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Comment by crispyporkbites | Hacker News Reader

After 21 days, what happens?

Do we lift the quarantine? Relax it a bit? Stay in quarantine indefinitely?

What does the model look like for that? Without a full picture the initial strategy could make things worse in the long run.

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The lockdown must be kept until the health system can cope with everyone's health problems. Then, you slowly lift it to ensure it doesn't saturate again, as that would mean a need for another full lockdown.

How do you "slowly lift it"?

By lifting the most adversely impacting parts, and monitoring infection on a wide-spread basis while maintaining measures that lower the how contagious it is without negative effects.

> monitoring infection on a wide-spread basis

Temperature checks in every commercial, retail and residential building and mode of public transportation?

> maintaining measures that lower how contagious it is

Masks for all? Expecting 20 sec handwashing vigilance to stay indefinitely? Restaurant tables and desks at work kept meters apart?

I’m wondering what the new normal looks like and how well it will be implemented in western countries.

> Expecting 20 sec handwashing vigilance to stay indefinitely?

This is not the same as the other two. People should wash their hands properly regardless.

You shouldn't only call a cab after going out drinking, only because you know there'll be a checkpoint that night, right?

That may be true, but humans tend to get lax once the immediate crisis is over.

Right, I'm not optimistic that we'll learn the lesson. I hope I'm wrong.

First open restaurants for lunch. A few days later open them in the evening. Then later again, open bars. Then theaters. Then clubs.

You have plenty of things to lift slowly.

if you look at what happened in china, specific manufacturing hubs were opened first then slowly other core economic areas finally ending with travel restrictions being lifted. the aftermath is that the populace is still fearful of infection so movement is still limited and thus spread of infection is much much lower to almost nonexistant

First you allow all shops to be opened, then few weeks later open public places like gyms, museums etc, another few weeks later you open borders again, even later allow some mass events etc. After every lift you wait at least two weeks to see how much it increases number of new cases and you balance it so that healthcare system does not get overwhelmed.

Once you have large scale testing available, you can do heavy testing in a region to determine the risk, and then you can release quarantine on regions where there are no infections.

Control is much easier if testing is cheap and ubiquitous, and quarantines can start to become a lot more targeted as opposed to widespread.

That's what I'm asking myself too. It's way too early for any kind of herd immunity, and you only need a handful of people who have broken the rules (or simply due to delayed intrafamilial infection) to have a few infectious people back out in the wild, and we're back to square zero.

Is the plan for a lockdown to completely eliminate the disease? Are we hoping the heat of the summer will stop it? Or does flatten the curve really mean that eventually 60-70% of the population will get infected. If so, we're in for a rough 2020.

The numbers I've seen so far are assuming 40% to 70% total infections over the next several months.

The current efforts are just trying to take some energy out of the first wave of hospitalizations, to buy time for more supplies and staffing and to get the current infected out of health care as new cases come in.

After a few weeks, it may turn out that hospital capacity and more widespread testing allows some restrictions to be lifted. Or, it may turn out that the situation in the US is far more severe than expected, and the restrictions will only worsen by then.

I'm hoping for the former but betting on the latter.

Flatten the curve _does_ mean that 60-70% of the population will get it.

But it also means that the peak will be lower do that hospitals are less overwhelmed. It also pushes more infections later in time, so that we have more time to develop and deploy a vaccine.

Not back to square zero - you have the core of a new outbreak amidst wide-spread monitoring for it and a population that is generally practicing better infection control. So perhaps a few dozen are infected before the flames are doused again.

> Relax it a bit?

Looks like it will work like that. This may lead to some undetected transmission, but hopefully the amount of more serious cases should be low enough that the healthcare system will be able to cope. More severe measures can be restored quickly in areas where community transmission is detected.

It is a bit like comparing interest rates on your credit card balances while still spending more than you earn: we may not get much choice about what is done in 21 days, but we have to stop the bleeding now either way.

The difference between a slow and a fast outbrake is that the fast outbreak overwhelms the health system which has all sort of negative side effects, aside from more deads.

I know humans usually have a hard time grasping exponential growth, but you need to grasp it to understand what is going on. Exponential growth means that on one day you say: "This is fine" and only two days later you have to introduce the triage and send people home to die, because there is no capacity for them.

And even if you had enough beds — will you have enough healthy professionals to staff them? If they have kids will they be able to come? Who watches for them? Grandparents who have a ≥20% of dying once they got infected?

