Harvard epidemiologist: my colleagues assumed UK coronavirus plan “was satire”
theguardian.com
theguardian.com
OK... but... isn't that what everyone is being advised to do right now? So maybe not a great example of something unrealistic to ask? Since in fact the UK would be asking it of fewer people than... many are saying it needs to be asked of -- although the US government isn't actually telling us to... yet? But that's the alternative those who who think the UK's plan is madness are suggesting, right? Asking everyone to withdraw from society for months?
I can see the desire: Wait, could we just ask high-risk people to withdraw themselves from society for months, instead of asking everyone to do that? Cause that'd be a lot less disruptive to our social and mental health maybe it'd be just as good? (There are real costs to mental health and social functioning of asking everyone to avoid all contact with everyone else; it might be the best option anyway, but it's definitely not without it's own health risks and consequences).
But I'm no expert. It kind of sounds like the experts are saying "not really, that isn't a good idea, everyone has got to do it". Sometimes what we are called upon to do is not easy or pleasant.
One of the frustrating and anxiety-producing things here is that we aren't getting very consistent messaging from the governmental authorities and experts. It seems like really a failure of the kind of consistent and pervasive public health educational messaging that would actually maximize compliance. Instead it's "everyone picks what forwarded chain letter on facebook makes sense to them" and we all know how well that works...
No. What everyone is advised to do right now is not to withdraw from society, it's to perform basic hygiene and social distancing in order to slow down the spread. Social distancing doesn't mean living like a recluse eating spam cooked on a gas burner, it's not getting into large crowds and trying to stay some distance from other people (outside spitting / coughing range). WaPo has an article with a "social distancing" simulator: https://www.washingtonpost.com/graphics/2020/world/corona-si...
"Self quarantining" is closer to what you're talking about, but it's for people who are at risk or likely to have been infected, not the general public.
Of course the latter you start the more it's already spread and the harsher measures have to be. And the more you'll have to ramp them up as you realise your initial measures were not sufficient, or your citizens have decided "freedom or death" is a good choice and decide to just ignore it.
FWIW Taiwan's already reopened its schools and life has gone back to something not entirely dissimilar to normal (people do have to wear masks and get their temperature checked to step into public buildings or businesses but they can move around just fine).
The bully pulpit is supremely important in these situations, and no government so far seems to have used it responsibly to disseminate a consistent message early enough to citizenry. Worse yet, in the US ones politics seems to be particularly predictive of opinion on coronavirus.
My current feeling is that the virus was not taken seriously when action could have mattered, and now the goal of government and citizenry is to reduce the carnage to both medically vulnerable folks (old people) and to economically vulnerable people. The latter risk in particular scares me, as there are many folks in the US who are going to be severely impacted by politicians reacting severely way too late who are too cowardly to protect those vulnerable people adequately.
I thought the UK (and Sweden, Finland etc) differed mostly in not closing schools yet. Are there other significant differences?
Is there a summary of the current recommendations? I mean surely gatherings etc are banned? Football is already cancelled, for example, as in other countries?
What? That sounds insane
(Today's deathcount is of course dependent on policy from weeks ago tough)
I think it's unwise for a few reasons, not least that if we delay we may have better treatments. Stuff like chloroquine and keltra seems to work but there haven't really been the proper studies - that sort of stuff shouldn't take that long. And there may be a vaccine. (China rushing vaccine stuff https://www.theaustralian.com.au/nation/china-coronavirus-va...)
...which presumes you don't live in a place with high-enough urban density that going outside your home immediately puts you into a large crowd.
Like, what are you supposed to do if you live in Manila? Mumbai? Dhaka?
Pretty much the only way to "practice social distancing" in those sorts of places is to never go outside.
I am getting mixed messages, I'm not sure why I think asking for another opinion on the internet will help, but there it is.
But that appears to be what we've got.
The shaming approach of "you want to be part of this effort?" (whatever that means) is unlikely to be an effective communications strategy either.
I don't know why I asked, I already had my choice of various opinions on the internet (usually given from a position of moral superiority and judgement).
I seriously don't understand why the U.S. public health infrastructure is failing so horribly here; if you want to maximize compliance, it seems obvious that you should be giving consistent and pervasive instructions, there should be literally a planned "marketting" campaign, with a consistent message. If people are getting different messages from different places of course they will be confused and compliance will be less.
Instead, we have "which chain letter on facebook and/or shaming and blaming comment on HN does my gut tell me seems right?" What the fuck America.
so don't go if you don't want to be that person.
> what are you supposed to do if you live in Manila? Mumbai? Dhaka?
Rejoice that you are with 99% certainty way under 70 years old.
https://www.bloomberg.com/news/articles/2020-03-15/manila-en...
[0] https://www.thelocal.com/20200315/norwegians-told-to-leave-c...
Yes but that's expected to, uh, not work. It's only expected to slow the progression.
