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Comment by chris_va | Hacker News Reader

It does beg the question, though...

If you can identify (maybe iffy) the subset of the population likely to required hospitalization, might it make sense to relax the quarantine to only that subgroup (and immediate contacts)? Building up herd immunity in the rest of the population once hospital supply lines are robust might be the best way to unwind the existing rules. With any exponential there is going to be a crunch no matter how things are done, so unwinding in risk order may be optimal.

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> Building up herd immunity in the rest of the population once hospital supply lines are robust might be the best way to unwind the existing rules

Have you been out in public in the USA since the "shelter in place" orders took effect in any of the affected states/cities?

This is not a quarantine, it's not an absolute containment effort. The effect is to simply slow the spread to something hopefully less than wildfire.

There will be herd immunity developing regardless of what we do. Vulnerable people are already afraid and staying home as much as possible.

Plenty of people are out going about their lives despite the shutdown. I'm in CA and went for a supply run yesterday, Home Depot was crowded with folks who seemed to be taking advantage of the time off to do home improvement projects.

Plenty of evidence of sick folks out there being careless as well. The contagion is spreading either way.

Our quarantine has thus far been socially enforced, and quite effectively I might add. Schools are closed across the entire nation, despite the fact that children are the least likely age group to even express symptoms upon contracting coronavirus, let alone die from it. If the contagion is "spreading either way", why not allow people in the lowest risk groups continue on with our lives while we help the most vulnerable groups weather the storm from the safety of their homes?

Are you aware that even with the measures you're arguing are unnecessary in place, our hospitals are fast approaching capacity and we're having PPE shortages?

It'd only be worse.

The UK considered this until late last week but reversed course over the weekend when new modelling revealed that ICU admission rates in populations they had previously assumed were less vulnerable were higher than anticipated if still very small. That would mean completely overwhelming ICU capacity (like more than 20x) for weeks at a time with otherwise healthy young people who would likely survive with ICU care and die without it.

That doesn't mean it's the wrong approach in general, just the wrong approach at this point in time.

In the short term, the curve needs to be flattened at (almost) any cost, while treatment and testing capacity ramps up.

In the long term, we need to gauge the risk and isolate more selectively. There is no way around herd immunity, we can't shut down almost everything for two years or more.

Likely very iffy. Age alone isn’t enough. Possibly, the best check would be something like “can run x miles/hour for y minutes” (‘measures’ lung function relative to body demand), but even if you can find even halfway decent criteria, who’s going to do the testing? Who’s going to repeat that testing every week?

Also, I would think a significant fraction of “the population likely to require hospitalization” currently already requires care (they are in hospital, care homes, or even just have family or neighbors visiting them every few days). You can’t quarantine those [1] , and you can’t afford having a large fraction of those caregivers fall ill at the same time, either.

[1] technically, camps housing all those in the danger group and their caregivers in ‘camps’ would probably work, but I think that’s a step up from asking the entire population to stay home.

Another significant but hard to measure factor is virus load. A lot of otherwise healthy young healthcare workers are at elevated risk due to constant exposure and lots of stress.

I think this is a reasonable point of action. The problem, IMO, is that the rest of the population MUST be more stricter than ever regarding their distancing. And here comes the rub, because I, honestly, do not think this is about to happen. People are _still_ not taking this seriously, even those in the most at risk groups. Enforcing this separately would be a nightmare.

We might end up there anyway, because I think people will get exhausted with the current situation and will sill up anyways. Once the cat is out of the bag and the disease is rampaging through the population, it will be too late.

No because if you relax the quarantine you turn a lot of people that don't have the virus right now into potential vectors for infection of new hosts once they do acquire it, which is pretty much inevitable once people start moving around again at the old rate. And once you have enough people spreading it those at risk will be more at risk than they are now.

Yes, but once the disease passes for them, they will be immune. Herd immunity is basically the only way this will pass away now, so we might as well be clever and push it on the side of the population that can take it.

EDIT: If we assume this is true and this will end when 40-50% of the population has already caught it, would it not be clever of us to make sure the 40-50% of the population that caught it is the one least affected by it? By making the measures the same for everyone you basically make sure the percentage affected will be uniformly distributed among all groups. If you make the measures distinct for each group, you tilt the odds in favour of one or another group, and might get a better outcome in the end.

IMO, now the people in power should balance several factors: - People in need of medical assistance - the group of people more likely to have permanent health effects from the infection - Economic impact of measures ( this, imo, can probably cause deaths in an indirect way as well) - population compliance to lock down measures (this will erode in time, I expect)

Ideally, the would find some social valve where they could play with the number of infected and they would direct this to the less at risk population and adjust the pressure over the medical system so it's just close to breaking, but not quite there, and directing the disease towards the least affected segment. Problem with this is the disease is not spreading linearly, so it's _very_ easy to loose this from under control. If they manage to make the status quo distanced enough so that the spread is more linear without disrupting too much the lives of normal people, and in the meantime playing with this valve for the less-at-risk population. If htis is feasible, I do nto know, but sounds like a reasonable idea.

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