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Comment by henryfjordan | Hacker News Reader

Garcetti, the Mayor of Los Angeles, covered this in his address last night.

We are buying time to get more tests, more hospital beds set up, more ventilators, more medicine. The Navy is talking about turning Aircraft Carriers into hospitals. China is getting things under control and switching factories to produce medical supplies. It takes time to build these logistics chains, and we are buying that time by slowing our economy down and implementing social distancing.

I agree that this information is not well-circulated right now.

EDIT: another commenter posted this great link which I will also share: https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-th...

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Thank you for this resource. Incredibly well researched and presented.

Those are linear increases for an exponential disease. The time-buying has to be for something new that battles the exponential: rushing a vaccine, finding an anti-viral, or figuring out how we can actually practice containment. (Testing availability is part of that, but we'd also need a tracking system.)

Replenishing the supply of masks, handing them out, and making them mandatory to wear in public places would go a long way to reducing the rate of spread, simply by changing people's behavior. I went out Tuesday for some errands (wearing a respirator of course), and it seemed to be business as usual for most people - very little distancing or concern about crowding.

Are you saying the masks are helpful to prevent contraction of the virus, or to stop the spreading of it from those who are contagious, but don't know about it yet?

They’re helpful for both, but even if they were only helpful for one, it’d still be worth doing.

They do both. But I was saying that at the very least masks would also remind people to actually keep distance from one another.

Masks definitely helpful to stop spreading it from those who are contagious. If they help prevent contracting it depends a lot on how disciplined you are at using them. If fiddling with a mask, you're more likely to contaminate it and yourself.

There is a very succinct explanation by Michael Osterholm [1][2] where he says that the virus is spread both by droplets & aerosols, and that sharing the same air with another person is the primary vector (that isn't intended to sound as alarmist as it probably does).

From what I understand the best prevention is to reduce face-to-face contact with other people where possible, but an N95 mask would definitely help prevent contraction in public spaces.

Of course, these measures seem extreme since ~80% of people will barely notice they are infected / have mild symptoms, but it's all about peak-load reduction.

[1]: https://www.youtube.com/watch?v=V1xBiBVH7U4 [2]: https://www.youtube.com/watch?v=E3URhJx0NSw&t=7s

Wearing a mask to prevent contracting it is like wearing medieval platemail to protect yourself against an M16.

It gives you very limited protection. There's no replacement for just avoiding people, 15 feet away from everyone.

They're mainly good for people who are infected to not transmit pathogens.

When doctors operate on infectious people, they wear hazmat suits. Full face mask, air filter and body condom. You can get a virus through your ears, eyes, mouth, nose, or microabrasions on your skin.

You can wear a mask, but I fear that people will start thinking it's anywhere near full protection. False sense of security is probably not worth even encouraging in a situation this dire.

Absolutely on board with both increasing availability and then making them mandatory. Along with gloves.

Masks are very hard to come by... that might be why it looks like business as usual? I'd love to get some myself, tips appreciated.

I disagree with gloves. Gloves may serve as a psychological signal, and they can be put on and taken off, but I haven't heard of hands being an infection route.

Several states fairly recently passed laws requiring food preparers to wear gloves. Then they backtracked when they realized that they actually decreased safety.

Hands are absolutely an infection route, by acting as a transport vehicle to your nose and eyes. Gloves don't change that fact though, unless it reminds you to not touch your face. (It does to me: I work with gloves and epoxy resin a lot, and I've developed a pretty strong reflex to not touch myself with gloved hands even though I do it all the time with bare hands.)

It was on NBC news two nights ago that the virus does not infect you through eyes or blood. It can only infect and replicate in the lungs. So only nose and mouth if that report was correct.

I have no idea whether this particular virus can survive contact with tears and make the journey, but your eyes drain into your nose.

My years in cleanrooms and a postdoc in a shared appointment in biochemistry have taught me to see gloves as contamination distributors.

It's literally not okay to be wearing gloves in a chemistry/biochemistry building when you push an elevator button.

Presumably that doesn't mean people forgo gloves in the lab though, right? The point is you get them dirty, and then you take them off.

You don't just "take them off". You carefully pull them off, inside out. And then dispose of them, as hazardous waste.

Yes, of course you remove and trash gloves to avoid contamination. I did biochemistry for years. We wore gloves to protect proteins in samples from our proteases, and to protect ourselves from radionuclides. When I labeled stuff with mCi levels of I-125, I worked in a fume hood, behind lead bricks, wearing a lead apron, and three layers of PVC gloves.

