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Comment by abeppu | Hacker News Reader

Everyone other than the Chinese government seems to agree that a zero covid policy isn't realistic anymore. And empirically, they haven't succeeded. But ... why is that the case? Why _doesn't_ an ultra-strict lockdown for this long prevent spread (and allow existing cases to resolve)? What are the remaining opportunities for it to spread?

Throughout 2021, I had sort of told myself that most of the harms of the pandemic were optional, b/c if we really wanted to, we could have given everyone 3 weeks of food, meds, etc, shut literally everyone inside their homes at the same time, no grocery stores, not parks, whatever, and it would have been way less cost and stress and trauma than the path we have taken. But ... evidently that's not true. Why not?

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So, firstly, because you can't actually do that. If literally everyone stays at home for three weeks, then there is nobody to staff power plants, water plants, etc, and those services fail. There are also no ambulances to help people who fall ill at home, no hospitals to take them to. No police to chase after people who decide to break lockdown and loot some deserted shops or prey on isolated families. No firemen to respond to accidents, wildfires, and arson. All of this kills immense numbers of people - the death rate might be low, but you're locking down eight billion people here.

And it's not just these people. It's all the people providing the services they need to do their jobs. Police station cooks. Ambulance mechanics. Hospital laundry staff. Couriers delivering spares to power stations. And the people they depend on: catering suppliers, cleaning supplies wholesalers, warehouses. And so on, the transitive closure of everyone depended on by essential workers. Which, because of the ramified and interconnected nature of a modern economy, is a substantial fraction of everyone.

Secondly, because even if you did that, not everyone would do that. Some people would break the lockdown to see their dying relatives, suicidal friends, starving neighbours, star-crossed loves, bridge partners, etc.

Thirdly, because even if they didn't, you're locking down whole households, and you can get serial transmission between individuals in a household, so SARS-CoV-2 can last longer than three weeks, it can last about two weeks times the number of people in the household (assuming there are no reinfections).

Fourthly, because even if it didn't, somehow you blocked intra-household transmission, in a handful of cases, infections can last longer than three weeks in a single person.

Fifthly, because even if they never did, SARS-CoV-2 has several animal reservoirs in wild species which live in close proximity to humans.

The idea of "three weeks to stop COVID" was always an absolute fantasy, and honestly, very obviously an absolute fantasy. I am not an expert on viruses, epidemiology, logistics, public health, anything like that. But i read the news and i thought about it for a few minutes. What i don't understand is how so many other people didn't.

Thank you for making the effort to type out such a clear explanation.

Covid further ratcheted up my hopelessness in people's ability to maintain the most basic grasp on how reality works. But in the early days, it was insanity-inducing to try and reason with friends who though the solution was a super-easy "just have every single person lock themselves inside with 100% compliance for two weeks and poof".

It's an unfortunate consequence of the complexity that allowed society to become so unimaginably rich that many people are so detached from the reality of what it takes to make everything work; it's even more unfortunate that these people vote.

Thanks for this reply. I'm guessing the first two points are the most important? And I would have hoped that after 2 years of planning, China could have figured out a lot of ways to improve 1. They certainly have some workforces who have been obligated to live at their workplace, with regular testing.

For 3-5, even if "lock down for 3 weeks" can't literally stop all cases, it still sounds like it could have been achievable to bring them back down to the level where track-and-trace could be effective, and China's efforts would be much more successful than they have been.

No that wouldn't have worked. Due to the long incubation time, contact tracing failed everywhere it was tried. All it takes is one infection to start the exponential growth again.

> But ... evidently that's not true. Why not?

The problem with lockdown measures is that it will inevitably harm someone. We might all be healthy and safe at home so harm is reduced with respect to Covid, but what about the harm caused by the lockdown measures themselves.

Say you have a town of 100 people. If you went into a hard lockdown to prevent any spread, you might save 10 people from dying of Covid; however, the lockdowns caused 10 people to loose their homes, businesses, some committed suicide, some overdosed. The problem with this line of thinking though, is that it's impossible to quantify that sort of harm. You can look at how many people foreclosed on their homes or went out of business but that really only gives you a partial outlook.

