Once testing becomes widespread enough that it's feasible to test a lot more people it's quite plausible to relax the restrictions. One big problem before the recent "shelter in place" state is that community transmission by asymptomatic people was/is out of control.
If only strongly symptomatic people are "allowed" to be tested and health care professions aren't tested, it's basically impossible to restrict spread of something as infectious as covid-19. And once people with a lot of contacts have it, and stay in contact, further spread will obviously accelerate.
If you look at the buildup of test capacity in the US (far far to late obviously), it's improving at a decent rate (from a totally embarrassing starting point):
https://covidtracking.com/us-daily/
(there's a lot of differening sources, several lagging, but the trend is similar afaictl)
So there finally does appear to be some serious and successful effort in building up test capacity. Testing everyone in the US seems far off still though.
Given the rates of hospitalization and available beds / respirators, it'd however be insane to rely on testing at this point. Spread would be far too fast, and there's obviously not enough testing.
But if infections slow down due to the isolation, and testing ramps up at the same time...
Anyone who has had the disease and recovered can afterward go about their life again, as they cannot (for at least a few months, if not longer) be reinfected or spread the disease.
https://qbrc.swmed.edu/projects/2019ncov_immuneviewer/
That's the chain of mutations for SARS-Cov-2 they've seen so far.
[1] https://news.cgtn.com/news/2020-02-20/China-leverages-techno...
I read it more as a "Shut it all down please, then let's figure out which parts we can start to re-open in 4-6 weeks" order.
It's the equivalent of firebreaks in forest fires. We know it's there, let's prevent it from spreading where/when we can.
To me it seems like social distancing (“lowering the R0”) can delay propagation but has no effect on the underlying infection rate. It’s hard to see how we are not “delaying the inevitable” with social distancing.
Can anyone clarify this? Sorry if it’s been asked multiple times.
it seems this virus dies in a few hours/days outside of a cozy host environment. so yes, get the transmission rate down far enough and it can die out.
It seems the most logical conclusion is that we’ll end up in a situation where the most vulnerable segment of the population remains self-quarantined at least until a therapeutic treatment becomes available, which could be over a year.
I have a very hard time imagining people able to do this.
more to the point, epidemiologists will eventually reach concensus that the infection rate is under control (close to linear, R0≈1, i imagine). most 80+ year olds might need to stay cautious for the rest of their lives (depending on both the actual epidemiology and treatment/prevention options we develop), but that's true of a wide array of threats, like cancer, heart disease, or even just falling.
so basically, it depends on your risk tolerance once we have enough information to determine the actual risks of dying (vs the guestimates we have so far).
But it’s a bit discouraging if this is the only benefit of flattening the curve. So we are all gonna get sick, but in an orderly fashion? And the mortality rate is unaffected?
All of us getting sick in an orderly fashion has a huge benefit even if it turns out that’s the best we can do. But perhaps we flatten the curve for long enough we buy time for treatments to come online and to get closer to a vaccine.
Yes you want to get sick, but the old fashion way. The way I think of it - if we get sick with healthcare services or without.
With healthcare services intact, I likely won’t know anyone who does from covid-19 (1/200, 50% infection rate, 1% fatality).
Without healthcare services I’m likely to know at least one person who’s died. (1/20, 50% infection rate, 10% fatality).
The more we flatten the smaller the denominator.
Nitpick: bigger (20 -> 200).
Also, while a vaccine is far, medication might be nearer. So buying time is essential, beside not wasting that time.
the embarrassing point is that in the US, isolation is the only effective tool at this point. it's embarrassing because ramping up testing was what South Korea did, and they started much sooner, and that's why they are over the hump now. the US simply doesn't have the testing scaled up.
https://www.reuters.com/article/us-health-coronavirus-testin...
https://www.usnews.com/news/health-news/articles/2020-03-10/...
Korea and other nations in the area took it seriously due to their proximity to China and previous recent experience with infectious disease: HK experienced SARS, Korea experienced MERS.
and
"US chose to design its own coronavirus test"
Yeah no. Not remotely. It was dead obvious. I think you're underestimating the influence a call from the head of the executive branch has. This was easily fixable weeks earlier.
They traced the chains of the infections and quarantined everyone until they were tested clean. They found new chains through sick people who were tested.
Without investigation and tracing the chain of infections, you can't contain it through testing alone.
And the fact that were was an undetected outbreak in the west coast of the United States for several weeks probably made containment impossible, even using the South Korean model.
These discussions are so far divorced from the reality of the interventions available to policymakers.
If it costs tens of billion dollars, so be it. That's far cheaper than shutting the economy for months at time.
This is essentially a war-time effort we are in. I believe government has the authority to mandate that companies with relevant manufacturing capability build and sell these machines in order to combat the virus.
However, sufficient availability of supplies and equipment for this scale of operation is a pretty big if.
Also need to give our healthcare workers time to mobilize all their emergency measures to handle surge capacity. I'd imagine the Bay Area is about 2-3 weeks away from its peak number of cases given the quarantine just started last weekend.
