small business owners will be killing themselves in a year's time. (But most of economic deaths are more subtle)

The UK is also reducing this.

They are also coming into Summer, it's crazy to not maximize during this time.

The right thing to do would be to purposely infect people with a spray and isolate.

Society won't allow this. So we have to do other methods. They have a lot of lag and are random and exponential so probably out of real control.

With the UKs plan they can't keep it to young people. That certainly won't work.

But they will save many invisible economic lives.

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