If we re-open, will there be a bad “second wave” of COVID-19?
Sorry, I don’t have an answer. But I have some thoughts on it.
First of all, we have to re-open, although doing it in stages and to different degrees in different locations is fine with me. Not only is it necessary for the economy, but for people’s mental health as well.
But here’s one possibility, as expressed by commenter “Joe”:
People seem to not appreciate that flattening the curve doesn’t eliminate deaths, it just spreads them out. It’s quite likely that when Norway and Denmark loosen their restrictions they will catch up [to Sweden].
Without a vaccine, deaths won’t stop until we reach herd immunity at approx 70% of the population.
No, deaths won’t stop. But there are quite a few things that might be hopeful developments. The shutdown was instituted in order to buy time, and the delay can be helpful in multiple ways. It would be ruinous were it to go on long enough to make a working vaccine or to achieve herd immunity. But the shutdown bought time for learning more about the way the disease works, and what might impact it and reduce its severity and/or slow its spread. With some of the following elements in place, it is very possible the situation will be significantly improved from what it would have been before:
(1) The development and testing of successful drug treatments, and the production of sufficient amounts of these drugs. This is not only a US effort but a global one, with sharing of data and progress worldwide.
(2) Other helpful treatment methods (such as, for example, patients lying prone instead of supine) emerging with time and increasing experience in dealing with COVID patients.
(3) As more people contract mild cases and become immune, any disease becomes at least somewhat more difficult to spread as it becomes more difficult for the virus to find new victims – and that starts to happen even before herd immunity develops.
(4) When the health care system is overwhelmed, other methods of approach such as contact tracing are difficult to put into practice. When there are fewer cases all at once, contact tracing and isolation of contacts can be more comprehensive and therefore more effective. It helps to have quicker and more widespread testing, which we now have but didn’t have in the earlier stages of the pandemic.
(5) If we keep all the following in place – fairly widespread mask-wearing and handwashing, some social distancing, and a travel ban to and from “hot” areas – it should slow down transmission and decrease deaths in those who have contracted the disease, without overly overburdening hospitals. At the outset, those things were not in place.
WRT number 4, there is also the fact that Trump is letting so much up to the individual states. State with low numbers of patients can do different tracing patterns and treatment tests. This allows us all to have a better idea of how the virus spreads. We know so little, every different input helps.
Japan, with it’s massive metropolitan globs all filled with people living in close quarters and making use of mass transit, is doing satisfactorily. It can be done. Masks, temperature checks at workplaces, gloves, and sanitizers. Perhaps a moratorium on the sort of celebrations which have generated superspreader events. People under 50 are seldom in life-threatening danger from this ailment, so a return to regular work schedules would begin with them.
We need to clear the supply chain back ups so people have the personal protective equipment they need. And we need to be careful – especially around the elderly.
Whats ever we hear with all agencies working hard to figuerout how to stope this desise and to find vaccines for it with all around the world and the clock working on it.
With news and other outlet full of fack news and data even the realities on the ground with evidences.
So those who talk about climate change and melting ice with none stop scenario spreading fear with data they cliam they had collected. we know that data not acurate and not far in time.
This rise questions and think we have this pandamic for last two or three monthes and the world from less democtratic to those of top of list struggle with what true and whats false in fact whats evidinces and possible scenario convincing to fight this pendamic.
Yes, without a doubt there will be a second wave. Rhino, corona, flu, and sars are all respiratory viruses that never go away until most everybody has had it.
The longer we shelter in place the longer it will take to course through the population. We recycle last years infection among those who missed it the first time. We develop widespread immunity and the viral presence disappears.
Mutations cause new versions of viruses and the cycle repeats. People in and of themselves cannot defeat these viruses but humanity always does.
The armchair epidemiologist …
https://twitter.com/i/status/1248963594999468033
from where? ace.mu.nu
Actually, I’m kind of surprised—with all of the information on past epidemics that I would think is available, and all the academic studies that were likely done on them—that epidemiologists didn’t have a good handle on this Pandemic from the very get go, and a list of necessary steps to fight and ameliorate it’s effects “in the can” and ready to go.
Contact tracing is not usually done by people who would otherwise be providing health care. It is done by ‘public health’ people, grunts.
The really important fact, second only to Joe’s flat curve note, is that the national economy cannot survive as is for even another two months, let alone two years.
There are 17 million more unemployed now than 3 weeks ago, as registered for unemployment benefits.
Despite the Fed’s and Congress’ actions, this cannot be reversed with low interest loans to the Fortune 500 and $1200 helicopter money to individuals. Crops such as salad greens are already going under, chicken eggs don’t leave the henhouses for market, and so forth.
