How might we stop a pandemic in the future?

[Maximum77]

I feel that we are doing the best we can with Coronavirus but humanity is still too primitive to truly eradicate a pandemic. If Coronavirus hit America in 2070 instead of 2020; what might we do different?

[Khedrac]

It's impossible to know (if you look at the predictions of most "futurists" they tend to be worse than most SciFi writers), but we can make some semi-educated guesses.

Mine is, looking at the advances in molecule manipulation we are making now, is that we will be able to map the protein structure of the virus' outside coat and then "3D print" empty copies to use as vaccines - identical for generating the correct antibodies, zero chance of being infectious and someting we may be able to turn around in days rather than months (and if we standarise and quality control the process, the approval for use should be much faster too).

(I believe the biggest advance needed to achieve this is the ability to map the protein coat of the virus in a timescale of hours or days.)

There would be a risk of allergic shock (if someone is allergic to the virus they will be allergic to the vaccine) but I think that would be easier to treat than eliminate.

Other possibilities include having a global opulation that is better educated about what to do and what not to do, but people being peole I think that a longshot!

[sihnfahl]

is that we will be able to map the protein structure of the virus' outside coat and then "3D print" empty copies to use as vaccines
Which is what I think CureVac is trying to do. A mRNA printer unit that's portable is what they're working on for COVID-2019.

[Khedrac]

Which is what I think CureVac is trying to do. A mRNA printer unit that's portable is what they're working on for COVID-2019.

I thought they might be getting there, which is why I suggested a turnaround of days in 50 years time.

[DavidBV]

Just look at South Korea and how they managed this pandemic, completely keeping it under control. Massive tests by day zero, a previously educated population that has the basic kits to self-protect and has been taught how to behave, and hospitals ready.

https://i.imgur.com/jEBFEpz.png

Without information, you can't make right decisions. Right now nobody knows how many infected are there in Italy... it could be 50K, 500K or a million. Not only the numbers, but who they are.

[Traab]

By then all of america will be uploaded into cybernetic bodies so the only thing we have to worry about are computer viruses which is an entirely different problem. /nod

[J-H]

Our big problem, even at this stage, is information. We don't truly know how many people we are sick, we don't know how many are really recovered, and we don't know what the true death rate is as a result. People who don't know they are sick can spread it, potentially for weeks.

The big, big, big key on this one is that it started in China instead of in a first-world country. If accurate information had started getting out in December instead of February, it would have made a big difference in helping medical personnel prepare to adequately handle this. It probably also would have gotten quarantine/travel restriction policies online several weeks faster, which is huge.

A big part of eradicating or slowing the spread of disease is having accurate and timely information, and unfortunately that was not the case on this one. Can't discuss why without going into politics and thus going against forum rules.

[NotASpiderSwarm]

Our big problem, even at this stage, is information. We don't truly know how many people we are sick, we don't know how many are really recovered, and we don't know what the true death rate is as a result. People who don't know they are sick can spread it, potentially for weeks.

The big, big, big key on this one is that it started in China instead of in a first-world country. If accurate information had started getting out in December instead of February, it would have made a big difference in helping medical personnel prepare to adequately handle this. It probably also would have gotten quarantine/travel restriction policies online several weeks faster, which is huge.

A big part of eradicating or slowing the spread of disease is having accurate and timely information, and unfortunately that was not the case on this one. Can't discuss why without going into politics and thus going against forum rules.All I'm going to say in response is that I'm not sure why you think it starting anywhere other than China would lead to accurate information being released.

[Vinyadan]

Without information, you can't make right decisions. Right now nobody knows how many infected are there in Italy... it could be 50K, 500K or a million. Not only the numbers, but who they are.

I am not sure about why they didn't show it in the graph, but 233,761 tests have been performed in Italy. Of these, 53,578 were positive. Of the ill, 4.852 died, and 6.072 got better. Physicians do think that something odd is going on, however, because lethality is just too high, and believe that the disease is probably going wildly underreported.

[Xyril]

Without getting too political, I will say that China is only non-"first world" in the more antiquated sense of being aligned with the former USSR, rather than the U.S.A.

By the more accepted meaning of the term (at least among contemporary lay-people)--China is much closer to a developed country than an undeveloped one. Moreover, in bioinformatics it is arguably taking the lead due to massive government support of the field, coupled with the lack of legal or cultural resistance to massive harvesting and analysis of individual genetic and medical data. The lack of information coming out had nothing to do with China's capability, and everything to do with its particular government and their priorities. In a different country, it might not be an authoritarian government trying to save face and protect its tourism and export based economy, but information could be suppressed or slowed for a number of other reasons. And these reasons might not necessarily be some variation of "this country is bad." I consider a strong tort system generally a good thing, but I could absolutely imagine a scenario where the first to know about a new disease would suppress that information for fear of legal liability. I believe that intellectual property protection is generally a good thing, but it has absolutely lead to situations where the first people to find something new (but unpatentable) decide not to disclose that information so that potential competitors can't start racing them to the first patentable innovations to come out of that information.

[Bucky]

I am not sure about why they didn't show it in the graph, but 233,761 tests have been performed in Italy. Of these, 53,578 were positive. Of the ill, 4.852 died, and 6.072 got better. Physicians do think that something odd is going on, however, because lethality is just too high, and believe that the disease is probably going wildly underreported.

Or Italian doctors are more likely to report a particular death as coronavirus-related when the patient had multiple life-threatening conditions.

[factotum]

Isn't it also the case that the Italian population as a whole is somewhat more skewed toward the elderly than most countries?

[Brother Oni]

Mine is, looking at the advances in molecule manipulation we are making now, is that we will be able to map the protein structure of the virus' outside coat and then "3D print" empty copies to use as vaccines - identical for generating the correct antibodies, zero chance of being infectious and someting we may be able to turn around in days rather than months (and if we standarise and quality control the process, the approval for use should be much faster too).

(I believe the biggest advance needed to achieve this is the ability to map the protein coat of the virus in a timescale of hours or days.)

The genetic sequence of COVID-19 was mapped out and was being shared from the 11 Jan 2020 (link (https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200121-sitrep-1-2019-ncov.pdf?sfvrsn=20a99c10_4)) and was finally published on the 11 Feb 2020, after 5 patients were admitted with the disease between the 18th and 29th Dec 2019: Identification of a novel coronavirus causing severe pneumonia in human, Ren et al, 2020 (https://journals.lww.com/cmj/Abstract/publishahead/Identification_of_a_novel_coronavirus_causing.9942 3.aspx).

We have an atomic level structure map of the spike protein that the virus uses to invade cells (published 03 Mar 20 (https://directorsblog.nih.gov/2020/03/03/structural-biology-points-way-to-coronavirus-vaccine/)), which is what one of the vaccines currently in clinical trials is targeting.

So we can get the information very quickly, it's just a matter of figuring what to do with it; target the wrong thing and at best, your vaccine will do nothing; at worst you've given the patient an autoimmune disease.


That said, the biggest hurdle for getting a new vaccine out isn't technological, it's regulatory. There's at least 2 vaccines that have been developed specifically for corona virus - both at in Phase I clinical trials. Even with the FDA and various other regulatory bodies fast tracking the process and every test and clinical trial going well, it's still 12-18 months before there's enough data to show that the vaccine is safe and effective before it can be officially launched (they also need time to scale up the manufacturing and production, but that typically runs concurrently during the Phase III clinical trial).

There's a vaccine originally developed for ebola epidemic a while back, that has shown some promise and has gone back into Phase III clinical trials; even that's several months out.


Back to the original topic, being able to design then manufacture a novel stable capsid without an associated virus genome, is akin to making a missile that you can slot a warhead of your choice into, ie designer bioweapons. That technology is going to be highly regulated or restricted.


All I'm going to say in response is that I'm not sure why you think it starting anywhere other than China would lead to accurate information being released.

Xyril has touched on why the PRC government might release inaccurate information - I'm just going to lay out the evidence for it:

Dr Li Wenliang and other doctors first reported the virus back on 30 Dec 2019, but were reprimanded by local police and later by the PSB (China's federal police force) for 'severely disturbing the social order': link (https://www.hongkongfp.com/2020/02/06/wuhan-doctor-punished-trying-warn-coronavirus-dies-infection/).

The PRC government then tried to suppress the news as it wasn't another 'SARS-like epidemic' (link (https://www.theguardian.com/world/2020/jan/05/mystery-illness-to-strike-chinese-city-is-not-sars-say-authorities-wuhan)), even initially passing on information to the WHO that it wasn't of concern (can't find a link for this one now) until they realise they couldn't contain it any more at the end of January.

[Kaptin Keen]

For something like Covid-19, a simple mudkicker approach would have been far, far superior: Isolate the vulnerable, infect the rest. In other words, put the elderly, the diabetics, the immuno-depressed, the astmathics and so on - all into quarentine. Let everyone else get sick. Get flock immunity. Save everyone.

For a disease that's actually dangerous - say malaria, or ebola - that wouldn't be wise.

[Brother Oni]

For something like Covid-19, a simple mudkicker approach would have been far, far superior: Isolate the vulnerable, infect the rest. In other words, put the elderly, the diabetics, the immuno-depressed, the astmathics and so on - all into quarentine. Let everyone else get sick. Get flock immunity. Save everyone.

Good idea! They should also have a marker on them as well to highlight that they're potentially vulnerable, like a little coloured badge to make them easily visible from a 2 metre distance. The more hardcore among them can even get identifying tattoos.


For a disease that's actually dangerous - say malaria, or ebola - that wouldn't be wise.

And COVID-19 isn't dangerous? Sure it's not killing the under-65s who are otherwise fit and healthy, but it's certainly causing lung and other organ damage: link (https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm).

[Vinyadan]

Or Italian doctors are more likely to report a particular death as coronavirus-related when the patient had multiple life-threatening conditions.

The dead are there, in completely abnormal numbers, and wouldn't be without the virus. I don't see how else they could report them.


Isn't it also the case that the Italian population as a whole is somewhat more skewed toward the elderly than most countries?

IIRC, Italy is second in Europe for both median age and longevity. It means lots of very old, very social people.



