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On May 07 2020 20:08 Elroi wrote:Show nested quote +On May 07 2020 19:31 Nouar wrote:On May 07 2020 19:20 Elroi wrote:
I'm sorry to repeat myself (from last page) but I haven't gotten any answers to this question so far: for those of you who want countries to stay completely closed until the disease is gone - lockdown and then track and then trace for the last cases seems to be the strategy in that case. What are you going to do after that with a population that has no immunity to a disease that has spread in the entire outside world? Have the borders closed until a vaccine with enough security measures in place, permanently, to quickly track down every new occurrence of the virus before it spreads too much in the population again? To me that sounds impossible. I'd love to be wrong, but I don't think I have heard anyone even try to give an answer to that question. Because I'm not sure anyone here wants that? It has mostly been to give time to health care to ramp up and prepare, and bring the first wave down to manageable levels to avoid uncontrolled spread and patient triage like we've seen in italy the first weeks... So everyone agrees with the herd immunity strategy now? It was viewed as extreme only a couple days ago afaik. I thought the consensus was something more like this: Show nested quote +On May 05 2020 20:12 Simberto wrote:
As has been discussed multiple times in this thread, the general plan is not (and has never been) to lockdown until vaccine. Originally, it was just flatten the curve to keep the healthcare systems from being overwhelmed, but that seems to have evolved into:
Reduce amount of infected people until you can individually track them again.
Individually track infections, and test and quarantine everyone the infected person was in contact with.
Which is clearly a possible way of solving this. This seems to be the direction taken by most countries that are viewed as successful, such as Germany and Norway. But if herd immunity is in fact the goal, that implies that those countries must change their strategy, right? The general strategy in most countries has been to lockdown to stop the high rate of spreading which would have run the risk of overwhelming healthcare.
The goal was to avoid what happened to Italy, Spain and parts of France.
Then remain in lockdown for a little longer to give more breathing room to hospitals and allow the amount of new cases to further decrease into a realm where it can potentially be managed. This is where most countries are now, just starting to open back up slowly or getting ready to do so.
From here the goal is to keep soft measures in place (social distancing, smaller gatherings, masks) to limit infection rate while testing a lot to trying to respond to new cases popping up. The hope is that new infections can be quickly tracked and isolate to stop an uncontrolled spread like back in Feb/Mar. If this fails and cases start to spike hard again a renewed lockdown might be needed to, again, stop healthcare from being overwhelmed.
If all this go's well you have small cases popping up from time to time but society generally moving along until a vaccine is finished or the virus burns itself out (so long as the R0, how many people an infected person will infect, remains below 1 it will slowly die out).
There is no need to let a population reach natural herd immunity when doing so in a controlled fashion will likely take longer then the time to get a vaccine out.
No one is going for a full lockdown until vaccine and I don't think anyone here advocated for that.
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On May 07 2020 20:10 farvacola wrote:
The two posts you quoted are not mutually exclusive, so it's still not clear what you're getting at.
So you don't think letting the disease spread at "manageable levels" is incompatible with "Individually track infections, and test and quarantine everyone the infected person was in contact with"? The latter seems to be the strategy in countries like Germany and Norway.
On May 07 2020 20:18 mahrgell wrote:
No, herd immunity is not a goal.
But just continue to pretend, that there is nothing between 70%+ infected in a year and full lockdown, nobody moves.
Steering in the middle is more complicated to fine tune, especially when the effects of different measures are so difficult to account for. But is rather obviously still the goal of countries like Germany.
I see herd immunity as a relative concept, ie you can maybe have a semi-normal life if 30% of the population has had the disease. So I agree with you that a middle way must be found. I still think many countries act as if the goal was to eradicate the disease entirely, which imo is counter productive and I was under the impression that many posters here thought that was a viable way forward.
