Now my company is close to going out of business and I have just been laid off. Partly due to high-ranking officials not believing in the virality of nCov-19.
I can't get W.B. Yeats "The Second Coming" from 1919 out of my head:
"Turning and turning in the widening gyre The falcon cannot hear the falconer; Things fall apart; the centre cannot hold; Mere anarchy is loosed upon the world, The blood-dimmed tide is loosed, and everywhere The ceremony of innocence is drowned; The best lack all conviction, while the worst Are full of passionate intensity.
Surely some revelation is at hand; Surely the Second Coming is at hand. The Second Coming! Hardly are those words out When a vast image out of Spiritus Mundi Troubles my sight: a waste of desert sand; A shape with lion body and the head of a man, A gaze blank and pitiless as the sun, Is moving its slow thighs, while all about it Wind shadows of the indignant desert birds.
The darkness drops again but now I know That twenty centuries of stony sleep Were vexed to nightmare by a rocking cradle, And what rough beast, its hour come round at last, Slouches towards Bethlehem to be born?"
The Moving Finger writes; and, having writ,
Moves on: nor all your Piety nor Wit
Shall lure it back to cancel half a Line,
Nor all your Tears wash out a Word of it
Rage, rage against the dying of the light.
It shows just how far behind we are.
TLDW: Temperature checks everywhere. Fever clinics optimized for quarantining the potentially infected.
China is trying to actually contain the virus. The only way out for us unless we significantly ramp up testing and lockdown is to admit defeat and simply optimize for slowing down the onslaught.
This has already happened. “Flatten the curve” takes it as written that most people will be exposed to the virus, and thus aims instead to just spread those exposures over a long enough period to avoid overwhelming the health care system.
It's still a good strategy for right now because it gives us some extra time to ramp testing and healthcare up.
This is difficult, not impossible. We'll see what actually happens.
https://medium.com/@joschabach/flattening-the-curve-is-a-dea...
I would assume that under that scenario, the backlog would disappear shortly after the 2-year mark.
The day after I got back we found out we had a case of covid-19 in our apartment block, so we were one of the first to get restricted entry/exit — each unit gets 2 cards and you have to present it when you enter or leave through the single open gate. I did 2 weeks going outside just twice to buy food, then slowly relaxed a bit. Many of my chinese friends are still basically not going out at all.
Now’s an exciting time for China because we’re at basically zero new cases in the country (had 4 new ones in Hubei yesterday, the rest were all retournees from outside the country). So since yesterday, it’s mandatory hotel quarantine for everyone who enters the country.
Really getting worried for my family and friends in the states though. Gonna have some long talks about how to prepare.
It's a picture of a society on a war footing, certainly. But people aren't locked in their apartments, and the hospital system isn't collapsing under its own weight.
So far, this is the most optimistic answer I've seen to "What comes after total lockdown but before a vaccine?"
However, even though the borders are now heavily restricted, inside the country most things goes on as normal. There are fewer people out, but I'm still having trouble finding parking at the mall for example.
Of course this may not last, and at some point we might see a huge increase in the number of cases, but the total daily new cases has been low until now.
I'd take that an indicator that the strategy works, at least as a tool to slow down the spread.
Let's say China has managed to isolate the virus to some pockets... that means the rest of China is not exposed and vulnerable for who knows how long.
The sheer amount of effort to prevent what seems like the inevitable might be wasted effort.
That's not to dismiss the casualties or the impact of a widespread outbreak or the desire to SLOW it. But man do you spend forever and all that effort isolating A from B & C ... and then B from A ... until there are huge amounts of vaccine available (late fall?)
- denial
- placating measures
- minor lockdowns
- major lockdowns and panic (running to the store to stockpile toilet paper, for some reason)
- total quarantine
- life slowly returns to normal
China is now on the final stage (restaurants and stores reopening, etc), with the rest of the world between 2 and 3 months behind.
Most people are unable to comprehend exponential growth, so this is the pattern that gets followed.
- placating measures
- minor lockdowns
- major lockdowns and panic (running to the store to stockpile toilet paper, for some reason)
- total quarantine
- life slowly returns to normal
When in the last 100 years has this happened that you're basing your 'typical pandemic response' examples on?
It certainly hasn't happened in my lifetime...
Exponential growth and epidemics:
Americans use lots of toilet paper.
I also suspect that most US consumer toilet paper is fluffier than the non US norm, with far fewer sheets per roll. So the 90g per roll conversion is misleading.