One of the frustrating and anxiety-producing things here is that we aren't getting very consistent messaging from the governmental authorities and experts.
The only sane course of action the extreme lockdown we are now seeing in many countries. But politicians, being gutless cowards, are coming up with other ideas until their hand forced ... I hope. The alternative of actually believe this stuff and sticking to it would horrific.
I mean, everyone should be definitely be isolating and doing everyone that they can to slow the infection. But we are going to need much stronger measures than individual action. This is a real war, not like drug or terrorism wars, OK.
It doesn't take that much to contain something like this. In no particular order:
(1) Temperature checks outside all major gathering places. Shops, subways, offices, etc. If you're running a fever you don't get in.
(2) Hand sanitizer at the entrance/exit of all major gathering places. Clean your hands before you go in and clean them when you come out. Don't clean them you don't get in.
(3) Wear masks everywhere in major gathering places. No mask, no entry.
(4) Widespread testing and contact tracing for those who have tested positive.
I agree that the West in general is handling this as dumb as possible. Shutting everything down is pointless if you don't use the respite to enact public health measures.
I do believe that widespread testing and tracing would be effective. Given that we don't yet have access to the scale of testing that is required to maintain public health, I think an immediate quarantine is the only way to save lives.
We don't need to stop 100% of the transmissions. Right now, on average, an infected person will pass it on to 2-3 people. The goal is to get that to below 1 and eventually it will fizzle out.
I'm not quite sure what's so controversial about my post. It's what countries in Asia have done and they've all contained the spread.
It is more effective against viruses.
The article's suggestions seem to be in line with the government's stance. The main difference is timing with Dr William Hanage saying measures should have been adopted weeks ago while the government claims their modelling tells them to adopt measures later.
The government should be challenged by questioning whether it truly is/was impossible to contain the epidemic and what the best time to introduce different measures is. This article, however, adds very little to that debate with hand-waving in place of evidence.
[0]: https://www.gov.uk/government/news/covid-19-government-annou...
What statistical model? They're talking of "careful modelling". In the article you link, they don't mention anything about statistics, or, say, a simulation etc. You're assuming too much when you're assuming a statistical model, or anything based on data, or any concrete sort of model at all. "Modelling" can just mean a bunch of officials sitting around having tea and brainstorming potential scenarios.
Good point, but it doesn't seem to be the case. From the Coronavirus action plan[0] published on March 3 2020
> The UK is a world leader in the field of outbreak modelling and data analytics. The NIHR HPRU in Modelling Methodology led by Imperial College London has developed novel analytical and computational tools which exploit novel data streams on infectious diseases such as COVID-19. This group and other leading academic groups have developed tools to prepare for infectious disease outbreaks, which include real time infectious disease models, allowing policy decisions to be made using the best possible data and are actively modelling questions of relevance to dealing with the COVID–19 outbreak.
[0]: https://assets.publishing.service.gov.uk/government/uploads/...
Really, the claims of having done "careful modelling" absent any evidence of that modelling (say, a graph or a table of the results) is a really bad sign.
I really hope the government knows what it's doing. They have promised to publish their models, so hopefully that will give some more confidence.
https://www.documentcloud.org/documents/6810602-200149-NBCWS...
Maybe their models are wrong, maybe other approaches will work better, but I like they are having an honest grown up discussion about it instead of insisting eradication is possible, or that there are no tradeoffs to be made and total global lockdown of society for 6 months is the answer (which apart from being of questionable efficacy would certainly cause another Great Depression and more deaths from poverty).
At a minimum, I'd like to know what their models are optimizing for. Is it "Minimum number of deaths" or "Minimum economic cost", or "Minimum economic cost taking into account a cost of $XM per death".
Minimum number of deaths probably isn't a smart metric, because the solution to that is to tell 99% of people to stay home in bed for the rest of their lives. Hard to catch a disease if you never leave bed.
Minimum economic cost (with a factor for cost of a death) is hopefully the model they've used, but it's politically suicide to accept that grandpas life was 'worth' $X.
Rationing happens and it will be necc. in the coming months in every country, whether that is by patient income or by outcome, I’d prefer it by outcome personally.
You can start making decisions based on such a model.
Then in parallel, you get teams refining the model and making it more accurate, while other teams work on implementing those preliminary decisions, potentially changing course if newer, more refined, models come up with different results.
There's no reason the crude model can't be published 1 hour after it was made.
If anything, publishing the model will help localized branches of government make their own decisions ('hmm, looks like we'll be expecting lots of ambulance use at the end of march, that isn't a good time for the fleet inspection!').
Private companies would also benefit from the model, and can better schedule logistics. Even a hugely inaccurate model is better than "who knows! panic!".
https://www.imperial.ac.uk/media/imperial-college/medicine/s...
Because the government already knew that rapid herd immunity would cause a huge number of deaths.