And COVID-19 isn't dangerous? Sure it's not killing the under-65s who are otherwise fit and healthy, but it's certainly causing lung and other organ damage: link (https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm).

Italy's so-called "patient one" (more like something around patient 200) was a 38 y.o, otherwise healthy and practicing sport. He ended up in intensive care anyway, and spent a month there.

[Strigon]

I feel that we are doing the best we can with Coronavirus but humanity is still too primitive to truly eradicate a pandemic. If Coronavirus hit America in 2070 instead of 2020; what might we do different?

Well, really, it depends what you mean. We've "eradicated" lots of pandemics before, when humanity was even more primitive. Most pandemics eradicate themselves after a while. In a year or two, once we have a successfully tested vaccine, we'll likely eradicate Covid-19. What do you define as "truly eradicating" a pandemic?

In any case, a new disease is a problem, because we don't know if the old medicines will work, and new medicines take years to properly test. That will be just as true in 2070 as it is in 2020. Increasingly reliable computer simulations will likely cut down some of the legwork, but I find it unlikely that we'll ever get to a point where we can officially endorse a treatment without actually testing it in live humans. So, even if the virus hit in 2070, or 2700, we likely wouldn't have a specific cure at this point.

That leaves us with two options: universal cures, or ways to reliably contain the infected. Reliably containing the infected requires quick and reliable testing. So, in the future, assuming we can stop pandemics, we'll likely have some sort of immune-boosting drug that we can break out to temporarily provide those likely to be exposed heightened protection, nanobots capable of seeking out and destroying viruses (though this is probably more science fiction than speculation,) or some way to scan people - even those who are asymptomatic - en masse before they travel. Obviously, these are all extremely difficult things to do.

The real way to stop a pandemic is to stop an outbreak before it becomes an epidemic, and if you can't do that, you stop an epidemic before it becomes a pandemic. Once it's a pandemic, you're already in big trouble.

Edit:

For something like Covid-19, a simple mudkicker approach would have been far, far superior: Isolate the vulnerable, infect the rest. In other words, put the elderly, the diabetics, the immuno-depressed, the astmathics and so on - all into quarentine. Let everyone else get sick. Get flock immunity. Save everyone.

For a disease that's actually dangerous - say malaria, or ebola - that wouldn't be wise.
https://i.imgur.com/y6KfmXF.jpg?1

Wow, that's... an awful idea.
First off, even if you got a perfect quarantine, millions would die. A small percentage of even the young and healthy need to be hospitalized and put into the ICU. Even taking out the most at-risk, they couldn't possibly handle the surge. So it fails on even a theoretical level. You could minimize that by trying to spread out the load, but then you're quarantining the vulnerable for a year or more.
Second, aside from the fact that people need to socialize, you realize that cutting off the most vulnerable people in the world has associated risks for those people? The elderly, diabetics, immuno-depressed, asthmatics, and so on, all need fairly regular care. It's actually pretty important that those people be able to see medical professionals on a regular basis. Not to mention the day-to-day care many of them need. How do you cut off their caretakers, too? Put them in isolation with the vulnerable? Sure, that works, but what about the families of those workers? Someone has to take care of their kids. So you put them into isolation, too. But then, they still need groceries and medications to live, so we need to keep otherwise healthy people at a reasonable distance as they go about their lives...

Hey, look at that, you just invented social distancing!

Seriously, no offense, but that's just not a good idea.

[Kaptin Keen]

It's a virus.

It's not going away.

Even if you're right - and you're not - there's no way we can wait in isolation until we have a vaccine. So those supposed millions are going to die (or, really, they're not) either way.

What we're doing now is that we're shutting down society - all of society - to protect a very, very few vulnerable people. That may seem ... benign. But we're spending trillions to save a very, very small number of people, and that money is coming from everyone else who's in need for any other conceivable reason.

Very, very few is of course relative. I don't agree that globally we may be talking about millions of people. Potentially. Malaria kills 3000 children daily. Covid-19 is on something like day 4, comparatively.

So if we want to act intelligently about this whole thing - no panic, no fear, just start, level headed rationalism, we protect the weak and let the strong build antibodies. And we move on.

It's just ... a flu.

Speaking of ... it's a very mild flu. It has a few tricks under it's sleeve, sure. It spreads quickly, it has a long gestation period, it's highly contagious, and in those susceptible, it seems to be slightly deadlier than other strains. But it's just a flu. 'Just', I should say. My mother died from the flu last year. I have covid-19 right now. I'm not unaffected. I just refuse to be irrational about it.

Until we start building actual antibodies, we're not doing anything at all except wait.

[Silverraptor]

And COVID-19 isn't dangerous? Sure it's not killing the under-65s who are otherwise fit and healthy, but it's certainly causing lung and other organ damage: link (https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm).

There are currently 2 dead from covid-19 in my area. An elderly woman who was 64 with several underlying lung health problems. The other was A 30 year old in excellent health and physical condition! This virus still kills everyone on all spectrums of life. Yes it has an easier time killing some over others, but the group who seems least at risk still has some risk.


It's a virus.

It's not going away.

Even if you're right - and you're not - there's no way we can wait in isolation until we have a vaccine. So those supposed millions are going to die (or, really, they're not) either way.

What we're doing now is that we're shutting down society - all of society - to protect a very, very few vulnerable people. That may seem ... benign. But we're spending trillions to save a very, very small number of people, and that money is coming from everyone else who's in need for any other conceivable reason.

Very, very few is of course relative. I don't agree that globally we may be talking about millions of people. Potentially. Malaria kills 3000 children daily. Covid-19 is on something like day 4, comparatively.

So if we want to act intelligently about this whole thing - no panic, no fear, just start, level headed rationalism, we protect the weak and let the strong build antibodies. And we move on.

It's just ... a flu.

Speaking of ... it's a very mild flu. It has a few tricks under it's sleeve, sure. It spreads quickly, it has a long gestation period, it's highly contagious, and in those susceptible, it seems to be slightly deadlier than other strains. But it's just a flu. 'Just', I should say. My mother died from the flu last year. I have covid-19 right now. I'm not unaffected. I just refuse to be irrational about it.

Until we start building actual antibodies, we're not doing anything at all except wait.

Do you know what else was "just the flu"? The 1918 flu (https://en.wikipedia.org/wiki/Spanish_flu). A virus so deadly that with just a mere 3% mortality rate, that flu killed more people then the entirety of WW1. Think about that for a second. A 3% death rate killed more people then a 4 year war where you had generals literally throwing men into machine gun meat grinders daily. It was a "War to end all Wars" because so many died and there was so much bloodshed, people didn't want to go to war anymore (I should add *most* people). The generation that fought in WW1 is known as the lost generation because so many men died in WW1.

Why the Spanish flu fizzled out was because the virus mutated to being more deadly at the end. In fact, it was so deadly at the end it killed the host faster than it could spread, effectively burning it out. And this was an era where people didn't quite know about viruses and how they spread, nor did they have the medical equipment to treat all the symptoms. The covid-19 virus is reported at 3% lethality rate initially (I think the official now is 4%). I think that may actually be higher because we do know about viruses and establishing quarantines. We have modern machines that can help treat the severe pneumonia this virus seems to cause everyone. And unlike the spanish flu that burned itself out, this virus has a 2 week incubation period before it makes the host sick, all the while, the host is spreading the disease to others and not knowing they are a carrier.

I'm sorry you're infected, but please think rationally. We have a real life situation about this that's very similar about a hundred years ago that caused an extraordinary amount of deaths. I just saw this morning that Italy just reported nearly 900 new deaths since yesterday and the rate is climbing. This is a true pandemic. Being infected, please try to avoid infecting others and take care of yourself as well. If you come down too sick and need to seek medical help, call ahead to the doctor and let them know before heading out, as giving them a heads up can help the doctor's prepare for you.

Stay safe everyone!

[Tvtyrant]

I feel that we are doing the best we can with Coronavirus but humanity is still too primitive to truly eradicate a pandemic. If Coronavirus hit America in 2070 instead of 2020; what might we do different?

We beat Smallpox, which killed more people in the 20th century then all wars combined and was worse than Covid in every regard.

The thing about viruses is they are highly derivative bacteria that evolved to not reproduce for themselves (yes they literally evolved to no longer be technically alive, nature is amazing.) Destroying them isn't that hard, its doing it without hurting ourselves. They are also probably important to us; they rewrite sections of our DNA which gives us a mutational flexibility we would otherwise lack. I'm not sure we want a general anti-viral to stop all pandemics, the loses to our biological flexibility could be dangerous in the longterm.

[Kaptin Keen]

In 1918 we didn't have 2020 medicine.

Not saying a real pandemic isn't dangerous - but this ... just isn't it.

I'm sorry. I know you're hearing the opposite from a bunch of people you have better reason to belive than me. Actually, I'm not saying I'm right and they are wrong. I'm saying there's more than one way to handle an epidemic, and I disagree that this is the right way. Based on ... personal opinion. I'm not a doctor, and I'd be the first to advise anyone to never take medical advise from anyone except doctors.

However.

The absolute, undeniable first line of defense against any infection is the immune system. There is no discussing this.

Right now, we've self-isolated across the globe, and that does only one thing: It slows the spread.

Nothing. Else.

Slowing the spread isn't a bad thing. The real danger of covid-19 is that it's unusual pattern creates a bottleneck - it yields a rush of infected, quite possibly millions at the same time, a low percentage of whom need intensive care to survive.

But we need not slow the spread for everyone. It is, in every way (that I can think of) better to slow the spread for those who actually risk dying. Those who die - almost without exception - are old, or diabetic, of astmathic, or suffer from heart- or circulatory disease .. or similar.

We should protect those who need protection, and let everyone else get antibodies.

And yes. There may be a price to pay for that. Traffic kills more people every day than covid-19 does. So does malaria. So does hunger.

Consider: We could easily feed the world - all the world, everyone everywhere - and treat everyone for malaria for the price we're paying to fight covid-19.

Oh, I forgot:


I'm sorry you're infected, but please think rationally.

Thanks, I'm fine though. As the media will inform you, it's really a very mild flu - unless it's not.

[Brother Oni]

We beat Smallpox, which killed more people in the 20th century then all wars combined and was worse than Covid in every regard.