My favorite institutional style paper comes in 1000 sheet rolls, which weigh 187g. The consumer brand that I recently bought comes in 220 sheet rolls, which weigh 106g.
We don't know about natural immunity duration, or if and when there's a vaccine, and for how long it will be effective. We don't know about mutations.
I think a lot of the questions are only answered 2 years from now.
In Czech Republic, only essential businesses are allowed to function, although the measures are not as extreme as they were in China. Restaurants are closed, or serve food only for takeaway, shopping centers are pretty much deserted, gatherings in large numbers are banned. Although, the quarantine is far from total: people still go outside, and parks are very crowded (some look like superspreaders congresses - that is, lots of kids playing), and surprisingly we are allowed to go to work, regardless of the type of business. In my opinion, this is allowed because doing otherwise would have significant economic costs, and so far it's hard to justify it: there are just 300+ confirmed cases in CZ. Of course, there will be plenty more unidentified cases, and the sh*t will hit the fan. It's just a matter of time.
- state wide quarantine from Monday morning, people can go only to work, to get groceries or to hospital/doctor
- all puliblic gathering over 30 people banned, but probably moot due to the above
- borders closed, foreigners can't go in and citizens can't travel travel out
- cross border trains/buses shut down, flights stopped
- schools closed for ~week already
- only food, medicine and drug stores are open, all other shops are closed
- there is a new exception for stores selling fabrics and clothes, as people are using clothes/fabric to manufacture their own protective masks
- all restaurants closed, only food takeout is allowed
- public transport is generally running, but the driver is extra-protected to not be in contact with riders (no selling of tickets, etc.), in some cities public transport is free to avoid any contact with riders and personnel at all
- everyone who arrived from the outside from an at risk country needs to do 14 day quarantine or else get crazy fines and possibly jail time
- a couple towns and villages (around 20k people) have got extra quarantined due to of-nominal number of cases, people can't leave the are for at least 14 days
- the army is helping out the police with patrolling the border crossings and to distribute medical supplies, army aircraft also just went to a round trip to China for more medical materials from Shenzen
- hospitals are clearing of any non essential surgeries and patients who can go home
- medical school students have been drafted to help in hospitals
There is a nice Wikipedia page summarizing many of the restrictions and overall progress (case numbers, etc.):
https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_t...
Pretty tough and so far surprisingly well executed measures I would say. People are generally respecting the special rules and there is a rather low amount of grumbling, considering this is Czech Republic.
Also a lot of solidarity - theaters sewing face masks, universities enrolling computer labs to Folding@Home, teaching student taking care of children of medical personnel, middle school student doing grocery shopping for old people who are most at risk, etc.
Now let's hope this all works and we can get this over with in a reasonably time in good shape.
They are not in total lockdown, but they are doing extensive testing and contact tracing, and substantial isolation of anyone who might be contagious.
Once we get testing infrastructure ramped up, this is not an unreasonable plan in the United States.
To be clear, lockdown is the only option for the US right now. But then what?
Yea, we're bigger. We also have more cities with high populations. But What SK did primarily in Seoul is the perfect pilot program to expand into national policy.
The problem is our government is filled with people deferring upward for decision making until it was too late.
Even today, the President went on TV with "guidelines." Not policy, not action, and certainly not teeth behind those guidelines. This is the inaction that we're fuming about.
1. Build up testing and contact tracing capabilities.
2. Massive mask making, everyone required to wear a mask in public.
3. Hospitals reconfigured to deal with covid patients.
People can then go outside and mingle again.
Without those masks increase your risk.
Don't wear masks.
Listen to literally all the medical advice telling you not to wear masks, unless you've been advised by people treating you to wear a mask. (eg one person in a family is infected and the family is self isolating).
You could also say "don't wash hands" because it's not effective unless you combine them with social distancing and other quarantine measures.
A preventive measure does not need 100% effectiveness to be recommended. For example, washing your hands.
they also have large distribution of sanitizer so you can shrink the contact vector too..
I wish europe went this way
Then each block is allowed movement after 2 months with community punishment if they hide cases and monetary incentive to follow rules, such as keeping contaminated clothing outside. Workers in critical industry will live at work and not allowed home to prevent contamination https://m.youtube.com/watch?v=yyucJekT87E
It's all so surreal, I can just imagine it. (In the US, I think some primary elections are under discussion for delays.)
I'm not worried, just wondering how to best disarm it from a distance.
If we know who has it well enough then we can focus care on them, wait until they can fight off the virus and go back to normal after. That is assuming people don't transmit the virus after recovering from it.
