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Comment by foobarbazetc | Hacker News Reader

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...

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...

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.

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...

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.

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