But I always tossed the gloves before leaving the work area. And usually I'd put on fresh gloves before removing the lead apron.

That wouldn't be workable day to day. You'd probably go through 50-100 gloves per day, doing it right.

I worked in biotech manufacturing with biohazards. 50-100 gloves/person/10hr day is about right.

I wore a p95 (similar in performance to the n95) today while shopping. I'm in the Midwest, and the number of looks made me think I had two heads.

My daughter is also sewing cloth mask using a pattern from https://www.craftpassion.com/face-mask-sewing-pattern/

I know these aren't as good, but they probably improve my chances of avoiding SARS-CoV-2 by at least 10% when I have to go outside. I plan on using them once, then leaving them in a bucket in the garage. Once I've used them all up, I'll wash them and by that time (and hopefully the detergent + bleach action), the virus will be dead.

> I know these aren't as good, but they probably improve my chances of avoiding SARS-CoV-2 by at least 10%

It's no better than avoiding personal contact generally.

Not everyone can avoid personal contact. Eventually you'll need to interact to some degree with others when getting groceries etc.

https://smartairfilters.com/en/blog/best-materials-make-diy-...

> Eventually you'll need to interact to some degree with others when getting groceries etc.

The main risk when getting groceries, unless people are coughing or sneezing in your face, is transfers from your hands, which a surgical or n95/r95/p95 mask does roughly zero to help with. (Now, getting everyone else to wear such a mask would reduce the odds of them contaminating something that would get on your hands, but that's not a benefit of you wearing mask.)

Please write to your political and opinion leaders to advocate this. If you need supporting evidence please consider my letter https://news.ycombinator.com/item?id=22641943

Social pressure can be strong.

When I went out for groceries this week (weekday late evening to avoid crowding) I was the only one in the store wearing a mask. Rationally I knew it was reducing risk for others but I still felt deeply uncomfortable being the odd one out.

Contrast this with places like Taiwan where a mask isn’t considered abnormal, and becomes a matter of course during times like this.

Same experience. I heard a few folks tell their kids "don't touch him" and kids ask why. I endure it because I consider it education to wake people up that the virus is here.

A mask does far more, comparatively, used by high-exposure or critical-service workers: medical staff and responders, retail workers. Those highly exposed and hard to replace.

For the average person, a mask likely is an individual benefit. But in a world with insufficient masks and asymmetric risks, social benefit, literally the health of the public, benefits most by limited and targeted use.

Distinguishing between personal and communal risk is critical here. That message has been poorly conveyed, even by ordinarily excellent communicators -- Zynep Tufekci comes to mind.

Yes, but fundamentally that's still just bargaining with the problem. If spread is supercritical, the hospitals fill up regardless of how protected healthcare workers are.

My comment was in the context of "what can time fix", which would mean supplying healthcare workers and everybody else with masks before letting up. Retail workers wearing masks would go a long way to creating some peer pressure to act differently.

A respiration device is complete overkill unless you are medically examining the person or in a confined space with people and highly vulnerable.

Catching a Corina virus with less than 15 minutes personal contact is very unlikely and it's extraordinary unlikely to be able to acquire a virion and get it to a host cell just walking past an infected perso on the street.

It's not even clear how infectious the surface to face vector is.

Italians and Spaniards running around kissing each other and rubbing cheeks as is their ancient custom likely has more to do with the issues there than anything

The time buying is to stop the exponential.

It does not stop the exponential spread - that ship has sailed. At this point, it just slows it down by reducing the multiplier - "flatten the curve".

Worse yet is that if we let the measures off, we just get the same curve later. A bit lower at peak, but still exceeding healthcare capacity several times (say, 6x rather than 8x, if we do a 5-month lockdown).

But this still saves lives - just not anywhere as many as we could have saved if we contained it. It also gives us a chance to build more hospitals, manufacture more ventilators etc - although it still won't catch up with demand.

The best endgame is that we either get a vaccine, or enough tests to test everybody, and then do targeted quarantine from there.

The "Best endgame" you describe is exactly the goal. We lockdown now so that we can buy time to get tests and tracing systems setup. Then we can start to open up everything again and control hotspots with aggressive testing and individual quarantine (as opposed to the blanket quarantine we are doing now). With good testing/tracing coverage, we can stop the virus from spreading exponentially for more than a few hops.

