> Is everyone in a high-risk group supposed to withdraw themselves from society for six months until they can emerge once the (so far entirely imaginary) second wave has been averted?
OK... but... isn't that what everyone is being advised to do right now? So maybe not a great example of something unrealistic to ask? Since in fact the UK would be asking it of fewer people than... many are saying it needs to be asked of -- although the US government isn't actually telling us to... yet? But that's the alternative those who who think the UK's plan is madness are suggesting, right? Asking everyone to withdraw from society for months?
I can see the desire: Wait, could we just ask high-risk people to withdraw themselves from society for months, instead of asking everyone to do that? Cause that'd be a lot less disruptive to our social and mental health maybe it'd be just as good? (There are real costs to mental health and social functioning of asking everyone to avoid all contact with everyone else; it might be the best option anyway, but it's definitely not without it's own health risks and consequences).
But I'm no expert. It kind of sounds like the experts are saying "not really, that isn't a good idea, everyone has got to do it". Sometimes what we are called upon to do is not easy or pleasant.
One of the frustrating and anxiety-producing things here is that we aren't getting very consistent messaging from the governmental authorities and experts. It seems like really a failure of the kind of consistent and pervasive public health educational messaging that would actually maximize compliance. Instead it's "everyone picks what forwarded chain letter on facebook makes sense to them" and we all know how well that works...
> OK... but... isn't that what everyone is being advised to do right now?
No. What everyone is advised to do right now is not to withdraw from society, it's to perform basic hygiene and social distancing in order to slow down the spread. Social distancing doesn't mean living like a recluse eating spam cooked on a gas burner, it's not getting into large crowds and trying to stay some distance from other people (outside spitting / coughing range). WaPo has an article with a "social distancing" simulator: https://www.washingtonpost.com/graphics/2020/world/corona-si...
"Self quarantining" is closer to what you're talking about, but it's for people who are at risk or likely to have been infected, not the general public.
Of course the latter you start the more it's already spread and the harsher measures have to be. And the more you'll have to ramp them up as you realise your initial measures were not sufficient, or your citizens have decided "freedom or death" is a good choice and decide to just ignore it.
FWIW Taiwan's already reopened its schools and life has gone back to something not entirely dissimilar to normal (people do have to wear masks and get their temperature checked to step into public buildings or businesses but they can move around just fine).
Plural anecdotes, but: most folks I’ve seen on social media, Reddit, friends very much have interpreted “social distancing” as withdrawing from society. On the NYC and coronavirus subreddits the consensus seems to be that you’re a selfish piece of garbage if you leave the house for any non-essential reason.
The bully pulpit is supremely important in these situations, and no government so far seems to have used it responsibly to disseminate a consistent message early enough to citizenry. Worse yet, in the US ones politics seems to be particularly predictive of opinion on coronavirus.
My current feeling is that the virus was not taken seriously when action could have mattered, and now the goal of government and citizenry is to reduce the carnage to both medically vulnerable folks (old people) and to economically vulnerable people. The latter risk in particular scares me, as there are many folks in the US who are going to be severely impacted by politicians reacting severely way too late who are too cowardly to protect those vulnerable people adequately.
The Norwegian government is prohibiting anyone from staying in cabins [0] because they fear it would overwhelm the small hospitals in rural areas and becomes harder to manage medical resources.
If I noticed anything in the past months it is that it hardly matters if you are an expert. There never was punishment for being wrong for hypotheticals. People just don't know. The WHO when declaring emergency said: "We don't know the damage this virus can do". Even this week professors in statistics compare the Italy crisis to heart attacks and their models all fall apart within a week.
OK... but... isn't that what everyone is being advised to do right now?
Yes but that's expected to, uh, not work. It's only expected to slow the progression.
One of the frustrating and anxiety-producing things here is that we aren't getting very consistent messaging from the governmental authorities and experts.
The only sane course of action the extreme lockdown we are now seeing in many countries. But politicians, being gutless cowards, are coming up with other ideas until their hand forced ... I hope. The alternative of actually believe this stuff and sticking to it would horrific.
I mean, everyone should be definitely be isolating and doing everyone that they can to slow the infection. But we are going to need much stronger measures than individual action. This is a real war, not like drug or terrorism wars, OK.
