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Comment by sershe | Hacker News Reader

What is the official end game? Are they hoping that it will be eliminated worldwide, will they continue in this mode indefinitely assuming it won't be, or do they plan to basically close the borders forever (i.e. anyone who enters has to be strictly quarantined so that the internal contact tracing regime could be relaxed)?

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What is the official end game for all the countries that have lockdown?

Have control over new infections and resulting hospitalizations so as to not overwhelm healthcare infrastructure. This is especially required in India, where a large section of the population is uneducated, lack propee facilities and live on daily wages, with little to no savings or assets.

As in South Korea, the idea is to ramp up testing so that the country can limp back to normalcy while affected areas are isolated.

Absent the strict lockdown, I dia does not have the infrastructure to handle the surge in cases.

Hopefully, the population gets immunity and effective medicines are developed to immunize or treat the disease.

There's a painful cognitive dissonance that people seem to have about this disease. If your lockdown stops the spread of the disease, your population doesn't get immunity. No amount of infrastructure will allow the population to get immunity without all of the deaths that come with it.

Absent effective medicines being developed, which are very unlikely to appear for a long time, countries need to consider that they're choosing somewhere to fall along a spectrum of disease, or disease + poverty.

In Star Trek there's the famous unwinnable test, the kobayashi maru, and our hero Kirk says there's no such thing. This is the kind of naive arrogance that is going to amplify an already bad situation.

I don't know much about India or its particular situation but rising food prices are going to be a hell of a struggle.

Aside from the fact that the jury's still out on whether infection actually confers immunity with Covid-19, the options are not just "get everyone infected" vs "eternal lockdown", you can actually suppress the disease to a level where new infections are rare and easily enough traced, or even completely absent.

You can do this in a closed system. India is not a closed system. At some point, someone is going to screw up. You can't shut down a city every time that happens.

Evidence shows otherwise. You're even complaining about it.

You're right, that's fair, technically India can do this if it wants to forever isolate itself from the rest of the global economy and into greater levels of poverty than ever before.

I had assumed India didn't want to be a closed system.

A lot of Asian countries are indeed showing that this is possible. That's good news!

Good luck trying to contain the flu that way. SARS-COV2 seems to be very virulent, but not so virulent like flu or measles that it can't be contained.

Isn't R0 for COVID supposed to be much higher than flu? That was one of the major parts of the arguments for lockdown that I've seen.

It is, but paradoxically it also seems easier to control. Perhaps because while it is infectious through the air, it is maybe not infectious over the same distance - but not as infectious inside a close distance.

I'm just guessing really. People say flu can't be controlled in the same manner. But we also haven't done that experiment like we're doing now. So maybe the people who say that are just wrong.

Thank you! Not sure why this is so difficult for people to understand.

This is what India is trying to achieve. Delay the spread (flatten the curve), ramp up health care facilities (doctors, beds and medicine), identify hot-spots and trace ruthlessly and finally hope that some medicine/vaccine would be quickly invented (the whole world is working on it).

Yeah, I don't see the point of crushing the curve in developing countries where it's not feasible to elevate substantially medical capacities. Where many people's ability to support themselves is a day by day process not paycheck to paycheck. It makes no sense to shut down hard other than political optics - all the rich countries are doing it therefore there's an expectation and pressure for leaders in these countries to as well, even though the outcomes will not be the same. Cure is worse than the disease territory. Developing countries with demographics that skew young might actually do better with herd immunity approach.

The point is avoiding mass death. They care about their families lives too and not just economics.

It's not a 'political' choice or about 'optics'.

It's also not just 'old' people who are dying. It affects 50+ year olds in not insignificant numbers.

It depends whether you prioritise health or economics.

You can balance health and economics and choose to prioritise one _before_ the other.

It does however requires the political will to support the economy (and the poorest) whilst health care is prioritised to buy time during the exponential phase.

This is all theoretically true, but my inclination is that healthcare cannot be prioritized in a meaningful way within a meaningful time frame in many countries. I would love for India to succeed, but it seems incredibly unlikely that they can delay mass deaths for the time it will take to roll out a vaccine, because it does not seem possible for India to elevate medical access to comparable levels with developing countries per capita in the same time frame. So this delay is just heaping on unnecessary economic damage which in many ways is linked to health. Either way, I wish them the best.

It's interesting that you mention cognitive dissonance while presenting a false dichotomy.

There's a painful cognitive dissonance that people seem to have about this disease - there isn't an option (unless you don't care about lots of people dying) where the economy doesn't take a big hit in order to contain the exponential phase.

It's not clear what the alternatives are?

I assume you're not advocating a no measures approach.

No lockdown even with social distancing still does huge economic damage and even then you would not get herd immunity - 60% infection rate is required.

This is ignoring that disease immunity can massively vary, and if the antibodies only confer immunity for a few months, then this naive approach means we're back to step 1 relatively quickly.

This also ignores the potential for a chickenpox-like situation where the virus could reactivate itself, in which case exposing our population to the disease is just going to cause further issues down the line.

German government declined the herd immunity strategy with the argument that for it to succseed in a year's time we have to increase the rate of new infections every day to 70k. No way our health care system can handle this. And there is also no need since we expect to have a vaccine ready in one year.

We have been told to expect a vaccine ready in about a year, but this seems to be based on wishful thinking. There's no guarantee any of these candidates will be any more successful than all the HIV and herpes simplex vaccines we've watched fail again and again for decades.

I am pretty sure that international travel will stay banned for quite some time more, maybe the end of the year? But the current lockdown is supposed to be "eased" on May 3, and we are already seeing lists of districts with zero new case, where things will become really easy. But at the other extreme, there are "hotspots" where the lockdown will not ease at all for some more time. The lockdown won't just end on May 3. Some states intend to continue the lockdown on their own beyond that. Local shops have been allowed to open already. Some travel will become possible, probably within city limits or state limits. Restaurants and malls are unlikely to be opened any time soon. Everyone is still waiting to see what the official policy is.

I think India opted to err on the side of caution. Now where is required or possible, the lockdown can be eased. Opposite strategy would have been far worse.

This is the main question I have too. We have a disease that is pretty much guaranteed to be endemic so there will always be the ever present threat of re-importing the disease.

- guaranteed to be endemic in countries that have not taken the necessary public health measures. Consequently there will be very tough restrictions on travellers from those countries. Maybe the world will divide into green and red zones?

It's simply not realistic to keep a highly infectious disease forever out of a country like India (unless the virus just doesn't thrive there for environmental or demographic reasons). What are they going to do, shut down entire cities every time there's a lapse in security?

If the world did somehow divide into green and red zones, you would have a worse problem on your hands. The red zones are the wealthier western countries, and are more desirable than the green zones. Good luck trying to maintain global economic relevance when you don't allow immigrants from the wealthiest countries in the world. There's a similar argument to immunity passports. If people need to be immune to the disease to re enter the workforce safely, they will infect themselves with the disease to do so.

Land borders are of course harder to seal than air - but not impossible. Having to shut down entire cities if there is a breach will make their vigilance that much higher.

The green zone will prosper, perhaps those wealthier western countries finding themselves in the red zone will no longer look so desirable. Of course I'm hoping it won't come to this, but it does seem to be the direction we are heading.

You are forgetting about international trade, tourism and migrant work. The only country I'm aware of that was a "green zone" pre-COVID is North Korea; it didn't exactly prosper.

You've written green and red, and somehow assumed that green is good. Green means your population is vulnerable to an infectious disease that, in this universe, is highly prevalent in all of the wealthy countries. Long term its a weakness.

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