So what do you do? In my personal opinion this is a no-win situation, with some things it's clear what the right thing to do is. In Covid's case it really wasn't clear at all. Do you lock down people to save lives from Covid? How much harm does the lockdown cause? Are the gains we get from locking down enough to offset the harms done by the lockdowns? Everyone will have an opinion on each one of these issues but there really is no good answer.

That's exactly the thing- it is almost always going to be a judgement call, so the worst thing in the USA was for it to become politicized. In China, a monolithic 'zero COVID' policy was easily arguably better than the USA's fragmented efforts and conflicts 1-2 years ago, but now?

The evolutionary path of COVID seems more likely to follow that of the Spanish flu than to become more and more deadly. What happens if the next strain is even more contagious but also correspondingly less dangerous (especially as natural and vaccination immunity continues to rise)? Yes, people still die but there are trade offs with all policies, that's why we don't have flu lockdowns.

I imagine the harsh crack down is partly to blame. If you suspected you had COVID but testing positive would mean you, your family, and everyone in your apartment building would get sent to a recovery center.. would you report it? I would bet the inspectors themselves are spreading it.

If in the West we incentivized it however.. a few weeks forced holiday with free groceries..

I don't disagree with your logic (people would try to hide sickness), but they do have mandatory testing.

If the whole world did this and the virus was contained, perhaps it would have worked out. But millions and millions of people caught it and are breeding more and more contagious strains on a continuous basis. All signs were that the original COVID strain was relatively contagious but Delta and now Omicron have accelerated that to just crazy levels, and there are new variations on Omicron coming down the pipe that look even faster. I don't know if anything can keep it contained now but putting everyone who catches it into a cage is definitely not a viable strategy.

> Why _doesn't_ an ultra-strict lockdown for this long prevent spread (and allow existing cases to resolve)?

It works, but 3 weeks is too optimistic. You need to deal with noncompliance, spread within apartments, and essential employment which adds additional time to achieve to 0-COVID.

I live on the Isle of Man, which successfully introduced a 0-COVID policy in 2020 (imprisonment for breaching restrictions) and subsequently removed all COVID restrictions once 0-COVID was achieved.

> Throughout 2021, I had sort of told myself that most of the harms of the pandemic were optional ... evidently that's not true. Why not?

Since it's infeasible to enforce a 0-COVID policy globally, strong border restrictions are required. With strong border restrictions, 0-COVID isn't economically viable long-term as it permanently affects any industry relying on tourism or travel which causes structural unemployment if left unchecked; very few visitors are going to accept a 2/3 week quarantine on arrival unless there's a large incentive.

If you could isolate everyone in the whole world for 3 weeks, you would cut down on a lot of infectious disease as most individuals would beat their infection in that time and little transmission would occur.

However, you still wouldn't fully eliminate infections because some people would not beat their infection in that time. They might sustain an infection for longer because of their own health, e.g. they could have an immune disorder or be on immunosuppresant meds.

Of course you can't actually do that because (1) the whole world's human population is incapable of coordinated action on this scale, (2) there would be lots of very valid exceptions -- e.g. are you going to split up a family with 10 kids or kick very ill people out of hospitals?, and (3) lots of people would try to cheat and many of them would succeed.

Basically we should be aiming for maximal vaccination, good treatments, constant monitoring, and good non-pharmaceutical interventions (e.g. ventilation, masks in crowded places). Lockdown-type measures should be used when there is the possibility that critical healthcare infrastructure could fail under excessive load, i.e. things like childbirth and broken legs could become dramatically more deadly.

This is just a personal guess but I think it’s because omicron is just so infectious that it’s simply impossible to stop the spread

Also, you have to keep stopping the spread, forever, or until you give up. It’s not going to be eradicated, it will keep coming back. Maybe they can still afford to lock down this time, maybe the next time too, but this is a losing strategy in the long run. Eventually it will go through the population and become endemic like it is in the rest of the world.

The safe minimum dose for exposure with absolutely guaranteed non-infection is zero virions and the theoretical maximum duration a virion can stay infective is basically infinite, just with an infinitesimally small chance. It's more like a half-life than like a TTL counter.