>although the US government isn't actually telling us to... yet? But that's the alternative those who who think the UK's plan is madness are suggesting, right? Asking everyone to withdraw from society for months?
It doesn't take that much to contain something like this. In no particular order:
(1) Temperature checks outside all major gathering places. Shops, subways, offices, etc. If you're running a fever you don't get in.
(2) Hand sanitizer at the entrance/exit of all major gathering places. Clean your hands before you go in and clean them when you come out. Don't clean them you don't get in.
(3) Wear masks everywhere in major gathering places. No mask, no entry.
(4) Widespread testing and contact tracing for those who have tested positive.
I agree that the West in general is handling this as dumb as possible. Shutting everything down is pointless if you don't use the respite to enact public health measures.
It's estimated that as many as 20% of the infected are asymptomatic, including no fever. A lot of your suggestions would fail to contain the virus.
I do believe that widespread testing and tracing would be effective. Given that we don't yet have access to the scale of testing that is required to maintain public health, I think an immediate quarantine is the only way to save lives.
To say the government opted 'to encourage the flames' is disingenuous. Presumably their statistical model indicated they won't be able to contain the spread which is why the current stated aim is to delay the spread[0]. Delay, not encourage.
The article's suggestions seem to be in line with the government's stance. The main difference is timing with Dr William Hanage saying measures should have been adopted weeks ago while the government claims their modelling tells them to adopt measures later.
The government should be challenged by questioning whether it truly is/was impossible to contain the epidemic and what the best time to introduce different measures is. This article, however, adds very little to that debate with hand-waving in place of evidence.
>> Presumably their statistical model indicated they won't be able to contain the spread which is why the current stated aim is to delay the spread[0].
What statistical model? They're talking of "careful modelling". In the article you link, they don't mention anything about statistics, or, say, a simulation etc. You're assuming too much when you're assuming a statistical model, or anything based on data, or any concrete sort of model at all. "Modelling" can just mean a bunch of officials sitting around having tea and brainstorming potential scenarios.
> "Modelling" can just mean a bunch of officials sitting around having tea and brainstorming potential scenarios.
Good point, but it doesn't seem to be the case. From the Coronavirus action plan[0] published on March 3 2020
> The UK is a world leader in the field of outbreak modelling and data analytics. The NIHR HPRU in Modelling Methodology led by Imperial College London has developed novel analytical and computational tools which exploit novel data streams on infectious diseases such as COVID-19. This group and other leading academic groups have developed tools to prepare for infectious disease outbreaks, which include real time infectious disease models, allowing policy decisions to be made using the best possible data and are actively modelling questions of relevance to dealing with the COVID–19 outbreak.
It’s not true, Italy had exactly the same deaths per day two weeks ago. They introduced the complete lockdown what will be tomorrow. They had 2 weeks of advantage compared to Italy, they already knew what the future was going to look like, and they squandered it all without doing anything.
Now uk is going to be in a much worse situation compared to Italy because of this. Just one day of delay in an exponential curve can mean possibly tens of thousands death. Here we are speaking about weeks or months of delay if they really want to infect 60% of the people.
The nazis probably caused less deaths in concentration camps than boris, but we’ll know for sure in a couple of months.
Holocaust involved death of 1-11 million people (depending on sources and who you want to count). Not a fan of government's current approach, but Boris shouldn't grow a pencil moustache just yet.
I'm posting this because of the narrative on this site that all experts agree with the UK's plan. To the extent that there is a consensus, it's a consensus against it.
I'm not sure there is a consensus against it. I've seen a few articles like this (which is worrying) but articles in favour of the status quo tend to not get so much prominence.
I really hope the government knows what it's doing. They have promised to publish their models, so hopefully that will give some more confidence.
Starting on about page 14 - a sizeable majority of USA voters who claim to prefer the GOP or claim to be independent do not think this covid-19 pandemic is a big deal.
The government has somewhat changed the message and they are now saying that their priority is to save lives, which does sound like contradicting their previous message of rapid herd immunity.
The BBC ran a piece designed to explain why the Govt policy was kosher and the logic behind it, it said there were no scientists in disagreement. Then it corrected the article to say no epidemiologists rather were in disagreement, which is ostensibly false as well. Now it says that at the time of publication no UK epidemiologists had spoken out in mainstream media. They basically admit they didn't do any due diligence when they wrote the piece (they were in a rush to give the Govt cover).
