Hacker News Reader

Comment by overcast | Hacker News Reader

Same here, I'm continuously amazed people are actively "standing up" to a virus. Like it's some terrorist threat that they won't back down in fear from. A dude last week told me he's flying out for a cruise this week. How many spring breakers hopped on planes to Mexico? Can you really not live without going out for a few weeks? Stay inside, read a book, watch some movies, work on that video game backlog, get some work done. The quicker we stop the spread, the quicker we can all go back to our normal lives. All you're doing is just making it longer and more devastating.

wtf people. Use your brains. It's totally irresponsible for you to be spreading this to everyone else.

View on HN

>The quicker we stop the spread, the quicker we can all go back to our normal lives. All you're doing is just making it longer and more devastating.

From my understanding, this isn't really true. "Stopping the spread" is an unreasonable and incredibly difficult undertaking. Isolation is about reducing the rate of cases. It's likely that similar infection numbers will be reached over the course of the whole pandemic no matter what. Nobody is going back to "normal life" any time soon - the only question is how drastic the counter-measures will be.

I don't think stopping the spread is unreasonable or incredibly difficult. It's being done in HK, Singapore, and Taiwan now. First you lock down to get cases to roughly single digits, then people come out, but it's different.

The trick is you need to get R0<1, so that when a new case pops up, it dies out instead of blowing up. You do that with mask wearing, hygiene, aggressive contact tracing, broad scale testing, and strict isolation. You keep people alive that get the virus by having good medical care.

The aggressive contact tracing, isolation, and good medical care don't scale. If you have only dozens of cases, you can afford to aggressively isolate and put a lot of manpower into tracing every case. You give the virus no breathing room. If there aren't too many people needing medical care, you can also provide them much better care.

This is why you need the lockdown -- to get R0<<1, to bring down the case count dramatically so that these other measures can work.

We could have just started with Phase 2 outside of China, but we didn't spin up all of the things that you need for Phase 2 in time. The countries that are doing the best had previous SARS experience, which was successfully eradicated with these measures, so they knew what to do right away and were institutionally prepared to act quickly.

For how long? Give me liberty or give me death.

In Wuhan they got R0 down to about 0.3 with lockdown, contact tracing, and central quarantine. Serial interval is about a week. I estimate we have about 40,000 infections in the U.S. right now. If you want 10 cases, you need a 4000x reduction we'd need about six weeks.

The sooner and more aggressively we start, the shorter the lockdown has to be. Half measures that leave R0 above 1 don't help much and just prolong the lockdown.

Take my liberty now so that I can have it later.

What is next though? It seems to me that, after you end the lockdown, the disease will just be brought back there from other infected regions.

The idea to social distancing is to slow the inevitable spread so health infrastructure isn't overwhelmed and death is minimized.

Also it gives us some time to think clearly about next steps and to have some control over the situation at an individual and organization level. Maybe someday we will also decided that herd immunity is the way to go but we may also decided to give the researchers a month to see if they come up with other options

> we will also decided that herd immunity

Or more critically, if we learn that lasting native immunity is even possible.

For the coronaviruses which cause the cold (such as CoV-OC43) the adaptive immune response is not particularly strong and immunity lasts only months. -- not due to mutation, but because of behaviors in the immune system which we don't yet understand. This has contributed to the difficulty in creating a vaccine for the prior sars virus.

As a result, the whole "get people immune for next season" idea may be a largely pointless goal. The best comparisons we have so far suggest that it is, though we just don't have enough information yet.

"For the coronaviruses which cause the cold (such as CoV-OC43) the adaptive immune response is not particularly strong and immunity lasts only months. -- not due to mutation, but because of behaviors in the immune system which we don't yet understand. This has contributed to the difficulty in creating a vaccine for the prior sars virus."

From what I understand, work on developing a SARS vaccine stopped because the epidemic was over, and there was no longer an interest or will to continue working on it.

In addition, here's what Vincent Racaniello of This Week In Virology[1] had to say about antivirals:

"We could have had antivirals against all coronas or many coronas if we had put the money in to making them, but there was no interest and therefore companies which need to make profits were not interested in pursuing them, but they could have been developed and stockpiled and been ready.

"So if you had infinite money and people you could say, 'Let's get a bunch of RNA polymerases from bat SARS-like coronaviruses and design something that will inhibit them all.' I don't think it would be that hard because they're very conserved. But without the financial incentive... so, antivirals are kind of a different thing because you could develop them and bring them, you could even do a phase one and then have them ready for actual testing when there's an outbreak."

[1] - at about 1 hr and 33 minutes in to episode 590 - http://www.microbe.tv/twiv/twiv-590/

Antivirals != vaccine.

Antivirals for sars-cov-2 seem MUCH more likely to arrive quickly than a vaccine, and I wouldn't be surprised to find that several of the things currently being tested (some of which are already approved for the treatment of other conditions) are effective.

That this keeps coming up on HN is fascinating.

