The Wuhan "first patient" was admitted Dec. 6, but nobody believes he was "patient zero". Since he likely contracted it Dec. 1, that means there were others with corona in Nov. or before. (Chinese people I've talked to invariably mention Oct. as when they started to hear chatter about corona.)
The problem is not whether this is more or less scary than the flu (or anything else), it is both. With no solutions aimed at buffering nursing homes/elderly.
Am I just insane? This narrative seems completely absent in all of the coverage.
We all acknowledge that it is deadly. Because it is. And you are right that this is in all the data. But the narrative is still holistic. We are locking down everyone to try and kill the virus.
Yes, it could work. But so could strict access to most nursing homes. Wouldn't be cheap, but could have even been more effective. Reasoning that we could reach herd immunity style buffer between the populations.
(Note that I flat reject just letting people die. I am not saying to abandon the older at risk crowd. I'm saying take pointed measures to explicitly protect them.)
There is lots of commentary on that strategy if you want to go back and read it. Even if you were gonna do this, you’d have to figure out how to isolate high-risk populations as thoroughly as possible, to the point of locking caretakers in with them and whatnot. If you lock everyone down, you have a lot more latitude to half-ass things as long as you keep R below 1. Isolating high-risk populations and deliberately pursuing herd immunity means operating consistently under the assumption that virtually everyone else will, as opposed to may, be contagious.
Note that I am still proposing an expensive solution. But asking if the barrier between the populations could be setup stronger. Such that the death and hospitalization load would have been what we have had, minus most of the elder population.
Edit: you edited on me. Yes, I am proposing that offering strict access to this crowd could have been done cheaper and more effective than what we have done.
The problem with isolating high risk populations is that you have to go round them all up and temporarily house them in quarantined facilities. And since the elderly are sometimes infamous for their unwillingness to be rounded up and forced to leave their homes, you have to either force them anyway or just abandon them to their fate. And that’s without touching the massive logistics of such an effort. (Not rounding them up would be even harder.)
Honestly, if you were gonna try and do that, I think geographical isolation would be a better option. Compartmentalize your state/region/country into separate zones, block all non-essential travel between zones, regularly test essential travelers, and change the lockdown status of each zone based on local conditions.
What will end up happening is occasional breaches between zones where a zone might go from green to red. But it gets us in a position where most people are mostly unrestricted most of the time. It also makes it possible to eradicate the virus without actually infecting most of the population, which is nice. Logistically you’d, at most, just set up checkpoints on roadways and inside airports and train stations to enforce the travel restrictions.
Over time you could even allow travel between green zones.
I think you could have gotten pretty good volunteer isolation. As simple as getting grocery stores to deliver to elderly. As expensive as renting the Ritz for a month. Still expensive, but cheap compared to what we have landed in.
It has been disastrous (comparatively). We had a couple of asymptomatic carriers infect some aged care facilities and now nearly 20% of the deaths country wide are from those incidents. And that's with the second best testing regime in the world though March/April (after South Korea).
We'd have been better closing the aged care faculties and moving people in with relatives. That's not very practical, but the COVID deaths would almost certainly have been less.
Here there has been very limited community transmission, and aged care facilities have turned out to be transmission clusters (not just death clusters). I guess shared facilities, lots of people in limited space etc.
And it's proved very hard to keep it out of facilities despite the best testing in the world. So here in Australia, (with different transmission dynamics to most places) they have been more likely to be exposed in aged care homes than elsewhere. This observation is made with the benefit of hindsight though.
Counter-factuals are hard, but in the proposed model where all old people are quarantined and the rest of the population is left to be infected the Australian experience indicates that the quarantine for aged care facilities wouldn't have been effective enough.
Note, I explicitly don't think this would be cheap. Such that I am not sure it is tenable without hindsight.
That said, I can see your point. With my firework shop metaphor, you are basically proposing to disperse the inventory such that one misfire will not ignite all of them.
I think I just have a hard time believing we will contain this with all of the other data we have seen. My gut is it is as likely that there is some yet unknown factor for the places that have seen better numbers.
About half of Sweden’s deaths have been in nursing homes, which prohibit visitors. Tegnell said health officials had thought it would be easier to keep the disease away from them..... "“We really thought our elderly homes would be much better at keeping this disease outside of them then they have actually been,” he told Noah."
https://www.businessinsider.com.au/coronavirus-sweden-lockdo...
