So here’s my question for all you epidemiologists and infectious disease experts out there –
Wouldn’t it be better to have only high-risk people stay home? People over 60 and those with pre-existing conditions? That way, if all those at low risk kept mingling, a lot of them would get a mild flu and herd immunity will be achieved fairly quickly, to the benefit of all, without overwhelming the health care system.
I’m not suggesting this as an actual policy right now, but I’m just wondering if my logic is flawed. I suppose the question is how long would it take for it to run its course and achieve sufficient herd immunity, and when would it be safe for us old folks to finally emerge. Also, would there be a lot of deaths among the younger ones in the meantime?
I just don’t see the end game for the current mitigation strategies. Wouldn’t we still get an overwhelmed health care system when everyone emerges? However, that doesn’t seem to be happening in China or South Korea at the moment, as far as I can tell – although I also don’t know whether many people have been allowed to “emerge” yet.
I was looking at a spate of recent articles on how Philadelphia and St. Louis handled the flu differently in 1918, with Philadelphia holding a big war bond parade despite the fact that the flu was beginning to make inroads in the city, and St. Louis canceling public gatherings (see this for just one example). The Philadelphia death rate soared and that of St. Louis did not.
However, most of the articles don’t mention this depressing fact:
According to a 2007 analysis of Spanish flu death records, the peak mortality rate in St. Louis was only one-eighth of Philadelphia’s death rate at its worst. That’s not to say that St. Louis survived the epidemic unharmed. Dehner says the midwestern city was hit particularly hard by the third wave of the Spanish flu which returned in the late winter and spring of 1919.
So, St. Louis did flatten its curve. But the deaths stretched out longer there.
And this apparently was a common occurrence in many cities:
If St. Louis had waited another week or two, they might have fared the same as Philadelphia, says the lead author on the first study, Richard Hatchett, M.D., an associate director for emergency preparedness at NIAID. Despite the fact that these cities had dramatically different outcomes early on, all the cities in the survey ultimately experienced significant epidemics because, in the absence of an effective vaccine, the virus continued to spread or recurred as cities relaxed their restrictions.
The second study also shows that the timing of when control measures were lifted played a major part. Cities that relaxed their restrictions after the peak of the pandemic passed often saw the re-emergence of infection and had to reintroduce restrictions, says Neil Ferguson, D.Phil., of Imperial College, London, the senior author on the second study. In their paper, Dr. Ferguson and his coauthor used mathematical models to reproduce the pattern of the 1918 pandemic in different cities. This allowed them to predict what would have happened if cities had changed the timing of interventions. In San Francisco, which they found to have the most effective measures, they estimate that deaths would have been 25 percent higher had city officials not implemented their interventions when they did. But had San Francisco left its controls in place continuously from September 1918 through May 1919, the analysis suggests, the city might have reduced deaths by more than 90 percent.
What was the effect of all this on the economy at the time? Here’s a pretty lengthy study. A summary:
Most of the evidence indicates that the economic effects of the 1918 influenza pandemic were short-term. Many businesses, especially those in the service and entertainment industries, suffered double-digit losses in revenue. Other businesses that specialized in health care products experienced an increase in revenues. Some academic research suggests that the 1918 influenza pandemic caused a shortage of labor that resulted in higher wages (at least temporarily) for workers…
Like today, there were a lot of mandatory closings and prohibitions in an attempt to blunt the effects of the disease. I can’t even begin to compare the extent of them, then and now (although I’ll probably do some more reading on the subject). But I do know that the 1918 flu pandemic killed a disproportionate number of people in the prime of life compared to what’s happening with COVID-19, and also killed a higher percentage of Americans in general, and so it stands to reason the economic effects would be maximized by those factors compared to the mortality trends with COVID-19.
One grave repository of uncertainty when attempting to reckon bugs like these — whether influenza or Wuhan coronavirus — is the dynamic moving target: the damned things are changing quite rapidly, be it for the worse infectivity and subsequent disease expression, or for the better. Without digging deep into the genomes of particular instances and the disease effects of those differences, we are impossibly hard pressed to say how our mitigation efforts would work in various hypotheticals.
