The rates staying flat rather than going up is already a success, not a sign that SIP has failed.
If the strategy is actually suppression and elimination, then the lockdowns are not working (at least not here in Oregon, where daily number of new cases have been flat for about 2 weeks; I'm not sure what things look like in California).
There's no better treatments coming. We've been fighting viral pneumonia since the dawn of medicine and the tool kit is pretty sparse. Finding anything nearing a cure or even a 20% improvement is wishful thinking.
Our health care capacity is adequate. NYC got to ~30% infected and while I'm sure none of the medical workers want to repeat the experience the level of care remained good. Any capacity increase is going to come with only marginally improved outcomes.
There's no purpose in extending the lockdown. Either we can get back to something resembling normal life and control the spread or we can't and everyone gets infected. Extending the lockdown is just delaying that day of reckoning.
Basically, all of the US media reporting around testing has been terrible, misleading, partisan nonsense designed to create an imaginary testing gap that can be blamed on the current president to try and kick him out of office in November. Publications like the Times are quite open about why they're doing it. The UK isn't much better though.
Perhaps you would like to read Dr Fauci talking about why we need more testing capacity before relaxing lockdown rules? https://time.com/5826161/anthony-fauci-covid-19-testing-capa...
Or Gottlieb, Trump's appointee for the FDA? https://www.vox.com/2020/4/14/21219021/scott-gottlieb-corona...
If you are dismissing "all of the US media reporting around testing" as terrible, misleading, partisan nonsense, then you are either looking for a particular opinion to be represented that isn't, or, more likely, you aren't reading all of it.
Also, how the amount of coronavirus testing the US is doing stacks up to other countries isn't an "particular opinion" - it's a fact, and it's a fact that pretty much the entire US press seems to have managed to misinform everyone about, including the fact check columns.
The amount of testing the US is doing is indeed a fact, and it's widely reported in US press.
The comment you are replying to should have also mentioned greatly increased testing capacity as well as contact-tracing. Extending the lockdown allows us to build up this infrastructure so that restrictions can be reduced while still preventing exponential spread.
If it were remotely possible to precisely control the transmission rate such that we stay just under hospital capacity, there would at least be a coherent argument for this. I'd disagree, since a huge part of slowing the spread is to buy time for other mitigation options, such as therapeutics, contact tracing, etc. That said, it has been immensely frustrating that CA and SFBA leadership hasn't provided more clear guidance on what, exactly, we're waiting for.
Not a doctor, this is not a rhetorical question: Shouldn't we have those 2nd-time sick people by now? Shouldn't the null hypothesis be that immunity works like most other colds?
Masks weren't "proven to be effective" until well after any reasonably thoughtful person was wishing they had one.
- of 4 coronavirus strains in one study (all the type that cause common colds), none gave long term immunity after exposure
- of those 4 strains, getting re-infected multiple times in the same year is common
- each person tends to have a consistent reaction (weak/strong symptoms the first time through predict a similar experience in any later infections)
- infection severity tends to run in families
- 6 years after SARS, doctors found T-cells, but no B-cells in humans . Mice re-infected with SARS were protected from the worst effects or SARS by memory T-cells.
Specifically related to covid-19:
- macaque monkeys were infected by covid-19 and exposed again 4 weeks after recovery. none developed symptoms or had detectable virus in their throats
- no reported cases of re-infection in Wuhan in the 5 months since the epidemic started
Maybe if there was no infection induced resistance, but with even moderate resistance lasting a few weeks, probably not outside of Wuhan, and it's not like we can be confident we'd get accurate information on that.
> Shouldn't the null hypothesis be that immunity works like most other colds?
Colds are mostly rhinoviruses, this is a coronavirus, so, no, you wouldn't by default generalize from colds. Coronaviruses don't particularly consistently produce long-term reliable immunity, instead what immunity they do produce typically wanes quickly. So the best assumption would be that whatever resistance getting infected confers is likely quite limited in duration.
The issue I have is that if we overload our medical system - just go on twitter to see the horror stories posted about ICUs and medical staff in serious depression - then even if you have a totally managable non-COVID acute issue, you could get infected or die by lack of treatment because the system is at or beyond capacity.
We are in a fight to keep our current medical system running. If you overload it recovery for that may take longer than the hypothetical herd immunity or vaccine.
For curves: Flat = working. exponential = not working.
I'm a little confused about your semantics, so I fell down the hole. A strategy is the plan of action itself to achieve a goal, and the tactic is the action or strategy to achieve the goal. Slowing the spread seems to fit both definitions depending on how you word your sentences.
No, we're still avoiding surging past healthcare capacity, which shoots the fatality rate for both the disease itself and anything else that competes for resources with it way up. That's the point.
It's true that on some places we may not need SIP to remain in the safe zone, but one of the big problems is that we don't have the kind of surveillance that lets us even be clear what the likely course is, because we're still mostly testing only the very sick because of limited testing availability and infrastructure, which means we have no good future window, and we won't be able to restore SIP in time to prevent a surge because by the time we see it in the case numbers the infections that will take us beyond capacity will already have happened.
That's one of the reasons establishing better surveillance is one of the keys to reopening identified by (among others) the West Coast group of states coordinating on the issue.
No,the death rate among those requiring ICU care shot up, too; and there is no question that the reason is that the systems were so overwhelmed that things like ventilators were rationed on criteria beyond medical need, because medical need exceeded supply. (That's also why other conditions became more dangerous, because it didn't matter why you needed, e.g., a ventilator, whether Covid or not, the supply shortage meant you might not get one.)
The strategy is basically, in order:
1. Reduce the rate of transmission to avoid overwhelming hospitals (which would increase the fatality of all other illnesses/injuries). When we have no reliable testing infrastructure, the only action we can take is sheltering-in-place as much as possible
2. This buys time to increase medical supply chain capacity and stockpile necessary supplies. This increases the amount of cases the system can handle, which is important when the public policy feedback loop doesn't see new cases until they're in the hospital weeks later
3. At the same time, build testing infrastructure to detect infections before they turn into uncontrollable outbreaks. This will hopefully catch cases before they get to the hospital, shortening the public policy feedback loop
4. At this point, we should be able to resume some moderate amount of activity without being completely in the dark. We will likely see a cycle of one week on, one week off, two on, two off, etc as we see how much we can control the rate of spread. This will increase herd immunity, but will likely require months to spread the infection without overwhelming our health system
5. All throughout this time, high risk populations will have to isolate as much as possible, since they cannot be infected safely. Medical companies will be working on a vaccine, but it will probably take closer to a year before they are ready for the market.