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Comment by misja111 | Hacker News Reader

>> get rid of the need to flatten the curve.

This. A policy of flattening the curve will probably have to last for one or two years until either a vaccine is found or there is enough herd immunity. This will not only destroy our economy but the isolation will be a psychological challenge for many as well.

We have to take one step back and think why we wanted to flatten the curve in the first place. And that is because our hospitals don't have enough capacity. So why don't we do something about that? IMO that, in combination with some moderate curve flattening, is the only acceptable solution in the long term.

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Hospital capacity is one motivation for flattening the curve. The other is to move infections later in time, when there will be more effective treatments and therefore lower rates of fatality and permanent disability.

We have to smash the curve so that we don't need the hospital capacity.

It turns out that getting the number of infected down close to zero would also be good for the economy.

I don't understand why so many people think that the best possible plan is for everyone to get infected. The best possibilities involve a few percentage points of the global population getting infected, no where near everyone.

This simply isn’t possible, and it’s a maddeningly irresponsible shifting of the goalposts. The public was sold these extreme tactics on the basis of preventing excess deaths, not locking down society for years on end until the virus (hopefully) goes away.

Respiratory viruses, once endemic, have never been completely suppressed. Even China is seeing a resurgence in cases. What we’re doing now isn’t sustainable or ethical, and we have to move on to smarter tactics soon.

The lockdowns are a necessary step to smarter tactics working.

My point is that if we move forward as if letting lots of people get infected is a 'smarter tactic', it's going to be worse in all ways. More death, more economic damage.

No, not “lots of people”, I don’t see anyone saying that. Given that it’s factually impossible to lock down the economy for a very long time we need conditions where the hospital system retains enough capacity to handle the really sick people.

Since it looks like we’re close to this (even in places like NYC that are sitting on a vent stockpile) we can start loosening the economy back.

No, you’re still shifting the goalposts.

The point of “flattening the curve” is not — and was never — to reduce the area under the curve. This is a contagious respiratory virus, and it’s going to spread until there is herd immunity. Maybe there will be a vaccine in 12-18 months. Maybe not. But regardless, we can’t go on for that long with over 30% of society out of work.

Most people are going to get this virus. If you don’t understand that, you are scientifically illiterate. You are pushing on the ocean to prevent the tide.

Trying to forestall the inevitable by keeping us all locked in our homes will inflict such massive economic and social collateral damage that it’s simply unthinkable. We won’t stop the virus, and we’ll burn down our society trying.

> This is a contagious respiratory virus, and it’s going to spread until there is herd immunity.

Umm, no.

The number of people who pretend South Korea does not exist is too damn high these days...

I am well aware of the numbers in South Korea. The virus is still spreading. There are still new cases, every day.

We have managed to eliminate one human virus in history: smallpox. And we only did that through mass vaccination.

We have never eliminated a respiratory virus, nor have we ever developed a successful vaccine against a coronavirus, despite huge financial incentives to do it.

The inevitable outcome here is herd immunity. Maybe we’ll get there by vaccine, but not for a long time.

South Korea has 51M people. If we have 1,000 patients every day, it will take 141 years to infect everyone.

We had 18 new patients yesterday.

(I'd normally write a snarky comment here, but the numbers speak for themselves.)

I don’t know why you’d write a snarky comment. You’re confirming what I said: the virus is still spreading in Korea.

I never conceded that flattening the curve was not about reducing the area, so I have not moved any goalposts.

I was going to make a comment on this article about the meme being too effective, in that it convinced people that the only point was to reduce the load on the medical system. Of course the goal is to reduce the load on the medical system, but that's step one, to get though the first wave of infections and to a situation where the spread is potentially controllable.

Well, Americans are going to be forced into multi-year lockdowns when they realize that reinfection is a real possibility and even if not that the infectivity of this is so high that lifting of stay at home orders will cause numbers to begin overwhelming hospitals again within weeks. Herd immunity is unlikely to save us in the short or even medium term.

There's talk of multiple strains or of it mutating in ways which aren't necessarily more deadly but make reinfection possible independently of the currently found 2% who seem to be testing positive again after "recovering" from covid

Then the powers that be will realize just how deep of a shit situation we are in. The people who are protesting now are likely infecting themselves or will soon know a loved one with this and soon they will personally realize how stupid they were to protest this. It's only a matter of time...

> think that the best possible plan is for everyone to get infected

That's like asking why does everyone think the best plan is for the sun to rise tomorrow morning.

It's not a "plan", it is fact. Everyone (to some level of precision) will be either have anti-bodies from infection or have been vaccinated (or the unrealistic enough to ignore; remain in isolation their entire life).

We don't have a choice in that. We can try to alter the parameters (rate, timing, etc.) of that. But, that is the limit of our control.

No, it's not a fact!

We don't run massive test and trace programs against cold viruses because they are relatively less harmful. We easily have the resources to run a massive test, trace, isolate and support program against COVID-19, and we can eradicate it using those methods.

And if a vaccine comes out before suppression is complete, so much the better.

The fact that we have only ever eradicated a pandemic by using vaccines is no reason to not try doing it without one. It's very hard to understand why people aren't screaming to spend a few hundred billion dollars to start doing this right now, as the payoff is essentially incalculable.

The defeatist mindest is really baffling to me as well.

I think some people must consider the economy to exist in a vacuum. But economics is based on confidence in the future.

A robust, unified, can-do response would do wonders to shore up that confidence.

conceptually, flattening the curve is meant to turn an exponential infection curve into something more manageable.