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On May 07 2020 20:08 Elroi wrote:Show nested quote +On May 07 2020 19:31 Nouar wrote:On May 07 2020 19:20 Elroi wrote:
I'm sorry to repeat myself (from last page) but I haven't gotten any answers to this question so far: for those of you who want countries to stay completely closed until the disease is gone - lockdown and then track and then trace for the last cases seems to be the strategy in that case. What are you going to do after that with a population that has no immunity to a disease that has spread in the entire outside world? Have the borders closed until a vaccine with enough security measures in place, permanently, to quickly track down every new occurrence of the virus before it spreads too much in the population again? To me that sounds impossible. I'd love to be wrong, but I don't think I have heard anyone even try to give an answer to that question. Because I'm not sure anyone here wants that? It has mostly been to give time to health care to ramp up and prepare, and bring the first wave down to manageable levels to avoid uncontrolled spread and patient triage like we've seen in italy the first weeks... So everyone agrees with the herd immunity strategy now? It was viewed as extreme only a couple days ago afaik. I thought the consensus was something more like this: Show nested quote +On May 05 2020 20:12 Simberto wrote:
As has been discussed multiple times in this thread, the general plan is not (and has never been) to lockdown until vaccine. Originally, it was just flatten the curve to keep the healthcare systems from being overwhelmed, but that seems to have evolved into:
Reduce amount of infected people until you can individually track them again.
Individually track infections, and test and quarantine everyone the infected person was in contact with.
Which is clearly a possible way of solving this. This seems to be the direction taken by most countries that are viewed as successful, such as Germany and Norway. But if herd immunity is in fact the goal, that implies that those countries must change their strategy, right?
You are talking like there is only 1 way possible : herd immunity or total lockdown until it disappears.
No, you get the numbers down to avoid the worst of the outbreak while nobody was distanciating, time for the population to learn how to protect itself, to produce masks, gel etc, and then you try to reach a cruise level where people get infected, people die, but hospitals are not overwhelmed and the progress of the disease is not exponential.
But then, many things can happen : herd immunity, a vaccine, an effective treatment, a seasonal effect, you don't know.
It's impossible to predict what can be reached first. But the prerequisite to have a working country without hundreds of thousands of deaths was to give yourselves (and science) some time by breaking the first wave. There isn't only one way.
Tracking contacts in Europe is way harder due to individual protections. It can only be voluntary, thus less efficient than say, SK. Passing laws to allow tracking of the population is going to be reaaaally hard.
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Here's a study saying that with a heterogenous population, herd immunity might be reached at 10 to 20% of the population. https://www.medrxiv.org/content/10.1101/2020.04.27.20081893v1
New serology study from Geneva came out.
Week of 6 to 10 of April: 3.1% infected (CI 95%: 0.2 to 5.9)
Week of 13 to 17 of April: 6.1% infected (CI 95%: 2.6 to 9.3)
Week of 20 to 24 of April: 9.7% infected (CI 95%: 6.1 to 13.1)
So by the 24th of April they estimate 48500 people infected vs 4741 cases, a 10x undercount. With 243 deaths on April 30, that's an IFR of 0.5%. They'll be doing this study for another 7 weeks, so it'll be interesting to see how it evolves.
https://www.medrxiv.org/content/10.1101/2020.05.02.20088898v1
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On May 07 2020 20:47 Elroi wrote:Show nested quote +On May 07 2020 20:10 farvacola wrote:
The two posts you quoted are not mutually exclusive, so it's still not clear what you're getting at. So you don't think letting the disease spread at "manageable levels" is incompatible with "Individually track infections, and test and quarantine everyone the infected person was in contact with"? The latter seems to be the strategy in countries like Germany and Norway. Depends on what you see as manageable levels and a countries tracking infrastructure.
several hundred cases a day may be to much for most countries to handle. Others might be able to, It depends on a lot of factors.
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opterown
Australia54784 Posts
On May 07 2020 19:20 Elroi wrote:
I'm sorry to repeat myself (from last page) but I haven't gotten any answers to this question so far: for those of you who want countries to stay completely closed until the disease is gone - lockdown and then track and then trace for the last cases seems to be the strategy in that case. What are you going to do after that with a population that has no immunity to a disease that has spread in the entire outside world? Have the borders closed until a vaccine with enough security measures in place, permanently, to quickly track down every new occurrence of the virus before it spreads too much in the population again? To me that sounds impossible. I'd love to be wrong, but I don't think I have heard anyone even try to give an answer to that question.
To be honest that might be what our exit strategy is like in Australia. We are mostly under control, a few sporadic outbreaks here and there but if we're still doing well in a week or two we will ease our internal restrictions. I suspect we will keep our borders relatively tightly shut to prevent imports of the virus, while we wait for something like a vaccine.