That’s my question too.
Also why not require (as soon as we can make them) all people out in public to wear low-tech masks, not the kind that protect the wearer, but to protect the public from our coughs and sneezes? Wouldn’t that help drive the reproductive rate (number of people each infected person infects) down below one sooner than otherwise, which would bring the epidemic to an end? Why, heck, even bandannas would be a step in the right direction.
We’ll see how Denmark, Germany, and the UK do.
neo: “Wouldn’t it be better to have only high-risk people stay home? People over 60 and those with pre-existing conditions? That way, if all those at low risk kept mingling, a lot of them would get a mild flu and herd immunity will be achieved fairly quickly, to the benefit of all, without overwhelming the health care system.”
I think this is the Brit approach.
https://marginalrevolution.com/marginalrevolution/2020/03/the-british-approach-to-coronavirus.html
We should make it official and change the national motto from ‘In God We Trust’ to ‘Better Safe Than Sorry’ with ‘If It Saves One Life’ below that.
JimNorCal:
It’s a gamble that might pay off. Or might not.
I’d hate to be the one making the decision.
The problem with the ‘herd immunity’ concept is what it connotes. We are not a herd of Baa-Baa Black Sheep, in which the odd member of the flock is ‘Ah, well’ just lost, dies and takes the deadly agent along. The corona virus has an extraordinarily long life span (14 days+) in asymptomatic persons, so passage occasions are extraordinarily numerous and will eventually lead to the infection and possible/probable death of our elders.
In the UK, I trust the young do still come home after gamboling about….to their parents and others aged 60 and over, with their health issues.
Cicero:
Have you found convincing evidence that it is transmissable without symptoms? When I researched that, the available information said that early reports were that it could be transferred by asymptomatic individuals, but later reports said no evidence of that (yet).
Also, if enough people become ill and recover, doesn’t the virus find it harder to find hosts that are not already immune and therefore spread would be much less efficient? Also, wouldn’t there then be a large reservoir of immune people who could give blood and this method of treatment might be available on a large scale?
Does that make sense?
It wont matter much either way…
the well wont stay in long enough for no residual virus not to present itself
as i pointed out in a different post, you change the angle of the rise mostly
its either short and quick and recovers early, or its more drawn out
in a way, Edgar Allan Poe knew this answer… (and Prospero found out)
[no one is sure what the disease was in the story, though it does sound like some form of hemorrhagic condition]
The point was that there was no real way to avoid the outcome just delay it at best.. and that is quite true, and even more so in modern societies where everything is linked up across large distances in short times.
There is also the issue that the west coast has a variant from china and that made it across the US, while Europe has another variant… that isn’t as prevalent here… [genetic analysis tracking the changes and creating a lineage to its source]
there are quite a number of variants already, and of course, we dont know if they have he same infection rates, and or the same death indications…
pandemic diseases tend to get nicer not nastier…
the nicer they are the easier their survival is…
the faster they lead to death, the less likely they can be transmitted…
So a condition that you barely feel is one that gets passed around a lot and fast
If its different for different ages given the response of the immune systems, thats just one more complexity for the math…
the 1918 flu killed young because their immune systems over responded..
ie. they were done in by their strength…
this one kills differently because of the opposite… the old cant fight it, and the youngest dont respond if they have it and over time they make enough antibodies to remove it without nary a peep…
its the response that gets you… not usually the disease itself.. (in this kind)
this post from Hotair speaks about that.
https://hotair.com/archives/allahpundit/2020/03/17/latest-study-isnt-good/
My read of that is that our best hope is to put almost everything we have into treatments.
I’d hate to be the one making the decision.
The beauty of a federal system is that there isn’t one person, but 50 states and thousands of local communities. Hypothetically if a bunch of cities adopted SF-style “shelter in place laws” (which would presumably keep away outsiders), and a bunch of others said “Residents over 70 shelter in place, everyone else go about your business,” we might learn which approach is more effective. We know the second one would be a lot less costly economically.