Enormous numbers of small businesses will quickly fail.
And totalitarians as state governors are on the rise. See Michigan, with its extensive ban on intra-state travel. See the churches, forced to close by state edict despite the First Amendment which begins with “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof;” Prohibiting the free exercise thereof. Uhh, No. Not today. Who in our secular progressive society cares?
Why do we have to end the lockdown indefinitely or keep it going indefinitely?
Exponential curves spend a long time at relatively low values before exploding upward. By alternating periods of lockdown with periods of normal behavior we might be able to take advantage of the small-values period while avoiding the explosive growth.
What would happen if we left lockdown after the peak? By then enough time would have passed that there would presumably be only a relatively few people who do not know they carry the Corona virus and can still infect others. Each one of these could trigger an exponentially growing cluster of newly infected acquaintances. It should take a while — probably longer than one week, maybe longer than two weeks — to reach the explosive growth stage. Suppose, at the end of one or two weeks, we went back into lockdown even if no unusual growth in Corona virus cases had been seen. Everyone would then be in the position of people flying back from China or Europe in early February of this year — maybe they became infected, but probably not. So the following lockdown is like a quarantine period when coming back from overseas, say around 14 days. Check for those who show symptoms, test them, and if they have it, they — and the people living with them — should skip the upcoming period of business-as-usual and continue their quarantine long enough so that, just by the passage of time, their cases resolve and none of them can infect others. The rest of us return to business-as-usual for one or possibly two weeks, until it’s time for the next 14 day lockdown. As time goes on and herd immunity grows, the period between lockdowns can increase until no more are needed.
So perhaps in this (idealized) world a solution of sorts exists: We plan to live on the low end of the exponential growth curve while leaving room for everyday life — and also without letting the government choose between needed and unneeded economic activities.
My wife and I rarely argue. We’re just not confrontational people and we see eye-to-eye on most everything. I think we’re pretty lucky that way, and therefore pretty happy all things considered. We’ve known each other since middle school when she was my younger sister’s best friend and we’re in our 40’s now.
But we had one of our most heated discussions/arguments we’ve had in years (maybe ever) the other night about the Great Re-opening. Being a nurse and working with COVID patients in the ICU, I believe she has what my grandfather called “foxhole vision”. I don’t know if that’s a term he made up or he got somewhere else but I think it certainly applies to my wife.
All she sees is the worst aspect of the disease, everyday she works. She dreams about it at night. She has to think about it all the time. She’s been tested 2 times after showing symptoms (both times she’s tested negative and goes back to work). I love her and admire her for what she does. But I also think she is prevented from seeing the bigger picture while stuck in the ‘foxhole’. She tells me that the number of deaths would be too great if we reopen but doesn’t seem to understand the number of deaths that could happen from the extended shut down.
We’ve had to agree to not talk about it anymore.
Snow on Pine:
I think it was because each virus behaves differently. Also because the first data was from China and they were covering up.
Dr. Birx said as much when she said they initially thought it would be like SARS because they were getting “incomplete” information from China. SARS was very lethal but not very contagious. So even though COVID is caused by a virus in the SARS family it acts very differently.
“When we reopen,” I’m betting that people’s attitudes about a lot of things that were “normal” and acceptable pre-Coronavirus will change, and that a lot of things that used to be acceptable will no longer be acceptable in the near, medium term, or just no longer going to be acceptable at all.
Tell me—after the lockdown is over—will you want to pack up the family and head for the local movie theater, so you can all sit in an enclosed space, literally rub elbows with strangers, and all basically breathe the same air?
How about the local enclosed mall—say, Plymouth Meeting, Tyson’s Corner, or Mall of the America’s?
Are you going to want to get up close to and to be part of the large crowds sometimes found there?
Same question about you favorite restaurant, with it’s tables sometimes squeezed close together to generate the greatest profit?
How about flying, how is that going to go, or, packed together, traveling by subway, bus, or train?
How about a crowded sports event, or a college lecture hall, filled with a hundred students or more?
Yes, I see a lot of changes coming.
how? if incubation of the virus is estimated to be 16 days, after 1 month of nationwide quarantining whomever had the disease should have either already recovered and not infectious anymore or have already been hospitalized. only possible source of the disease is some carriers of the virus bringing it in from the outside, just close the borders and then open back up the economy, problem solved. dems are underestimating the threat of a failed economy and how much lives it could claim, if we experience massive surge of depression related suicides the dems have blood in their hands by continuing to keep the economy down to win election by exaggerating the threat of the pandemic while downplaying the threat of mass unemployment.
