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Comment by jbermudes | Hacker News Reader

I'm glad people are realizing that all this social distancing is merely a pause button on the virus. Once we press play on society, exponential growth will happen again and we will have effectively rolled back the clock until we reach herd immunity through things like the OP's suggestion.

At least this next time we'll hopefully have more PPE.

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It's not a pause button, it's a playback speed button that slows down the contamination.

Remember #FlattenTheCurve.

What is true is that it would take waaaay longer to reach herd immunity this way.

Another thing that people usually get wrong is the her immunity concept: from what I understand, it doesn't mean we ALL need to be infected. We just need to be enough, so the virus can't spread anymore.

At that R0 herd immunity will be probably achieved when at least 70% of the population is infected. So it’s not all, but we are still speaking of about 5.5 billion people globally...

Alas, if you do some order of magnitude calculations you might find that that'll take a very long time.

And if immunity lasts 6 to 24 months as this author suggests, there might well be no chance for a herd immunity.

Herd immunity doesn't happen until you have a vaccine.

Or until something like 95% of population has been infected and we know for sure that those who already had the disease can not spread it anymore.

Statistically a disease reaches herd immunity if everyone except 1 / R0 are infected.

For a disease with R0 of 3 (such as covid) this would be 66%. To explain: If two out of three are immune then a disease which usually infects three people will run out of steam.

Has this ever happened in humans? I haven't been able to find an example.

Isn't this why there is a 1918-related flu outbreak every generation and why bubonic plauge used to recurved every generation because there aren't immune?

I think bubonic plague is bacterial, and was solved with antibiotics.

It doesn't matter that it's bacterial to have recurrences.

Also, we never "solved" the plauge, but it died down a lot before antibiotics were even a thing.

What about people born after that point? As immune people die over time from other causes, and as people are born without immunity, the percent of the population with immunity from having had it falls.

Non-vaccine acquired herd immunity is temporary.

I think the idea is that once there is herd immunity, the virus has no way to propagate and ends up disappearing w/o vectors. However, that would require global immunity.

You are right, I haven't thought about that.

The whole idea of herd immunity in this context is fucking nonsense. No self-respecting epidemiologist would even bring it up this early into a pandemic.

Herd immunity is the last resort for the immunocompromised or unvaccinated, not the foundation for public health policy.

When would bringing up the topic be acceptable for you?

Not sure who says it's last resort. There's a paper linked in a sibling comment about herd immunity's role in smallpox eradication.

They had a vaccine that let them not actually infect everyone with full blown smallpox to get to herd immunity.

The point of social distancing is to bring the number of cases down to a point where other measures are possible, such as test-and-trace. Social distancing is step 1, not the whole process.

I'd much rather live in a world where everyone is required to wear masks all the time than live in a world where we are all told to stay home all the time.

I believe it's also well established that any measures taken to slow the spread of a new virus will always result in fewer total deaths, in that sense quarantining is much more effective than just being a pause button.

"where everyone is required to wear masks all the time"

And this is what bothers me with such laws. No it does not make sense to wear masks all the time. (even assumed only outside) When I am running alone in the forest I do not need a mask. While driving a car alone, or with a partner, I do not need a mask. So the law should be, wearing masks all the time in populated public spaces.

"I believe it's also well established that any measures taken to slow the spread of a new virus will always result in fewer total deaths"

And this is only true if you look only isolated at the virus and do not take into account the various big side effects of a lockdown. Because you will get deaths from: suicide, domestic violence, other diseases, because staying home is not really good for the immune system and general health. Also this only takes into account the rich world. In india staying home is also required, but this is a really serious death risk, if your home is a metal barrack in the slums, with no AC, meaning you just get cooked. Before you starve to death, because you have no income anymore.

This is a false dichotomy. Masks or gloves as worn by ordinary people are nowhere near effective enough to mean lockdowns could end. They're very effective in clinical settings with proper ppe head to toe and procedures for taking them off outside the dirty ward, but there's no way most people can stick to those, nor keep their houses/shops clean enough.

I believe it's also well established that any measures taken to slow the spread of a new virus will always result in fewer total deaths

In the sense that they prevent a healthcare system being overwhelmed yes, in any other sense no, they are very much just a pause button for the spread of the virus, not a cure.

We wouldn't insist that people 'stop breathing' to prevent the spread of coromaviris. It's only somewhat different to insist that we all stop living and working.

Masks and gloves, plus generally keeping 6ft apart and routinely testing and contact tracing/quarantining infected individuals... what's the effective rate there? 95%? The modern medical establishment would move heaven and Earth, and incur thousands of dollars per person to get that last 5%. Most of us routinely ignore them in this regard, with respect to our own personal health, as we live our daily lives.

There just isn't a lot of evidence for the case that the choice is shutting the economic or killing millions.

> There just isn't a lot of evidence for the case that the choice is shutting the economic or killing millions.

Which is why we have models, no?