We are flattening the curve, yes, initially because hospitals don't have capacity, but the root of this issue is the exponential nature of infection transmission.

If we have the ability to build hospitals at a rate to match O(2^n) time then we can let everyone out and declare quarantine over! But as you know, an O(2^n) algorithm is extraordinarily hard to keep up with once n approaches any large number.

That's the curve we're trying to flatten - by changing the approach, changing the "algorithm" so to speak, by not allowing people to interact so they have less chance of infection.

If you are able to build a new hospital in a week, and then continue building a new hospital every day after that and then one every hour after that, and then a new hospital every few seconds after that, then you have a chance to keep up with an exponential curve (well, until the virus runs out of people to infect, so until it reaches 100% of the global population).

I was writing that we should both create hospital capacity and have some moderate flattening of the curve. Of course we shouldn't let the virus run free.

But unless you are hoping for a vaccine to be invented soon, which would of course be wonderful, you have to face the other scenario and that is that we have to slowly build up herd immunity. Herd immunity means that people have to get infected and a percentage of that will have to go to the hospital. No matter how you manage it, bigger hospital capacity simply means that you are able to reach herd immunity more quickly.

> Herd immunity

What does her immunity actually mean though? What other diseases do we try to tackle using herd immunity? How many deaths would make herd immunity acceptable or not acceptable?

There are 350m people in the US. We need to get about 60% of them to have had covid-19. That's 210m people. We don't know how fatal covid-19 is yet, so here are some lower numbers:

  0.1% =   210,000 deaths
  0.2% =   420,000 deaths
  0.5% = 1,050,000 deaths

And once we've killed off all these people what have we achieved? Covid-19 would be in the population and will come back every year as a seasonal respiratory illness, killing off more people every year until we get a vaccine.

There are ways to limit the number of deaths and still reach herd immunity. For instance by keeping elderly and sick people isolated but the healthier part not, until herd immunity is reached.

This disease has to be handled with intelligence and common sense, not with rethorics and dogma's.

> Covid-19 would be in the population and will come back every year as a seasonal respiratory illness, killing off more people every year until we get a vaccine.

Do you have any evidence to support that it would keep coming back? As far as I know there's only very small anecdotal evidence of people getting reinfected and we simply have no way of knowing yet whether the average person's immunity will last weeks, months or years.

For context, about 3 million people die each year in the US.

IF (and that's a big if), the infection fatality rate really were just 0.1% (i.e., regular flu), then yeah I think letting this thing run its course is the reasonable thing to do.

In my mind, the reason for the lockdowns is because we don't know the morality rate yet, and so we should be cautious in case it's 1-3% how it was looking at first.

I could turn the question around on you, and ask what fatality rate makes the "run its course" strategy reasonable to you? No deaths?

But our hospitals do have enough capacity. So far we have not seen widespread hospital overruns as predicted. Army field hospitals were set up and then taken down with no one treated. New York wanted 40000 ventilators but only needed 5000. Surely we should increase availability, but the original predictions that inspired this level of lockdown have not come to pass and with the information we have now, we know they are just delaying the inevitable.

At any given moment, the appropriate way to look at a fast spreading infectious disease is to consider the more likely range of potential outcomes, work for the best one and plan for the worst one.

When the work pays off with a better outcome, it's foolish to look back and criticize the planning for worse outcomes, especially when the tools to manage the infection are pretty limited (social distance works well, but it's a brutal tool, so you want to use it only as necessary).

> the original predictions that inspired this level of lockdown have not come to pass

The predictions of what would have happened had no lockdown been introduced then haven't materialized precisely because the lockdown have been executed.

That is no argument that the lockdown haven't been needed.

No, my claim is that the models that were used with the lockdown were wrong. Cuomo claimed to need 40k ventilators after the lockdown was put in place. He ended up needing only a fraction of that. Obviously, without the lockdown, there would likely be more needed. Of course, modeling has errors, but this is an extremely large error, and one that has direct policy implications.

Had the model's predictions been more accurate we could have found a better middle ground when it comes to lockdown. Every job saved and individual financially secure is one more person who can contribute to the community's well-being. I think it's pretty safe to say in retrospect that the lockdowns need not have been as draconian as they were. We had the hospital capacity to have less severe lockdowns and we should have done that. While we can't change the past, we can certainly look at how our models failed and rework our approach in the future. Anything else is irresponsible.

> No, my claim is that the models that were used with the lockdown were wrong. Cuomo claimed to need 40k ventilators after the lockdown was put in place. He ended up needing only a fraction of that.

What you state now reflects exactly how many casual observers have problems to understand the exponential nature of the epidemics: if one observes the doubling time of three days, and that is what has been observed, this means only that the difference between needing 10k ventilators and needing 40k ventilators is only 6 days -- less than a week! Nobody can wait to actually need them to order them and get them delivered in so short time frames!

It was surely not possible to predict reliably how would have people reactd to which kinds of measures requested of the people, and the exact impact to the slowing down the spread (when exactly would doubling time get to be how much longer as a response).

Having an error of just 6 days in the middle of the exponential growth is not so negative if you are attempting to allocate resources to avoid tens of thousands of unnecessary deaths. And that statement of needing 40k ventilators is not what prevented some "better middle ground".

The "better middle ground" was surely possible to achieve by simply treating the epidemics much earlier as a serious issue and not acting as it is "just like flu" or would "disappear" overnight before anything has to be done.

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