Also locking down everything DOES stop the exponential spread. That's the whole point. If you don't see other people, you aren't spreading the disease, reducing the rate of new infections. If each infected person infects less than 1 other person on average, we'll have stopped the spread. China and SK have already succeeded in this.

* If each infected person infects less than 1 other person on average, we'll have stopped the spread.*

This isn't exactly correct. It means that, eventually, the spread would die out even if there were an infinite number of potential hosts. But it's still spreading. If that number is exactly 1, ~everyone will still end up getting infected. If it's just a bit below 1, it will behave as a decaying exponential but will still take a long time to die out.

My point was that a 1-month or even 3-month lockdown doesn't stop exponential growth permanently, it just pauses it. A permanent lockdown would stop it, but it's obviously not sustainable.

And I wasn't trying to dispute your claim that the "best endgame" is the goal, merely clarify it - and also point out that even then, we will still see our healthcare overwhelmed, and a lot of people will still die because they will be rationed out of the system. People who wouldn't have died if we locked things down when containment was still realistic - so I consider them all preventable deaths that we have failed to prevent as a society.

To be absolutely clear: a lockdown is still our best bet, and the lives it'll save are worth it.

Slowing down infection rate whether exponential or not is good because it lets more time for medical system to prepare and because it spreads cases over long period of time.

There are two sides to an exponential. If R0 is >1, it just keeps going up. However, if R0 is <1, it just keeps going down. The point of the lockdown is to get it <1 so it keeps going down for a while, until the case counts are low enough that we can adopt a different strategy.

Including cycling lockdown on and off without me very reaching a caseload that causes collapse of the healthcare system until we get a vaccine, etc., to change the basic equation. But first we've got to get R<1.

Those things are happening too. Here's a summary of sixteen companies' efforts according to https://www.statnews.com/2020/03/19/an-updated-guide-to-the-...

- Gilead Sciences; remdesivir for treatment; currently in phase 3 clinical trials

- Ascletis Pharma; danoprevir/ritonavir for treatment; currently in phase 1 clinical trials

- Moderna Therapeutics; mRNA vaccine; currently in phase 1 clinical trials

- CanSino Biologics; attenuated vaccine; currently in phase 1 clinical trials

- Arcturus Therapeutics; hybrid RNA vaccine; currently preclinical

- BioNTech; mRNA vaccine; currently preclinical

- CureVac; mRNA vaccine; currently preclinical

- Eli Lilly; isolated antibody treatment; currently preclinical

- GlaxoSmithKline; vaccine adjuvants; currently preclinical

- Inovio Pharmaceuticals; DNA-based vaccine; currently preclinical

- Johnson & Johnson; attenuated vaccine; currently preclinical

- Pfizer; assistance with both vaccines and treatments

- Regeneron Pharmaceuticals; engineered antibody treatment; currently preclinical

- Sanofi; hybrid DNA-based attentuated virus vaccine; currently preclinical

- Takeda; isolated antibody treatment; currently preclinical

- Vir Biotechnology; isolated antibody treatment; currently preclinical

Most of these are in very early stages, but I'm optimistic that that speed of development of both treatments and vaccines will exceed the consensus expectations.

Could you explain your reasoning or evidence for saying “ I'm optimistic that that speed of development of both treatments and vaccines will exceed the consensus expectations.” or is it just a feeling?

Just a feeling. I used to work in medical device testing, so I'm familiar with the layers of regulation that weigh down the pipeline. Even in normal times there's debate about whether it's too onerous. But now a lot of that shit's going to be cut out. For example, Moderna is skipping the animal safety trials, and starting with phase 1 human testing straight away. They say animal testing will proceed in parallel if a special new breed of mouse is ready in time.

This, along with recent advancements in bioengineering will, I believe, lead to surprisingly rapid progress.

(The best current mouse models for human coronavirus are not very good; the mice are generally resistant to the virus, so it's difficult to determine whether a vaccine or treatment is working.)

Curious about this new breed of mice you mentioned - what's special about it.

We learned from the SARS epidemic that there are no naturally occurring animals that match humans in terms of receptiveness to the virus, direct symptoms, and immune-enhanced damage. Here are a couple of articles that explain better than I can:

https://www.statnews.com/2020/03/05/coronavirus-labs-scrambl...

https://www.statnews.com/2020/03/11/researchers-rush-to-star...

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