It's not that SIP does nothing - it's that past a certain point, the rates are what they are. San Mateo and Santa Clara counties have seen a slight increase in the number of cases last week over the previous week. Other Bay Area counties have seen a slight decrease [1].
I don't see how increased traffic/travel as we're starting to see [2] will do anything other than increase transmissions.
But if the rates stay the same, then all we're accomplishing is slowing the rate at which we reach herd immunity. If herd immunity is the strategy we're pursuing, then we should lift restrictions enough to meet hospital capacity, so we can get to herd immunity as quickly as possible and get the economy back to something approaching normal levels of activity.
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).
> If herd immunity is the strategy we're pursuing, then we should lift restrictions enough to meet hospital capacity, so we can get to herd immunity as quickly as possible and get the economy back to something approaching normal levels of activity
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.
> But if the rates stay the same, then all we're accomplishing is slowing the rate at which we reach herd immunity.
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.
That's the trouble - there's evidence the main reason that the fatality rate shot up massively in places like Lombardy and Wuhan with overwhelmed healthcare systems is because the shortage of healthcare resources meant they massively undertested mild cases compared to elsewhere. It's a statistical artifact that was presented as a real thing by the useless media. Also, people aren't getting healthcare right now because of the lockdown and the fear. All over the Western world, cancer screening and treatment is getting skipped, people with strokes and heart attacks are seeking medical care far too late, kids are missing vaccinations...
> That's the trouble - there's evidence the main reason that the fatality rate shot up massively in places like Lombardy and Wuhan with overwhelmed healthcare systems is because the shortage of healthcare resources meant they massively undertested mild cases compared to elsewhere.
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 slowing the spread. Elimination was impossible the day the virus left wuhan. We can't lift restrictions to meet hospital capacity because that is an extremely dangerous gamble, especially when all our numbers on the spread of this disease are bound to be underestimates.
The goal is to not overwhelm the medical system. We are achieving that goal currently by not overwhelming the medical system. The strategy is working right now, no reason to balk from it if it's getting desired results as this pandemic runs its course.
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.
With a two-week asymptomatic incubation period, there is basically no way to eliminate the disease just by sheltering. It's impossible to enforce that every person in the world self-isolates for 3 weeks, so as soon as we "return to normal" it will come back.
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.
There's also the goal of slowing down and stalling in hopes of getting a vaccine, better treatments, production to catch up with supply shortages for healthcare facilities, and allowing healthcare facilities to increase capacity, etc.
Has there been any research on survival rates over time? If given the choice of getting COVID-19 today or two months from now I would much prefer the later infection because that’s two more months of doctors learning how best to treat the disease. Even delaying infection by a week seems like it would offer a better fighting chance. The medical community is learning as much as they can as quickly as they can and that benefits everyone who will eventually get sick.
It’s complicated a bit because of limited hospital capacity and related treatment supplies. If where ever you are is still below saturation later is better than now probably but once your local system is in the band where they’re running out of supplies things can get pretty dire.
Barring a miracle, mass production of a vaccine is at least 9 months away. Likely more like a year+
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.
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.
We can't control the spread until we can test people for the disease. As multiple leaders have stated, the lockdowns need to continue until we build up testing capabilities. For instance in WA, the governor said they are waiting for "widely-available testing, quick isolation for those who may have the virus, identifying people who came into contact with a positive case and getting them into quarantine."
The only country where this seems to have even vaguely worked is South Korea, and the US is already testing much more people for coronavirus than South Korea even in per-capita terms. Has been for a while. Now, the New York Times editorial board has been pushing the idea that you're behind South Korea because more of your tests are coming back positive - but the way they dropped that number is by using stricter social distancing measures to drop transmission rates, not increasing the number of tests. That doesn't seem to be happening in the US even with a full lockdown, and we don't really know why.
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.
I don't care what the comparison to South Korea is, and I don't expect other countries to have already achieved this. I care whether testing is widely available enough that a person who finds out that they had dinner with someone last night who has coronavirus can go and get tested immediately, not wait until they are short of breath and feverish.