Smallpox is different in that we're the only reservoir and once someone has had it, they're largely immune. Coupled with a very intensive, expensive, global and aggressive vaccination campaign, it still took 30 years to eradicate it (dating from the first hemisphere wide vaccination campaign in 1950, to it being declared eradicated in the wild in 1980).

Compare this to a corona virus, which can undergo both antigenic drift and antigenic shift, plus jump species. While it's less lethal than smallpox and less infectious, this ability to shift its surface antigens and have multiple reservoirs makes corona viruses in general very hard to contain.

For comparison, COVID-19 has a mortality rate of ~4% (based the figure above) and using data from January and February, had an R0 of 2.35 initially, which has dropped to 1.05 after the lockdowns (link (https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30144-4/fulltext)). Coupled with its ~2 week incubation period, people can get far and wide while still being infectious.

In comparison, smallpox had an overall mortality rate of ~30% (it varied between the different strains with the 'ordinary type-confluent' strain being 50-75% fatal, the 'ordinary-type semi-confluent' being 25-50% and the 'haemorrhagic' type being 90-100%) and an R0 of 3.5 - 6, making it on paper the more dangerous virus, however its 2-4 day incubation period with the lesions being visible after 12-14 days makes it far easier to spot and contain.


In 1918 we didn't have 2020 medicine.

Not saying a real pandemic isn't dangerous - but this ... just isn't it.

I'm sorry. I know you're hearing the opposite from a bunch of people you have better reason to belive than me. Actually, I'm not saying I'm right and they are wrong. I'm saying there's more than one way to handle an epidemic, and I disagree that this is the right way. Based on ... personal opinion. I'm not a doctor, and I'd be the first to advise anyone to never take medical advise from anyone except doctors.


Yet in 2020, despite all the modern medicine and the various restrictions, we still have ~4500 dead in 3 weeks in Italy, alone. What do you think the death toll would be without modern medicine and all the various measures put into place?

You keep on harping on about 'this is just a flu and not a real pandemic', yet in the very next sentence, you put a disclaimer that this is based on personal opinion and that people should be taking information from doctors and other experts.

All the experts in this, from doctors to epidemiologists who specialise in the spread of disease, say it's a pandemic, yet you apparently believe your personal opinion is as good as their years of experience, training and actual facts.


We should protect those who need protection, and let everyone else get antibodies.

And yes. There may be a price to pay for that.

You might consider it worthwhile to pay this cost. All the experts disagree with you and the people in charge, agree with the experts too.



Consider: We could easily feed the world - all the world, everyone everywhere - and treat everyone for malaria for the price we're paying to fight covid-19.

If only money was the sole reason that was stopping us from feeding the world and treating malaria.

[DavidSh]

While I don't imagine that we'll all (or even a significant number of us) will have uploaded by 2070, I do expect that there will be semi-autonomous remote-control "robots" that will allow anybody in quarantine to effectively go out and do their business. Some of the pieces needed for this already exist.

[Kaptin Keen]

Yet in 2020, despite all the modern medicine and the various restrictions, we still have ~4500 dead in 3 weeks in Italy, alone. What do you think the death toll would be without modern medicine and all the various measures put into place?

You keep on harping on about 'this is just a flu and not a real pandemic', yet in the very next sentence, you put a disclaimer that this is based on personal opinion and that people should be taking information from doctors and other experts.

All the experts in this, from doctors to epidemiologists who specialise in the spread of disease, say it's a pandemic, yet you apparently believe your personal opinion is as good as their years of experience, training and actual facts.

You might consider it worthwhile to pay this cost. All the experts disagree with you and the people in charge, agree with the experts too.

If only money was the sole reason that was stopping us from feeding the world and treating malaria.

Italy has the oldest population in the world, and just about the lowest number of ICU's in the western world. Bottleneck. Like I said.

It's an epidemic. We have them yearly. This one is worse, but not by a degree that warrants worldwide panic. Take your information from doctors. Yes. Do you seriously feel entitled to tell me that bars me from having an opionion, or voicing it?

Not all the experts agree. Not all the people in charge agree.

Money is the primary reason we don't feed the world - and treat malaria.

[Strigon]

We should protect those who need protection, and let everyone else get antibodies.


Except you literally cannot do that.
People still need to be in contact with others. Those with pre-existing health conditions more than others. We could lock them away from society for the next year, but more of them would die preventable deaths from lack of medical care than would die from the disease. Your scenario only works if we can keep them away from every other human on the planet, because according to you, we'll all get it anyway. But these people rely on others to survive - they need medicine, regular check-ups, heck, some of them literally can't get themselves out of bed.

Your proposed solution is worse than doing nothing in pretty much every way, because it combines the worse aspects of doing nothing with the worst aspects of a lockdown.

[Kaptin Keen]

Except you literally cannot do that.
People still need to be in contact with others. Those with pre-existing health conditions more than others. We could lock them away from society for the next year, but more of them would die preventable deaths from lack of medical care than would die from the disease. Your scenario only works if we can keep them away from every other human on the planet, because according to you, we'll all get it anyway. But these people rely on others to survive - they need medicine, regular check-ups, heck, some of them literally can't get themselves out of bed.

Your proposed solution is worse than doing nothing in pretty much every way, because it combines the worse aspects of doing nothing with the worst aspects of a lockdown.

I don't know what to tell you.

No quarentine is ever 100% effective. But it doesn't need to be. It needs to be mostly ok. A decent level of protection.

The vast majority of everyone doesn't need quarentine. For almost everyone, covid-19 is a mild infection. And for a few, it's really, really bad. This isn't that different from any other flu, btw. The real difference is in how it spreads. And the real danger is in the bottleneck. In the fact that a lot of people get sick at the same time, and need intensive care.

What we really need to prevent a situation like in Italy is a slower spread, so capacity will suffice. That's all. Some will die - they always do. Every year, millions of people die from the flu. It's like the third most common cause of death in the western world.

And then - because the virus isn't going anywhere - we will need flock immunity. Which we only achieve by vaccine, or infection. Vaccine is infection anyways. Kinda.

[DeTess]

What we really need to prevent a situation like in Italy is a slower spread, so capacity will suffice. That's all. Some will die - they always do. Every year, millions of people die from the flu. It's like the third most common cause of death in the western world.


What do you think all those things that are currently being doen are meant to facilitate? "flattening the curve' is basically the medical buzz-word of the year, and that's what all the recommendations for self-isolation are meant to accomplish. No one thinks it'll result in the disease affecting significantly fewer people, just that the rate of infections is reduced enough to not overwhelm the hospitals.

[Kaptin Keen]

What do you think all those things that are currently being doen are meant to facilitate? "flattening the curve' is basically the medical buzz-word of the year, and that's what all the recommendations for self-isolation are meant to accomplish. No one thinks it'll result in the disease affecting significantly fewer people, just that the rate of infections is reduced enough to not overwhelm the hospitals.

Yes.

But none of that has any impact on the point I'm trying to raise.

[DeTess]

Yes.

But none of that has any impact on the point I'm trying to raise.

Then what is your point? That we need to protect the vulnerable? Of course we do, and as far as I can tell, most heavily affected countries are taking steps to protect them.

Is deliberately exposing all the people that aren't in the risk group a good way to do that? Of course it isn't! That's a good way to kill a lot of people that don't need to die, as this disease has proven to be deadly in some cases even to the healthy and young. If it was the only way to stop the disease, I might agree with you as its a case of the lesser of two evils. But that's not the choice we have to make, or all the experts would be telling us this.

edit: anyway, to get back on track, I'd expect that, since stuff like coronavirus outbreaks will continue to happen every decade or so, it wouldn't surprise me if some sort of big breakthrough in the development of vaccines happens, allowing for the very rapid development of effective and safe vaccines in the future.

[Silverraptor]

One thing I think we need to do is try to figure out how to revamp our quarantine procedures. What happens when a quarantine is formed and you lock everyone in a certain area is that the disease spreads to the healthy and more and more people get infected in the quarantine zone. This causes a panic among the population there and then quarantine runners start occurring, which risks an infected getting lose from the quarantine. I think there should be a layered quarantined approach. Yes, you cut off the whole area in absolute quarantine like above, but then you expand that zone into different sections with temporary residence to move the "healthy" population out of the absolute quarantined zone into these segmented extra quarantined zone. That allows a chance to get the non-infected out of the hot zone and if you do allow an infected by accident into one of these zones, then it's still contained and not the whole evacuated population is infected. It's still a work in progress on how I think it should be done, but I think it would allow for a better quarantine management instead of draw a circle and assume everyone in that zone will get infected.

[Tvtyrant]

Smallpox is different in that we're the only reservoir and once someone has had it, they're largely immune. Coupled with a very intensive, expensive, global and aggressive vaccination campaign, it still took 30 years to eradicate it (dating from the first hemisphere wide vaccination campaign in 1950, to it being declared eradicated in the wild in 1980).

Compare this to a corona virus, which can undergo both antigenic drift and antigenic shift, plus jump species. While it's less lethal than smallpox and less infectious, this ability to shift its surface antigens and have multiple reservoirs makes corona viruses in general very hard to contain.

For comparison, COVID-19 has a mortality rate of ~4% (based the figure above) and using data from January and February, had an R0 of 2.35 initially, which has dropped to 1.05 after the lockdowns (link (https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30144-4/fulltext)). Coupled with its ~2 week incubation period, people can get far and wide while still being infectious.

In comparison, smallpox had an overall mortality rate of ~30% (it varied between the different strains with the 'ordinary type-confluent' strain being 50-75% fatal, the 'ordinary-type semi-confluent' being 25-50% and the 'haemorrhagic' type being 90-100%) and an R0 of 3.5 - 6, making it on paper the more dangerous virus, however its 2-4 day incubation period with the lesions being visible after 12-14 days makes it far easier to spot and contain.


True. I suppose my point was that we have beaten pandemics in the past, including the two worst fairly recently (India had a plague outbreak in 1897 and Smallpox was a more or less permanent pandemic.) It's not the science that is lacking, its the time factor. How many people that die before we get it under control.