“transferred by asymptomatic individuals”
I too have read that there is a lack of evidence to support asymptomatic contagion. However in the last couple of days the number of US cases for which no exposure can be traced has ballooned, to something like 4593 out of 5303 total diagnosed cases (NY Times, March 17, 4:21 pm ET), which seems to have led health experts to conclude that there must be “stealth spreading” going on. Anyway, that’s what I read is at least one justification for the massive lockdowns, to try to stop people who don’t know they are sick from spreading the virus.
Hotair followed up that pessimistic piece Tom links at 5:56 with this one:
https://hotair.com/archives/allahpundit/2020/03/17/stanford-prof-coronavirus-may-less-deadly-think-mild-justify-aggressive-countermeasures/
Really the “experts” are all over the map on this.
I have to wonder how much of the spread is from truly asymptomatic people vs people with minor illnesses that don’t seem any different than any other winter bug. Today, everyone with a cold or flu immediately assumes that they have COVID-19; two or three weeks ago, most people with COVID-19 probably thought they had a cold or flu.
Physician Speaks Out – Social distancing is a mistake, virus is spread by surface contact…
https://www.citizenfreepress.com/breaking/physician-speaks-out-social-distancing-is-a-mistake-virus-is-spread-by-surface-contact/
So if he’s right then gloves, frequent use of hand sanitizers, disinfectant wiping down of things like doorknobs and/or washing your hands is the ticket?
Regarding the various approaches nations are taking to handle the virus, I made this comment on another site. Nobody responded, well, it’s a fair counter to say the data is just not reliable enough to make conclusions. But I present for your critique or amusement:
If you go to the worldometers site, click on the various countries and examine Daily New Cases you get a clue as to where each of the nations is at.
For China and S. Korea, there is a bell curve: rise, peak then recede. Clearly they are over the worst.
For US, and the EU countries it’s still early. There is only the rise. It hasn’t leveled off yet.
But, the UK is different. Could very well be a glitch in the data, but they have a short rise of cases and now it’s in decline.
https://www.worldometers.info/coronavirus/country/uk/
Keep an eye on this.
Maybe there’s a glitch and we’ll some new high UK numbers. But if the trend continues it could mean they took the right approach: protect elders and at-risk individuals but allow virus to run free otherwise.
Here’s South Korea for comparison:
https://www.worldometers.info/coronavirus/country/south-korea/
And here’s a random EU country:
https://www.worldometers.info/coronavirus/country/france/
Again–scroll down to Daily New Cases. I think this is the best number to show how quickly the disease is spreading.
In general, experts are rarely experts. There are so many unknown unknowns here that taking experts seriously is a proverbial shot in the dark.
Keep your finger outside of the guard guard folks.
It occurred to me a couple days ago that my best personal survival strategy might be to make sure I get infected early, while the health system is still functioning well and all supplies are still available.
Note: I am not actually pursuing that plan. I am not in the high-risk population. But, Neo isn’t the only one considering alternative strategies.
Let’s see the serological tests done on large numbers of Americans; let’s see who has antibodies built up, how many have them, and for how long; let’s see med histories for these people. Did they come down with a second bout of flu this last December, as I did (after an earlier worse flu infection in mid Nov into early Dec)? Was that second illness in late Dec/early Jan not the flu? This is the nagging question I’ve got. Has nCov19 been cycling through longer than we know? Extensive serology should be able to answer that, and much more besides.
I basically don’t believe the story about asymptomatic passing of the disease- it would basically be you infected and you body not responding at all as it normally does. What is surely happening is people, at least up to the last week, had been treating their illnesses as they always did- some being conscientious, and some not being so. That has changed in a big way. I go the gym every afternoon, and I have noticed that everyone wipes equipment down diligently before using it and afterwards- this is a big change since few people actually did so before and after, and I would say about half only did so after using the equipment.
I think we will see the same pattern seen in South Korea in the US- we will get to about 40,000 total cases (we are bigger country) and about 2000 deaths by the end of the first week of April, and that will be the peak of active cases.
