Some thoughts on COVID 19

[andrewducker]

There are two approaches to a pandemic. And which one you take depends on whether you think it can be controlled.

If you think that it can be stopped then you trace every case, you find everyone who they touched, you confine every possibly contagious person, you wash everything they've come into contact with, and if you're very very lucky you completely eradicate the disease.

The other approach is the one you take when you no longer believe that to be possible. When you come to believe that it has spread too widely, that it is loose in too many countries, that there are too many holes in the net, and containment has failed.

At that point you know - everyone is going to catch this disease. The only question is when.

Everyone catching it at once will be much much worse than if you can spread the cases over several months. But even worse would be to make it look like you'd stopped it, but only a small proportion of the population had been through the disease and developed immunity.
Because then when it does, inevitably, spread through the population again (once people start traveling again), it does so at a time you have no control over, and quite possibly in a massive spike. So your want to slow it and spread it over the summer, not stop it entirely.

The question is no longer "How do we keep everyone alive?" - that ship has sailed. The question is "How do we keep as many people alive as possible?"

And that is why people in the UK are being told to self isolate if they get a fever - to slow it down. Why they aren't being tested - there is no cure, so testing is irrelevant except for statistical testing to give an idea of the disease spread. Why care homes are to be "cocooned" until the disease has gone through the healthy parts of society and left us with hopefully enough herd immunity that the virus can't spread any more.

There is no doubt that we are in a worse situation than if we hadn't hollowed out the NHS through 10 years of austerity, bringing it to the point where there is no spare capacity to deal with a situation like this. And we should have started sooner - containment might have worked if we'd started a few weeks earlier than we did. But unless we shut society down for the next few months - not just here, but worldwide, so that there's no new Patient Zero anywhere to restart things - then we need to deal with containment having failed, and we're now having to work out how to delay and control the spread.

China built hospitals, they cleansed city blocks, they locked up infected people away from their families until they were no longer infectious. They did everything they could to take the first route out of the epidemic.

I wonder how angry they'll be when we spread the disease back to them.

(I'd share some useful links, but they're all over on Pinboard, where you can filter by "disease". This one is probably my current favourite though.)

Comments

[anna_wing]

It's not an 'either or'. Containment isn't about eradication. None of the countries that were prepared and acted fast (unlike the West, which had two months notice and did bugger all), thought or think that the virus could be eradicated. All of them are globalised and know they can't cut themselves off totally. The point of all those measures (scorned as only fit for authoritarian countries, until Italy did the same) was and is indeed to slow down the spread, so that healthcare systems aren't overwhelmed, and the number of new cases coming in is the same as or less than the number of cured cases going out.

There are already imported cases coming into Asia (and Australia) from Europe and the US, so I expect they'll let you know what they think about that.

[coth]

Wait til India kicks off. The first guy to die there had come back from the Middle East and his family moved him between several hospitals before the test results came back and then he died while they were moving him again.

[gingicat]

My big worry is immunity - since it takes a year to get a vaccine going, we could have short disruptive outbreaks right up until mass immunization.

[andrewducker]

I've been hearing November 2021 as the earliest we might have a vaccine.

[marahmarie]

Why they aren't being tested - there is no cure, so testing is irrelevant except for statistical testing to give an idea of the disease spread.

Testing is relevant for isolating those who test positive, to limit spread. I'm not sure why you think the UK approach (not testing, to take this at face value?) is not relevant?

I really would've said this sooner but was waiting for an edit or some clarification, but since none came...

[andrewducker]

The advice is that you isolate if you have symptoms. Therefore it doesn't matter what the tests say, you will be preventing spread. So the results wouldn't be relevant.

[marahmarie]

The advice is that you isolate if you have symptoms.

Will most people really do that, though? Without an official diagnosis?

Therefore it doesn't matter what the tests say, you will be preventing spread.

This doesn't sound right.

It seems the right approach would be to test as many people presenting with symptoms as possible, trace back who they've come into contact with, isolate the tested person and those they've had contact with as well, and keep good records and tabs on all of them to assess overall severity of illness and long-term outcomes.

Oh, and if I seem grouchy, I am. I just had two possibly hacked DW accounts subscribe to me and have a headache I cannot shake, so don't mind me too much.

[andrewducker]

That's fine.