Yes, although reality seems to be disagreeing with the models more and more. You have countries in southeast Asia with community transmission but no lockdown, and countries in Europe with the military enforcing a strict lockdown, and the latter are far worse off in terms of hospital admissions and deaths per capita than the former.

Did the European countries not get their transmissions before they implemented a lockdown?

My understanding is it takes 1 - 3 weeks to see the effect of a lockdown?

"fewer total deaths" Yes, but not fewer total infections. You save lives by spreading out the infections over time, reducing strain on the healthcare system.

Neither please. Hospital facilities available and keeping immune systems up, a big yes, but also we have to accept that people die.

How about neither.

> I'd much rather live in a world where everyone is required to wear masks all the time

A properly fitting mask is uncomfortable. It hurts your nose, it hurts your ears. If you wear spectacles they fog up. People don't tolerate them, and so they fiddle with the mask, taking it off and putting it back, or dropping it under their chin.

Here's what happens when you wear a mask for a couple of shifts at work.

https://twitter.com/gabbyjackson95x/status/12479391789623255...

https://twitter.com/george_kerris/status/1241821041107906560

https://twitter.com/LeaBasra/status/1246467174589517825

https://twitter.com/CorneliaLG/status/1247309904106393608

https://twitter.com/paigeleigh95/status/1247509440405876738

https://twitter.com/gsmarri/status/1241845315587715073

https://twitter.com/molliemariaa/status/1246285482130059267

https://twitter.com/freyja_woolston/status/12472261992120115...

https://twitter.com/johnnynash69/status/1248278245914693639

https://twitter.com/TJGrundy/status/1247771125553065986

https://twitter.com/rosenorth_/status/1247235204957208577

https://twitter.com/erikalouxx/status/1245240263947227136

https://twitter.com/ilkahannah/status/1248395954102759431

https://twitter.com/LeanneThornex/status/1247587759025504256

https://twitter.com/drccr74/status/1247601616548769798

https://twitter.com/lauraworwa/status/1246469150735826944

(I am not a professional, so what I write below might be wrong)

Having more time to develop a vaccine or effective treatments is essential, it doesn't have to be herd immunity. Plus in countries where covid19 rate is low enough, social distancing can be helpful for finding and isolating clusters to suppress the epidemic.

Of course, there are two ways out of this, herd or vaccine. The above is a variation of herd that may result in less deaths.

The real problem is that waiting until a vaccine is just not even remotely realistic for so many reasons that it's not even funny. We could end up causing more indirect deaths with social isolation than we could possibly imagine, worst case being a huge collapse in the economy results in a large regional or global conflict.

Do you have any evidence that social isolation will cause more deaths than an unchecked pandemic? That makes no sense.

Indeed, CDC's numbers for March indicate that social isolation is reducing non-ncovid-19 deaths by twice as much as sars-cov-2 is adding them. That's short term, so not what GP was talking about, but very significant numbers nonetheless.

They’re talking about the conservative/trumpy talking points of the economy being more important than grandparents.

How many suicides? Guys losing their businesses that they put everything into. Can't even go fishing without their fellow man ratting them out to Big Brother.

Or indefinite tracking, tracing and isolating.

Herd immunity generally depends on having a vaccine. https://www.vaccines.gov/basics/work/protection

Are there any examples of humanity developing herd immunity without a vaccine?

Black Death?

I don't think so. https://www.theweek.co.uk/76088/what-was-black-death-and-how... says:

"How did it end? The most popular theory of how the plague ended is through the implementation of quarantines. The uninfected would typically remain in their homes and only leave when it was necessary, while those who could afford to do so would leave the more densely populated areas and live in greater isolation.

Improvements in personal hygiene are also thought to have begun to take place during the pandemic, alongside the practice of cremations rather than burials due to the sheer number of bodies."

This isn't really correct, and the proof is that most of east asia is relaxing restrictions right now without experiencing another exponential outbreak.

Testing, tracing and quarantine of infected people does work. It requires a bunch of infrastructure that we don't have yet (and in many places still aren't building, which is beyond frustrating). It also requires that the baseline level of the outbreak be small enough that you can catch most of the cases, which thus requires the continued lockdowns until we get back to that level. But it does work.

Exactly. There is also everyone in poor countries that is beyond the reach of expensive vaccines.

A country without other options might be more interested in the idea? I imagine that many first world countries would be too worried about the potential liabilities.

I suspect even the first world will be interested in options like this after a few more months of social isolation.

On second thoughts perhaps the idea wouldn’t work in countries that don’t have an effective lockdown. Could the infection wave of a less dangerous genotype overtake the number of infections of the more dangerous genotype before the population has been mostly infected already?

Yes if we act soon as we can spread the less dangerous version faster than the normal human-to-human spread of the dangerous version. For example if we were to send a postcard infected with the less dangerous version to 10 million people it would get out ahead of the dangerous version spreading normally.

good luck, we could have completely eliminated HIV by now but corporate profits are more important than that so the vast majority of the population who has the virus doesn't get the medication they need to not transmit it.

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