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This discussion suffers from a lack of clarity on what herd immunity means without a vaccine. What does herd immunity mean without a vaccine? It means that virtually the entire population has caught covid-19. How would that occur without overwhelming local healthcare, without some means of slowing transmission?
It would entail that all the vulnerable population will essentially die and die rapidly. The population of that country now have herd immunity, but what's the point when those you want to protect had to go through an overwhelmed healthcare and so are already dead?
Also those countries who have successfully controlled covid-19 within their own borders wouldn't be particularily happy about allowing those from countries that haven't from entering them.
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On May 07 2020 22:38 Dangermousecatdog wrote:
This discussion suffers from a lack of clarity on what herd immunity means without a vaccine. What does herd immunity mean without a vaccine? It means that virtually the entire population has caught covid-19. How would that occur without overwhelming local healthcare, without some means of slowing transmission?
It would entail that all the vulnerable population will essentially die and die rapidly. The population of that country now have herd immunity, but what's the point when those you want to protect had to go through an overwhelmed healthcare and so are already dead?
Also those countries who have successfully controlled covid-19 within their own borders wouldn't be particularily happy about allowing those from countries that haven't from entering them.
I'm not sure about this definition. From what I understood, it meant a sufficiently high proportion of the population has caught it so that it is unlikely to spread further. How high this is exactly depends on how much people interact and depends on the level of social distancing, but it doesn't need to be "virtually the entire population". I'm no specialist, but I remember reading it being around 60-70% of the population, and there's people out there arguing it is less conditional the on maintenance of social distancing, though this is a conjecture and doesn't have scientific consensus.
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On May 07 2020 17:35 SC-Shield wrote:
On a different topic, Russia's case shows how unreliable their government is. From coronavirus is "under control" to 10-11k new cases every day. I'm pretty sure they lied in order to get their political agenda (they expect a referendum to increase Putin's mandate as far as I know), but they probably saw that things are getting worse and delayed their election. Yesterday I predicted they're going to be next Italy and now I think they'll have more infections than Spain too.
The ~11k death rate plateau Russia's daily case load has settled at is far less worrisome than the 20% daily growth in case rates for several weeks when posturing was at an all-time high. That posturing continued for about a week longer than it should have (when there was ~20k potential cases and almost 1k confirmed it was pretty obviously time for lockdown), probably quadrupling the actual case load by lockdown time.
Other than that, I'd have to say the response has largely been very good. Testing rate is phenomenal, travel restrictions started back when closing access to China was met with a response of "lol, paranoid much?", and contact tracing was extensive back when that strategy appeared viable. We'll see where death rates ultimately fall (as with every other country, they will inevitably be revised upward in retrospect), but at this point I'm inclined to believe the high infection rate is because they found more cases rather than that they had more.
I honestly expected worse, given Russia's appallingly bad healthcare system in general. With the exception of being too slow to the lockdown, the government has done all the right things in the past few months.
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On May 07 2020 22:55 Sbrubbles wrote:Show nested quote +On May 07 2020 22:38 Dangermousecatdog wrote:
This discussion suffers from a lack of clarity on what herd immunity means without a vaccine. What does herd immunity mean without a vaccine? It means that virtually the entire population has caught covid-19. How would that occur without overwhelming local healthcare, without some means of slowing transmission?
It would entail that all the vulnerable population will essentially die and die rapidly. The population of that country now have herd immunity, but what's the point when those you want to protect had to go through an overwhelmed healthcare and so are already dead?
Also those countries who have successfully controlled covid-19 within their own borders wouldn't be particularily happy about allowing those from countries that haven't from entering them. I'm not sure about this definition. From what I understood, it meant a sufficiently high proportion of the population has caught it so that it is unlikely to spread further. How high this is exactly depends on how much people interact and depends on the level of social distancing, but it doesn't need to be "virtually the entire population". I'm no specialist, but I remember reading it being around 60-70% of the population, and there's people out there arguing it is less conditional the on maintenance of social distancing, though this is a conjecture and doesn't have scientific consensus. You miss the bit where those advocating for herd immunity are advocating for it as an alternative to social distancing and lockdowns. Lets say it is 60-70% of the population, so 60-70% have to be infected, local healthcare is overwhelmed and 60-70% of your vulnerable population is dead. What's the point of achieving herd immunity at such a cost? The people you want to protect with herd immunity are dead due to this policy. UK tried to attempt herd immunity, and then backtracked when an excessive amount of people might die trying to acheive it. Not a good look.