Also I've just discovered Australia publishes deaths in aged care facilities vs subsidised care at home. The home death rate is much lower.
https://www.health.gov.au/news/health-alerts/novel-coronavir...
Note. Not cheap. At all.
For the at home rate, we need the question of would that have simply shifted if we sent them home?
Edit. Realized I didn't say it directly. I do find these interesting. Thanks!
Then the use of ventilators was shown to be ineffective, so they can re update the models and bring back the original plan.
(See recent articles. In summary none of the patients who are put on ventilators survive.)
Biggest problem: determining if someone dies because or despite of ventilators.
That's simply not true. A very high percentage of them die (because you only put very sick people on ventilators), but to suggest that they all die is just absurd.
https://www.webmd.com/lung/news/20200422/most-covid-19-patie...
There are also millions of people in low risk groups who care for people in nursing homes and other high risk populations. How do you propose keeping them from infecting those they are caring for?
The thread is also predicated on a very high base reproduction number. A high R0 means a very large percentage of the population needs to be immunity before "herd immunity" is a thing (on the order of 80-90%). Even with a very low IFR, that is hundreds of thousands dead.
I'll note some of the first cases in WA included a high school student that had not been traveling. I cannot square that, how contagious this is, and the idea that it wasn't widely in that school.
I think herd immunity is silly at the holistic level. At a cohort level, though, it could work reasonable. Consider, at this point we could start rotations of health workers that have the antibodies.
I have said it before, but I will stress again I am just a random internet poster. Much of why I am posting this is to get challenged on it.
What are you talking about?
That was never the goal in the US.
Of course, the more data we get, the less control we see that it was ever in. Such that right now,I don't think we have a coherent plan.
So, unless they have something protecting them, just reopening slowly didn't really have a mechanism to protect them.
Now, they could go for herd immunity in care workers. Rotate in those with antibodies, and you are simulations how we protect the elderly from the flu.
But just slowly reopening? What is the mechanism that is expecting a change?
This is like watching for a spark in a firework store, while you start letting active smokers back in...
Evil dictator idea. App on peoples smartphones that collects the number of unique close contacts and rebroadcasts that. So then people get warned that someones a risk.
That is, we do not have data showing this is deadly for pretty much why identifiable group, other than elderly. Such that no matter where a flare up is, we need to isolate the elderly.
My fireworks quip was that if a spark gets in there, the whole thing blows. But, large parts of the city could likely take a flare up and not notice. That is, the whole city is not a firework store. Right?
This is absolutely insane. My ex was telling me today, "well we could have a vaccine in 18 months" and I am so getting sick of this bullshit big-pharma narrative.
Safe vaccines take 5~10 years to develop. A vaccine in <2 years seems like a disaster waiting to happen. Vaccines for SARS1 were very difficult to make and some caused reinfections worse or incomplete protection[0].
We still don't have safe vaccines for HIV or Herpes. I feel like people talking about vaccines in 18 months are being totally unrealistic and irresponsible.
Note I am not happy about a race to a vaccine. Just feels like that is what our grand plan is.
But there's no telling if or when one of those drugs will pan out (and it would certainly be before a vaccine). There is no talk of reconstruction now, which really needs to happen.
E.g. https://blogs.sciencemag.org/pipeline/archives/2020/04/23/a-...
Human trials have already begun, so they seem reasonably confident that it's safe and works.
I think a lot of the time taken to develop vaccines historically is due to lack of resources. That's not a problem in the current climate.
There is of course some trade off between number of deaths avoided and amount of money we should be prepared to throw at the problem. Where on this spectrum are you?
My specific point is that people need to stop looking at a single IFR/CFR stat. It does no good. We look to be getting safer numbers there by simply increasing testing. (Of note, NYC has a strict lower bound on its numbers with how many in its population has died. But, do note they have more people over sixty than most cities do people. Such that most places will not be comparable.)
And that is the problem. The virus has not gotten safer as we get more data. Our understanding is just not focusing on helping the elderly. We seem to be taking a crap shot that everyone can stay home and we can out sit the virus.