[Xyril]

I'm sorry. I know you're hearing the opposite from a bunch of people you have better reason to belive than me. Actually, I'm not saying I'm right and they are wrong. I'm saying there's more than one way to handle an epidemic, and I disagree that this is the right way. Based on ... personal opinion. I'm not a doctor, and I'd be the first to advise anyone to never take medical advise from anyone except doctors.

However.


Respectfully, you keep following the pattern of "you guys would be stupid to listen to medical advice from non-experts, and I'm no expert, and I'm not saying that I'm right and the experts are wrong, but here's why I'm right and the experts are wrong."

And the last time you were active here, you were insinuating that the World Health organization was exaggerating the threat from this virus in order to keep themselves relevant.

I have two non-rhetorical questions for you:

1) How many people have died since you the last time you graced us with your insights, and in light of that number, are you still so confident in your assertion that the WHO was needlessly overreacting like you think they apparently did with ebola, SARS version 1.0, swine flu, etc?

2) Given how the situation is developing in countries that took the overreacting experts advice (i.e., South Korea, Taiwan) versus the countries that took something much closer to your "it's just the flu, failing to continue with business as usual would be more harmful than the disease" approach (i.e., Iran), do you still feel that your advice is the best approach moving forward?

Also, follow up question: Do you think that a country that keeps its economy going at 100% (well, as close to 100% as possible given that a few percent of their population will die in a brief period, while a larger percentage will likely be unable to work for at least a few weeks) is going to have that much of an advantage economically versus a country that attempted mitigation?

[NotASpiderSwarm]

That said, the biggest hurdle for getting a new vaccine out isn't technological, it's regulatory. There's at least 2 vaccines that have been developed specifically for corona virus - both at in Phase I clinical trials. Even with the FDA and various other regulatory bodies fast tracking the process and every test and clinical trial going well, it's still 12-18 months before there's enough data to show that the vaccine is safe and effective before it can be officially launched (they also need time to scale up the manufacturing and production, but that typically runs concurrently during the Phase III clinical trial).The issue there isn't really regulatory. They have to inject people with the vaccine and then wait long enough to be relatively sure the vaccine doesn't have any horrible side-effects. If the vaccine kicks off an auto-immune disease with a 50% mortality rate 12 months from now, they want to know that before injecting it into a couple billion people. Yes, that's enforced by regulations, but this isn't a case of a law passed in the 1890's still being enforced because lol bureaucrats, there's legit reasons to wait that long before deployment.


Xyril has touched on why the PRC government might release inaccurate information - I'm just going to lay out the evidence for it:

Dr Li Wenliang and other doctors first reported the virus back on 30 Dec 2019, but were reprimanded by local police and later by the PSB (China's federal police force) for 'severely disturbing the social order': link (https://www.hongkongfp.com/2020/02/06/wuhan-doctor-punished-trying-warn-coronavirus-dies-infection/).

The PRC government then tried to suppress the news as it wasn't another 'SARS-like epidemic' (link (https://www.theguardian.com/world/2020/jan/05/mystery-illness-to-strike-chinese-city-is-not-sars-say-authorities-wuhan)), even initially passing on information to the WHO that it wasn't of concern (can't find a link for this one now) until they realize they couldn't contain it any more at the end of January.I'm not saying China was accurate. I'm saying that there's plenty of other countries which would also ignore, downplay, or misrepresent info in similar ways. Indeed, China is far from the only country to have done so during this epidemic.

[Saintheart]

I don't know what to tell you.

No quarentine is ever 100% effective. But it doesn't need to be. It needs to be mostly ok. A decent level of protection.

The vast majority of everyone doesn't need quarentine. For almost everyone, covid-19 is a mild infection. And for a few, it's really, really bad. This isn't that different from any other flu, btw. The real difference is in how it spreads. And the real danger is in the bottleneck. In the fact that a lot of people get sick at the same time, and need intensive care.

What we really need to prevent a situation like in Italy is a slower spread, so capacity will suffice. That's all. Some will die - they always do. Every year, millions of people die from the flu. It's like the third most common cause of death in the western world.

And then - because the virus isn't going anywhere - we will need flock immunity. Which we only achieve by vaccine, or infection. Vaccine is infection anyways. Kinda.

This is the sort of quasi-Objectivist thinking that has had a large hand in killing over fourteen thousand people so far, as well as hospitalising a good ten times that number worldwide. It's thinking done largely out of ignorance. We have no strong data as yet as to how complete the "recovery" is from the virus, whether reinfection with the virus is possible, what permanent damage is done for those who have a severe case but luckily don't die, or the ongoing medical costs of all of those measures.

There is also no data about any unseen effects the virus might be having on children: it is said the virus is not affecting children, or not affecting them as badly. I say absence of evidence is not evidence of absence. I would start a longtitudinal study of kids diagnosed with COVID-19 right now. It wouldn't surprise me in the slightest if those same kids wind up with a statistically significant rate of respiratory disorders such as asthma in about 20 years' time, if not sooner. Because the human immune response, as folks treating COVID-19 are finding out when people drop dead in front of them, is a funny thing.

The right way to deal with a very communicable virus about which you know very little is to overreact, or at least be cautious, at the start. That's called the precautionary principle. That's what Singapore, South Korea, and Taiwan did, and the reason they did was because they'd been smashed by SARS and therefore knew from experience how to protect their populations. That's also what certain statisticians and immunologists in the West were saying way back in December last year, but they weren't listened to. As it is we know comparatively little about this virus beyond the fact it seems to be transmitted like the flu, but kills like pneumonia and has a higher complication rate than the flu. There is case after case available in the MSM or elsewhere in which young, healthy people are infected with the virus or their systems suddenly collapse without explanation. The hilarity of the "staged" or "measured" response is about to be demonstrated in the United States, Britain, and Australia, if not in the entire EU.

[factotum]

The hilarity of the "staged" or "measured" response is about to be demonstrated in the United States, Britain, and Australia, if not in the entire EU.

Just to note, there are several EU countries in a worse position than the UK is right now, Italy being the most obvious example but France, Spain and Germany also have far more confirmed cases than we do (although not many deaths in Germany so far, so they're doing something right).

[Liquor Box]

I tend to think that most countries have acted appropriately in response to the virus.

I don't agree that overreaction is best. There's a cost to everything, and there's a huge cost to isolation (mostly in terms of people not working).

Saintheart, you pull out a couple of isolated examples. But both Italy and China have had relatively strong responses to Coronavirus (eg Italy acted faster and imposed more restrictions than most Euro countries), and the two have been amongst the worst hit.

That's not to say that testing and social isolation don't help - I'm sure they do. But it is not simply a case of do little and virus gets worse, overreact and it gets eradicated - it's more complicated than that. And whatever action is taken against the virus must be weighed up against countervailing factors.

[georgie_leech]

I tend to think that most countries have acted appropriately in response to the virus.

I don't agree that overreaction is best. There's a cost to everything, and there's a huge cost to isolation (mostly in terms of people not working).

Saintheart, you pull out a couple of isolated examples. But both Italy and China have had relatively strong responses to Coronavirus (eg Italy acted faster and imposed more restrictions than most Euro countries), and the two have been amongst the worst hit.

That's not to say that testing and social isolation don't help - I'm sure they do. But it is not simply a case of do little and virus gets worse, overreact and it gets eradicated - it's more complicated than that. And whatever action is taken against the virus must be weighed up against countervailing factors.

Sure. Just keep in mind there are costs to the economy when people get sick, regardless if any particular case is one that threatens to be fatal. A pandemic like this is going to have a rather negative effect on the economy regardless. Given that, do you want the economic costs of being sick, or the economic costs of doing something about it?

[Liquor Box]

Sure. Just keep in mind there are costs to the economy when people get sick, regardless if any particular case is one that threatens to be fatal. A pandemic like this is going to have a rather negative effect on the economy regardless. Given that, do you want the economic costs of being sick, or the economic costs of doing something about it?

To answer your question - it depends which economic cost is greater.

To add some perspective to that though - only about 1/1000 of Italy's (the worst effected country) workforce has been found to be infected by covid-19. So this week the economic cost of the sick people being off work is only 1/1000th of the cost of everyone being off work for isolation purposes.

Of course it's not as simple as that, and the counter-argument is that if left unchecked the effects of the virus will grow. But it is not clear how bad it will get if left unchecked, or how effective containment will be. It's not clear how long containment will be required for (probably longer than the symptomatic period of the disease).

I think there is good reason to think the sickness would cause less economic damage than isolation (if everyone is isolated then 100% of people would have to get covid-19 to have the same impact of work - assuming similar downtime for each).

However, the lessor economic impact has to be balanced against non-economic factors. I tend to think more people will die from covid-19 being left unchecked than from the economic fallout from isolation.

Overall, I don't think it is a no-brainer what should be done, and I think most countries have acted appropriately.

[Brother Oni]

The issue there isn't really regulatory. They have to inject people with the vaccine and then wait long enough to be relatively sure the vaccine doesn't have any horrible side-effects. If the vaccine kicks off an auto-immune disease with a 50% mortality rate 12 months from now, they want to know that before injecting it into a couple billion people. Yes, that's enforced by regulations, but this isn't a case of a law passed in the 1890's still being enforced because lol bureaucrats, there's legit reasons to wait that long before deployment.

I disagree, it's mostly regulatory for this class of drug product. Unlike other drug products where you have to show an improvement compared to the current gold standard treatment, there is no current gold standard, so any measured improvement in antibody production is better.
While I concede that I don't know whether the current diagnostic tests measure for the virus or measure for the antibody, they only require a few days after infection for detection - the Phase I clinical trial for the vaccine targeting the spike protein is something like 11 doses over 2 months in a small number of healthy male volunteers (at work at the moment, so can't check the exact numbers), and they're not even assessing vaccine effectiveness yet (that's in Phase II), only toxicology.

With regard to toxicity, an auto-immune response can happen within hours (e.g. Theralizumab (https://en.wikipedia.org/wiki/Theralizumab)), but I concede that any other chronic toxicity effects will take months to identify and assess.