Once that flattens out and the growth rate slows or decreases a concerns is that folks will head back out, assuming the coast is clear.
That could cause a second wave of infections that restarts this whole thing.
Folks not taking this seriously is a problem, imagine what happens when folks who don't take this seriously think that it's finally over, when it really isn't.
Isn't this a virus? There's not a single virus that we have a treatment for - we know how to deal with bacteria but not viruses.
Ebola patients either die or their immune system fights off the disease.
But on the bold assumption that we somehow contain the virus, we have a global economic collapse to tend to.
If we have an "unlimited" (by which I mean we manufacture them faster than we consume them) number of test kits with a turnaround time of < 24 hrs, then everyone on lock down for 14 days. Medical/Drive through facilities set up to process everyone for a test. Get a test, and then within 24 hours get a text on what their status is (infected, uninfected, immune (post infection)).
People who test positive go into quarantine to be re-tested weekly until they are immune.
People who test immune are allowed to resume work movement while keeping good practice (washing hands, coughing into elbow, Etc.)
People who test as non-infected are required to come back for re-testing every week, can move around with social distancing.
I don't know if it would work (I'm not a public health professional) but from a systems perspective surveillance of the infection seems to be the best strategy for staying on top of outbreaks.
Once a vaccine is available it becomes one of the things you get every year like a flu shot.
Ralph Baric: "I saw some very interesting data from Stan Perlman the other day, who has been looking at serum neutralization titers of MERS patients from the Middle East kingdom of Saudi Arabia area and it's quite intersting that people peak fairly quickly with high neutralization titers but then they wane over the next year to almost background levels or just slightly above background levels by the second year, and with MERS there have been several reports of people who have seroconverted. They were rtPCR positive and their serum neutralizing titers and even ELISA titers went to almost zero within a few months."
Baric: "And it has not been studied and it should be studied, and this is the contemporary human Coronaviruses -- nobody knows how they maintain themselves in human populations. They don't undergo rapid antigenic variation like influenza. There's not 115 common cold or corona virus type genotypes or whatever they're called, serotypes. Sorry Vincent, I just butchered the coronaviruses."
Vincent Racaniello: "That's ok." <laughter>
Baric: "So one hypothesis is that they cause a transient protective immune response that wanes quickly and then they can reinfect and cause mild upper-respiratory tract infections and that's how they maintain themselves. So it is quite possible.. there's been a number now of reported cases in China of SARS2 infections where people were documented to be infected and recovered. They were rtPCR negative. They went home and they became reinfected a month later or so."
Baric: "In this case the United States has sufficient cases that we can actually track the serologic responses of the individuals and their general immune.. both B- and T-cell responses after infection and we can get a handle on the long term immunity that may be elicited after infection."
[1] - http://www.microbe.tv/twiv/twiv-591/
[2] - about 15 minutes and 50 seconds in to the program
If you’re interested, I can post some news reports. Forbes actually has a pretty good rundown of the various news articles, but Forbes isn’t always the best place for facts or safe browsing, so I’ll avoid posting that one. In the interest of fairness, I can also post (much older) news reports that called HIV/AIDS “Gay Related Immuno-deficiency” and we know how good that science was.
I don't know if that simply continues until a vaccine is viable or some other factor intervenes.
But this new reality won't be short-lived.
Once (whenever that may be) the curve is shown to be flattening and hostpitals are in control, it'd be logical to see some gradual loosening of the restrictions that are currently being ramped up.
I personally doubt that loosening of restrictions, once above conditions are met, will be contingent on a proven and widely available vaccine having been developed (not least because there's no guarantee that one ever will be).
At this point it's anyone's guess how long it'll be in any given country until things appear to be more under control... Even in South Korea, who seem to have done best job in containing this, I've yet to see any estimates of how long it'll take at current rates on infection for the majority of the population to get it and/or get to "herd immunity" point.
In the US all bets are off.. it seems we were (and still are) extraordinarily slow to recognize the severity of this and take appropriate actions (severe lockdowns, widespread testing and resulting case tracking), so a reasonable expectation is that we may be following the case trajectories of the harder hit countries, with similar measures as they have in place coming to the US.
The question assumes this has already been done: "single cases here and there, maybe even 0 cases".
It seems to me that the key question at that point is, if there are no active cases--everyone exposed to the virus who is still alive has either never developed symptoms in the first place, or has recovered from whatever symptoms they had and is now asymptomatic--is there still a risk of spreading the virus further?
