I’m going to try and lay out the case in as neutral terms as I can, although to be clear I think they are probably right. They’re going to take an awful lot of stick for it though, and indeed already are.
They believe that there are basically two mitigation strategies. One is to have a very drastic early lockdown that shuts down the virus before it spreads widely. The problem with that is, once you lift the lockdown it will simply start all over again. The problem with this is lockdowns are most effective the first time you do them, and then mostly in the first few weeks of the lockdown. Do it too early, and yes it will be very effective in the short term, but later on when cases become much more prevalent the lockdowns will be less effective.
The option they are going for is to start the lockdown a little later in the cycle. The hope is this will make the lockdown more effective at a higher point in the spread. Effectively instead of a series of booms and busts, you get one longer slower initial burn and then you’re mostly done. They believe that in the long term this will make it easier to protect those most vulnerable to the virus, because you only have to do it once, at the cost of increased prevalence among people least vulnerable to it. So they see it as a better longer term strategy.
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The lockdown as implemented by Italy and France aims at slowing down the spreading of the virus. It is not meant as a strategy to overcome the virus. It is meant to flatten the curve of the exponential growth of infection to minimize overloading the health system and to provide more time for preparation and for the acquisition of best practices regarding the situation. There is no disillusion that this might somehow stop the virus. The expected total infected percentage of population, with lockdowns is still in the range of 50-60%. Italy went into lockdown on March 9th when # of new cases reached 1791 and total deaths was 463. This does not seem to qualify as a very drastic early lockdown, as stated by parent.
Given everything we know regarding exponential spread, the high percentage of cases requiring icu treatment, and the mortality rate, I fail to see how the absence of any measures to mitigate the spreading of the virus makes sense.
The assumption that there are only two viable strategies, lockdown & no measures, is a plain wrong oversimplification. There is a wide range of intermediary steps that can be taken in between to attempt to slow down the virus.
Attempting to minimize the degree of overload on the health system by applying such measures in a coordinated fashion is meant to reduce casualties caused by system overload.
Those are good points. Because Italy was hit hardest first they had very little time to prepare. The UK has had about an extra month, which puts us in a different strategic position, so we might be able to afford an approach not viable for Italy.
But the response will be less pronounced here with knowledge, self isolation and a lack of kissing when greeting. A month is probably a better guess than 2 weeks, but not a single person knows is rather the point...
But there's a third strategy that works better than either: don't lockdown, but do effective testing, case tracking, and treatment, well enough so that exponential growth can't happen in the first place. That's the policy of Hong Kong, Taiwan, and Singapore, who are doing great.
HK, Taiwan and Singapore all acted extremely early on, to the point where HK knew before the news broke out in China. And the culture allows you to wear mask, which seems to be something most western nation are completely against.
Most part of Europe and UK reacted very late in the cycle. Since the Virus has an extremely long stable period before any symptoms appeared or to the point where you could be infected but showing no symptoms at all. It highly likely they are already in wide spread. 500 people each inflecting two, do that 11 times and we have 1 million infected.
Then there is the death rate, at least so far it seems to be extremely mild for anyone below 50.
Not saying I totally agree with Herd Immunity, but judging from the current data and situation it is possibly the best route to go.
Isn’t that the whole point of a lockdown? After ~6-8 weeks you get the new infection rates down low enough that you basically reset the clock and have a second chance at responding like Hong Kong and keeping it in the containment phase. Then you have to keep that up for hopefully 9 months until a vaccine is available.
It’s certainly not easy, but it seems possible and it’s not clear this would be much worse on the economy in the long run. Plus it saves half a million lives, so it seems like a moral imperative to at least try.
If your population already has lived through similar outbreaks, sure.
But look at the US. There is a sizable portion of the population who thinks this thing is a hoax, who simply don't believe in this pandemic. How do you lock down those people? They're going to completely ignore government recommendations, and they'll scream bloody murder when government cancels events and restricts travel and assembly.
But let's say you manage to lock down the US to contain the current wave, and that you manage to ramp up testing so that you can be more sure about actual infection rates. Once it dies down in the US, then what? Ease the lock down? What about other countries where it's still rampant? What if it flares up again in the US? Go into a second lock down? You've already spent an enormous amount of political capital getting the first one through, good luck getting a second one.