In any case, there's still another 2 phases to go before the product is remotely ready for general release (Phase II is limited number of patients, Phase III is larger number of patients); Phase III trials can take months to run (I think the last one we did was ~8 months over 200-odd patients, with 2-4 months recruiting beforehand).

I'm not saying that the delay is unnecessary; various disasters like the 1937 Elixir of Sulphanilamide, 1957 Thalidomide, 2008 Heparin adulteration, etc, have all shown that gathering vast amounts of information is necessary to prove that your product is safe, effective and fit for purpose, but it's worth remembering that this data is all mandated by the regulatory authorities and barring dispensations for compassionate use (I believe some Italian doctors have received permission to use some of these vaccines on their worst affected patients), they're the main reason why it takes so long to develop a new drug product.



I'm not saying China was accurate. I'm saying that there's plenty of other countries which would also ignore, downplay, or misrepresent info in similar ways. Indeed, China is far from the only country to have done so during this epidemic.

True, point taken.

[sihnfahl]

barring dispensations for compassionate use (I believe some Italian doctors have received permission to use some of these vaccines on their worst affected patients), they're the main reason why it takes so long to develop a new drug product.
Due to a lot of talk on various medications helping with COVID-19, I believe there has been a rush on requesting those meds for compassionate use.

Problem goes back to the fact that they're still -in trial- for use with COVID-19. So I anticipate compassionate use being denied because they're trying to ensure availability not only for the usual consumers of said drugs, but also for the directed trials and evaluations in controlled medical settings...

[NichG]

To add some perspective to that though - only about 1/1000 of Italy's (the worst effected country) workforce has been found to be infected by covid-19. So this week the economic cost of the sick people being off work is only 1/1000th of the cost of everyone being off work for isolation purposes.

...

I think there is good reason to think the sickness would cause less economic damage than isolation (if everyone is isolated then 100% of people would have to get covid-19 to have the same impact of work - assuming similar downtime for each).


I've basically been working full time from isolation for the last 3 weeks. Only jobs that absolutely require direct physical interaction with other humans would be shut down 100%.

If everyone who can work from home did, those that can work at a distanceffrom others did, etc that would improve the situation significantly at zero direct loss of any essential activity.

[Ibrinar]

About the future in 50 years, most jobs that require manual work will likely have been automated or can at least be done by remote control of robots. And tele-presence will be quite a bit more advanced too. So I think in 50 years we can do something like this without stopping any work except for work that is stopped because it is about many customers in one place.

Aside from that we might have much better ways to monitor health, decent chance it just gets stopped cold by finding the first few cases. Sure we will be better at treatment too but stopping the spread at the start is likely still the least resource intensive option.

[Xyril]

About the future in 50 years, most jobs that require manual work will likely have been automated or can at least be done by remote control of robots. And tele-presence will be quite a bit more advanced too. So I think in 50 years we can do something like this without stopping any work except for work that is stopped because it is about many customers in one place.


We're already at that point, in theory. Manufacturing is already highly automated and jobs directly related to tangible production--manufacturing, extraction, agriculture, transportation, research--comprise a very small fraction of the economy as it stands. Right now, pretty much every developed country and a lot of undeveloped ones could keep enough people at home to drastically slow the spread of the virus without sacrificing production of "stuff."

The problem is that in practice, the economy is all interconnected, and keeping those mines and factories and farms running requires faith that people will buy what they're producing, and ultimately their demand is driven by a consumer-base largely employed in fields that involve face-to-face interactions. Much of this is due to cultural influences, not technological limitations. Yes, there are jobs that can't be done remotely--i.e., most surgeries still, complex inspections--that could be in the future if the technology advances enough. However, much of the stuff we do face-to-face is because humans see value in that sort of interaction or don't want to adapt to remote work.

We are fortunate enough to live in a time and place where most of our necessities--at a societal, but not necessarily individual, level--aren't an issue. This means that a lot of our economy is based on selling experiences: Spending a day at a theme park, eating out with a group of friends, seeing a movie or a concert. Taking away these jobs suddenly will hurt the economy, as would suddenly losing any arbitrary chunk of the economy that big. It gets even worse once you factor in the many jobs that could be done remotely, but remains largely face-to-face due to cultural inertia and the inability to adapt.

The legal system has done better than a lot of industries in adopting remote and electronic systems to increase efficiencies, but there is still a strong bias towards in-person for many aspects. Customers who pay thousands of dollars for representation want to meet their attorney in person, or at least talk to him live on the phone. Plaintiffs and defendants want the judge and the jury to see them and their witnesses directly, not through a video screen--if you look at the criticism of certain court systems, one point often raised is "the judge isn't even there, he's off site watching through a camera," as if everyone would naturally agree that using telepresence means (literally) phoning it in and not giving the case serious consideration.

[Vinyadan]

And yes. There may be a price to pay for that. Traffic kills more people every day than covid-19 does. So does malaria. So does hunger.


Reminder that road accidents in Italy killed 3,300 during the whole of 2018, while COVID-19 has killed over 6,000 in a few weeks.

[Fyraltari]

I am not an epidemiologist but it is my understanding that pandemics are caused by pathogens jumping species in a place that has regular contact with the outside world/lots of people in it

So unless we eradicate every other animal species and/or go back to hunting-gathering in tribes of a hundred-odd people, we can’t actually avoid pandemics. Just limit the casualties.

[Brother Oni]

Due to a lot of talk on various medications helping with COVID-19, I believe there has been a rush on requesting those meds for compassionate use.

Problem goes back to the fact that they're still -in trial- for use with COVID-19. So I anticipate compassionate use being denied because they're trying to ensure availability not only for the usual consumers of said drugs, but also for the directed trials and evaluations in controlled medical settings...

Getting a bit technical here, there's a difference between compassionate use and off-label use.

A dispensation for compassionate use is where an otherwise unauthorised drug is granted permission to be used in a very limited number of patients. The best example is where a drug product has failed in its Phase II or Phase III trial but has shown an improvement in the condition for a limited sub section of the patient test group. Rather than destroy all remaining unused supplies, the drug company can instead can transferred all remaining supplies to those patients, who can use them until the stock runs out.

This can be a very long time - for one clinical trial re-supply I was involved in, we made ~20,000 devices, with a device lasting a month under recommended dosing. Assuming a 50% usage rate in the trial, that's enough devices to last 100 patients over 8 years each.


Off label use is when a drug product has been licensed and is sold for treating one disease, but has unexpectedly been found to have some effect in treating a completely different disease - this is the case with chloroquine and hydroxychloroquine, both intended to treat malaria, but has shown some promise in treating COVID-19. Off label use is much harder to stop, as a doctor could simply say they're prescribing it for malaria. To prescribe either drug for COVID-19 requires another phase III trial, as stated by the FDA director recently.


Incidentally the repurposed ebola vaccine, Remdesivir, falls under neither category. It's not intended to treat COVID-19, nor did it ever complete the approval process to be sold, so any use of it for COVID-19 comes with a stack of waivers as thick as my arm.

[Tyndmyr]

For something like Covid-19, a simple mudkicker approach would have been far, far superior: Isolate the vulnerable, infect the rest. In other words, put the elderly, the diabetics, the immuno-depressed, the astmathics and so on - all into quarentine. Let everyone else get sick. Get flock immunity. Save everyone.

For a disease that's actually dangerous - say malaria, or ebola - that wouldn't be wise.

This is a risky approach. Not every disease targets the traditional vulnerable. Some target the healthy. If you misidentify this way one time, welp, there goes humanity.

Plus, even if that isn't the case, it is logistically difficult or impossible to get most of society sick at one go. How do you do that, care for the sick, and still maintain services to those in quarantine? Plus, with that much infection around, it's that many more chances for an accidental quarantine breach.

And of course, there is probably still a non-zero mortality rate. Yeah, it may be quite low, but if you are going for a mass infection approach, the absolute number of bodies attributable to this method would be large.

The approach may be simple, but it is not at all superior.



Even if you're right - and you're not - there's no way we can wait in isolation until we have a vaccine. So those supposed millions are going to die (or, really, they're not) either way.

What we're doing now is that we're shutting down society - all of society - to protect a very, very few vulnerable people. That may seem ... benign. But we're spending trillions to save a very, very small number of people, and that money is coming from everyone else who's in need for any other conceivable reason.

Well, it's...more than a few vulnerable people. The proportion of society that is elderly alone is not small. Once you add in the wide swathe of other conditions that puts one at risk, you may be well at a majority of the population. If not, at least very close.

At a certain point, it's easier to put in safety measures for everyone than for almost everyone. Consistency helps.

Yeah, I have a lot of concerns about the cost, and specific actions may or may not make sense, but generalized anti-infection measures are pretty logical in general. Even if everyone is going to get it, having them get it more slowly so the medical system can cope helps.

It would have been far, far cheaper to address it correctly from the start, but that opportunity is past, and there's not much to be done about that now. Yeah, panic buying a mountain of toilet paper won't help, but taking measures like staying at home whenever possible, sure. That makes sense. I'd be willing to discuss specific measures, and talk about what might be most effective, but "it's just the flu" is probably not the way to go.

[Asmotherion]

I suppose that when we'll have a fully decoded dna, we'll be able to develop softwere that can analise a viruse and suggest counter measures in a matter of a few seconds. Then we'll be able to bio-engenire a measure that immunises humans in 8 hours, and spread it faster than the pandemic itself. I'd say it's realistic to expect this by around 2050.

[Tyndmyr]

I suppose that when we'll have a fully decoded dna, we'll be able to develop softwere that can analise a viruse and suggest counter measures in a matter of a few seconds. Then we'll be able to bio-engenire a measure that immunises humans in 8 hours, and spread it faster than the pandemic itself. I'd say it's realistic to expect this by around 2050.

DNA sequencing is already a thing. Countermeasures and bioengineering are not at all simple, even if you have the entire genome. I don't think that's the roadblock.

[Strigon]

I am not an epidemiologist but it is my understanding that pandemics are caused by pathogens jumping species in a place that has regular contact with the outside world/lots of people in it

So unless we eradicate every other animal species and/or go back to hunting-gathering in tribes of a hundred-odd people, we can’t actually avoid pandemics. Just limit the casualties.

