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.

[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...

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.