Some thoughts on COVID 19
Mar. 14th, 2020 09:56 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
andrewduckerThere 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.)
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.)
no subject
Date: 2020-03-14 12:34 pm (UTC)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.
no subject
Date: 2020-03-14 01:36 pm (UTC)no subject
Date: 2020-03-14 02:02 pm (UTC)no subject
Date: 2020-03-14 02:14 pm (UTC)no subject
Date: 2020-03-15 06:28 am (UTC)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...
no subject
Date: 2020-03-15 10:46 am (UTC)no subject
Date: 2020-03-16 06:10 am (UTC)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.
no subject
Date: 2020-03-16 07:45 am (UTC)(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
no subject
Date: 2020-03-16 07:51 am (UTC)Reading the FB post now.
no subject
Date: 2020-03-17 06:56 am (UTC)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.
no subject
Date: 2020-03-17 07:15 am (UTC)no subject
Date: 2020-03-17 07:26 am (UTC)Go head, don't touch your face while reading this.
Date: 2020-03-15 07:10 am (UTC)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.
Date: 2020-03-15 10:48 am (UTC)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.
Date: 2020-03-15 02:13 pm (UTC)Re: Go head, don't touch your face while reading this.
Date: 2020-03-15 03:41 pm (UTC)I suspect a fair number (like your parents) will ignore the advice.
Re: Go head, don't touch your face while reading this.
Date: 2020-03-15 08:27 pm (UTC)Re: Go head, don't touch your face while reading this.
Date: 2020-03-15 08:56 pm (UTC)Re: Go head, don't touch your face while reading this.
Date: 2020-03-16 06:19 am (UTC)Re: Go head, don't touch your face while reading this.
Date: 2020-03-15 05:33 pm (UTC)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.