You're confusing pandemics with disease outbreaks - a pandemic only happen once the disease spreads around the world. There are plenty of ways to stop a disease, once identified, from spreading. It's just a matter of timing.


This is a risky approach. Not every disease targets the traditional vulnerable. Some target the healthy. If you misidentify this way one time, welp, there goes humanity.

That's a bit extreme. Diseases, by and large, aren't all that deadly. A really nasty illness might have a 30-40% mortality rate. Very few diseases go higher than that, and as far as I know, none of them are pandemic material - nor are any pandemics likely to approach that threshold. Humanity could survive a 40% reduction in numbers, as a species. Not only would you need to have the disease be unbelievably deadly and ridiculously infectious, but you'd also have to somehow confuse it with an almost harmless disease in order for humanity as a whole to be threatened.

I mean, it's still risky because of the threats to daily life and civilization, but the line between a civilization-changing event and "welp, there goes humanity" is very thick, indeed.

[NotASpiderSwarm]

We're already at that point, in theory. Manufacturing is already highly automated and jobs directly related to tangible production--manufacturing, extraction, agriculture, transportation, research--comprise a very small fraction of the economy as it stands. Right now, pretty much every developed country and a lot of undeveloped ones could keep enough people at home to drastically slow the spread of the virus without sacrificing production of "stuff."

The problem is that in practice, the economy is all interconnected, and keeping those mines and factories and farms running requires faith that people will buy what they're producing, and ultimately their demand is driven by a consumer-base largely employed in fields that involve face-to-face interactions. Much of this is due to cultural influences, not technological limitations. Yes, there are jobs that can't be done remotely--i.e., most surgeries still, complex inspections--that could be in the future if the technology advances enough. However, much of the stuff we do face-to-face is because humans see value in that sort of interaction or don't want to adapt to remote work.

We are fortunate enough to live in a time and place where most of our necessities--at a societal, but not necessarily individual, level--aren't an issue. This means that a lot of our economy is based on selling experiences: Spending a day at a theme park, eating out with a group of friends, seeing a movie or a concert. Taking away these jobs suddenly will hurt the economy, as would suddenly losing any arbitrary chunk of the economy that big. It gets even worse once you factor in the many jobs that could be done remotely, but remains largely face-to-face due to cultural inertia and the inability to adapt.

The legal system has done better than a lot of industries in adopting remote and electronic systems to increase efficiencies, but there is still a strong bias towards in-person for many aspects. Customers who pay thousands of dollars for representation want to meet their attorney in person, or at least talk to him live on the phone. Plaintiffs and defendants want the judge and the jury to see them and their witnesses directly, not through a video screen--if you look at the criticism of certain court systems, one point often raised is "the judge isn't even there, he's off site watching through a camera," as if everyone would naturally agree that using telepresence means (literally) phoning it in and not giving the case serious consideration.There's also the fact that "theoretically possible" and "actually feasible" are two different things. Dispatchers from my company can and have made the schedule with their cell phones, a netbook running off a hotspot from a different cell phone, and paper records. But they were all in the same room at the time. Doing it from 4 different homes via a shared Google Docs spreadsheet is a lot more likely to see something go wrong. There's a lot of things that technically SHOULD work, and probably would with 6 months to get used to the transition and figure out new procedures, but that's 6 months from now, which doesn't help.

[Liquor Box]

I've basically been working full time from isolation for the last 3 weeks. Only jobs that absolutely require direct physical interaction with other humans would be shut down 100%.

If everyone who can work from home did, those that can work at a distanceffrom others did, etc that would improve the situation significantly at zero direct loss of any essential activity.

You are right that some people would be able to work from home. I think you significantly overestimate how many would be able to though. Even in the most developed country only some jobs are mostly at a computer - and in several of those cases the business is not setup to allow remote working.

Also, we are not talking about "essential activities" here. We are talking about economic damage from isolating the population.

[NichG]

You are right that some people would be able to work from home. I think you significantly overestimate how many would be able to though. Even in the most developed country only some jobs are mostly at a computer - and in several of those cases the business is not setup to allow remote working.

Also, we are not talking about "essential activities" here. We are talking about economic damage from isolating the population.

The difference between essential damage and inessential damage is whether that damage can be ameliorated by the way in which the lockdown is performed and associated measures and policies taken.

If restaurant waiters can't work, for example, then paying them not to work solves that issue - those losses can be spread out to avoid long-term damage from short term closures. If farmers can't work, then we starve regardless of monetary measures taken.

[Xyril]

There's also the fact that "theoretically possible" and "actually feasible" are two different things. Dispatchers from my company can and have made the schedule with their cell phones, a netbook running off a hotspot from a different cell phone, and paper records. But they were all in the same room at the time. Doing it from 4 different homes via a shared Google Docs spreadsheet is a lot more likely to see something go wrong. There's a lot of things that technically SHOULD work, and probably would with 6 months to get used to the transition and figure out new procedures, but that's 6 months from now, which doesn't help.

Well that's my whole point, isn't it? It is actually feasible given a few weeks to adapt, and not something that we need decades of technological development to pull off. Just to use your example, the only thing stopping your team of four from working from home isn't some technology of the future, it's just the fact that they haven't had a reason to adjust to working remotely (and apparently haven't heard of Skype or Zoom.)

Right now, a few specific industries and business models rely heavily on remote work because they see particularly clear benefits from doing so. For everyone else, it's a bunch of minor pros and cons that are largely situational. And not everyone will agree on what the priorities are. I personally like working around people--I see that as a drawback of remote work. Others feel the opposite way, I'm sure. Given all that, I'm not surprised that inertia wins out.

Maybe the risk of contagion changes that calculus now--maybe "everyone isn't all together in case of a new disease outbreak or terrorist attack" becomes the consideration that makes remote work the default for jobs that don't absolutely need to be done in person. Personally, I hope not. What I think is more likely is that businesses just become more prepared to transition: The default is working together in person, but they implement just enough training and tools so that if something happens, the sky isn't falling down and people aren't taking six months to adapt. Instead, it would be closer to our reaction to an earthquake or a hurricane: There's brief disruption as everyone adapts to the quarantine, and then enough people return to some semblance of normal that the economy as a whole bounces back.

[Liquor Box]

The difference between essential damage and inessential damage is whether that damage can be ameliorated by the way in which the lockdown is performed and associated measures and policies taken.

If restaurant waiters can't work, for example, then paying them not to work solves that issue - those losses can be spread out to avoid long-term damage from short term closures. If farmers can't work, then we starve regardless of monetary measures taken.

"Essential damage" is not a thing. You were talking about 'essential activities', which in this context usually means activities necessary to support societies function at the desired level (maintenance of food supply, medical etc).

You were arguing against my contention that mass isolation would cause massive economic loss. Your suggestion that we could remedy this by "paying people not to work". Who is going to pay the majority of the workforce to not work? Whoever it is (the employer or the government), there would be massive economic consequences.

[NichG]

"Essential damage" is not a thing. You were talking about 'essential activities', which in this context usually means activities necessary to support societies function at the desired level (maintenance of food supply, medical etc).

You were arguing against my contention that mass isolation would cause massive economic loss. Your suggestion that we could remedy this by "paying people not to work". Who is going to pay the majority of the workforce to not work? Whoever it is (the employer or the government), there would be massive economic consequences.

There are various ways to make this argument, but lets do the simple math one.

A hospital stay for a (non-fatal) Covid-19 case is about two weeks long, costs about $10k, and is needed in about 20% of cases. So if someone generates less than $2200 a month of economic surplus compared to them not working, the overall cost to the economy is the same at the level of that single person for a 1-month lockdown in which they absolutely cannot work at all versus just the 'just let everyone get sick' plan: 0.2 * ($10k hospital bill + $1100 for the 2 weeks lost) ~= $2200.

So basically, you pay as much to have them keep working as you would to have them stay home - it's just perhaps different people footing the bill in either case. If you take into account the people that person would likely infect (about 2.5 people on average per case) one step down the line, then the break-even point is $5500/month economic production. If the person could work at some percentage of full efficiency during lockdown, divide by that fraction.

This is not taking into account the added costs of death, costs of having synchronized impacts to the workforce due to failure of infrastructure versus desynchronized ones, how easy it is to bounce back from or legislate around different kinds of economic slow-down (which was the reason for my point about essential/non-essential), etc. And it's not yet taking into account that the one route involves deaths and the other route doesn't. In safety cost calculations, the value of a life in the sense of 'how much is too much to ask someone to pay to reduce deaths by 1 in aggregate' is about $10M. If 1% of cases lead to a death, then just on the deaths alone over a year of lockdown would still be break-even. The place where that breaks down is deaths from associated economic damage, but again in that case it matters whether those deaths could be prevented or not through attendant strategies, and that comes back to essential versus non-essential labor.

So yeah, I think that if for example you just paid food service people to stay home, you can actually save quite a lot of money in the long run. There are practical difficulties in implementing that (which verges into politics, so lets not), but at least from the point of view of what a hypothetical society with 50 years of prep time to the next pandemic could implement, it's a good option to consider.

[Chen]

$2200/month is only around $13.75/hour full time. I can’t fathom what industry actually produces less than that per employee.

[NichG]

$2200/month is only around $13.75/hour full time. I can’t fathom what industry actually produces less than that per employee.

That's about double US minimum wage, and restaurant margins for example are only ~3-5%, so there are plenty of jobs around the world that would fall into that range (which, note, doesn't take into account the people that person will infect), and in fact those are the jobs most likely to have high social contact and therefore anomalously large degrees of transmission of infection.

[Chen]

That's about double US minimum wage, and restaurant margins for example are only ~3-5%, so there are plenty of jobs around the world that would fall into that range (which, note, doesn't take into account the people that person will infect), and in fact those are the jobs most likely to have high social contact and therefore anomalously large degrees of transmission of infection.

Wages to revenue ratio shouldn’t be more than 30-35% for restaurants. We’re talking about how much money someone produces not how much they are paid.

[Liquor Box]

There are various ways to make this argument, but lets do the simple math one.