You're missing my point. I'm not saying that R0<1 implies "single cases here and there, maybe even 0 cases". I'm saying the converse: that "single cases here and there, maybe 0 cases" implies R0<1. Which is obviously true. And the scenario posed in this "Ask HN" question assumed "single cases here and there, maybe 0 cases", so if that implies R0<1, and it does, then the OP's scenario does assume R0<1, even though it doesn't say so explicitly.
Experimental treatments are being researched, but with only very small numbers of patients. It'll take quite some time for those treatments to become widely available.
It's unlikely that we're going to even begin to see things return to normal in a month or even three of isolation, especially if that isolation isn't as effectively and universally enforced as in China.
Afterwards there has to be extremely aggressive testing, tracking, and monitoring, or the outbreak has a very good chance of starting all over again.
In addition, the health care system itself has to have time to recover and replenish its equipment, ICU capacity, and healthy and able medical personnel.
Your epidemiologist should talk to a chemist or look at a wikipedia entry. In 1957, the H2N2 pandemic vaccine was available in 3 months. Still managed to kill a few million people.
https://www.globalsecurity.org/security/ops/hsc-scen-3_pande...
There was a thread last night about people worrying that improvised ventilators aren't FDA tested or whatever. That's a great thing to worry about in soft times. If I (or a member of my family) am facing death while waiting for a ventilator to save my life, I'll take my chances on the doodad cobbled together from a CPAP machine without FDA approval. Same story with vaccinations.
The vaccine, once developed, should be free for everyone to encourage high uptake herd immunity.
Use that as a yard stuck.
A lockdown isn't 'successful' it does little, except drag society into the dirt while a little time is bought to work things out.
Time China bought us but we squandered.
If you're lucky it's a winter desease so it'll become summer and it'll die off. But that's coin flipping a little.
Treatments might be found but it's hard to know how fast, especially while everyone is on lockdown.
Slowing down the spread is useful to soften the blow on medicinal infrastructure.
Have a look at a flatten the curve with actual numbers not cartoons.
Make sure the hospital capacity is seasonal and accounts for the fact nurses and doctors will wear out and supply's will dwindle.
Then say it softens the blow.
Summer..
once the summer starts and we see 30c or above , i think the spread will be limited and the quarantine might end.
But, worrying part is what comes next, without a Vaccine, coming Winter might be lethal, and we may end up with same cycle..
https://www.scmp.com/news/china/science/article/3074131/coro...
South Africa only has 62 cases and New Zealand only has 8 cases. Not much there yet.
In other words, don't count on it (additionally, ignoring any "medical information" that comes out of POTUS' mouth is likely a good idea, too).
Second, our reaction has be abysmal which, similar to the 1918 Spanish Flu pandemic, massively increases the chance of a second or even third wave of massive infection spread. That will be on many peoples's minds.
And one more thing I want to touch on so people here can get it through their thick heads: just because the death rate is supposedly "low" and "only" impacts old people mostly, that doesn't mean it doesn't impact YOU. If YOU have an emergency and the hospital is packed with COVID-19 patients, it doesn't really matter what you have, you are affected.
Even ignoring the ethical implications of just letting people die from this, I think most people who would do that are unlikely to ignore implications to themselves so figure out where you land or not, it doesn't matter, the goal of keeping hospitals from being overloaded affects everyone.
You definitely develop immunity to viruses that sicken you. For the average person who is healthy.
If there is a second wave it will only be because of overly aggressive quarantining. This is why I said it won’t happen. For it to work, it would have to be air tight. All these young kids staying home are just saving fuel for a second wave. Old people ought to stay home and let younger people gain herd immunity as quickly as possible.
On the other hand, if you prevent the kids and young healthy people from getting it, you pretty much guarantee a large vector for continuous outbreaks well into the future, which may end up killing far more people in the long run and at a much higher economic cost.
I'm not an epidemiologist, so if anyone here is, please share why this approach isn't getting more consideration.
Common cold causing coronaviruses have recurring waves every 2-4 years. If they don't mutate like flu it means that immunity is not that long lasting.
So it's crazy to me how little, relative to the hard economic costs of the virus, is being spent on mitigation.
I'm a totally uninformed lay-person, but the below seems reasonable:
Huge testing effort, something like 5% of the country's population gets tested every day (once every 20 days per person). Manage electronically. If positive, quarantine that person and known contacts.
Huge contact tracing and small lockdown strategy (found 10 cases in Omaha, Omaha lockdown for 2 weeks).
Seems that would be doable, cost billions and billions, but enable economic activity and minimize health+human consequences. Would be a great RoI.