It's not impossible to get infected from someone a hundred miles away, just very, very unlikely. Early variations were sufficiently unlikely to successfully take root in a new host from small exposures to make it quite easy to push that R value below one, but omicron pushes the threshold for "good enough" far out.

COVID is airborne, so lockdowns in a dense city do not work.

Cleaning surfaces doesn't do anything, those plastic dividers also don't do anything.

The regular masks barely do anything. The N95 masks only work until people take them off and they eventually have to.

Vaccines only work for a short time, but they do reduce deaths because the eventual infection is not as severe.

Basically not a single thing that we did actually helped. It just made people feel better by giving them a sense of control.

The only thing that worked, in a sense, is allowing COVID to infect people and giving them natural immunity.

I say in a sense because there were deaths by following that process.

Lockdowns have been very effective each time they have been enforced. Shanghai the latest example. Things go wrong when they are prematurely lifted.

People only have to take their masks off to eat/drink. Do that outside, or within your own home.

Vaccines have been extraordinarily successful in reducing sickness and death, and indeed transmission. However, alone they are not enough to quell Covid.

Disease acquired immunity has in fact not worked, even combined with vaccination, as Covid has evolved to evade immunity and reinfections are common.

Nonsense. The virus is here to stay. Regular people aren't going to spend the rest of their lives wearing masks. Disease acquired immunity works very well for most patients. You are spreading irresponsible misinformation.

https://peterattiamd.com/covid-part2/

"Regular People" might find they have to do things they previously wouldn't - like wearing seatbelts.

Reinfection is now understood to be common - after all, Omicron is spreading rapidly though a population that is not only vaccinated, but also largely already had Covid.

Be aware, almost nobody stands to gain from making Covid seem worse than it is, but many many powerful people stand to lose from public health interventions to prevent Covid, so gain from downplaying the problem. I wonder which Peter Attia is? "As his residency drew to a close, Attia joined the consulting firm McKinsey & Company in the Palo Alto office as a member of the Corporate Risk Practice and Healthcare Practice."

Reinfection is not a serious concern. While patients can get reinfected, symptoms are typically mild. Did you even listen to the podcast I linked? It contains a panel discussion with several noted experts that Dr. Attia brought in to explain the real situation.

Regular people aren't going to wear masks regardless of what the alarmists say.

> symptoms are typically mild

Has that been definitively shown? It was not so long ago that re-infection was thought to be very rare. I don't think our understanding of the effects of repeat infections is very good yet - not least because we are at the beginning of this (reinfection was much rarer before Omicron).

But Regular People ended up wearing seatbelts? If mask mandates come back, then yes they will wear them too.

When something has an r similar to measles, ie naturally spreads to 12-18 people, it's probably not just people you are in contact with who can catch it from you. Perhaps particles sit in the air and float really far, or door handles, that kind of thing that might mean eliminating contacts doesn't even help. Basically you won't even know why infected you when rates are that high.

I agree with you. I also thought we were screwed in the West precisely because we couldn't do the kind of strict lockdowns China initially did, which worked so well for them.

Things have changed. I would say because countries don't exist in a vacuum, it's not tenable to have a covid zero policy. You'll always get reinfected from outside. This is only more apparent as covid had become more infectious. Combined with effective vaccines and a less dangerous variant - the optimal strategy seems to be just getting on with life and adding restrictions only as needed to keep hospitals from being overwhelmed.

The problem with comparing out success to China's is that we know China lies about their numbers. From the outside yeah it looks like what China did worked; however, can we really trust the numbers? Hell can we trust the numbers coming out of the US or any other country.

>But ... why is that the case? Why _doesn't_ an ultra-strict lockdown for this long prevent spread (and allow existing cases to resolve)? What are the remaining opportunities for it to spread?

because it only takes one infected individual to infect the whole world. that's what the Wuhan patient zero did, according to the official legend. 3 months between the fated bat soup and worldwide lockdowns.

covid is here to stay forever. that's pretty clear now, 2.5 years in. despite a global hysteria and massive financial incentives to develop tests, vaccines and treatment, objectively we have pretty much nothing. things are as bad now as they were two years ago, just with much less hysteria in the media now that they thankfully got something else to screech about

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