Neo,
I strongly disagree with your 7:37 pm statement concerning the contagiousness of old SARS. And the rest of the old SARS is very similar (though not exactly the same) to COVID-19.
Severe acute respiratory syndrome
This is very contagious.
Look at reference 31, only cover notes available, but those indicate that the infection swept through airplanes (partially) and hospitals.
[31] Twenty-first Century Plague: The Story of SARS
Normally I’d say the US can’t do an effective job of contact tracing; we’re too loose. But we have an unusual opportunity with this extraordinary lockdown. We can gradually re-open with vigorous contact tracing that we’d never have been able to pull off before.
As I understand it, it used to be that standard public health protocol in things like, for instance, sexually transmitted diseases, was to closely question a person who had been infected, and to very meticulously trace every one of their contacts that you possibly could and, then, to track them down, and so on down the line.
But, from what I understand, when the AIDS epidemic started, “gay” activists were able to shut such contact tracing down as “discriminatory,” so I don’t know what kind of contact tracing is done or allowed these days.
TommyJay:
SARS was not as contagious as COVID, in the sense that it was only spread in more limited conditions, such as when symptoms were severe. Therefore it was much more easily contained. For example:
Here’s more information on why containment was far easier with SARS and why community spread was less:
SARS was a very serious disease but because it was ordinarily transmitted only when patients were in fairly dire straits, they were usually in health care settings at that point and transmitted it to close family members and/or health care workers. COVID is a very different creature indeed – often causing mild or no symptoms and yet transmissible nevertheless even without close contact and without serious symptoms.
Snow on Pine:
I wrote a paper about contact tracing and AIDS when I was in grad school. The previous policy of contact tracing for sexually transmitted diseases was ended or reduced with AIDS as a result of political activism. I don’t know what the policy is now for AIDS, but I have read that for COVID they are doing contact tracing. The problem is that it can’t be very thorough with COVID because evidence is that the disease doesn’t need such very close contact to spread.
I never really thought about it until reading this thread but I imagine that HIPAA must really hamstring contact tracing efforts?
No, if we open up there will not be a second wave of infections, because the damned virus is already everywhere. It’s not a herd of sheep or a flock of goats; it’s sub-microscopic bits that have been in the U. S. since probably November 2019, perhaps earlier. You can’t stop an epidemic of viral or bacterial respiratory infections without first an effective treatment and, more importantly, without a vaccine. Home truths, straight out, no politics or b.s. Open the nation’s economy back up and take whatever comes. Continuing the shutdown will only kill more people in the end. And don’t believe all the crap about “Oh, the shutdown saved X number of lives”. It isn’t possible, after the fact, to determine whether any particular health policy – and sometimes even other more straight-forward policies – had any certain effect. The virus only kills a fairly small percentage of the general population, only infects about 20% or so of those exposed and only kills about 1.5% to 2.0 at the most of people who are infected. General shutdown will kill a lot more folks than that for a long period and will cripple our nation. Tell all these wanna-be dictators and bosses to go fly a kite and open us back up.
“Without a vaccine, deaths won’t stop until we reach herd immunity at approx 70% of the population.”
Yes and no. Death won’t stop, but epydemic will. The only thing necessary to stop an epydemic is to ensure that at average each infected person would infect less than 1 another person. At this treshhold epydemic vanish exponentially. And this requires much less than 70% of population. I can not say how much, data are not here yet. But long-term effect of a temporary lockdown can significantly reduce overall death toll, may be, by 80%.
For all we know, this is the second wave.
Many have theorized that the virus started up earlier than first reported (in October/November instead of December). I had the worst flu I’ve had in years over the MLK long weekend, just when we started hearing about the outbreak in China. Until widespread antibody testing for immunity/prior infection is done, we won’t know for sure how widespread this was and how many were infected/carriers.
how? if incubation of the virus is estimated to be 16 days,
Median time is five days. If I’ve understood correclty, 97% within eleven days. Fourteen days is a maximum.
The previous policy of contact tracing for sexually transmitted diseases was ended or reduced with AIDS as a result of political activism.
I’m trying to imagine how you trace contacts when the median lapse of time between infection and illness is 11 years and the subculture in question is chock full of people with a long history of sex with strangers – a lot of strangers. Remember Andrew (“RawMuscleGlute”) Sullivan’s remarks about Edward Laumann’s survey research summarized in Sexual Organization of the City? “I found that survey very odd. I get more sex in a week-end than these people seem to get all year”.
No, if we open up there will not be a second wave of infections, because the damned virus is already everywhere.
It isn’t.