[1] https://www.theguardian.com/world/2020/mar/16/new-data-new-p...
To reach 'heard immunity', if it is even possible at all for sars-cov-2-- there is good reason to expect that it won't be-- without overwhelming critical care will, unfortunately, take years.
Unfortunately, too great a percentage of cases need critical care.
Even with places trying to mitigate-- with the exception of the few places where it was actually contained-- their ICUs are going to be (or are already being) overrun.
> , but I like they are having an honest grown up discussion about it
There is no evidence of this. Experts have been calling on the UK to publish their models and so far they have declined to do so. I would take a sizable bet that no such models exist which support their initial stance (which they are slowly and quietly backing away from, and moving to a position much more like other western countries).
Whether eradication is possible or not, the FACT is that 6-8 months is extremely fast and can only lead to a collapse of the health services.
Handling that many cases over that short period is simply mathematically impossible considering the health care resources available. That is not an opinion, even the Health Secretary acknowledged that today.
They took the course they took knowing that.
We would consider such measures in order to protect vulnerable individuals with underlying illnesses and thus at greater more at risk of becoming seriously affected by the disease. The effectiveness of these actions will need to be balanced against their impact on society."
[1] https://www.gov.uk/government/publications/coronavirus-actio...
https://www.bbc.co.uk/news/science-environment-51874084
and here was the first published version: https://web.archive.org/web/20200313155320/https://www.bbc.c...
That obviously doesn't mean it's incorrect, but try to be aware of all biases, there are plenty on all sides.
https://www.theguardian.com/world/2020/mar/15/uk-coronavirus...
Even if the peak is spread out over nine months, that still means setting up, equipping, and staffing around a million extra beds over the next few weeks. At a time when existing medical staff are incapacitated.
This is not going to happen. The only way it might be possible is with civil conscription - literally taking people off the street and putting them through basic nursing boot camp. Even then there would be huge issues with supplies of equipment and consumables.
So the reality is that most people who need to be hospitalised in the UK (and probably the US) won't be - at least not effectively. Italy has shown what this means: without adequate care the CFR rises from 1% to 7% or so.
Which in turn means that without aggressive containment measures to slow the spread, the actual death toll will be in the millions, heavily concentrated among the over 65s.
There are around 10 million over 65s in the UK. If these numbers are right, around 10% of them will die.
Just an observation on your Guardian link, not the numbers you've derived.
Britain’s chief scientific adviser ... said that about 40m people in the UK could need to catch the coronavirus to build up “herd immunity” and prevent the disease coming back in the future. [2]
Sir Patrick told Sky News that experts estimated that about 60 per cent of the UK’s 66m population would have to contract coronavirus in order for society to build up immunity. [2]
Read more:
[1] https://www.nytimes.com/2020/03/13/world/europe/coronavirus-...
[2] https://www.ft.com/content/38a81588-6508-11ea-b3f3-fe4680ea6...
Possibly, the isolation is not going to be purely age based, but young people that are more susceptible to the disease might be isolated, in that case the fatality rate could drop significantly.
The problem is that in many cases it's hard to know whether you're susceptible until it's too late. It can be an undiagnosed pre-existing condition, or caused by stress (e.g. due to the crisis itself). For many working adults it might not be easy choice to self isolate (must provide for family etc) so many might likely downplay their susceptibility.
And this is all just talking about fatality rate while hospitals still function normally.
You also have to isolate young people with preexisting comorbidities such as cardiovascular disease, diabetes, chronic respiratory disease, and oncological diseases.
There is also no guarantee that the immunity will last. You can catch common cold (which incidentally is also caused by a coronavirus) multiple times. We don't know if that's true for Covid-19 as well.
It has been studied and determined most people cannot catch the same cold virus again within a short-medium time frame.
This is starting to look like a form of eugenics where the old and weak are simply left to die.
1) Fatality rate is based on hospital care being available for people who do get sick. This will include some nonzero percentage of otherwise healthy young people. Some of these patients will need advanced support, including ventilators.
2) Assuming you could contain to 40M young people (likely impossible), if even .5% of them need hospitalization, the UK hospital system will be overrun. (Not even accounting for all the other people who need hospitalization.)
3) Therefore: the low fatality rate assumption in #1 would likely not hold.
TL;DR; the absolute numbers are too big relative to health system capacity.
- Google the # of hospital beds in the UK
- Google the # of ventilators in the UK
- Pick your own fraction as to how many are currently available
- pick your own fraction of 40mm that will require hospitalization
- pick your own fraction of 40mm that will require ventilation
- Make your assumptions fit the # of hospital beds and ventilators
I haven't done all the arithmetic, but my gut says you will end up assuming that people in the "young" bucket are all essentially immune to severe forms of the disease. This is at odds with evidence in e.g. France, which would indicate a problem with your assumptions.