I was trying to make this argument yesterday and got piles of comments responding exactly this way: "oh, that's only 300 signatures from UK scientists in opposition", "oh, but some of the people who agree with you don't have enough credentials".
As a counter to that, unless proven otherwise, you can assume a significant bias in any article on government policy coming from The Guardian, as in the OP here.
That obviously doesn't mean it's incorrect, but try to be aware of all biases, there are plenty on all sides.
Apparently the government's own (secret) figures suggest around 500,000 deaths, and around 8 million people in need of hospitalisation - in a country which currently has around 4,000 ICU beds, and almost no spare capacity in hospitals.
Even if the peak is spread out over nine months, that still means setting up, equipping, and staffing around a million extra beds over the next few weeks. At a time when existing medical staff are incapacitated.
This is not going to happen. The only way it might be possible is with civil conscription - literally taking people off the street and putting them through basic nursing boot camp. Even then there would be huge issues with supplies of equipment and consumables.
So the reality is that most people who need to be hospitalised in the UK (and probably the US) won't be - at least not effectively. Italy has shown what this means: without adequate care the CFR rises from 1% to 7% or so.
Which in turn means that without aggressive containment measures to slow the spread, the actual death toll will be in the millions, heavily concentrated among the over 65s.
There are around 10 million over 65s in the UK. If these numbers are right, around 10% of them will die.
Sir Patrick Vallance, England’s chief scientific adviser, said the government was looking “to build up some kind of herd immunity so more people are immune to this disease and we reduce the transmission.” [1]
Britain’s chief scientific adviser ... said that about 40m people in the UK could need to catch the coronavirus to build up “herd immunity” and prevent the disease coming back in the future. [2]
Sir Patrick told Sky News that experts estimated that about 60 per cent of the UK’s 66m population would have to contract coronavirus in order for society to build up immunity. [2]
for reference, at this moment there are 21,157 (according to john hopkins map) confirmed cases in Italy, which probably translates to anything between 50k-500k infections total. lombardy healthcare is near collapse and there's 1.5k people dead already. multiplying by 80-800 (best-worst case to get to 40M) left as an exercise to the reader. at that point the government might not only buy all ventilators on the market but also all diggers.
But if the UK government can managed to isolate elder people, and can get those 40M to contain almost exclusively younger people, won't the fatality rate be far lesser?
The idea is that if the government can infect low risk citizens then they can recover on their own without relying on the healthcare system. It's the high-risk individuals who put load on healthcare, so the proposal is to use the low-risk citizens to build up immunity.
I spoke with one doctor neighbor from England who now lives in the US. He said he felt much more optimistic about the UK plan because the government was doing a better job of consulting experts. He seems to think the US plan is "satire." But let's not get too political.
The problem is the alternative is even less feasible. Containment is very unlikely to work, and slowing the epidemic too much leads to it happening in winter.
The only thing which they should have done is delayed a decision on this. They are a few weeks behind other countries, and could have observed effectiveness of social distancing in arresting spread. If it worked, it could be copied (ina modified form) and if it failed, it would be much easier to sell to the public. Currently it’s a brave (but likely correct) position it would seem.
But then again, what do I know. While I’m a doctor, I’m
No specialist so my opinion is of limited value, and experts seem to disagree with each other. This is what makes this so difficult, no one seems to know what is the best option this current data.
The problem is the alternative is even less feasible. Containment is very unlikely to work, and slowing the epidemic too much leads to it happening in winter.
Containment has worked in Wuhan. Containment is being attempted after-the-fact in Italy. Containment is possible, it's just a matter of how extreme gets. But even the most containment does not look the hundreds of thousands or millions dead that letting everyone be infected looks like.
For now, but what's going to happen as they go back to work, school and resume travel? Unless they stay locked down until we have a vaccine, which is a year+ away at least. And second waves can be worse than the first.
I don't think anyone knows for sure what strategy is going to work best in the meantime, considering experts disagree and the world is conducting a massive A/B test...
It's possible to contain it with extreme measures, of course. But what happens when you release the lock down and it's still burning through the rest of the world, especially Africa and India? Do you ban every foreign visitor for the next year?