(I get added by one of those about twice a week. Good luck with the headache)

On the testing front, here's a statistician with experience in disease: https://m.facebook.com/story.php?story_fbid=10220413984953353&id=1042839072&sfnsn=scwspmo&extid=A2IZt0JFVikOHZNg

[marahmarie]

Thanks.

Reading the FB post now.

[marahmarie]

(I get added by one of those about twice a week. Good luck with the headache)

They just got suspended. Pays to report them, I guess (I can PM the report to give you a template, if what you're experiencing is similar). I thought spammers aggrieved me until those accounts came along that night to tick me off even more.

[andrewducker]

I just say "spam profile: [URL]" and they tend to be taken down in a day or so.

[marahmarie]

Glad to hear you report them, too. There's at least one more report from another user in the que right now.

Go head, don't touch your face while reading this.

[agoodwinsmith]

I think some of the individual response will depend on the circle around that person. For instance: currently my immediate circle is composed of mostly people in their 80s and older (that Silent Generation just goes on and on like Energizer Bunnies). A few of them have precarious health. Herd immunity or not, I don't want them getting it even once.

However, I have read that where people with SARS 1 had the active virus linger in their throats up to four weeks, even after no longer showing symptoms, COVID 19 people have been shown to have the active virus linger in their throats for five weeks or longer.

And, some people appear to not take the virus hard enough the first time, and come down again with a harder bout. Whether that is re-infection or active lingering virus may matter, but will have the same impact on the person who is ill again.

And, just for entertainment value, the evidence from Korea, where absolutely everyone was tested, whether showing symptoms or not, shows that the highest incidence of infection is in the age group 20-29, and this age groups is also the least likely to show symptoms. And so they share it while wandering freely in innocence. (Also: guess which age group makes up most of the care aide in the nursing homes?)

So. How do I keep my crowd of old adorable people from never ever getting it? I don't see how I can, but I really want to. I'm not interested in a heroic death in another person's movie.

Edited for spelling - always spelling. I'm sure I haven't caught everything yet. Piffle.

Re: Go head, don't touch your face while reading this.

[andrewducker]

The UK is apparently about to quarantine all people over 70 for 4 months:
https://www.itv.com/news/2020-03-14/elderly-to-be-quarantined-for-four-months-in-wartime-style-mobilisation-to-combat-coronavirus/

Re: Go head, don't touch your face while reading this.

[channelpenguin]

And how many of them will still be able to walk after 4 months at home? Hell, I'm under 50 and I lost the ability in 6 weeks the other year (inactivity + old accident damage plus very mild ankylosing spondilytis/psoritic arthritis - nobody is due sure which or both maybe). Who is going to make sure they all get fed and meds? My parentsstew 72 and fit as fiddles - but if you lock them in floor 4 month they won't be so!

Re: Go head, don't touch your face while reading this.

[andrewducker]

Yup, all sorts of negative possibilities.

I suspect a fair number (like your parents) will ignore the advice.

Re: Go head, don't touch your face while reading this.

[anef]

Surely if this measure is for the protection of elderly people it is up to them to comply or not (provided that they are aware of the risks and not endangering other people). I mean, if my 87 year old mother goes for a walk by herself with her trolley (or whatever you call these walking aids), is she going to be arrested?

Re: Go head, don't touch your face while reading this.

[andrewducker]

One hopes not.

Re: Go head, don't touch your face while reading this.

[marahmarie]

That's horrible. It's 100% a "Lock the door, throw away the key" reaction, why can't everyone stop picking on old people. "Die in place", huh. They're not spreading it so much as catching it from everyone else who spreads it. Who is going to take care of them?

Re: Go head, don't touch your face while reading this.

[agoodwinsmith]

This is good (well, better than no action at all, I think maybe, not sure argh), but who will deliver food and TP to them?

My mother-in-law is 100 and she lives in an assisted-living facility. Somebody comes in to her suite to strip and make the bed and take the sheets and towels away for laundry. Someone cooks her meals. Someone serves her food. Someone conducts the chair tai chi. Someone vacuums the hallways. Someone repairs the walls of the hallways when someone's walker dings them. And so freakin' on.

It's all very well to make sure people can take time off when ill, and the unions have fought pretty hard to keep those benefits for healthcare workers - but who do you get to fill their spots while they are away?

My auntie is 84 and has oxygen delivered.
My uncle is 83 and gets insulin supplies.

My Mom is 83 and, while very strong right now, is not teflon.

And so on.