I would wager we could have setup hotels and strict access controls on supplies into and out of at risk communities cheaper than what we have done. Certainly if you count on all of the job loss.
This is the narrative we keep getting fed over and over again, but it doesn't seem to be working out. There are a lot of people who were afraid to go to doctors for minor issues, a lot of important surgeries canceled for being elective, etc. On top of that, 80% of people who need a ventilator who are older or have other health issues, will die on them[0]. For the younger patients, it's almost a coin toss.
Some hospital systems are overwhelmed, but some are totally empty. Treating a region as large as the US as one unified geographical region, even with our unrestricted travel, didn't seem sound.
The devastation to peoples jobs, lives, savings, homes .. everything ... we keep saying Lives > Economy, but unless our leaders address how to deal with reconstruction (no one seems to be talking about this), there could be a lot of consequences worse than covid down the line.
0: https://www.webmd.com/lung/news/20200422/most-covid-19-patie...
We know from the high rate of corona infection in SF with low mortality that corona stats are being improperly analyzed.
The numbers show that this is <1% fatal and probably <0.1% but all it takes is one story of some 30 year old dying on the news and everybody loses their minds.
Granted, I was very scared myself before we had numbers, but I don’t know how many people are willing to actually take a look at them now that this has become sort of political. It’s like how a school shooting will get a lot of coverage, but nobody talks about how way more people are shooting themselves in the head. Emotions over facts.
In New York City about 0.15% of the entire population of the city have already died from the virus, putting a lower limit on the IFR.
Estimates of the IFR have been consistently between about 0.5% to 1% by most authorities I have confidence in.
And calculate that IFR per age band. Running WA numbers in https://news.ycombinator.com/item?id=23080035 shows that the IFR here ranges from .7% to 15%(!) if you do that.
Now, it says the cases are 33% above sixty, and the deaths are 91% above sixty. So that would be a CFR of 758/5011, 15%.
Contrast with below sixty. Which comes to a CFR of about .7%.
If I go with just under twenty, the paper doesn't give me enough data to calculate. They are 4% of the cases, but don't even get listed in the deaths breakdown.
Under forty, the rate is about 1.5%.
And note that more testing can drive down these numbers. But it's unlikely to do so for the elderly.
I think you're confusing Covid with pneumonic plague: https://www.nytimes.com/2019/11/13/world/asia/plague-china-p.... There's apparently evidence based on mutation rates that COVID-19 can't be older than late October, and it wouldn't have been detected until mid-late November, which matches official timelines.
FWIW, in MA the average age of hospitalized C19 patients is 69, average age of positive tested is 53 -- Interestingly over the last 2 weeks the average ages for deaths and hospitalizations has been creeping up and the average age for a positive test creeping down. In all, 1% of the MA population has tested positive (out of 4.67% the total pop. tested).
[0] https://www.mass.gov/doc/covid-19-dashboard-may-4-2020/downl...
[1] Graphs of today's MA numbers (courtesy of /u/oldgrimalkin on reddit) https://i.redd.it/bpb0884w7tw41.png
Because nursing home patients don't travel, so they lag in catching it, then die.
There's other weird effects going on -- some countries that look really really similar have vastly different experiences with the virus. (Canonical example is DR and Haiti, although the situation is dynamic enough no-one knows if that'll last.)
My takeaway from the difficulty in measuring this thing is that there is pretty high variance in transmission. Some carriers spread it REALLY well. Some carriers spread it poorly. With a lot of variance it matters a ton to figure out what is the deal with high-transmission situations. My take so far is we have some clues but no certainty. (Seems to spread in public transit and healthcare environments more rapidly, but slower than you'd expect in schools and prisons.)
It'd clearly be a gigantic win in terms of intervention policy to understand this better, and we simply cannot do that without extensive contact tracing so we know what's going on. They're doing a pretty good job of this in China, HK, Taiwan, South Korea. As nearly as I can tell we're doing a dismally poor job in the US and Europe.
You read papers that have diagrams of restaurant tables and bus seating charts from China. In the US it's hard to get stats on aggregate nursing home vs non-nursing home fatality rates. Maybe it takes some time for these papers to come out, but I don't see evidence that high-quality pre-pub contact tracing data is being relied on to develop policy responses.