> Plus it saves half a million lives
You pulled this number right out of your ass by multiplying a guesstimated death rate as measured in China, where the virus spread unchecked through an entire province, and where the medical system wasn't prepared, and you're assuming that the demographics of the people catching the virus in the UK is going to be the same.
But if your medical system is prepared, if you're quarantining vulnerable people, if you have good testing, then letting the virus roll thorough the remaining un-quarantined population won't lead to the same death rates, or the same hospitalization rates, because all the underlying factors are different.
You will need a Lockdown AND Mask, or you will simply just need Mask and not even lockdown. I would argue social distancing only is not enough. But somehow even people in Italy refuse to wear mask. So I think a culture issue is also a problem there.
I don’t think masks are as effective as you think. WHO says only wear a mask:
If you are healthy, you only need to wear a mask if you are taking care of a person with suspected 2019-nCoV infection.
Wear a mask if you are coughing or sneezing.
Masks are effective only when used in combination with frequent hand-cleaning with alcohol-based hand rub or soap and water.
If you wear a mask, then you must know how to use it and dispose of it properly.
Except we have clear evidence with all the countries listed above, SK, HK, Singapore, Taiwan that wearing a mask is effective. Even in many cases without social distancing. There are little working from Home in majority of the business in those cities, They have a much higher population density that has a higher chance of being infected with coronavirus.
The mask also protects you from bad actors who are not doing any standard hygiene procedures such as washing your hands.
We don't have enough masks in Europe, and those few are needed for professionals.
Besides that, I think that especially in times like this, it is important to stick to the recommendations of experts. Here in Germany, the expert recommendation is akin to the parent comment. These recommendations are crafted by people with a lot of expertise on the subject and who care for the health of people, and I think it is not productive to fundamentally questions their advice.
>We don't have enough masks in Europe, and those few are needed for professionals.
That is the only valid argument I could possibly understand. Although I would argue we could have ramp up production line. And Medicals get priority with Mask.
>I think it is not productive to fundamentally questions their advice.
I dont know, but Japan, South Korea, Taiwan, Hong Kong, ( We exclude China for comparison ) 200M+ Population together has far fewer death than just Italy with a population of 60M. Let alone Europe. And people are dying.
But hey, I guess as long as the people in Germany and Italy and UK are happy with what is being done then that is fine.
It's not only this reason. Even N95 masks are rated only to .3 micron. COVID-19 is .1 micron. It will prevent droplets from those already infected but I don't see how it would help in the healthy much. Maybe it slows down the air breathing out? But I don't see that helping a lot.
Arh. I see it now. When ever Mask is mentioned in the context of CJK, it meant medical mask with 95% PFE, VFE and BVE mask. Stopping size of 0.1 Micron.
Sorry I wasn't being clear enough. We knew very early on N95 doesn't work.
That’s a very good point, you’re quite right. However all three of those are relatively very small population centres with very easily controlled borders. Britain does have the advantage of being an island, but it has a large rural hinterland that the virus can ‘hide out’ in, and many dense population centres without borders, so it’s a completely different environment.
Take London. We could introduce a system of tracking and isolation within the M25, and that might work to lock down community transmission within the London population, but millions of people flow into and out of London each week so it would be completely pointless and ineffective. Meanwhile that level of tracking and isolation simply can’t work across the whole British isles. It’s administratively and logistically impractical.
The equivalent of the entire population of Glasgow passes through Kings Cross station in the morning rush hour. There are 4 other stations with similar flows. Over 20 million people live within an hour or 30 miles of Piccadilly Circus.
That level of population flow and population density are not as special as you are making them out to be. The transfer station nearest Seoul's most recent cluster (discovered 7 days ago) gets about 25% more annual traffic than King's Cross, according to Wikipedia (125,000 per day at Sindorim Station vs. 34 million at King's Cross annually). Despite the cluster having developed at the beginning of March, Seoul is finding fewer than 100 new patients per day. With masks, reduction in ridership, cancellation of meetings, extensive WFH, extensive testing and isolation measures, this epidemic is not as hopeless as the UK seems to be making it out to be.
That's the policy of Hong Kong, Taiwan, and Singapore, who are doing great.