Now, I don’t know if this would be good news or not. While China and South Korea are both passed the point where the number who recover each day is more than the new cases number, neither country looks likely to have zero new cases any time in the next 2 months, and if restrictions/closures mattered a lot more than changes in individual behavior, then the easing of restrictions is going to lead to a resurgence in new cases. This is why I like the British plan more than others, you let the virus just infect whoever it could infect and you don’t have to worry about a resurgence of this particular strain.
Like JimNorCal did above, I looked at the various countries and assessed where they are- Clearly, China and South Korea have seen the peak in new cases, and the recovered numbers are rising faster than both deaths and new cases. Most of the major European countries are still rising in new cases each day except for Italy, who might have reached that peak this weekend, but a few more days of data would be more persuasive. As the UK, I think that is probably an artifact- that new cases have dropped, but it is also quite possible their behavior changes happened early enough that they arrested the spread earlier than, let’s say, anyone else other than, maybe, Japan.
If the UK numbers of new cases keep dropping, that would be very good news for, at least, them in the short term, but it won’t be because of their unique plan for this disease- it will just be that the measures they did take and emphasized were the most effective at actually arresting the spread.
I’m no expert. It seems to me, though, that after this current two-week nationwide “distancing” is finished, it’s just too expensive to everyone to continue the quarantine for those under 65 or so and without existing health problems. Let the younger people out to get on with life at the end of March, and let us older people stay more isolated until we see how this plays out.
Younger people need to earn income, and to produce the goods and services the nation relies upon.
Research is going strong on treatments, including plasma from recovered patients, antiviral medications, and chloroquine (for people without heart conditions). With treatments coming online and older people still keeping their distance, it should be possible to avoid the swamping of the ICU units which everyone is so worried about.
It would have been far less damaging to just have gone for a massive effort to gather/build the medical equipment you needed to care for the claimed numbers of critically ill, but just gone on as before with life. We could have easily taken real effort to isolate the most vulnerable to buy the time necessary.
I can’t shake the feeling that there are a lot of “experts” who are gleefully pushing this disaster as a way to induce a deep recession, but at the rate they are doing it, it won’t be a recession, it will be a full on economic catastrophe with 50% unemployment if we don’t change direction soon. What I have noticed that everytime it looks like someone starts to take this problem seriously in a rational way, someone else pipes up with a study about how the disease is starting to kill the young, is leaving the young with irreparable lung damage, or the virus will mutate and kill us all if we don’t stop its spread now.
In short, I think there are too many of our experts just lying through their teeth about a lot of things.
TepidAir says the Brit plan is no good.
https://pjmedia.com/instapundit/361704/
sdferr’s comment @8:43pm is spot-on.
Well the NHS’s plan for “herd immunity” is deemed a very risky bit of quackery? Well they are the same crew who came up with the Liverpool Pathway for the elderly, so maybe they were just helping to speed up entry onto the path. Macabre thought, but it is modern Great Britain after all.
See this on containment/suppression, herd immunity, and a possible 18 month timeline, released 3/16:
https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf
For the record i am often an asymptomatic suffer of cold or flu…
what do i mean? what does it mean to ‘suffer’ that way?
well, most of the time i am well… once in a while my head is slightly stuffed, and i feel a bit under the weather. however by any real measure its not a cold or flu… its barely a cold or flu and you could easily miss it as an ‘off’ day. over the years with my wife i have figured out i was sick, as she gets sick like clockwork after this…
it also works the other way, she is sick… doesnt want to give it to me… but i get a day or two of barely sniffles and we figure i got something…
symptoms are not what makes one contagious, shedding virus particles is what does it… so there are probably a lot of asymptomatic people who can transmit who do so by rubbing an itchy nose, a normal sneeze, etc…
i do not know if this is related working for a medical center for 15 years…
re: Brits, their new cases spiked to a new high. Sigh
It’s never made much sense to me to say “but young people with mild cases will just infect older people and other vulnerable people.”
Obviously, the rules should be:
1. If you are young, for chrissake DON’T VISIT GRANDPA.
2. If you are Grandpa, don’t take visitors and don’t leave the house.
But instead, we’re all trying to avoid infection by turtling up, but we’ll all get it anyway when people inevitably rebel against the restrictions.