Sorry, where do you see that in [0]? Table 3 has a pneumonia diagnosis but isn’t broken down by age, Table 1 is broken down (somewhat) by age but only differentiates between nonsevere and severe “disease”?
If you look in methodology (search for severity), severity is defined by severity of the pneumonia according to American criteria. So these columns refer to how bad the pneumonia is.
Well, good luck?
[1] https://www.nytimes.com/interactive/2020/03/13/world/asia/co...
Also UK: People won't react negatively when hundreds of thousands of people die. Keep Calm and Carry On.
The only thing which they should have done is delayed a decision on this. They are a few weeks behind other countries, and could have observed effectiveness of social distancing in arresting spread. If it worked, it could be copied (ina modified form) and if it failed, it would be much easier to sell to the public. Currently it’s a brave (but likely correct) position it would seem.
But then again, what do I know. While I’m a doctor, I’m No specialist so my opinion is of limited value, and experts seem to disagree with each other. This is what makes this so difficult, no one seems to know what is the best option this current data.
Containment has worked in Wuhan. Containment is being attempted after-the-fact in Italy. Containment is possible, it's just a matter of how extreme gets. But even the most containment does not look the hundreds of thousands or millions dead that letting everyone be infected looks like.
I don't think anyone knows for sure what strategy is going to work best in the meantime, considering experts disagree and the world is conducting a massive A/B test...
A variety of the world's diseases are controlled by testing and surveillance, not by cures - TB, for example.
Most viruses aren't as infectious as this one is, comparison to TB or even previous SARS viruses doesn't work for that reason. You can track people down by them expressing symptoms, then test them, then isolate them and it works. That hasn't worked so far with this.
Except in Hong Kong, Singapore, Taiwan, or (more arguably) Japan. And South Korea, while they had a rougher early outbreak, seems to have gotten a lid on the disease now.
That's not really correct. Containment certainly can work. Whether it will or not is still an open question. Right now no western country has been able to match that. Italy, Spain, France and Germany are probably out of time to try. But the UK is still relatively early on its curve.
So, for that matter, might the UK "infect the herd" trick. The science isn't unsound, though it's not nearly certain. So the risk management is just crazy and I can't understand it either. But... it really might work.
And how long can they keep strict containment in force, and what happens when it lifted? You're speaking as if China or SK are now magically immune from a second wave as soon as they relax their restrictions.
In this case the science is flat out unsound: There are several coronaviruses known to infect humans. None are known to result in lasting immunity, and some are known to not result in lasting immunity. This is one of the challenges in making a vaccine.
Given the observed hospitalization rates, many millions in the UK will require hospitalization due to corona. At the moment, their hospitals could support merely thousands. We know from other cities that the mortality rate (particularly among younger people) is dramatically higher when adequate medical care is not available.
Under the UK's argument, the worst outcome of aggressive mitigation is that you are actually successful at it and achieve containment which just shifts the infection later in time at a high economic cost. Given the existing known infection rates in the UK that seems unlikely at that point, but even if it were to happen it would provide time to ready treatment facilities and allow for the discovery of more effective and/or scalable treatment techniques.
Fortunately, the UK has been backing off from its initial position and has now been recontextualizing their position as 'mitigate as much as possible'-- which is what pretty much all of the west is doing.
Time is vital.
Given the state of modern politics, this is a time for people to very carefully consider their opinions, because the unpopularity of Trump and Boris is going to potentially sway decisions irrationally. This includes professionals and key decision makers.
This is not a value judgement regarding any world leaders. It's just a call to be very aware of bias and spitefulness can cloud judgement even in the most rational among us.
The person is making a fair point, but cocking it up a bit.
It is very hard to avoid thinking of it this way but: what happens if a vulnerable person fails to isolate, for whatever reason (stupidity, ignorance, accident, etc)? Is the blame on them? They were told to protect themselves and they failed, so it's their fault?
if I think of it this way it very much sounds like the UK government is planning to just er, wash its hands of vulnerable people and refuse to take any responsibility for their fate.
France reports that half their patients in critical care are under 60, which is supposed to be the "low risk" group.
In the Netherlands there are between 40-50 covid-19 patients in ICU in critical condition. Over half of them are younger than 50. (Youngest is 16yo)
Mortality is much higher for the older group, but hospitalisation happens a lot in the younger age group as well. Obesity is a high-risk factor.
A comment in the reddit post[2] which discusses that article notes that in China the 15-49 age group made up 41% of severe/critical cases.
(The below 50 age group accounts for a bigger part of the population to be sure. I see no data for hospital admission rate as fraction of the age group.)
[1] http://www.ad.nl/dossier-coronavirus/40-a-50-nederlandse-cor...
[2] https://old.reddit.com/r/Coronavirus/comments/fj1owh/over_ha...
There are no facts anymore, because nothing and nobody can be trusted.
Herd immunity will be hard, since antibodies for coronaviruses last only about 4 months.