All of which have tiny populations compared to the UK.
For larger nations, there simply aren't enough tests available, nor enough treatment facilities for those who are likely to become very sick if the virus spreads rapidly through the population.
> For larger nations, there simply aren't enough tests available
Why? If your nation is twice as big, then all else equal, your government has twice as much money, twice as many resources, and hence twice as many tests. China now has more tests than they need and they're the 2nd most populous nation in the world.
No amount of money helps if there aren't enough tests available to buy. What is missing are manufacturing and distribution facilities, which of course are calibrated to the normal levels of work and not to a relatively sudden pandemic outbreak of one particular virus.
China has huge resources but has managed so far to keep the infection mostly contained to one specific area. It's not clear how long they'll be able to sustain that or whether they'd have enough resources to go around if all of China were the same as Hubei.
Of course all of this also assumes that tests are effective and that you can then do something useful if you confirm that a patient is indeed infected.
The honest answer is that I don't know. Perhaps I generalised too readily before, given Taiwan is quite a bit closer to the UK in population than the other two.
Even so, assuming that strategies that appear to have been relatively successful in a smaller, more densely populated country will necessarily also work in a larger and less densely populated one seems to be dubious. We know that we don't have the resources we'd need to implement that strategy in the UK right now, and I haven't personally seen any experts arguing that it's a viable option for us, so I'm cautious about extrapolating too much here.
China does seem to be on of the most interesting cases so far.
The quarantine measures, once introduced, do seem to have been viewed favourably by the experts and do seem to have been remarkably effective. This assumes we trust the reported statistics, which I acknowledge as a possible risk in this instance.
On the other hand, it may be that China has been able to achieve that in part by pulling resources from all over to focus on the main region affected. That isn't necessarily an option that will be open to other nations, particularly if their outbreaks are distributed across their whole area almost immediately.
Taiwan is 23 million people. The UK is 67 million people. The level of confidence of your comment does not seem to be warranted by your level of knowledge.
Please don't make comments like this on HN. They lower the tone and add nothing of value to the discussion.
We have explored a little whether the population of Taiwan being somewhat closer to the UK's than the other two named countries was significant in a sibling thread.
In addition, in the UK, which is the subject of this discussion, it is certainly the case that we do not currently have sufficient resources to cope with a widespread, uncontrolled outbreak. There have been a number of further announcements today regarding how the government is hoping to acquire new space for treatments, acquire essential equipment like ventilators on a much larger scale than is currently available, and bring in more trained staff to make use of these resources to help treat coronavirus patients. Even if these plans work out as is hoped, all of them will require at least several weeks to make a large difference. This isn't my opinion, it's coming straight from senior government figures and their senior medical and scientific advisors.
I'd like to ask you to not make comments like the one you did — confident assertions about things you know nothing about, that you haven't made even the most trivial effort to verify, whether that's the population of Taiwan or the general relationship between country size and testing kits per capita. Regardless of how politely you make them, statements unconnected to any concern for truthfulness lower the signal to noise ratio, and they add nothing of value to the discussion. On the contrary, calling out such recklessly false statements does add something of value to the discussion.
It is true that the UK does not have sufficient resources to cope with a widespread, uncontrolled outbreak, lacking for example one to two orders of magnitude in ventilator capacity; but, as should be obvious, this is not a result of the UK being a large country — the UK is much smaller than China, slightly smaller than Japan, the same size as South Korea, and slightly larger than Taiwan. But this conversation would be of higher quality if, instead of containing such your obviously false assertion and also fact-based rebuttals such as these, you had not posted the assertion in the first place (perhaps because you had read enough to see that it was false), so no rebuttal would be necessary.
Continuing to adopt such a hostile tone still doesn't further the discussion. I am happy to debate this subject, but I will not reply further if you continue to make unnecessary personal attacks in your comments.
Is it your contention that the countries you mentioned do have sufficient tests and treatment facilities available to successfully implement the "third strategy" advocated by knzhou in the comment I first replied to? I can see little evidence that would support such a claim so far, in this discussion or otherwise.