A neighbor on the NextDoor app says Kansas will close schools till next year. Really? Really?
Theories:
1) our political class is mad
2) the people who hoarded TP were ahead of the curve and had access to inside info
It does look like there is now some evidence of virus transmission from people who don’t have symptoms.
https://www.sciencedaily.com/releases/2020/03/200316143313.htm
I concluded earlier this week that the only approach likely to work, and for that matter likely to happen long-term, was for us older Americans to bunker up while younger Americans make and distribute the food, etc. I hope this has the added advantage of spreading out the infection and serious-symptom rates enough that our limited supply of ventilators will be less overwhelmed than it otherwise would have been. It might also give us time to ramp up the production of more ventilators along with remdesivir, chloroquine, survivor serum, or whatever other treatments show promise. We might even find that we’ll able to produce a vaccine quicker these days if we’re really motivated and we do a society-wide indemnification against the tort claims.
The plan is to flatten the curve to buy time not just to allow time for the production and distribution of more equipment. The main purpose is to buy time for the development, production and distribution of treatment medications which can and will be available much faster than a vaccine.
Today’s update. Please note I am plotting active cases, not total cases which includes recoveries and deaths. This morning, 6311 cases, still 12 serious, which is same as yesterday. Curve fit which I’ve now filled in with daily data from worldometer:
cases = 48.397e^0.2893(days) which predicts about 6500 cases. And the final number isn’t updated on the site until midnight. Social distancing, with an active period of 14 days, I would suspect take two weeks to show an effect.
I see more people at my cafe this morning. I’m coming around to the arguments that COVID won’t be as severe as feared and social distancing past two weeks is probably overkill.
I’m annoyed how little, beyond raw data, is nailed down about this disease. I remain mystified at how different the stories told by the data are in different countries.
I wonder why COVID hasn’t burned through US homeless encampments. Wouldn’t we hear about that?
Here’s an article I find persuasive. I’ve been reading Ioannidis on the reproducibility scandals of published studies for several years.
The data collected so far on how many people are infected and how the epidemic is evolving are utterly unreliable. Given the limited testing to date, some deaths and probably the vast majority of infections due to SARS-CoV-2 are being missed. We don’t know if we are failing to capture infections by a factor of three or 300. Three months after the outbreak emerged, most countries, including the U.S., lack the ability to test a large number of people and no countries have reliable data on the prevalence of the virus in a representative random sample of the general population.
This evidence fiasco creates tremendous uncertainty about the risk of dying from Covid-19. Reported case fatality rates, like the official 3.4% rate from the World Health Organization, cause horror — and are meaningless. Patients who have been tested for SARS-CoV-2 are disproportionately those with severe symptoms and bad outcomes. As most health systems have limited testing capacity, selection bias may even worsen in the near future.
–John P.A. Ioannidis
https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-as-the-coronavirus-pandemic-takes-hold-we-are-making-decisions-without-reliable-data/
1. Nothing at all unusual about asymptomatic transmission. All bugs pass this way, from people who (still) have mild symptoms. Young people are not immune to this virus – they just can fight it off, and as for all bugs that takes time. Which means that for some time their bodies are not clean of the infectious element.
2. It’s not practical to completely separate older people. Families spread over several generations and include all ages. We do not have the resources to take all old and vulnerable people out of their families and communities.
3. Shutting down public venues and inducing people to avoid contact does slow the rate of new cases. And the rate = the number of serious cases our hospitals must handle at once.Too many serious cases simultaneously causes bad outcomes by swamping health care facilities.
So: we can’t prevent Grandpa from getting the virus, but It may now take a few more weeks for his teenage grandchild to get infected and bring it home – and that may save him.
We do not have the resources to take all old and vulnerable people out of their families and communities.
So what? You want to improve matters, segregate the old as much as you can manage.
Today Italy, Spain and Germany report 4207, 2084 and 1935 new cases respectively.
The US isn’t looking too cool either with 1267 new cases. Meanwhile China, which has 8043 active cases, only reports 13 new cases.