Except in Hong Kong, Singapore, Taiwan, or (more arguably) Japan. And South Korea, while they had a rougher early outbreak, seems to have gotten a lid on the disease now.
That's not really correct. Containment certainly can work. Whether it will or not is still an open question. Right now no western country has been able to match that. Italy, Spain, France and Germany are probably out of time to try. But the UK is still relatively early on its curve.
So, for that matter, might the UK "infect the herd" trick. The science isn't unsound, though it's not nearly certain. So the risk management is just crazy and I can't understand it either. But... it really might work.
> Except in Hong Kong, Singapore, Taiwan, or (more arguably) Japan. And South Korea, while they had a rougher early outbreak, seems to have gotten a lid on the disease now.
And how long can they keep strict containment in force, and what happens when it lifted? You're speaking as if China or SK are now magically immune from a second wave as soon as they relax their restrictions.
In this case the science is flat out unsound: There are several coronaviruses known to infect humans. None are known to result in lasting immunity, and some are known to not result in lasting immunity. This is one of the challenges in making a vaccine.
Given the observed hospitalization rates, many millions in the UK will require hospitalization due to corona. At the moment, their hospitals could support merely thousands. We know from other cities that the mortality rate (particularly among younger people) is dramatically higher when adequate medical care is not available.
Under the UK's argument, the worst outcome of aggressive mitigation is that you are actually successful at it and achieve containment which just shifts the infection later in time at a high economic cost. Given the existing known infection rates in the UK that seems unlikely at that point, but even if it were to happen it would provide time to ready treatment facilities and allow for the discovery of more effective and/or scalable treatment techniques.
Fortunately, the UK has been backing off from its initial position and has now been recontextualizing their position as 'mitigate as much as possible'-- which is what pretty much all of the west is doing.
>While I’m a doctor, I’m No specialist so my opinion is of limited value, and experts seem to disagree with each other.
Given the state of modern politics, this is a time for people to very carefully consider their opinions, because the unpopularity of Trump and Boris is going to potentially sway decisions irrationally. This includes professionals and key decision makers.
This is not a value judgement regarding any world leaders. It's just a call to be very aware of bias and spitefulness can cloud judgement even in the most rational among us.
Readit News
OK... but... isn't that what everyone is being advised to do right now? So maybe not a great example of something unrealistic to ask? Since in fact the UK would be asking it of fewer people than... many are saying it needs to be asked of -- although the US government isn't actually telling us to... yet? But that's the alternative those who who think the UK's plan is madness are suggesting, right? Asking everyone to withdraw from society for months?
I can see the desire: Wait, could we just ask high-risk people to withdraw themselves from society for months, instead of asking everyone to do that? Cause that'd be a lot less disruptive to our social and mental health maybe it'd be just as good? (There are real costs to mental health and social functioning of asking everyone to avoid all contact with everyone else; it might be the best option anyway, but it's definitely not without it's own health risks and consequences).
But I'm no expert. It kind of sounds like the experts are saying "not really, that isn't a good idea, everyone has got to do it". Sometimes what we are called upon to do is not easy or pleasant.
One of the frustrating and anxiety-producing things here is that we aren't getting very consistent messaging from the governmental authorities and experts. It seems like really a failure of the kind of consistent and pervasive public health educational messaging that would actually maximize compliance. Instead it's "everyone picks what forwarded chain letter on facebook makes sense to them" and we all know how well that works...
No. What everyone is advised to do right now is not to withdraw from society, it's to perform basic hygiene and social distancing in order to slow down the spread. Social distancing doesn't mean living like a recluse eating spam cooked on a gas burner, it's not getting into large crowds and trying to stay some distance from other people (outside spitting / coughing range). WaPo has an article with a "social distancing" simulator: https://www.washingtonpost.com/graphics/2020/world/corona-si...
"Self quarantining" is closer to what you're talking about, but it's for people who are at risk or likely to have been infected, not the general public.
Of course the latter you start the more it's already spread and the harsher measures have to be. And the more you'll have to ramp them up as you realise your initial measures were not sufficient, or your citizens have decided "freedom or death" is a good choice and decide to just ignore it.
FWIW Taiwan's already reopened its schools and life has gone back to something not entirely dissimilar to normal (people do have to wear masks and get their temperature checked to step into public buildings or businesses but they can move around just fine).
