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Comment by makomk | Hacker News Reader

This. It's pretty obvious at this point that a general lockdown is worthless as a replacement for locking down care homes specifically - Spain had one of the strictest lockdowns in Europe but massively screwed up their handling of their care homes, and ended up with an even worse per-capital death toll than Sweden. Unfortunately, mainstream media publications have been spinning this instead as evidence that herd immunity wouldn't work by taking the incredibly high infection fatality rate from Spain, scaling it up, and claiming this is the best measure of how many people would die to achieve herd immunity.

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The same thing happened in Quebec and it lead to one of the highest per-capita death rates in the world (5,500/8,500,000)

The previous government gutted budgets for care homes which lead to chronic understaffing. When the pandemic hit, the current government enacted a fairly strict lockdown but still did nothing to help the situation in care homes, which was worsened by caretakers staying home by fear of catching the virus. This in turn lead to patients being neglected and to caregivers working in both "cold" and "hot" facilities, causing even more outbreaks.

Sweden has been doing this a long time too. Some areas have a pool of extras that travel around the whole city to different places to work. This might have spread the virus very effectively to the most vulnerable.

Heard on the radio today that we have less educated people working with elder care compared to our neighbours and that this could have made a difference too.

> It's pretty obvious at this point that a general lockdown is worthless as a replacement for locking down care homes specifically

New Zealander here, our general lockdown went very well and enabled us to isolate clusters of transmission and prevent it becoming community transmission. While two of our clusters were rest homes, several others were not - a school, a St Patrick's Day celebration at a pub, and a wedding, are significant "not rest home" examples.

So yeah, I think your focus on rest homes is too specific.

New Zealand is a special case where it may be feasible to isolate yourself from the rest of the world and reach zero cases. With that said, it remains to be seen that it is possible to maintain zero community spread over the long term, and whether the economic impact of isolating yourself from the rest of the world is worth it.

We aren't economically isolated from the rest of the world. We're still exporting and importing. Exports in some industries are higher than ever. We're still bringing in workers in certain key roles. NZers can leave (though they'll probably need to pay for quarantine when they get back). The main things that are suspended are international student and tourist arrivals, and when the flood of NZers returning home abates, we'll probably be bringing them in through the quarantine system.

https://www.reddit.com/r/newzealand/comments/hlmo1q/new_zeal...

We're only isolating human traffic. We're not isolating exports or imports of goods.

What was the death rate and high-severity rate of infection for each of those clusters? The reason people focus specifically on the retirement homes is that it tends to have the most dire outcomes.

Australia had a very, very tight lock down on aged care homes, and yet very nearly 50% (62/106) of the COVID deaths in Australia were in these homes.

It turns out to be pretty much impossible to keep out of aged care if there is community spread.

NZ ditto, except just about all our COVID deaths were in rest homes.

Not all elderly are in rest homes, either.

I don't know of anywhere with widescale community spread that has been really successful at protecting the elderly.

Right. From what I've read, it seems like the most effective strategy would be locking down elder care homes tightly. And also tightly locking down staff at elder care homes. Because once one resident gets infected, there's no way to prevent other residents, and staff who care for them, from getting infected. At least, short of staff wearing ebola level protection, and changing between residents. Which would be impossibly expensive and time consuming.

Others in the general population who are at serious risk of complications, such as elderly and those with preexisting conditions, should also isolate themselves. As I gotta say, I have done.

But I suspect that it will turn out that general lockdown is neither good enough, nor worth the long term economic consequences. Except of course that those long term consequences will arguably mitigate global climate change.

Don't forget that deaths are just one measure of the damage covid brings. My wife is/was a fit and healthy 40yo no underlying conditions - she had covid 4 months ago and has barely been able to climb the stairs some days. The 'crazy' thing is that her actual covid infection wasn't hat bad and she had no shortness of breath etc at the time. But here she is with symptoms very like ME some 100+ days later.

Obviously that doesn't happen to everyone but it appears a significant proportion of those getting ill have serious symptoms some time after the illness, with no clear end in sight.

Sorry :(

Maybe she carries that susceptibility sequence from Neanderthals. It'd also be good to focus on isolating people with that and other relevant genetic markers.

So basically focus on isolating all people above 60, all people with comorbidities, and any with genetic sequences that are ill-defined, likely many of them that we haven’t uncovered, and more expensive to test for than Covid screening?

Easy.

Or lockdowns, easy accessibility to testing and good contract tracing. Which has worked well in lots of countries

> Which has worked well in lots of countries

Has it really? Lots of people in LTC facilities have died, no?