Even the strictest quarantines possible in the West don't compare to the mild quarantines in the East. The laws don't allow for contact tracing with GPS coordinates and credit card purchases, like they do in Singapore.
Quarantine methods put selective pressure on the strain types that are more infective and severe, since such mutations and recombinations are the only ones able to escape quarantines.
So the plan seems to be to turn this into a community virus, much like herpes or HIV. Then the selective pressure is for the mortality rate to drop and the disease becomes manageable. It would seem silly to damage your economy with heavy quarantine methods when local community cluster spread continues to pop up.
Of course, the UK government can not come out and straight up say this, but they seem one of the few governments that is realistic about facing this virus and its impossible to contain infection rate. I am guessing they ran the numbers from the Italy quarantines and based their decision on that.
Mind sourcing this? This seems the exact opposite of what I'd expect. I'd expect quarantines to s left for milder strains that are harder to detect.
Harder to detect I would see in a strain that has a longer asymptomatic spread period. The only way for a virus to escape a strong quarantine and survive is to survive on surfaces longer, be asymptomatic longer, cause more severe illness (spread through cough and sneezes, especially in hospitals), linger in the air longer, etc.
on the contrary, more sever illness makes it less likely to spread, no?
You are always spreading germs around, if you have high fever or start coughing blood you'll get isolated but if you just have a runny nose you will keep living normally and the virus will happily keep infecting other people when you shake hands.
Community viruses mutate to see a lower mortality, severity, and infectiousness, since there is no selective pressure to have an r0 much higher than 1. For a community virus there is also no selective pressure to mutate to a vastly different strain, so the antibodies for other strains don't help, whereas if the virus is confined inside a city like Wuhan, the only way to reinfect is to mutate to a vastly different strain.
Sources? And if so why?
> This is because coronavirus antibodies do not last for a long time. Also, the antibodies for one strain of coronavirus may be ineffective against another one.
> The general trend of IgM peaking at ≈1 month after symptom onset and IgG peaking at 2–4 months was consistent among different studies.
- Article on SARS-CoV https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851497/
- Article on Coronaviruses in general https://www.medicalnewstoday.com/articles/256521#symptoms
It's probably not a good idea to make concrete assumptions about a specific virus from the family it belongs to. A good place to look when starting to characterize, not necessarily a complete guide to how the virus will interact with our immune systems.
The coronaviruses that cause colds (such as CoV-OC43) don't mutate much. Immunity to them doesn't last long for reasons that aren't well understood.
Some other viruses that cause colds escape immunity through mutation, other non-CoV cold causing viruses escape are like CoV and also just have short immunity periods without mutation.
https://www.theguardian.com/news/2017/oct/06/why-cant-we-cur...
I don't understand this.
We just saw what looks like containment in China and South Korea who the WHO praised for their response.
> estimated projections of as many as 96 million cases in the US, 4.8 million hospitalizations, and 480,000 deaths associated with the novel coronavirus.
All Western countries moved to fase 2 of epidemic control: Stop testing and contact tracing, since you have many many clusters of local community spread and no idea where it is coming from. They are hesitant to come out and outright say it. Some do, but not with permission of their superiors:
https://nypost.com/2020/03/13/ohio-health-officials-believe-...
Mild cases continue to spread, and don't self-isolate, because they may not even realize they are infected.
China and South Korea have laws that allow for containment: If you message your friend on WeChat and say you have a cough, then you can expect a visit from the Chinese containment crew. If you buy cough syrup in the drug store with your credit card, then South Korea health officials know this.
Containment is pragmatically impossible with an r0 > 2 in the West. Just slowing down is possible.
Western countries likely have laws already and even still it isn't hard to pass new emergency, sunsetting ones.
Australia, NZ, U.S., Italy, they all see sustained local community spread. Australia is still exponentially increasing. Shutting down flights when there is local community spread is show politics, something to point to afterwards and say: We took decisive action. It is purely symbolic.
Sure, U.S. could pass emergency law and use their military surveillance systems to track, tag, and contact trace all of their civilians, as if they were Chinese spies.
But is this desirable in a free society? And what difference does it make when there are 100.000 infections in a single state, of which you will miss a 100 and start all over again 2-3 weeks later, but now with 99.900 angry citizens with guns?
One of the reasons that SARS-CoV is deemed a useable bioweapon is exactly because isolation security methods are very expensive and invasive at scale. The cultural damage would be enormous if people receive letters from the government after they had a private chat on Facebook about symptoms.
Not sure why every country couldn't do the same to isolate incoming infections.
This isn’t really tenable if you want a functioning economy, and cases will slip through.
And it seems a pretty common sense preventative measure since a 14 day quarantine isn't too onerous.
(LOL in Norwegian)
Quoting the article:
> The UK should not be trying to create herd immunity, that will take care of itself.
That's a clear blatant lie.