The bully pulpit is supremely important in these situations, and no government so far seems to have used it responsibly to disseminate a consistent message early enough to citizenry. Worse yet, in the US ones politics seems to be particularly predictive of opinion on coronavirus.
My current feeling is that the virus was not taken seriously when action could have mattered, and now the goal of government and citizenry is to reduce the carnage to both medically vulnerable folks (old people) and to economically vulnerable people. The latter risk in particular scares me, as there are many folks in the US who are going to be severely impacted by politicians reacting severely way too late who are too cowardly to protect those vulnerable people adequately.
I thought the UK (and Sweden, Finland etc) differed mostly in not closing schools yet. Are there other significant differences?
...which presumes you don't live in a place with high-enough urban density that going outside your home immediately puts you into a large crowd.
Like, what are you supposed to do if you live in Manila? Mumbai? Dhaka?
Pretty much the only way to "practice social distancing" in those sorts of places is to never go outside.
[0] https://www.thelocal.com/20200315/norwegians-told-to-leave-c...
Yes but that's expected to, uh, not work. It's only expected to slow the progression.
One of the frustrating and anxiety-producing things here is that we aren't getting very consistent messaging from the governmental authorities and experts.
The only sane course of action the extreme lockdown we are now seeing in many countries. But politicians, being gutless cowards, are coming up with other ideas until their hand forced ... I hope. The alternative of actually believe this stuff and sticking to it would horrific.
I mean, everyone should be definitely be isolating and doing everyone that they can to slow the infection. But we are going to need much stronger measures than individual action. This is a real war, not like drug or terrorism wars, OK.
It doesn't take that much to contain something like this. In no particular order:
(1) Temperature checks outside all major gathering places. Shops, subways, offices, etc. If you're running a fever you don't get in.
(2) Hand sanitizer at the entrance/exit of all major gathering places. Clean your hands before you go in and clean them when you come out. Don't clean them you don't get in.
(3) Wear masks everywhere in major gathering places. No mask, no entry.
(4) Widespread testing and contact tracing for those who have tested positive.
I agree that the West in general is handling this as dumb as possible. Shutting everything down is pointless if you don't use the respite to enact public health measures.
I do believe that widespread testing and tracing would be effective. Given that we don't yet have access to the scale of testing that is required to maintain public health, I think an immediate quarantine is the only way to save lives.
Deleted Comment
The article's suggestions seem to be in line with the government's stance. The main difference is timing with Dr William Hanage saying measures should have been adopted weeks ago while the government claims their modelling tells them to adopt measures later.
The government should be challenged by questioning whether it truly is/was impossible to contain the epidemic and what the best time to introduce different measures is. This article, however, adds very little to that debate with hand-waving in place of evidence.
[0]: https://www.gov.uk/government/news/covid-19-government-annou...
What statistical model? They're talking of "careful modelling". In the article you link, they don't mention anything about statistics, or, say, a simulation etc. You're assuming too much when you're assuming a statistical model, or anything based on data, or any concrete sort of model at all. "Modelling" can just mean a bunch of officials sitting around having tea and brainstorming potential scenarios.
Good point, but it doesn't seem to be the case. From the Coronavirus action plan[0] published on March 3 2020
> The UK is a world leader in the field of outbreak modelling and data analytics. The NIHR HPRU in Modelling Methodology led by Imperial College London has developed novel analytical and computational tools which exploit novel data streams on infectious diseases such as COVID-19. This group and other leading academic groups have developed tools to prepare for infectious disease outbreaks, which include real time infectious disease models, allowing policy decisions to be made using the best possible data and are actively modelling questions of relevance to dealing with the COVID–19 outbreak.
[0]: https://assets.publishing.service.gov.uk/government/uploads/...
I really hope the government knows what it's doing. They have promised to publish their models, so hopefully that will give some more confidence.
https://www.documentcloud.org/documents/6810602-200149-NBCWS...
https://www.bbc.co.uk/news/science-environment-51874084
and here was the first published version: https://web.archive.org/web/20200313155320/https://www.bbc.c...
That obviously doesn't mean it's incorrect, but try to be aware of all biases, there are plenty on all sides.
https://www.theguardian.com/world/2020/mar/15/uk-coronavirus...