It isn’t? Then where does the speculation that this is the “second wave” come from? Then where did the reports of infected in the Amazon jungles come from? And where did Wyoming’s cases come from? Only a few contacts have been traced there. You think the sheep brought it in?? And if it isn’t “everywhere”, then what good is this shut down? If it isn’t “everywhere”, then isolating those who test positive ought to work without all the economic dislocation of the shut down. Too much politics, too much bureaucratic nonsense, too much “look at me! I can save you!” And not enough serious hard honest appraisals of the facts as they appear now and the guts to say, “It’s bad and a tragic thing but we can survive.”
Art Deco:
Come on man, up you game, where are the data and statistics to support Andrew Sullivan’s anectdotal, certainly credible truth about gay sex during the 1980s?
Come on man, up you game, where are the data and statistics to support Andrew Sullivan’s anectdotal, certainly credible truth about gay sex during the 1980s?
It’s made reference to above.
Thanks Neo,
There was one SARS spreader who boarded a plane to Singapore and infected 21 passengers and flight attendants with SARS. Possibly he should have been in a hospital at that time. That would be consistent with your points.
If the published SARS Ro = 2 to 4 is correct, that specifically denotes a relatively high level of community spread, when no precautions are taken. Probably not as high as in COVID. Though the latest data I’ve seen suggests that COVID transmission does not meet the technical definition of “airborne” which can transmit over dozens of yards.
My readings suggest that while both China’s gov. and the WHO were asleep in the first couple weeks of SARS, the WHO and others stepped up fast and hard after that, in terms of tracing and quarantining. I believe that the WHO’s response was worse this time around.
Ike has hit the bullseye. You cannot justify quarantining an entire population of a country without the idea that “it is everywhere.”
Emerging evidence clearly points to this being the opposite of what was originally sold to us, by China, back in January. This is a readily transmissible virus that causes only a small percent of those infected to become seriously ill. The original idea of the lockdown was to prevent “overwhelming” hospitals. Well, weeks have gone by and now hospitals in many areas are so empty that they’re furloughing medical employees.
So now the goalposts have been moved: we should just hide in the house as long as it takes to get a vaccine.
Wouldn’t it be nice if human beings had the capability of overcoming a viral infection? Oh that’s right … we do. Vaccinations were a revolution in community health, making it possible to prevent populations from having to actually catch diseases that were highly likely to kill you or ruin you for life (smallpox, polio, etc), but paralyzing the world for a year or two to wait for a vaccine for a virus that may end up with an IFR of well under .5% is insane.
Tommy Jay: The WHO is infiltrated by pro-Chicomm and actual Chinese people drawing fat UN salaries. The US pays WHO ‘dues’ of $400 million per year, and China pays $40 million.
We need the US to withdraw from WHO. It is of no value to us. Nor to the planet.
TommyJay:
Whatever the calculated RO of SARS, it was not spread by casual contact and it was only spread when symptoms were quite severe. That makes it a very very different disease than COVID.
Also, regarding RO:
Art Deco:
Contact tracing for AIDS, meaning also HIV-positive. Even decades ago (I wrote the paper in the 90s), people with a lifestyle that might lead to AIDS would sometimes (or even often) get tested without having symptoms and would discover their HIV-positive status. The time between infection and HIV-positive status was ordinarily just months.
Contact tracing for AIDS, meaning also HIV-positive. Even decades ago (I wrote the paper in the 90s), people with a lifestyle that might lead to AIDS would sometimes (or even often) get tested without having symptoms and would discover their HIV-positive status. The time between infection and HIV-positive status was ordinarily just months.
The antibody tests weren’t available until March 1985. IIRC, by 1986, public health officialdom were estimating that about 1/2 of the male homosexual / bisexual population were infected. I recently read of a retrospective examination of a set of blood samples taken from male homosexuals in Manhattan under treatment for hepatitis. Fully a quarter of the samples were HIV+. The blood samples were drawn in 1980.
The thing about contact tracing is that the people whose contacts you can most readily trace are the people least likely to be infected.
While we’re at it. About 4.6% of all deaths each year are attributable to lung cancer among people with a history of cigarette smoking. Roughly 35% of the adult population has such a history. So, about 13% of current and former smokers can be expected to be felled by this. The annual death toll from emphysema is about half that for lung cancer, so perhaps 20% of those with a history of tobacco use can be expected to be felled by one of these.
About 15,000 people die of AIDS generated ailments every year. North of 60% are male homosexuals / bisexuals. IOW, roughly 15% of those of that subculture who shuffle off every year do so consequent to HIV infection.
There was a physician in Massachusetts (and ENT specialist, IIRC) who pointed out the consequences of sodomy for personal and public health in an intra-office memorandum. As a consequence he was removed from the attending list at four area hospitals.