[0] https://twitter.com/jasonfried/status/1240818423795515393
Frankly, I expect in 3 weeks people won't need the order because it will be like Italy and people will be terrified to go outside. But at that point, you STILL have 3-4 weeks before things turn around.
Also consider the asymmetric knowledge here. The people in power surely know things they aren't telling you. Destroying the economy is not in their best interest. How bad must it have to be for them to be willing to destroy the global economy and potentially their own fortunes and power structures?
People treat this like a binary choice between “save the economy” and “save the elderly”, but if you’ve been following this at all it’s clear that there’s no simple answer in either direction.
We didn't shut down. We stopped doing what's unnecessary.
There's a big difference, and now that reality has made us "wake up" we should probably reevaluate how we structure our economy and society.
It's also hard to imagine that couples who live apart are actually going to stay away from each other until the vaccine.
China is down to zero cases. South America except for the two black sheep (Mexico and Brazil) is shutting down (Peru had curfew-in-place since the weekend; anyone even driving their car outside is arrested). Europe is also going there, plus Israel, several Arab countries, etc.
Only big black sheeps right now are the US, parts of Europe, India, and Africa (which is only now getting their first wave).
Zero own cases, they still have imported cases. And that only means no cases that are symptomatic.
And zero cases just means zero cases now not in the future.
This thing spreads like a common cold. More infectious than a flu. You can't suppress common cold.
Not forever.
Humanity never eradicated a disease without a vaccine.
SARS within the last 2 decades? Look, I think eradication is a pipe dream at this point, but it'd be worth mildly checking your facts before posting.
e: If I'm getting flagged, at least tell me why?
I could be wrong but that's how I remember it.
I think we don't get human cases because jumping to humans again is quite hard for SARS.
Seems to me that the virus that can spread among humans is a different version than the one common among the animal population.
I think so:
https://www.who.int/csr/don/2003_06_19/en/
> Seems to me that the virus that can spread among humans is a different version than the one common among the animal population.
Not necessarily. Ncov that spreads in humans came to be in bats and skipped effortlessly to other species including humans with no meaningful changes.
What about places with wars going on... Syria? Yemen? Afghanistan? What about places with no functional government (which I will decline to list to avoid pointless arguments)?
It doesn't need to be a big black sheep to re-introduce this... it only takes one case.
https://www.nytimes.com/2020/03/17/world/asia/india-coronavi...
Excerpts:
The authorities used GPS technology, CCTV footage and mobile phone records to trace the movements of one Indian family believed to be among the first infected here. They returned from Italy in late February, and within days, medical teams fanned out to all the places they had visited including banks, restaurants and churches and quickly quarantined just about everyone they had come in contact with — nearly 1,000 people.
India was also one of the first nations to essentially shut its borders, canceling visas and denying entry to all but a select few foreigners. Some states, such as Kerala, are beginning to beef up internal borders, taking the temperature of passengers in cars and screening people on trains.
Do you think their poor can eat if they self-isolate? If you are hungry then you keep working, you have few choices to avoid social contact, and you have few resources to help you if you are sick.
Do you think India has the capacity to test enough people to effect efficient blocks against transmission? Do you trust their bureaucracy to mostly act decisively and effectively for the majority?
Do they have the social mores to cooperate with rules to prevent transmission? (I’m not judging, I have some very conscientious Indian acquaintances, I’m just unsure about the population on average).
At least they will have some medicine - they produce a lot and they stopped exporting many drugs on the 4th March.
What about the hundreds of thousands or millions [0] of illegal border crossings every year at the mexican border though?
[0] Naturally good stats for this are impossible to find, but in FY19 851,508 individuals were apprehended at the american southwest border [1]. It seems reasonable to assume the same order of magnitude of people successfully crossed.
> Sky News understands the [UK] Government has asked mobile network O2 to hand over anonymous mobile phone location data in order to ensure people are following social distancing guidelines during the COVID-19 outbreak
I suspect it's at least being discussed.
(I'm also skeptical that stopping illegal immigrants will be as simple as tracking phones, but whatever)
The US doesn't have even close to the necessary number of testing kits or infrastructure to test 300 million people. They're working on ramping up production and availability of tests.
I understand allowing reasonable time to complete trials, but let's not act like this is just a routine drug approval.
The unprecedented scale will allow more parallel efforts, to the point that the odds of a viable vaccine being available next year are much greater, but it won't speed up the minimum time.
There's already a plan in place, and most people don't know it but there's already a timeline. At this point testing people is useless: hospitals already provide numbers to the government.
I don’t think it would get quite that far, though, because once people start literally dying in the streets, people will be afraid and massively self-quarantine. So... maybe four million dead and the economy completely shuts down anyway.
Really, the quicker and more aggressively we jump on this, the less the damage, both in terms of human life and economic impact.
We’re too late to have a small impact. We’ll feel this for years. Let’s at least try to make something we’ll forget in a generation. Let’s especially make sure we don’t have something they’ll be talking about hundreds of years from now.
It is much, much more comforting to have a plan than just hunkering down and waiting your turn to find out if you will live or die.