Even if the peak is spread out over nine months, that still means setting up, equipping, and staffing around a million extra beds over the next few weeks. At a time when existing medical staff are incapacitated.
This is not going to happen. The only way it might be possible is with civil conscription - literally taking people off the street and putting them through basic nursing boot camp. Even then there would be huge issues with supplies of equipment and consumables.
So the reality is that most people who need to be hospitalised in the UK (and probably the US) won't be - at least not effectively. Italy has shown what this means: without adequate care the CFR rises from 1% to 7% or so.
Which in turn means that without aggressive containment measures to slow the spread, the actual death toll will be in the millions, heavily concentrated among the over 65s.
There are around 10 million over 65s in the UK. If these numbers are right, around 10% of them will die.
Britain’s chief scientific adviser ... said that about 40m people in the UK could need to catch the coronavirus to build up “herd immunity” and prevent the disease coming back in the future. [2]
Sir Patrick told Sky News that experts estimated that about 60 per cent of the UK’s 66m population would have to contract coronavirus in order for society to build up immunity. [2]
Read more:
[1] https://www.nytimes.com/2020/03/13/world/europe/coronavirus-...
[2] https://www.ft.com/content/38a81588-6508-11ea-b3f3-fe4680ea6...
[1] https://www.nytimes.com/interactive/2020/03/13/world/asia/co...
Deleted Comment
Also UK: People won't react negatively when hundreds of thousands of people die. Keep Calm and Carry On.
Deleted Comment
The only thing which they should have done is delayed a decision on this. They are a few weeks behind other countries, and could have observed effectiveness of social distancing in arresting spread. If it worked, it could be copied (ina modified form) and if it failed, it would be much easier to sell to the public. Currently it’s a brave (but likely correct) position it would seem.
But then again, what do I know. While I’m a doctor, I’m No specialist so my opinion is of limited value, and experts seem to disagree with each other. This is what makes this so difficult, no one seems to know what is the best option this current data.
Containment has worked in Wuhan. Containment is being attempted after-the-fact in Italy. Containment is possible, it's just a matter of how extreme gets. But even the most containment does not look the hundreds of thousands or millions dead that letting everyone be infected looks like.
I don't think anyone knows for sure what strategy is going to work best in the meantime, considering experts disagree and the world is conducting a massive A/B test...
Except in Hong Kong, Singapore, Taiwan, or (more arguably) Japan. And South Korea, while they had a rougher early outbreak, seems to have gotten a lid on the disease now.
That's not really correct. Containment certainly can work. Whether it will or not is still an open question. Right now no western country has been able to match that. Italy, Spain, France and Germany are probably out of time to try. But the UK is still relatively early on its curve.
So, for that matter, might the UK "infect the herd" trick. The science isn't unsound, though it's not nearly certain. So the risk management is just crazy and I can't understand it either. But... it really might work.
And how long can they keep strict containment in force, and what happens when it lifted? You're speaking as if China or SK are now magically immune from a second wave as soon as they relax their restrictions.
In this case the science is flat out unsound: There are several coronaviruses known to infect humans. None are known to result in lasting immunity, and some are known to not result in lasting immunity. This is one of the challenges in making a vaccine.
Given the observed hospitalization rates, many millions in the UK will require hospitalization due to corona. At the moment, their hospitals could support merely thousands. We know from other cities that the mortality rate (particularly among younger people) is dramatically higher when adequate medical care is not available.
Under the UK's argument, the worst outcome of aggressive mitigation is that you are actually successful at it and achieve containment which just shifts the infection later in time at a high economic cost. Given the existing known infection rates in the UK that seems unlikely at that point, but even if it were to happen it would provide time to ready treatment facilities and allow for the discovery of more effective and/or scalable treatment techniques.
Fortunately, the UK has been backing off from its initial position and has now been recontextualizing their position as 'mitigate as much as possible'-- which is what pretty much all of the west is doing.
Time is vital.
Given the state of modern politics, this is a time for people to very carefully consider their opinions, because the unpopularity of Trump and Boris is going to potentially sway decisions irrationally. This includes professionals and key decision makers.
This is not a value judgement regarding any world leaders. It's just a call to be very aware of bias and spitefulness can cloud judgement even in the most rational among us.