Well, we can expect full compliance with future government “suggestions” so don’t worry about a second wave.
https://babylonbee.com/news/government-issues-new-directive-telling-everyone-to-jump-off-a-bridge
Hydroxychloroquine may or may not be a therapeutic benefit, you know that anecdotal non-evidence thing, but progressives appear to be willing to self cull for now. Because of “Science!” and Orange Man Bad. Remind me again who are the sheep led to slaughter?
https://bongino.com/poll-finds-media-created-massive-partisan-divide-on-hydroxychloroquine/
To clarify Art Deco’s claim, I offer this from Wikipedia:
“An estimated 15,807 people with an AIDS diagnosis died in 2016, and approximately 658,507 people in the United States with an AIDS diagnosis have died overall. The deaths of persons with an AIDS diagnosis can be due to any cause—that is, the death may or may not be related to AIDS.”
https://babylonbee.com/news/bernie-sanders-drops-out-as-campaign-goals-of-locking-everyone-up-destroying-economy-already-achieved
“The shutdown was instituted in order to buy time”
Sort of true.
The real immediate driver is the limitation of the medical infrastructure, labor, and supplies to handle the surge load, coupled with the uncertainty around many aspects of the virus, given its potential large scale impact.
It does buy time to build capacity in these areas, as well as work on understanding the virus better, developing vaccines and more effective treatments.
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“flattening the curve doesn’t eliminate deaths, it just spreads them out.”
Sort of true. Actually, the number of TOTAL deaths would be much, much higher if the medical system was overloaded – including deaths from those who would normally been saved in a regular emergency.
So, it is not a 1 for 1 as implied by this quote from Joe – not sure he meant it this way, but cannot tell from the quote.
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Don’t have the link, but “herd immunity” for Covid-19 is estimated at 60%. Even if in the right ballpark, we are far from that today.
To further complicate things, some recent studies out of South Korea suggests that there is some possible re-infections on a few people previously determined to have recovered from the Coronavirus.
If this is possible, at an unknown but high enough rate, it may make partial opening far riskier than many are assuming.
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There is also a statistical analysis out that identifies the normal monthly volume of deaths in NYC vs reported Coronavirus deaths in March, vs TOTAL known deaths in March.
There is a huge delta between TOTAL deaths and reported Coronavirus deaths that are not accounted for by normal monthly deaths. The last spike was in Sept 2001, and this TOTAL is multiples of that.
So, we may be getting a much more “positive” reporting of Covid-19 deaths than is actually the case. Part of the “fog of war” uncertainty aspect to this.
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“It helps to have quicker and more widespread testing, which we now have but didn’t have in the earlier stages of the pandemic.”
One HUGE pre-requisite for opening back up, even just partially, is the ability to test on a scale several orders magnitude than we have now.
We’ve passed the point of contact tracing being practical and managable, as the scale is too high – we are now over 25K new cases a day and it is still growing at too fast a pace. And, we are unlikely to adopt technology solutions en masse that could assist, but would violate our privacy.
We need tests that will give extremely reliable results within minutes. This will allow multiple organizations to identify people who have it (e.g. entering mass transit, schools, office buildings) and, probably most importantly, for people to test at home before they even go out.
Even then, people will still need to take precautions (e.g. masks, gloves, reduced travel) until we are past this thing.
But it will go a long way to getting us close to “normal” again.
Opening up before that point is very likely to cause a second wave. And that wave could well rival or exceed the current one.
Big Mac:
Of course we’re not at or even near herd immunity. But as I wrote in the post in #3: “As more people contract mild cases and become immune, any disease becomes at least somewhat more difficult to spread as it becomes more difficult for the virus to find new victims – and that starts to happen even before herd immunity develops.”
That is one of the reasons curves often flatten over time for diseases, even without special social distancing. The real question is how long it takes and what the toll is in the meantime.
The costs of continuing the draconian rules at some point becomes much greater than the cost of the disease itself if those rules are removed. It is tricky to decide when that is, but I think it’s soon, and even sooner in states that are mostly rural. And it’s not either/or; people will continue to adopt some extra measures without cutting off economic life so utterly.
As far as contact tracing goes, of course we’re past containment through contact tracing. But it’s still being done and still has benefit. It is definitely part of Fauci’s plan.
One problem is the supply chain back ups. People need the protective equipment and its use has to be mandatory in select circumstances. We also need a selective moratorium on certain activities. (1) Mass gatherings, (2) group singing, and (3) overstuffing of eating and drinking establishments. Japan has kept outbreaks to a minimum with protective equipment and mindfulness. We can do the same, while returning to work.