China's recent official statistics may not be entirely trustworthy: they showed the expected exponential growth curve earlier on, but then levelled off remarkably quickly. In any case, its strategy has so far been primarily one of containment, with resources focussed on one specific area, Hubei, where the outbreak was also concentrated at the start. It is not known whether China has an effective testing or tracking regime in operation at this point, nor whether it has sufficient resources to treat large numbers of people if they became seriously ill in the absence of that containment, as may yet happen when the heavy quarantine measures are eventually lifted.
Japan's official statistics have also attracted scepticism, with the suspicion that they aren't testing widely enough to get an accurate picture of how the virus is spreading.
South Korea has had possibly the most successful response so far in terms of credible raw numbers and as such it is certainly worth looking at, but the strategy there has also been primarily one of containment. Again, that doesn't tell us anything about whether SK has the resources to look after much higher volumes of intensive care patients than usual if those containment efforts fail, or if heavy lockdown measures were not attempted and instead that "third strategy" of test, track and treat were used.
The UK isn't just "slightly larger" than Taiwan, it has almost 3x the population and almost 7x the land area. As I already acknowledged in the other thread long before you replied to me, I may have chosen too strong a word when I described three countries including Taiwan as having populations that were tiny compared to the UK, but my fundamental point stands in that we should not assume a strategy that could work at the scale of Taiwan would necessarily also work at the scale of the UK.
You argue for fact-based rebuttals, but where is the evidence that your examples are countries that do have sufficient testing and treatment facilities available to employ that test, track and treat strategy rather than the stronger quarantine measures that most countries are attempting?
and much denser populations, with a lot of international travel. which have a huge culture of eating food in hawker centres which would really seem to make a big threat to containment yet they appear to be doing well.
It's far too early to say whether they're doing great. Several months too early. Their lockdowns are preventing virus spread now, but at some point, the lockdowns will end, and then there is a vulnerable population waiting to be infected by a carrier coming from abroad. Will they be able to keep carriers out? Will they be able to respond to further outbreaks with more lockdowns indefinitely? Will there be a vaccine soon enough that they can protect everyone and then end the lockdowns before it all goes wrong?
I don't know enough to say that the UK strategy is correct (i hope it is - i live here, and more importantly, so do my parents). But i think the situation isn't cut and dried.
Hopefully, we will get a lot more detail in the next few days, and then the real experts can come to a consensus.
I would rather have the spread stopped/slowed domestically with aggressive measures than to do little to nothing to stop the spread thinking it will somehow solve the problem.
The UK approach here is basically just accepting that a majority of the population is going to get infected by design. That's fine. It might even be true. (It obviously will be if you don't do anything to stop it, but even in aggressive lockdowns I mean)
But it benefits nobody to have it spread quicker. Maybe life in the UK gets back to normal a little faster for people who are not at-risk or aren't treated at risk but we live in a very global society and if everyone else is locked down then it's hard to see much benefit for the UK itself.
And your parents and the portion of the population who are most vulnerable are more at risk.
An imperfect defense is better than not even trying.
There won't ever be a consensus of experts. That whole concept is one I've really come to hate over the years. When it comes to decisions about what to do, versus the outcome of replicable experiments on nature in lab conditions, there is always disagreement and there always will be. The idea that any decision can be resolved by a bunch of scientists sitting in a committee beard stroking doesn't reflect how people really work.
Amongst other problems, the term "expert" is ill defined (see discussion above about mathematicians) and there's always value in contrarianism for people who aren't directly making decisions. If they're wrong nobody will remember and there's nearly no reputational impact. If they're right, they can win fame and glory.
I believe the current UK Gov’s huge majority and long remaining term allow them to make decisions that many other countries would not be able to make at this time. I think they’re right, not that this makes things any easier, both my parents are in their mid 70’s and have health problems.
As far as I know, they did not communicate an overall strategy or comprehensive action plan. The basis of this thread are a series of tweets making assumptions about what the government strategy could be (given a lack of measures taken as a basis).
I do not understand how not communicating a comprehensive action plan is meant to be the harder choice ("a decision many other countries [...] not able to make") when contrasted with messures such as declaring national emergencies and widespread lockdowns of public life.
They held a press conference live streamed on YouTube where the PM and the two chief scientific advisors answered questions and explained their strategy for nearly an hour. The answer to one question alone took over ten minutes. You may not be aware of their communication about their strategy but it's on YouTube waiting for you.