UK is NOT trying to create a herd immunity. UK is trying to flatten the curve. And UK is admitting that 60% population will get invected. And then the UK will get herd immunity.
For example, it is explained (again) in this video: https://www.youtube.com/watch?v=2XRc389TvG8
Feel free to downvote, that's a popular sport here on HN.
They've pulled back a bit from it because they've seen the vehement public reaction to it.
Cummings may well be evil, but he's not stupid.
They did not.
I watched an hour long full press conference by PM and two adisors.
https://www.youtube.com/watch?v=xRadMzCKnCU
I also watched an hour long Chris Witty Q&A for MP following day.
https://www.youtube.com/watch?v=IfJcwDaZrsA
Both of these talks were about flattening the curve because of NHS capacity etc etc.
The scientists mentioned herd immunity couple times, but not like they are intentionally trying to create it. It was rather like: herd immunity will happen in several months.
> Cummings may well be evil, but he's not stupid.
Likely he got his information from dishonest journalist articles and started self-promotion.
But it's a shame that smart people on HN continue to retransmit this fake.
So Germany, with twice as many hospital beds, gets 2.4 days extra of reaction time.
Exponents are terrifying.
People can agree or disagree with the British government's logic. Only someone very biased would treat it as inherently absurd.
So let's look past the headline at what this guy is actually saying.
He starts this piece by asserting his authority as an expert. But he isn't revealing any new information or critical analysis that would change anyone's minds. In fact as you read further down you find he's actually agreeing with the government's policies.
The key points of the article are:
• Herd immunity will happen anyway and shouldn't be a goal.
• A second wave may or may not happen, it shouldn't drive policy.
• Be like South Korea and close everything for an unspecified period of time.
• Close the schools! But keep children away from Nana and Grandpa.
The entire article says nothing that hasn't been said elsewhere; the only benefit this guy's epidemiology experience seems to add is credentialism. But there are also major logic problems in the argument.
Let's start with his last point about children and schools. He obviously realises children shouldn't come into contact with grandparents, but fails to apply the common sense knowledge that many parents can't stop working to take care of them e.g. because they work in the healthcare system, or logistics, or grocery retail, or pharmaceuticals, or government, etc. So those children will all go to their grandparents, assuming they have some: the one place you don't want them to be. This is a point the scientific advisors to the government made in their announcement press conference but he fails to address it. Children need to be kept away from grandparents and in the presence of young, fit, healthy adults. These conditions can be found in schools.
He says:
Second waves are real things, and we have seen them in flu pandemics. This is not a flu pandemic. Flu rules do not apply. There might well be a second wave, I honestly don’t know. But vulnerable people should not be exposed to a virus right now in the service of a hypothetical future.
The belief a second wave is likely has nothing to do with how flu-like the virus is. Saying flu rules don't apply is a non-sequitur. Second wave is a simple observation based on the fact that stopping infected people coming in and out of the country isn't possible, nor will it be possible going forward. International travel isn't going to remain shut down for long, which means even if the government could somehow wipe out COVID-19 purely via social control policies, it would come back the moment those measures ended and normal life returned. The only way to stop it permanently is if most people are immune so it can't spread.
Also, just saying "this might or might not happen, who knows" is a poor basis for policy making. This guy is an expert, where's the probabilities?
He says:
The UK should not be trying to create herd immunity, that will take care of itself
But the UK isn't "trying" to create herd immunity. What would that involve, actually? Encouraging chicken pox style virus parties? It's not doing anything like this.
Believing that requires an especially bad-faith reading of a (perhaps poorly phrased) statement by a fellow scientist. The goverment understands that herd immunity is going to happen sooner or later, it's the only way to end this, and that's why reaching it with as few fatalities as possible is the stated aim.
Finally, his recommendations are useless. He just recommends social distancing and shutdowns without any time frames attached. Does he believe people can self isolate and schools can remain shut indefinitely? If not, if he believes these measures don't last for long, then there is a question of when the optimal time to deploy them is. And trying to answer that question is how the government arrived at its current policy.
I have to say, reading this makes me glad the government has better scientists than this guy advising it. Maybe Dominic Cummings is onto something after all.
You are implicitly believing that those measures can last for a long period of time if implemented right now. The government is arguing that there are inherent limits to how long that can go on for and that if they must be used at the right time, when more people are infected than at the moment.
The author of the article makes the same mistake. He writes as if social distancing is something you just switch on, and then the outbreak ends. There's no concept that normalcy must return, and so that there's some kind of planning involved in when and how to ramp it up/back down.
$ grep bed https://news.ycombinator.com/reply?id=22591395&goto=item%3Fid%3D22586451%2322591395
that there aren’t enough hospital beds to support a country that doesn’t aggressively and ruthlessly implement social distancing and contract tracing right now
$
Look, the key point here is neither you nor the author actually know to what extent "aggressively and ruthlessly implementing social distancing right now" will impact the need for beds, that concept isn't well defined. And you are still ignoring that such measures can't last indefinitely.