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On May 07 2020 23:20 JimmiC wrote:Show nested quote +On May 07 2020 22:58 LegalLord wrote:On May 07 2020 17:35 SC-Shield wrote:
On a different topic, Russia's case shows how unreliable their government is. From coronavirus is "under control" to 10-11k new cases every day. I'm pretty sure they lied in order to get their political agenda (they expect a referendum to increase Putin's mandate as far as I know), but they probably saw that things are getting worse and delayed their election. Yesterday I predicted they're going to be next Italy and now I think they'll have more infections than Spain too. The ~11k death rate plateau Russia's daily case load has settled at is far less worrisome than the 20% daily growth in case rates for several weeks when posturing was at an all-time high. That posturing continued for about a week longer than it should have (when there was ~20k potential cases and almost 1k confirmed it was pretty obviously time for lockdown), probably quadrupling the actual case load by lockdown time. Other than that, I'd have to say the response has largely been very good. Testing rate is phenomenal, travel restrictions started back when closing access to China was met with a response of "lol, paranoid much?", and contact tracing was extensive back when that strategy appeared viable. We'll see where death rates ultimately fall (as with every other country, they will inevitably be revised upward in retrospect), but at this point I'm inclined to believe the high infection rate is because they found more cases rather than that they had more. I honestly expected worse, given Russia's appallingly bad healthcare system in general. With the exception of being too slow to the lockdown, the government has done all the right things in the past few months. Not according to the Doctors that "fell" out of windows. They are according them force doctors to work even after testing positive themselves and have far to little PPE. I think it is going to only get worse there for a while. https://www.cnn.com/2020/05/04/europe/russia-medical-workers-windows-intl/index.html
Don't know of a single country with a significant spread of infection without doomsayer doctors. Seems to be a good mix of genuine concerns (equipment / capacity shortages etc) and politically motivated plays made for the benefit of the international news. That said, healthcare is more than a bit subpar in most places in Russia, so horror stories within hospitals is no surprise.
Best way to prevent death is to stop enough spread of the disease to avoid having too many patients in the ICU in the first place. By the time they reach that state, even the best of care can only save so many...
On another note, and I'm probably late to the party on this one, it looks like the UK has now surpassed both Spain and Italy in reported coronavirus deaths. It's an odd mix of alarming and unsurprising.
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On May 07 2020 22:38 Dangermousecatdog wrote:
This discussion suffers from a lack of clarity on what herd immunity means without a vaccine. What does herd immunity mean without a vaccine? It means that virtually the entire population has caught covid-19. How would that occur without overwhelming local healthcare, without some means of slowing transmission?
It doesn't necessarily, for two reasons:
1. As I shared above, the model saying herd immunity is = 1- 1/R assumes a homogenous population. Models assuming natural variation demonstrate this could be as low as 10% to 20%: https://www.medrxiv.org/content/10.1101/2020.04.27.20081893v1
Here's a more indepth study on the matter:
https://necpluribusimpar.net/lets-have-a-honest-debate-about-herd-immunity/
2. Even assuming a homogenous population, what if contact tracing, testing and isolating + masks in public transport alone brings R to, say, 1.2? That doesn't seem to me too outlandish to keep up for 1 or 2 years until the vaccine comes. Then we just need to do those things and have infections at 17% of the population, which might very well be the case in many countries at this point.
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On another note, and I'm probably late to the party on this one, it looks like the UK has now surpassed both Spain and Italy in reported coronavirus deaths. It's an odd mix of alarming and unsurprising.
The UK is still better off per capita, 443 per million vs 491 and 558 for Italy and Spain respectively. The USA "only" has 226 dead per million, but there are many reasons why that is still high compared to Europe, and there was another 2,5k day yesterday.