The idea of quarantine is a numbers game: slow down the spread enough so the health system (and amthe rest of civilisation) can cope better If you have no vaccine the only way to deal with this is reducing the chances for the virus to transmit. And you do that by not having people cough in each other faces, touch everything, breath everything in etc. or even more effective: don't have them interact at all. If we all would manage to perfectly isolate for two weeks the thing would be gone after that two weeks.

So until we will develope a cure at some point this is the only thing we can do.

China may be able to do regular lockdowns. I can’t see that happening in the west. Lockdown needs to be a one time shot at the right time, but getting the right time is painfully hard when there is no way to know how many have the virus but not yet testing positive or showing symptoms.

I keep hearing this, but why though? If cases start rising again after the end of a quarantine, I'm sure that there will be support in the community to go back in quarantine if it will save lives.

Didn’t work that way in the 1918 flu pandemic. No city kept the public health interventions going long enough to avoid a second peak in deaths after they stopped them.

Good point, and that's why you can't simply lift every restriction overnight. But the 1918 flu pandemic was literally over 100 years ago, I'd like to think we have learned something in the meantime about how to control disease outbreaks.

We did learn things and it caused us to develop a national health care infrastructure. Things have started to decay on that front over the last couple decades though, at least in places like the US which haven't had a SARS outbreak. It's almost like we have to relearn lessons every 4 generations or so, as the older generation dies off and we forget their experiences. Strauss-Howe Generational Theory, here might be our Crisis...

Not sure there will be - I've been scared of this since the New Year, and even I'm all too aware that I'm trading off _having a life_ so people over 70 with pre-existing conditions don't have a couple of years shaved off. Right now, like literally starting this weekend, it turned hip to say you're staying home. We'll see how that looks in 6 weeks, when there's no end in sight and mass layoffs

Please, for the love of God, give me the benefit of the doubt on this comment folks. I'm not saying it's right, only that I doubt this sedate state will persist, given the effects of said state.

> China may be able to do regular lockdowns. I can’t see that happening in the west. Lockdown needs to be a one time shot at the right time

People keep saying this, but I've yet to see any real argument or evidence. The WHO used to think that locking down entire cities or wide regions (60M people or so in Hubei alone) would be impractical in the West, but Italy managed it quite nicely and now other countries in the Western world are following along. Long-term lockdown is going to be the same thing.

sorry for spamming my own reply, but here's what 21 days after in China looks like: https://news.ycombinator.com/item?id=22587840

After the first wave self quarantining should be able to start ramping down

It just depends on the number of cases in your local area

This is calling for a full shutdown, not self quarantine. We’re talking checkpoints, military presence to ensure compliance, protected supply chains and rationing.

The model has to account for a long term strategy (6-12 months) to keep the mortality rate down and the global economy operating, or we open ourselves to even greater risks.

Lets be clear, the economy will not survive anything like that for even one month. We are desperately hoping that after 2-3 weeks herd immunity, better medicine and first wave passing we can reopen.

Herd immunity is what Italy is doing. I guess their economy is more severely impacted than South Korea's. I don't know.

I agree we need to follow South Korea. I said this is what we are hoping for, not meaning it is in any way a smart thing to do.

I don’t think the economy can survive 1-2 months in full lockdown. There are just too many vulnerable living paycheck to paycheck, and the financial system artificially boosted already and is ready to come crashing down.

I think it is impossible to speculate what will happen after that, but it looks like the big money wants this thing to go down from what is happening in the UK and in the US senate. Could be in for scary times in the west.

We can have a mandatory regulatory lockdown without draconian enforcement. Don't let perfect be the enemy of good.

Relax and eventually lift yeah, because you would've "starved" the virus out by not giving them new non-immune hosts to jump to.

That's the bit I don't understand. The virus jumped from a handful of infected people on a market in china to hundreds of thousands all around the world in a few weeks. Unless we eliminated 100.0000% of the virus, how will it not pop up again as soon as we lift the curfew?

at some point enough people have had it that we can get some herd immunity kicking in

Yes, but I don’t think this is what quarantine achieves.

quarantine slows the spread to a level the hospitals can deal with

Right now we don’t know if immunity lasts long enough for herd immunity to work.

Herd immunity = aka giving up and killing millions globally. Fuck that shit and arrest everyone who suggests it on crimes against humanity.

no you quarantine to slow the spread so you slowly infect everyone and the hospital system keeps up. then you release quarantine and boom herd immunity saves you. or a vaccine.