I'm just imagining some programmer in a future interview talking about their familiarity with async functions in Javascript. The interviewer glances down at an app named "Mirror Test Pro" that cross-referenced that claim against an old HN post revealing ignorance about the upshot of social distancing. It consequently overlays a red "X" on the programmer's avatar. "Thanks, we'll be in touch," the interviewer says as the programmer is shuttled out the door.

And I'm imagining many such programmers becoming frustrated when a breach of MTP data reveals why they kept getting rejected in interviews. They would band together and write a powerful DDOS tool to exact vengeance upon the world that humiliated them. Lucky for the world, their sudden, synchronous silence gives enough advanced warning to thwart the attacks while their CPUs helplessly whir on one giant blocking call.

I have no idea what this comment is trying to say.

The problem is that the 20% or so that end up in severe or critical condition and need hospitalization are too much for the medical system to handle. The more they can slow the spread the better they'll be able to help all those that will need medical care.

In Italy the number of people that end up in ICU is 10%. Now think of the population of people that are in your area and how many intensive care beds that are available to them... do you think your local hospitals can handle 10% of that number? Probably not. This is what makes it a big issue.

“...20%...severe or critical...ICU is 10%...”?

Wait, what? Source?

Quick search brings up this: https://www.politifact.com/factchecks/2020/mar/13/viral-imag...

Which doesn’t shows that there isn’t a single consensus source yet. The article points out one source with 25.5% severe and another with 13.8% severe. Meanwhile for critical, it shows the numbers 4.7% and 6.1%.

While OP isn’t entirely accurate, for off the top of the head numbers, it’s not wildly off base either it seems.

Let's assume that untreated severe means death. Let's take the lower value 13.8%.

Now let's factor in that in a developed country there are some 0,5% hospital beds total capacity. Let's say that Covid-19 can have at disposal half of those beds.

If you do not do all you can to flatten the curve, you are probably looking at a 10% death rate over infected population, if not more.

That's over 6 million people in the UK.

IMHO, you have to do something to buy more time, although it is yet to be seen if lockdowns will be effective enough as this guy seems to be too strong.

Oh, and I'm not counting the deaths caused by the army shooting at people panicking or killing each other not to get infected. Human nature is like that.

The WHO situation report for 06/Mar says:

> For COVID-19, data to date suggest that 80% of infections are mild or asymptomatic, 15% are severe infection, requiring oxygen and 5% are critical infections, requiring ventilation.

Ventilation would have to be done in the ICU, in my understanding.

Source: 06/Mar/2020 Situation Report from https://www.who.int/emergencies/diseases/novel-coronavirus-2...

This page mentions a study in China: https://www.worldometers.info/coronavirus/coronavirus-sympto...

I haven't found exactly the 10% in ICU (and I'd be especially interested in the percentage of young people requiring ICU), but yeah basically 80% mild cases and the others needing assistance.

That's the issue, people are still acting it's somewhere else's problem. Bars are still busy, people are still getting on cruises, that's why this is scary.

Stopping the spread isn't the goal, though, it's flattening the curve, so that there's ICU space for critical patients and health services aren't overwhelmed (all the other stuff that needs ICU).

Here's an explanation on why decreasing the rate a little bit via the isolation may save lifes tenfold https://news.ycombinator.com/item?id=22548734

"The quicker we stop the spread, the quicker we can all go back to our normal lives"

Actually no, it's the opposite. "flattening the curve" means spreading the period of time infection spreads to not overwhelm the medical services at any one point. So the quicker we slow down the spread, the longer it'll take to get back to normal.

The idea we can completely stop the spread at this point is unlikely, the best we can do is slow it.

Getting the healthcare system "back to normal" ASAP is the top priority, and you do that by flattening the curve as much as feasible. Once we actually know what the sustainable carrying capacity of the medical system is and how not to exceed it, we can maybe think about relaxing these policies and moving cautiously towards a "herd immunity FTW" approach.

You are right. But many people want something different. They are used to getting their problems solved and they just can't accept the reality that you have put your finger on. They are demanding action now when that fails to work (either because there is action and it fails, or because there is not perceived to be enough action) they will get angry.

I wonder if there will be a process of grief leading to acceptance about this event, I feel we are in denial now, tending to anger. Next will be bargaining (I think evidenced by isolation and hording) or maybe not - maybe the population will simply fail to process this.

> Like it's some terrorist threat that they won't back down in fear from.

Ironically, even the actual terrorists decided to back down in fear from it, suspend their terrorist activities, and teach themselves how to wash hands properly.

https://www.politico.eu/article/coronavirus-isis-terrorists-...

Well I for one am distancing to the point of isolation, even from my family for a few days until a clean state of health is established following trips abroad. We have a vulnerable family member (young, but complex conditions) and are taking no chances. And yes, we accept that it could take many months - until either we do catch it or there is a vaccine, it’s hard to see the end of it.

Reply on news.ycombinator.com