Source: https://www.worldometers.info/coronavirus/#countries
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On May 08 2020 00:32 warding wrote:Show nested quote +On May 07 2020 22:38 Dangermousecatdog wrote:
This discussion suffers from a lack of clarity on what herd immunity means without a vaccine. What does herd immunity mean without a vaccine? It means that virtually the entire population has caught covid-19. How would that occur without overwhelming local healthcare, without some means of slowing transmission? It doesn't necessarily, for two reasons: 1. As I shared above, the model saying herd immunity is = 1- 1/R assumes a homogenous population. Models assuming natural variation demonstrate this could be as low as 10% to 20%: https://www.medrxiv.org/content/10.1101/2020.04.27.20081893v1Here's a more indepth study on the matter: https://necpluribusimpar.net/lets-have-a-honest-debate-about-herd-immunity/2. Even assuming a homogenous population, what if contact tracing, testing and isolating + masks in public transport alone brings R to, say, 1.2? That doesn't seem to me too outlandish to keep up for 1 or 2 years until the vaccine comes. Then we just need to do those things and have infections at 17% of the population, which might very well be the case in many countries at this point.
An R of 1.2 still means number of cases grows exponentially, so unless you've got a good idea of how long until herd immunity kicks in, you may have a hard time keeping up with ICU availability over time. I'd prefer trying to reach an a R of 1 with an ICU occupation of about 2/3, end then continuously (weekly, or bi-weekly) adjusting measures to keep the spread steady. Edit: just looked it up, why does bi-weekly have both meanings?
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The % of infected people reduces the actual R. So if the prevention measures bring R to 1.2, then having 17% of the population infected bring R to 1, and anything above the 17% will bring it under 1.
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On May 08 2020 00:41 Slydie wrote:Show nested quote +On another note, and I'm probably late to the party on this one, it looks like the UK has now surpassed both Spain and Italy in reported coronavirus deaths. It's an odd mix of alarming and unsurprising. The UK is still better off per capita, 443 per million vs 491 and 558 for Italy and Spain respectively. The USA "only" has 226 dead per million, but there are many reasons why that is still high compared to Europe, and there was another 2,5k day yesterday. Source: https://www.worldometers.info/coronavirus/#countries
Yes, can't really compare population density even in town centers, in the US vs in old Europe... If it reached the same per capita, it would be really worrying...
The UK reaped the results of its policy. Notice how for the past 3 days, number of deaths have been the highest in the top3 countries where their presidents and their policies towards the virus are... well.. You know who I'm talking about. US/UK/Brazil. (Yes, Brazil is huge so per capita figures are still low, but it's one of the countries where it's still growing at full speed)
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On May 08 2020 00:53 warding wrote:
The % of infected people reduces the actual R. So if the prevention measures bring R to 1.2, then having 17% of the population infected bring R to 1, and anything above the 17% will bring it under 1.
Ah, you're right, I thought you put in everything to get to 1.2, sorry.
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On May 08 2020 00:41 Slydie wrote:Show nested quote +On another note, and I'm probably late to the party on this one, it looks like the UK has now surpassed both Spain and Italy in reported coronavirus deaths. It's an odd mix of alarming and unsurprising. The UK is still better off per capita, 443 per million vs 491 and 558 for Italy and Spain respectively. The USA "only" has 226 dead per million, but there are many reasons why that is still high compared to Europe, and there was another 2,5k day yesterday. Source: https://www.worldometers.info/coronavirus/#countries
The trendline suggests we're no more than a week off from the UK being worse by per capita, total infection, whatever metric you prefer.
Anyone have any detailed statistics on infection density? It's almost certainly trivially true that it's going to be mostly in London ("follow the airports" seems to be the best way to measure infection these days), but I'm still curious.
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On May 08 2020 02:10 LegalLord wrote:Show nested quote +On May 08 2020 00:41 Slydie wrote:On another note, and I'm probably late to the party on this one, it looks like the UK has now surpassed both Spain and Italy in reported coronavirus deaths. It's an odd mix of alarming and unsurprising. The UK is still better off per capita, 443 per million vs 491 and 558 for Italy and Spain respectively. The USA "only" has 226 dead per million, but there are many reasons why that is still high compared to Europe, and there was another 2,5k day yesterday. Source: https://www.worldometers.info/coronavirus/#countries The trendline suggests we're no more than a week off from the UK being worse by per capita, total infection, whatever metric you prefer. Anyone have any detailed statistics on infection density? It's almost certainly trivially true that it's going to be mostly in London ("follow the airports" seems to be the best way to measure infection these days), but I'm still curious.
You can see what you get out of this, maybe:
https://coronavirus.data.gov.uk/#category=nations&map=rate&area=e92000001
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EPT