I’m not understanding how these numbers work, assuming they are roughly accurate.
“Science” magazine recommends South Korea as an example of good COVID control:
South Korea has tested more than 270,000 people, which amounts to more than 5200 tests per million inhabitants—more than any other country except tiny Bahrain, according to the Worldometer website. The United States has so far carried out 74 tests per 1 million inhabitants, data from the U.S. Centers for Disease Control and Prevention show.
South Korea’s experience shows that “diagnostic capacity at scale is key to epidemic control,” says Raina MacIntyre, an emerging infectious disease scholar at the University of New South Wales, Sydney. “Contact tracing is also very influential in epidemic control, as is case isolation,” she says.
–“Coronavirus cases have dropped sharply in South Korea. What’s the secret to its success?”
https://www.sciencemag.org/news/2020/03/coronavirus-cases-have-dropped-sharply-south-korea-whats-secret-its-success
jakhny on March 18, 2020 at 9:19 am said:
The plan is to flatten the curve to buy time not just to allow time for the production and distribution of more equipment. The main purpose is to buy time for the development, production and distribution of treatment medications which can and will be available much faster than a vaccine.
* * *
I assume most readers are following the treatment developments.
The problem lies not with the doctors & developers, but with the entrenched gatekeepers.
A couple of promising developments from Dictator Trump:
https://www.nationalreview.com/news/trump-admin-to-allow-all-medical-personnel-to-practice-across-state-lines-to-stem-spread-of-pandemic/?utm_source=recirc-desktop&utm_medium=article&utm_campaign=river&utm_content=top-bar-latest&utm_term=third
https://www.powerlineblog.com/archives/2020/03/the-fda-strikes-again.php
Let’s hope The Dictator overrules The Bureaucrats.
For Huxley, the numbers you show don’t really look bad for us. Italy, Germany and Spain total about 190 million population, while we are at 330 million. 8200 new cases for them in total, 1300 for us. Given all 4 countries got exposed at the same time from China related incoming travelers, we should have experienced about 40% more new cases than they totaled, yet we actually have 1/6th their new cases.
Logically speaking the most likely reason is Trump sealing the Border with China almost immediately, even tho the start dates were close to one another, far fewer people got into the US with this than other countries, who just in the past few days sealed their borders.
I’m very angry that we are reacting so severely that we are crushing many people’s lives over concern for a hypothetical case for which we have absolutely no corroborating date to support the official outlook. Nobody at this stage knows exactly what percentage of the population has had or does have this, so we don’t even know the infection rate or the fatality rate, anywhere, due to small testing samples.
There is one exception to this, and that is the Diamond Princess, which is the only closed system in which we know the exact population, the number infected, and the number of fatalities. In that closed environment, with petrie dish conditions ideal to disease transfer, 18% of the population on the boat got sick, about 700, and there were 7 deaths, generating a case fatality rate of 1%, and a population mortality rate of .002. That’s with a demographic spread that is significantly older and more infirm than the overall US demographic. All of the fatalities were over 65 years old.
IMO, the most practical way to deal with this is to have the gravely at risk population stay home, receive no visitors, including family members, until there is a vaccine or successful therapeutic treatment, and the rest of the population go back to work. Governors and mayors, by their draconian shutting down of entire industries in the name of “flattening the curve
“ through social distancing are putting millions of workers who live paycheck to paycheck in a position of financial disaster and risking not just a recession, but a depression. We flat out don’t know this is worse than the flu, which kills hundreds daily and 15,000-70000 in any given year, with tens of millions infected. We don’t shut down the economy for the flu, and we shouldn’t shut it down for Wuhan virus.
We’ve come to this pass due to the media scare tactics, combined with the at risk elderlies putting extreme pressure on politicians, who than cover their butts by edicts ceasing various forms of commerce such as restaurants, bars, conventions, trade shows , city lockdowns that greatly interfere with our personal freedoms as well as costing jobs for people who live paycheck to paycheck, which is at least 40 % of Americans.
So I’m hoping that the so called professional will find a way to get us back close to normal except for the most fatally at risk ASAP,else our economy will go into deep recession.