That hour long press conference, that I’ve seen live, can be condensed in don’t do anything at all, let’s get 60% of the population infected so we’ll have herd immunity.
> The problem with that is, once you lift the lockdown it will simply start all over again.
Well, no, because the world at the end of the lockdown is not the same as the world before the disease started spreading. Some differences:
- People now know there is a dangerous disease and how to act and sanitize to mitigate its spread.
- Manufacturing and other logistics for medical providers have had the time of the lockdown to ramp up.
- Testing has had the time of the lockdown to ramp up.
- A vaccine is that much further along--which is the only viable long-term strategy.
- And most important, scientific understanding of the disease has had that much longer to develop.
Britain's "expose the youngsters" strategy has a terrible flaw, which is that we don't know if the disease is actually safe for young people! All we know are some basic statistics about messy data that was reported by overwhelmed medical systems with spotty testing.
There are reliable reports of a) some young people getting very sick from this disease, b) people who seem to have recovered going back into decline and in some cases death, and c) long-term lung damage among those who did not die.
The ideas that this disease is somehow safe for young people, and that contracting it once confers long-term immunity, are ideas that are yet to be scientifically proven. They are, for now, at best heuristics to aid triage.
Exactly this. I don’t have published numbers to back the following, but we expect them after the weekend.
Over half of ICU admitted covid-19 patients in the Netherlands are <50 years old. I get this information from friends and colleagues working in several hospitals. If this turns out to not be a fluke, the young are much more affected by this corona virus vs normal flu.
The distribution of age of corona patients on the ICU is NOT the same as the age distribution of all corona patients vs. disease severity. It could be and quite possibly is the case that many people below the age of 50 are infected but never reach an ICU. Most get better without severe symptoms, so looking at ICU admission stats is misleading if you extrapolate the data to the whole population.
I hate that this fact is spreading in the Netherlands without a proper explanation.
Why would operating as normal and mostly ignoring the problem cause a "slower initial burn"?
It won't. This is nonsense of the most obvious kind, because we're already past the stage where the virus is spreading quickly.
In fact the reverse is likely to be true. Lockdown minimises the number with the disease, but that number is not zero.
Which means that if immunity is possible (questionable for a CV, but let's pretend), immunity will spread wider and wider in each lockdown wave - and the health system won't be swamped.
This plays for time, raising the odds that a vaccine or some other treatment will appear.
Successive lockdowns will do exactly what they're supposed to do - spread out the peaks, minimise casualties over time, and minimise health system stress. (Although it will still be very high.)
What they won't do is keep businesses afloat. Mass bankruptcies are going to be a huge problem throughout the entire global economy.
Other countries understand this, and are stepping in with financial measures to help. Presumably the UK doesn't want to do this.
The tell is the fact that the government has plans to quarantine for four months - i.e. place under house arrest - over-70s who are infected. Without access to intensive care - it won't be available if the NHS is swamped - the mortality rate in this demographic is going to be higher than that of any other developed country. It could easily be twice the nominal 15% CFR for this demo in China.
It's hard to avoid the conclusion that the real plan is to cull the old and sick while pretending that's not happening.
They're not operating as normal: they're telling anyone with a cough to self-isolate for seven days. And the plan isn't to quarantine over 70s who are infected: it's to quarantine them all, when they're not infected.
They believe that there are basically two mitigation strategies. One is to have a very drastic early lockdown that shuts down the virus before it spreads widely. The problem with that is, once you lift the lockdown it will simply start all over again. The problem with this is lockdowns are most effective the first time you do them, and then mostly in the first few weeks of the lockdown. Do it too early, and yes it will be very effective in the short term, but later on when cases become much more prevalent the lockdowns will be less effective.
The option they are going for is to start the lockdown a little later in the cycle. The hope is this will make the lockdown more effective at a higher point in the spread. Effectively instead of a series of booms and busts, you get one longer slower initial burn and then you’re mostly done. They believe that in the long term this will make it easier to protect those most vulnerable to the virus, because you only have to do it once, at the cost of increased prevalence among people least vulnerable to it. So they see it as a better longer term strategy.