I’m not talking about Sweden, or the US, or Italy or the UK or France, But NZ, Vietnam, China and Australia (current flare up not withstanding) have pursued policies of lockdowns, contract tracing and heavy testing. Your proposal is more convoluted and relies on the imperfect information we have regarding susceptibilities (genetic susceptibilities) being correct, and being able to scale tests to a couple billion people almost immediately so we can tell who should stay inside.

Sure, but it's likely that this won't be going away. So as soon as you relax lockdown, it may well come back. Unless there's a vaccine, which I'm not betting on. And then there's the chance of another zoonotic virus in a few years. Time will tell, but it may turn out that isolating vulnerable populations is the best long-term strategy.

You’re right that it’s a marathon not a race. But isolating the vulnerable (on a semi permenant Basis) is not easy or good for these people. With good testing infrastructure and contact tracing, we can minimise harm. We just have absolutely no definite idea who are those who are otherwise healthy who are going to end up hospitalised (say for my age group 30-40 males it currently looks like 1:500 will end up needing hospital support) and that’s even before you look at those who may do fine without hospital but still be carrying some serious consequences (ie original poster’s partner).

I for one would like to avoid getting this altogether

Maybe more than marathon. I mean, the influenza strain that caused the 1918 pandemic is still circulating. Notwithstanding herd immunity through vaccination.

Who knows - I have nearly 4 percent neanderthal dna (according to 23andme) which means I have more neanderthal dna than 99 percent of people alive today, and it didn't hit me at all.

It will be very interesting to see what we learn in a year or more, but it does appear that there is the possibility of physical for healthy people - on her slack group (with over 7000 'long haulers') some people are showing heart scaring, some lung damage, some kidney issues. The only commonalities for most is that while they felt ill with covid, most were not dangerously ill. And many are resting negative to the antibody tests as it appears their T cells fought the virus. The research can come too soon for us.

> But I suspect that it will turn out that general lockdown is neither good enough, nor worth the long term economic consequences.

Hang on, this is an article showing that a looser lockdown still ends up with your economy hammered anyway. This should not be surprising, analysts if the Spanish Flu pandemic showed that cities that locked down later and lighter actually suffered more economically. This is because the higher infection and death rate, and larger number of people caring for sick relatives. People ended up Locking themselves down anyway out of fear, and the epidemic dragged on for longer.

Now we know this wasn’t due to special conditions back then, it’s true now too. There simply isn’t an option to ‘choose the economy’.

It’s so simple. (1) Your economy will be hit whether or not you lockdown. People are gonna reduce their activity due to the threat of the disease.

The lockdown affects behavior at the margins. And at the margins, the economic gains are linear to the additional activity due to not having a lockdown, but the growth of the virus is exponential.

Then the fact that the virus persists longer means places without a lockdown that did not drastically reduce the spread of the disease continue suffering economically.

Those are good arguments. I'm very curious what the data will show over the next couple years. However, I'm concerned that data for incidence and mortality will be too incomparable to draw reliable conclusions.

> Hang on, this is an article showing that a looser lockdown still ends up with your economy hammered anyway.

Well, there is effectively no "looser lockdown" when you're part of the EU, and even more economically tied to the rest of Scandinavia.

But anyway, the most important point is that a general lockdown that doesn't adequately protect the elderly, and others with preexisting conditions, won't reduce the death rate very much.

Spain had one of the strictest lockdowns in Europe AFTER doing almost nothing to stop spreading the virus for a long time. They only reacted when there was no alternative.

It is not just bigger than Sweden, official deaths in Spain are 27.000, the real number (taking seasonal death rate) is way over 43.000, making it the biggest per million deaths rate in the (Western) world, as Belgium (the one with the biggest number) did consider the seasonal rate.

By the way, in Spain the gobertment "resurrected" over a thousand people, going from 28.750 to 26.830 overnight.

Remember that Spain did nothing because the socialist-communist government did not want to cancel the women's day march the 8th of March and waited until 9th for starting to do something. They announced that and waited another week before implementing what they had announced.

While doing nothing, they minimized the problem, and told the people not to worry, they were in charge, only a couple of cases were expected. TVs joked about coronavirus and denounced other countries attitude against Spaniards, putting them on quarantine for staying in infected countries.

So Spain has the most deaths of the Western world because they waited almost 2 weeks letting more than a million people(100.000 positive PCRs test) get infected before doing something.

The lockdown made that million people only infect from 5 to 6 other million people(it could infect more than 40 million). If was extremely painful for the economy and made the country temporarily a dictatorship of the socialist-communist that put them in that position in the first place.

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