OK, so everyone is put under total curfew right now and shot if they're found on the street. The spread slows then stops. After a month life starts getting back to normal, and then case numbers start shooting up again. What then?
The optimal position is for every bed to be taken all the time, as that way the curve is flat at exactly the right point to get everything back to normal as soon as possible by having people build up immunity. We all have no idea when the right time to start asking people to hide in their homes is, or even if asking everyone to do that is a good idea. But we can be pretty sure it can't last forever and the right time for people to be isolating themselves is when most people have it, as that way they're getting sick and recovering at home. It's not at a time when most people don't have it and the home stay does nothing but put off the inevitable for a few more weeks.
1. You can't shut down the economy indefinitely. At least not if your goal is to minimize fatalities. And if you don't do that, your "quarantine" is not going to be effective
2. You can't maintain quarantine for more than a month or two, after which your epidemic simply re-starts, and you don't get to re-impose the quarantine then because the first quarantine "failed".
3. Vaccine is over a year out in the best case, assuming it works at all. If it's anything like the flu vaccine, chances of it working reliably on mutated strains are approximately nil.
4. Younger people tolerate the disease much better, and if they build up immunity to it while the senior population self-isolates, the overall number of deaths could be minimized.
5. Due to how widespread and virulent this is, it will just become the "new flu", and it will come back with mutations every year. We can't do what we're doing now every year, at least not if the goal is to minimize deaths.
2. China did.
3. So then there isn't any point to herd immunity.
4. Only younger people who are in good health. There are many disabled and sick young people.
5. It could be the new flu. Or it could be like SARS/MERS.
#3: there is: if 60-70 percent of people are equipped to kill the virus, it's the best "quarantine" imaginable for people who are at risk
#4: those who have comorbidities could also self-isolate; it's still much better than telling _everyone_ to self-isolate - that's simply not going to happen unless you weld people's doors shut
And as we've seen in Italy it's absolutely possible to have everyone self-isolate. You just police it.
+ treatment plans not well understood, but evolving rapidly
+ not enough face masks
+ not enough sanitizer
+ not enough test kits to identify and isolate outbreaks
All four of those elements are absolutely critical to controlling the virus, and all 4 will be in a much better place 30-60 days from now than they are today.
If you want to go the route of herd immunity, do so when you are at appropriate levels of preparedness.
1. while I'm also skeptical re vaccines, we might well have more effective medical treatment options in a few weeks or months. There are a whole range of different phase 3 trials happeninig right now, some of which have shown anecdotal promise, esp Remisdivir.
2. We learn something new about this disease on a daily basis, meaning that in a few weeks we have diff picture of who exactly is most vulnerable (e. g. folks on ACEinhibitors, or we find ACEi actually are protective and ARBs are an issue etc etc
It's not a binary choice between life as normal and total shutdown. The whole discussion is about reducing non-essentials to slow down the spread, so the health system can cope with the demand spread over time.
> 2. You can't maintain quarantine for more than a month or two, after which your epidemic simply re-starts, and you don't get to re-impose the quarantine then because the first quarantine "failed".
Again, not a binary situation. Given the degree of individualism and freedom, that's unlikely to work anyway.
> 3. Vaccine is over a year out in the best case, assuming it works at all.
Agreed
> If it's anything like the flu vaccine, chances of it working reliably on mutated strains are approximately nil.
While this is likely -- I'm not an expert, so I'd rather refrain from such categorical statements.
> 4. Younger people tolerate the disease much better, and if they build up immunity to it while the senior population self-isolates, the overall number of deaths could be minimized.
False dichotomy -- younger people can still be better protected by reducing non-essential contacts.
> 5. Due to how widespread and virulent this is, it will just become the "new flu", and it will come back with mutations every year. We can't do what we're doing now every year, at least not if the goal is to minimize deaths.
That's right, but counting primarily on herd immunity while neglecting other measures does NOT minimize deaths.
Neglecting what?
There's widespread information in the UK concerning symptoms and self-isolation, huge changes in working patterns and people undertaking their own 'social-distancing'.
Information on hand washing is pretty much universally understood and huge numbers of events have been postponed or cancelled. Ordinary citizens, businesses and events are undertaking huge changes. Sports, music and other events are postponed or cancelled for example, and a large percentage of people are looking to work from home.
I have a wide network of friends/former colleagues as a by product of work/charity/previous careers/family spread across a huge swathe of jobs/life in the UK. Massive amount of planning and preparation is taking place and there are huge changes to peoples everyday lives.
Just because a Government hasn't mandated a lock down doesn't mean nothing is happening or people are walking around licking handrails on public transport because there is no threat.
In another interview with the BBC, Sir Patrick said: “If you suppress something very, very hard, when you release those measures it bounces back and it bounces back at the wrong time.”