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.
If no country has ever achieved this, what's even the evidence that it's actually possible? There are some pretty fundamental reasons to think it wouldn't work, not least of which are asymptomatic, pre-symptomatic and barely symptomatic spread, and the fairly impressive R0 of this particular disease. If the person you're having dinner with doesn't have symptoms and you have a slight sniffle, how do you even know to get tested?
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.
Thats what contact tracing is. Your dinner companion finds out they are sick two days later, and everyone they were in contact with gets found and tested.
The amount of testing the US is doing is indeed a fact, and it's widely reported in US press.
People keep saying that, but I haven't heard of any clear examples of actual sick people who got it again, just positive tests that seem to be within the error bands for the tests.
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
> Shouldn't we have those 2nd-time sick people by now?
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.
Herd immunity? Is it proven that immunity lasts long enough to provide coverage to the herd?
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 confused how the SF chronicle is calculating numbers. Santa Clara added 183 cases in last 7 days vs. 256 in the previous week (quite a downturn in the face of increasing test capacity).
They might have gotten hit by a glitch where Santa Clara didn't report for 3 days.
That was/is the precise reason given, so it's hard to imagine this going on much longer given that hospitals are doing fine. I think another month is going to lead to chaos and many people rebelling.
Ah yes, the argument that protective measures are succeeding and therefore they are no longer necessary. Completely irrational in a scenario where the danger being protected against hadn't gone away.
Instead of gallantly assaulting a straw man, you could acknowledge that lockdowns are not an on/off proposition and that there is almost certainly a better implementation of precautionary restrictions for achieving our goals than what we currently have.
Calling it a straw man implies that you don't think anyone is actually making this argument, and that's simply not true.
If you feel compelled to defend your own position instead of the one I'm criticizing, go ahead, but I don't share your certainty of there being better possible implementations.
Where did I "argue" that protective measures are succeeding therefore X? I'm merely stating that you cannot have a society of 350M people completely stop what they're doing for 6 months and not have disastrous consequences. At some point we have to choose whether the lives we're potentially saving after lockdown month X vs the emergent problems from shut down are worth it.
gotcha. I think it's disingenuous to effectively say that people are too stupid to make their own decisions regarding personal safety. There're growing calls to ease the lockdowns right now from people with top scientific credentials. I personally know doctors working in large hospitals who have said it's time to ease restrictions in most areas. It doesn't have to be all-or nothing.
If this were about personal safety, it'd be an entirely different scenario. The problem is that people's actions here are significantly affecting the safety of other people.
A virtually identical argument could be made for the same thing with the sides swapped. Some people's actions (i.e., those imposing lockdowns and other restrictions) are significantly affecting the safety (i.e., mental health, solvency, etc) of other people. It's a balancing scale, not just an independent bar you're trying to drop to zero.
Sure. And that's why there is a complex list of things that are being banned or not, that varies by location, instead of simply telling everyone to go inside their house and not come out for three weeks. And significant legal changes, like unemployment eligibility, loan programs, etc. Exactly who are you thinking of, that is advocating to continue lockdowns because they aren't aware of all the tradeoffs involved?
I can't prove he's unaware, but I have yet to hear a single mention of any tradeoffs like these from Washington's governor. Every single rationale he has provided for his actions has solely been based on covid-19 infected and deaths numbers.
So the WA governor (which is where I live) is the one who declared expanded unemployment access, defined and modified the list of essential businesses and is constantly talking about what is preventing us from opening up the economy - and yes, that's the deaths you mentioned. And you aren't sure if he knows about the disadvantages of everything being closed, because he hasn't included any details on why he wants to work towards reopening everything? I don't even know where to start. I think that the idea that is unaware of these factors is simply ludicrous.
I don't see how increased traffic/travel as we're starting to see [2] will do anything other than increase transmissions.
[1] https://projects.sfchronicle.com/2020/coronavirus-map/ [2] https://www.sfchronicle.com/bayarea/philmatier/article/Bay-A...