A hospital stay for a (non-fatal) Covid-19 case is about two weeks long, costs about $10k, and is needed in about 20% of cases. So if someone generates less than $2200 a month of economic surplus compared to them not working, the overall cost to the economy is the same at the level of that single person for a 1-month lockdown in which they absolutely cannot work at all versus just the 'just let everyone get sick' plan: 0.2 * ($10k hospital bill + $1100 for the 2 weeks lost) ~= $2200.

Even putting aside Chen's points and assuming your un-sourced figures are correct, this argument doesn't work for what we were discussing.

The flaw is that your math rests on an assumption that every single worker WILL get sick. Of course if you know a particular person will get (or is) sick it's better to isolate them. I think everyone would agree that's a no-brainer. But we weren't talking about isolating only people who were sick, we were talking about isolating the entire population.

I take it from your later answers that your figures are from the US, so lets stick with that example. On current figures only 1 in every 10,000 Americans has had the virus. Lets assume that the proportion of workers who are sick is consistent (in reality its likely to be lower because the elderly are worse effected).

So that means cost of the risk of sickness for a given person is the $12,200 (hospital plus time off work) divided by 10,000 (the chance of actually getting sick) = $1.22, and then divided by 5 (the chance the sickness requires a hospital visit.

So while I accept that it's possible that the average cost for a person who does get sick might be $2,200, the cost of 40,000 or so people getting sick averaged over the population is less than a dollar.

Now the flaw in my argument is similar to the flaw in yours. You assume that everyone will be sick. I assume sickness rates at their current levels. The truth (if isolation didn't happen) would almost certainly be somewhere in between. But the math holds even if tens of millions of people were sick. Even if 50 million people were sick your $2,200 figure would be divided by 6 (50m being a 6th of the population). So, my opinion remains that mass isolation is likely to cause much more economic damage than the cost of letting covid-19 run its course. As I said previously, that has to be balanced against the non-economic cost.


So yeah, I think that if for example you just paid food service people to stay home, you can actually save quite a lot of money in the long run. There are practical difficulties in implementing that (which verges into politics, so lets not), but at least from the point of view of what a hypothetical society with 50 years of prep time to the next pandemic could implement, it's a good option to consider.

So yeah, I think that even using a relatively low paid person (waiter) as an example the cost of sending him/her home greatly outweighs the cost of keeping him/her at work from the risk of exposure to the virus (unless infection rate approaches 100%).

[Tyndmyr]

That's a bit extreme. Diseases, by and large, aren't all that deadly. A really nasty illness might have a 30-40% mortality rate. Very few diseases go higher than that, and as far as I know, none of them are pandemic material - nor are any pandemics likely to approach that threshold. Humanity could survive a 40% reduction in numbers, as a species. Not only would you need to have the disease be unbelievably deadly and ridiculously infectious, but you'd also have to somehow confuse it with an almost harmless disease in order for humanity as a whole to be threatened.

I mean, it's still risky because of the threats to daily life and civilization, but the line between a civilization-changing event and "welp, there goes humanity" is very thick, indeed.

Fair, I did engage in a bit of hyperbole. Some humans would undoubtedly survive, even if our current civilization does not. Still, if we're including existential risk, that seems like a big enough deal to be a huge point against this plan.

As for the economic calculation, a bit more has to go into that, I think. Lives lost are most certainly an economic cost, and a fairly large one. Looking at it merely as a function of time off work doesn't even capture it all. Consider a person who is retired, sure, if they get sick or die, no time off work may be lost, but there is most certainly still a cost. That person may contribute to society in other ways outside of a job. Grandma watches the grandkids when the middle generation needs to work, sometimes? Well, child care ain't free. And when we're talking about deaths, they have impacts on others as well. You get a call saying someone you love has died, and you will probably no longer be working at top efficiency, yknow?

So, if you're accepting something like a 20% illness rate or worse, and a sizable death percentage out of those(Italy has taken action, and still has something like a 6% death rate, right? It climbs as more are sick, so if 20% of the population were sick at once, it'd be an ugly death rate) and we're talking about immense costs.

I'm all for figuring out how to optimize the economic impact of this, but even something like "only" losing 2% of the population would be crushingly bad.

[NichG]

Even putting aside Chen's points and assuming your un-sourced figures are correct, this argument doesn't work for what we were discussing.

The flaw is that your math rests on an assumption that every single worker WILL get sick. Of course if you know a particular person will get (or is) sick it's better to isolate them. I think everyone would agree that's a no-brainer. But we weren't talking about isolating only people who were sick, we were talking about isolating the entire population.

I take it from your later answers that your figures are from the US, so lets stick with that example. On current figures only 1 in every 10,000 Americans has had the virus. Lets assume that the proportion of workers who are sick is consistent (in reality its likely to be lower because the elderly are worse effected).

The figure I used was actually from South Korea. I've seen a figure reported for the US that someone without insurance was charged $40k for the full treatment for their coronavirus case, but generally US medical costs are a significant outlier in terms of the world-wide situation so I went with the more conservative number.



So that means cost of the risk of sickness for a given person is the $12,200 (hospital plus time off work) divided by 10,000 (the chance of actually getting sick) = $1.22, and then divided by 5 (the chance the sickness requires a hospital visit.

So while I accept that it's possible that the average cost for a person who does get sick might be $2,200, the cost of 40,000 or so people getting sick averaged over the population is less than a dollar.

Now the flaw in my argument is similar to the flaw in yours. You assume that everyone will be sick. I assume sickness rates at their current levels. The truth (if isolation didn't happen) would almost certainly be somewhere in between. But the math holds even if tens of millions of people were sick. Even if 50 million people were sick your $2,200 figure would be divided by 6 (50m being a 6th of the population). So, my opinion remains that mass isolation is likely to cause much more economic damage than the cost of letting covid-19 run its course. As I said previously, that has to be balanced against the non-economic cost.


If you don't mitigate this pretty much everyone will get it. The herd immunity point given the observed replication rate of the virus is something like 60-70% of the population. If less people than that get it, then there won't actually be enough systematic immunity in the population for it to stop growing given it's current observed dynamics. So that's a factor less than 2x from the back of the envelope estimate.

[Liquor Box]

The figure I used was actually from South Korea. I've seen a figure reported for the US that someone without insurance was charged $40k for the full treatment for their coronavirus case, but generally US medical costs are a significant outlier in terms of the world-wide situation so I went with the more conservative number.

Why did you compare it to the US minimum wage then?

Anyway, that doesn't change the maths much. If ultimate infection rates are short of circa 50% then it probably does less economic harm to allow the virus to run its course than to isolate.


If you don't mitigate this pretty much everyone will get it. The herd immunity point given the observed replication rate of the virus is something like 60-70% of the population. If less people than that get it, then there won't actually be enough systematic immunity in the population for it to stop growing given it's current observed dynamics. So that's a factor less than 2x from the back of the envelope estimate.

I don't agree that there would necessarily be near 100% infection rate if only minimal isolation steps are taken (isolating people as they get sick). If I have missed, perhaps you could direct me to a source, but I haven't sene any expert opinion estimating a near 100% infection rate.

The other side of the coin is that you could isolate people for a month and then have them get infected anyway, because the virus survives the isolation period. That is especially true in circumstances where different countries are isolating differently.

So for the economic harm of not mass isolating as against the economic harm of isolating to be as you suggest, we would have to assume two things (neither of which is a given, or even likely):

A very high infection rate from not isolating (approaching 100%); as well as
Isolation for four weeks being effective in limiting the spread of the virus to a very small proportion of the population.


If either of those things is not true then self isolating for a month appears to be a higher economic cost than not doing so. That higher economic cost must then be balanced against the non-economic factors (people dying). But it's certainly not a no-brainer.

[Xyril]

Why did you compare it to the US minimum wage then?


Presumably because they didn't have access to South Korean minimum wage figures and didn't have access to comparable U.S. figures. In addition to problem they mentioned of a lot of U.S. costs being higher due to our particular insurance/payment scheme, we are earlier on the initial infection timeline. Out of the countries already well into the disease cycle, South Korea has the best published data and serves as the best--though still imperfect--analog for ball-parking U.S. costs. They are a largely free-market liberal democracy with supply chains and trade/tariff schemes that largely align with the U.S. (at least, more so than China or Iran.)

[NichG]

Why did you compare it to the US minimum wage then?

Anyway, that doesn't change the maths much. If ultimate infection rates are short of circa 50% then it probably does less economic harm to allow the virus to run its course than to isolate.



I don't agree that there would necessarily be near 100% infection rate if only minimal isolation steps are taken (isolating people as they get sick). If I have missed, perhaps you could direct me to a source, but I haven't sene any expert opinion estimating a near 100% infection rate.


This is a study looking at a number of response strategies: https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf

It estimates 81% coverage in the no-intervention case, and that partial mitigations (quarantine of only those showing symptoms for example) don't reduce things by all that much.

In terms of mixed approaches, the good news is that small clusters of outbreaks seem like they can be managed if you test proactively. So a handful of infected travelers won't necessarily ruin the whole thing.

[SerenaRaeyld]

I realize these forums are known for going wildly off-topic. However, I've just got to ask:

At what point did we shift from asking "How do we prevent a pandemic in the future" to asking "How much money would we have to save before it's worth an extra 39,000,000 (thirty-nine million) deaths world-wide conservatively*?

Let alone "Hey, we could, as a species, survive if we just let a pandemic whack 4 out of every 10 people dead. My financial situation (assuming I survived) would probably be aces!"


*Back of napkin/Excel calculation assuming 50% (low-estimate herd immunity) infection of 7.8 billion world population with lower-end 1% morality rate, not even taking into account that lack of curve-flattening measures (just continuing to go about our business) would likely overwhelm local health-systems and push that mortality rate much higher.

[Tyndmyr]

At what point did we shift from asking "How do we prevent a pandemic in the future" to asking "How much money would we have to save before it's worth an extra 39,000,000 (thirty-nine million) deaths world-wide conservatively*?

It isn't unreasonable to do cost-effectiveness assessments on if a specific thing is worthwhile.

But yes, in this case, quite a lot is worthwhile. Even if one is taking a fairly callous outlook on human life, plagues are not historically associated with wealth. Quite the opposite. Plague and famine both tend to result in the diminishing of financial outlook. War, well...at least some can make a fairly tidy profit off that, but mass disease is harder to dodge the effects of.