He added: “Our aim is to try to reduce the peak, broaden the peak, not suppress it completely; also, because the vast majority of people get a mild illness, to build up some kind of herd immunity so more people are immune to this disease and we reduce the transmission, at the same time we protect those who are most vulnerable to it.”
Source: https://www.ft.com/content/38a81588-6508-11ea-b3f3-fe4680ea6...
So this means letting natural selection do its thing.
It is fine to state this is risky, it is. It’s unproven, also true. However the methodology is not survival of the fittest (do nothing). Don’t miss label.
> Herd immunity is not our policy, it's not our goal. Our goal is to protect life. I want to be absolutely crystal clear that we will do what is necessary to protect life.
How many people are going to die from other causes, if we shutdown entire country for 6 months? How many of those will be children and young people?
It may sound harsh, but as a younger person I prefer this plan.
Coz you need to balance out infections and with that manage them, so you will see periodic lockdowns in some parts to throttle back infection and also those most at risk will see themselves issolating for months and however you do things, you want to be doing that anyhow.
So infect, isolating those who high risk and letting others carry on and manage infection rate with hospital numbers as you will get risk people getting infected anyhow, so focusing on managing infection in those you can and getting it out the way, has logic behind it. yes people will die, they are not flowing that up, but equally, they are planning for those longterm to be lower than falling victim to the seasonal waves ala spanish flu and how that went.
Yes it does seem harsh, but as an older person it is the best plan for the whole and I'm high risk.
also, if bojo wants to ask old people to stay home for 4 months in a couple weeks, why not ask them now to stay home for 4 and a half months? not enough dead in the calculation or what?
But if you have a solution to how an entire country can completely isolate and operate in today's times for any European sized country then I'm all ears to hear it as we are talking a year at least until any sort of vaccine is available.
As for `super spreaders` that's a given, just the same way Europe has easy access to heroin and cocaine that are all imported - you can't stop things spreading even with best intentions and efforts and viruses are much smaller than smuggled drugs. So given that, people who spread this will happen and how would you ever stop that? Sure isolate from the vulnerable and at risk and those groups are already on the case, heck the amount of old people I know and saw 2 weeks ago buying a years worth of toilet roll - well, they are already self isolating and no need to be told by some PM they may or may not respect when they have a lifetime of common sense and experience to draw upon and effectively kick into war-mode mentality lockdown. Though many will learn that over the comming year as this is a world war, only it's the entire world this time fighting a virus. Looking at how the spanish flu went, the real fear is not the hear and now, but the winter to come.
These cool (and callous) calculations will be forgotten the second the hospitals get overwhelmed and there is chaos everywhere. When the country is on fire, the government will be pissing on fires.
Cool calculations involving the facts that people will die, happen more often in many walks of life without being questioned. Kinda how insurance policies work.
If those calculations show less people die overall then how can that be bad - yes it's involving human life but you have to look at the big picture and not just yourself. I'm about 50% likely to die from this given my health and age, if I'm one of those stats that is in the death count, then so be it, I'll die I certainly won't be blaming the current planned approach by the UK and has much going for it, time will tell but hey - worst case We are an Island so you can all set up navigation warning buoys if it all goes pete tong (sorry British Humour included and slang "pete tong" sames as going pear shaped, going wrong...).
More testing = lower mortality rate.
The alarming mortality statistics from Wuhan and Italy turned out to be extremely high due to lack of available testing and mild cases that were never reported.
Statistically there are likely already thousands of unreported cases in Seattle, but nobody can get tested. If you have a fever, people are being asked to stay home and not go to the hospital at all. So they’re not even counted in the official numbers.
Source? You're ignoring the fact that the number of deaths lags behind the number of people infected, which means the numerator is also being underestimated. Assume people either will/will not die three days from diagnosis. Then the naive case fatality rate is (for small t)
CFR_naive = [D exp(t - 3)] / [I exp(t)]
CFR = CFR_naive * exp(3)
Do you mean that the limiting factor is e.g. ventilators and that these countries haven’t exhausted their capacity yet?
Source: https://yougov.co.uk/topics/politics/articles-reports/2019/1... (And anything else I could find by googling gives similar stats)
The government may not be moral, but I don't know if any government makes plans for losing election in a landslide. Is there something I am missing here?
I certainly hope "how can we avoid our voters dying and kill of those of the other party" isn't a factor in the decisions.
At the very least it's morally repugnant. The majority of the politicians are in vulnerable demographics, so at least they'll pay the price like everyone else.
That's a false dichotomy: GDP is correlated with life expectancy, so you can't really choose one without the other. It's a question of which method saves more lives in the long-term, and UK appears have made their choice. Note that they most likely have much better understanding of the resources and capacity of NHS than U.S. scientists have.
The number of ICU beds and respirators in the UK is public knowledge. It's also enough for less than 1% of the tsunami of cases I expect to swamp the NHS over the next sixty days.