In pressure cooker environments, bacteria are known to mutate at higher rates. When we kill enough of a species, infections typical of that species tend to jump species.

We've never had 7 billion people on the planet before. I (very unscientifically) feel like this is turning global in a way that I haven't seen previously.

The world is in all new territory. I wouldn't count on things working like anything we have seen previously.

please calm down. the laws of physics haven't changed. we'll likely have a vaccine in a few years at worst. we survived the flu of 1918 without all this new-fangled technology.

please calm down.

I'm not being hysterical.

The laws don't have to change for them to work differently when conditions change.

We are in a situation the world has not seen before. I don't think you can realistically predict where this is going.

There's nothing hysterical or crazy about making that observation.

well the epidemiologists do think they can predict the course and make useful suggestions. South Korea basically beat this thing already. Meanwhile non-scientific beliefs that "things are different this time" are usually wrong.

Yeah, so, I think you are reading in something I never said. It sounds to me like you are hearing some doomsday prediction I never made.

All I said was "I don't think we can predict where this goes." That's it. That's my entire point.

And I don't know why you have such a problem with that.

The virus "jumped" because people were clueless about it, and missing even the slightest precautions. No washing hands, no wearing masks, no social distancing even among total strangers, etc. etc. There's no way this will happen again with the same ease.

I don’t know. The tube in London at peak hour looks like to me as an even better spreading zone than a school. Not much we can do about that.

> Not much we can do about that.

You can avoid packing people in the trains to that extent, for starters. Take temperature readings at all stations, so that the people with the worst symptoms (who are at the highest risk of spreading the virus) can be kept out. And spread out "peak hour" by having people enter and leave workplaces with flexible hours, while others just stay home altogether.

Shut it down, print money for UBI. It's only 3 weeks life will go back to normal afterwards.

I believe we are rather talking about 2-3 months

The incubation period is only 2 weeks, why would you need 2-3 months? Wuhan, the worst hit in the world only lasted about 5 weeks.

It's been 4 months already since early December, so not a few weeks. A few weeks is enough time to control a small spread, see Singapore or Taiwan for example for what great results can be achieved with diligent testing. You keep testing people aggressively and follow up on any positives. Contact tracing is enough to stop the spread if you do it early enough, and like I said, proof is in Singapore and Taiwan. The problem in the west is no testing so there's nobody to follow. RIP potentially millions for that failure.

This won’t work. The virus is in over 100 countries, some sufferers are asymptomatic and many have symptoms comparable to a cold. To make matters worse there’s already community transmission in every Western country I’m aware of. It’s too late for contact tracing to be a long term solution. The last time that was possible was when the virus was confined to Wuhan. This is going to infect 60-70% of the population in every country unless they adopt Israel style two week quarantine for all international travelers or North Korea style killing everyone who gets the virus, or just close the borders completely.

It's too late for contact tracing NOW. Contact tracing is the "relaxed" solution after we bazooka the virus with a quarantine such that the virus dies in 99% of current hosts. That brings the numbers down to a manageable level so that contact tracing will be effective.

We Pulse-Wide-Modulate a case rate that is just soo below what the strained public health system can take, prioritize the most important economic systems slowly back to life and hope that the vaccazines come just in time to end this nightmare.

After that reforms. Lots of them.

Fortunately, as time goes on we'll improve our ICU capacity and it's likely that some anti-viral treatments will turn out to be effective, which should diminish the ICU load.

We could within half a year-- given massive impact from deaths and shutdowns encouraging bypassing some amount of protocol-- have clonal antibody treatments that prevent hospitalization in a large portion of infections.

> as time goes on we'll improve our ICU capacity

This seems unlikely. On what timescale do you think this will happen?

Prioritize ‘the most important economic systems’ is very subjective, unfortunately.

Who decides the ‘winners’, as grotesque as that sounds?

I don't know, maybe the bits that keep the population fed and the lights on. That seems a start.

Ok, so restaurant supply companies, like Sysco, or the Krogers, Publix, etc.?

Linemen for powerline infrastructure, HVAC and telecom techs to maintain the cell towers?

Truck drivers to deliver chemicals needed for both water and waste-water treatment? Also, transporting the sludge afterwards?

Garbage pickup?

Doctors,nurses, police, firefighters, 911 dispatchers?

What am I not thinking of?

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