[Liquor Box]

This is a study looking at a number of response strategies: https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf

It estimates 81% coverage in the no-intervention case, and that partial mitigations (quarantine of only those showing symptoms for example) don't reduce things by all that much.

In terms of mixed approaches, the good news is that small clusters of outbreaks seem like they can be managed if you test proactively. So a handful of infected travelers won't necessarily ruin the whole thing.

Sorry to be late on the response, work has been a bit crazy.

On my read case isolation alone is a 33% reduction of the 81%. Case isolation and voluntary/elder social distancing combined reduce the 81% by 67%. So that study suggests that you can get infection rates well below 50% without isolating your workforce.


I realize these forums are known for going wildly off-topic. However, I've just got to ask:

At what point did we shift from asking "How do we prevent a pandemic in the future" to asking "How much money would we have to save before it's worth an extra 39,000,000 (thirty-nine million) deaths world-wide conservatively*?

Let alone "Hey, we could, as a species, survive if we just let a pandemic whack 4 out of every 10 people dead. My financial situation (assuming I survived) would probably be aces!"


*Back of napkin/Excel calculation assuming 50% (low-estimate herd immunity) infection of 7.8 billion world population with lower-end 1% morality rate, not even taking into account that lack of curve-flattening measures (just continuing to go about our business) would likely overwhelm local health-systems and push that mortality rate much higher.

As Tyndmyr said, it is relevant to consider the cost.

Not least of all because there is a clear relationship between the economy and health generally. In other words, even if we managed to avoid covid-19 killing anyone directly, the recession/depression resulting form mass isolation would probably lead to a large number of deaths - intuitively I assume it would be less deaths that 39m worldwide, but I'm not certain of that.

Even in first world countries (ignoring the more difficult plight of third world countries) mass isolation will dramatically increase the poverty rate. Those of us who are able to afford it, might be able to sit back and say that the economic consequences of covid-19 are much less important, but many people will really struggle with a month or more without income - those who lose their homes due to the economic downturn might feel differently.

Add to that the fact that mass self isolation may well not be completely effective either, because countries will isolate t seperate times etc, and we may do all that economic damage (including health impacts) and only partly avoid the covid-19 deaths you mention.

I'm not saying its wrong to do mass isolation of the population. I'm only saying it's not an obvious decision, or one that every country should have made immediately.

[Themrys]

I feel that we are doing the best we can with Coronavirus but humanity is still too primitive to truly eradicate a pandemic. If Coronavirus hit America in 2070 instead of 2020; what might we do different?

Probably nothing. Because most people are too stupid to learn from the past.

We could have learnt from the Spanish Flu. It was long ago, but not that long ago. Data about it exist.

In Germany, we could have looked at Italy and immediately acted. Did we? No, we didn't. (Well, our politicians. If that was my job, I would have cancelled all parties and other not-at-all-important stuff from the day the first case arrived. Perhaps even before that, as the first known case will never be the real first case.)

Some experts didn't even bother looking at the Spanish Flu data before giving recommendations or making predictions. I recall reading somewhere that one expert changed his opinion after an US colleague mailed him Spanish Flu data.

One might hope that, in the future, we will have a better health system (Germany still copes, but the medical personnel are overworked as is, and have been before Coronavirus already), better social system (so that everyone can afford to stay home from work for a month or two) and a population who panics less and acts more sensibly.

Scientific progress is nice to have, but it is very, very foolish to rely on it alone.

It is a very simple matter: Even the best treatment has to be applied by a qualified person. The more complex it is, the better trained the person applying it has to be. And if everyone gets sick at the same time, then no one is able to apply the treatment.
Even assuming health personnel won't get sick, a 300% increase in patients is just too much. That's why we need to flatten the curve, and why it is callous and cruel to suggest to "just let it run its course" when some patients will only survive with good treatment. Treatment that can only be guaranteed by flattening the curve.

[Brother Oni]

Probably nothing. Because most people are too stupid to learn from the past.

Thankfully, some countries do. After the SARS outbreaks a few years ago, places in the Far East have experience in dealing with a respiratory virus like this one, so they knew exactly what to do and how to avoid it. South Korea, Taiwan, Japan and Singapore for example are coping very well.

[Tyndmyr]

Some experts didn't even bother looking at the Spanish Flu data before giving recommendations or making predictions. I recall reading somewhere that one expert changed his opinion after an US colleague mailed him Spanish Flu data.

I mean, it's not really common medical practice any more to prescribe 50 aspirin for the flu. Some historical lessons are interesting, but perhaps of limited relevance to modern medical practice.

[NichG]

I mean, it's not really common medical practice any more to prescribe 50 aspirin for the flu. Some historical lessons are interesting, but perhaps of limited relevance to modern medical practice.

Looking at distancing measures and lack thereof and their outcomes is relevant information we can get from that period. For example, St. Louis implemented a number of shut-down measures during the 1918 wave and was able to keep the death toll to 1700, whereas Philadelphia had business as usual (and held a parade with 200k attendees) and ended up with 16k deaths (a better measure might be deaths per 100k people, which was ~750 for Philadelphia and ~300 for St. Louis). Of course, direct causality of the form 'the parade was responsible for X amount of deaths' would be an overclaim, but at the very least there'd be a range of outcomes and a number of potential correlations to study and confirm against possible causal models.

The various intervals in which gatherings/etc were banned are public record, as are the case curves, so you actually can get some idea of e.g. how bad the bounce can be if you relax quarantine at a certain stage of the process (as well as the cost of delays or gains from acting early).

[NotASpiderSwarm]

Thankfully, some countries do. After the SARS outbreaks a few years ago, places in the Far East have experience in dealing with a respiratory virus like this one, so they knew exactly what to do and how to avoid it. South Korea, Taiwan, Japan and Singapore for example are coping very well.
Japan's not testing much, so it's hard to claim they're actually doing well. It's the usual "If we don't test, we have no cases, and therefore there's no problem" problem. In a month, maybe they're still great, maybe they're worse than Italy.

[Brother Oni]

Japan's not testing much, so it's hard to claim they're actually doing well. It's the usual "If we don't test, we have no cases, and therefore there's no problem" problem. In a month, maybe they're still great, maybe they're worse than Italy.

Anecdotally, my in-laws in Japan are doing fine. While shops were cleared out at the start of their crisis back in Janurary, things have started to return to normal (they even offered to send us food in the UK in response to the news reports of our shops being bare!).

Officially, despite Japan's`s first confirmed COVID-19 case back in January, things are only starting to get worse now with a weekend long lockdown in Osaka prefecture and they're debating a 2 week lockdown in Tokyo now.
There's been no massive spike in the deaths of vulnerable groups as far as I can tell, so something must have been working in their favour to naturally slow the progress of the disease. There's a fair amount of debate over what that actually is, but the most popular hypothesis is the lack of human to human contact in social settings (e.g. bowing instead of handshakes), people already wearing masks if they have a case of the sniffles, never directly handing cash to shop assistants, etc.

One thing that's struck me is the limiting of contact at things like fast food places; people may be aware of the new system that MacDonalds has brought in where you order on a screen then pick up your food from the counter - they've been doing that in many places inJapan for decades.

For the UK folks, I wonder if this is the future for all shop buying - every place becomes like Argos? :smallbiggrin:

[NichG]

Anecdotally, my in-laws in Japan are doing fine. While shops were cleared out at the start of their crisis back in Janurary, things have started to return to normal (they even offered to send us food in the UK in response to the news reports of our shops being bare!).

Officially, despite Japan's`s first confirmed COVID-19 case back in January, things are only starting to get worse now with a weekend long lockdown in Osaka prefecture and they're debating a 2 week lockdown in Tokyo now.
There's been no massive spike in the deaths of vulnerable groups as far as I can tell, so something must have been working in their favour to naturally slow the progress of the disease. There's a fair amount of debate over what that actually is, but the most popular hypothesis is the lack of human to human contact in social settings (e.g. bowing instead of handshakes), people already wearing masks if they have a case of the sniffles, never directly handing cash to shop assistants, etc.

One thing that's struck me is the limiting of contact at things like fast food places; people may be aware of the new system that MacDonalds has brought in where you order on a screen then pick up your food from the counter - they've been doing that in many places inJapan for decades.

For the UK folks, I wonder if this is the future for all shop buying - every place becomes like Argos? :smallbiggrin:

I'm in Tokyo, and it's been pretty heterogeneous. I know a lot of people who can't find toilet paper or paper towels, and just recently there was a rush on food items. But we mostly order things online and there was a lag between when the physical stores were out of stock and when that propagated to online stores.

I've mostly been staying at the apartment for the last month, but when I last went out two weeks ago I saw a combination of some usual places being totally empty (including the local hospital - there was literally no one sitting where I was waiting, and that waiting space was shared with the respiratory illness department) - but other things being business as usual in terms of crowded trains/etc. My company has basically said 'work from home if you can' and so I have been, but other people are out at hanami, or going to boxing matches, clubs, and other large-scale crowded events. For every drunk college kid in the US saying 'I'm not going to have my spring break ruined by Covid-19' it seems like there's someone here who gets on the news and says 'dancing will protect me from the virus' or other sorts of bravado/'everything is fine and I will prove it' type behaviors. There's a preschool near my apartment and it's basically going on full blast even with the general school closures that were put into effect (since it's basically a daycare and therefore an independent business, I guess).

Japan's current trajectory is pretty hard to explain I think. It's not likely to be from under-testing because the overall death rate this season hasn't been noticeably different (and if anything, it's a mild flu season compared to previous ones). The mask use thing is the most coherent argument I've heard - not just reduced infections, but also that if people get infected and were wearing a mask then the initial viral load would be lower and so it'd be more likely to be a mild/less infectious case. That would be consistent with the curves in other countries in the area where mask-wearing is normal and socially expected being generally slower than curves in western countries where there's a stigma against masks as well as ongoing shortages.

However, I don't know of any systematic attempts to really figure out what's going on, and generally there has been significant pressure both governmental and social against testing here. The founder of Softbank offered to donate a million free tests, and they were publically chastised for potentially flooding the health system. So, um...