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  1. - Top - End - #61
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    Default Re: How might we stop a pandemic in the future?

    Quote Originally Posted by Strigon View Post
    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.
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  2. - Top - End - #62
    Ettin in the Playground
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    Default Re: How might we stop a pandemic in the future?

    Quote Originally Posted by Liquor Box View Post
    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.

  3. - Top - End - #63
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    Default Re: How might we stop a pandemic in the future?

    Quote Originally Posted by NichG View Post
    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.

  4. - Top - End - #64
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    Default Re: How might we stop a pandemic in the future?

    Quote Originally Posted by Liquor Box View Post
    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.)

  5. - Top - End - #65
    Ettin in the Playground
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    Default Re: How might we stop a pandemic in the future?

    Quote Originally Posted by Liquor Box View Post
    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/imp...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.
    Last edited by NichG; 2020-03-24 at 06:15 PM.

  6. - Top - End - #66
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    Default Re: How might we stop a pandemic in the future?

    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.

  7. - Top - End - #67
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    Default Re: How might we stop a pandemic in the future?

    Quote Originally Posted by SerenaRaeyld View Post
    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.
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  8. - Top - End - #68
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    Default Re: How might we stop a pandemic in the future?

    Quote Originally Posted by NichG View Post
    This is a study looking at a number of response strategies: https://www.imperial.ac.uk/media/imp...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.

    Quote Originally Posted by SerenaRaeyld View Post
    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.

  9. - Top - End - #69
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    Default Re: How might we stop a pandemic in the future?

    Quote Originally Posted by Maximum77 View Post
    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.

  10. - Top - End - #70
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    Default Re: How might we stop a pandemic in the future?

    Quote Originally Posted by Themrys View Post
    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.

  11. - Top - End - #71
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    Default Re: How might we stop a pandemic in the future?

    Quote Originally Posted by Themrys View Post
    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.
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  12. - Top - End - #72
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    Default Re: How might we stop a pandemic in the future?

    Quote Originally Posted by Tyndmyr View Post
    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).
    Last edited by NichG; 2020-03-27 at 11:59 AM.

  13. - Top - End - #73
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    Default Re: How might we stop a pandemic in the future?

    Quote Originally Posted by Brother Oni View Post
    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.

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    Default Re: How might we stop a pandemic in the future?

    Quote Originally Posted by NotASpiderSwarm View Post
    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?
    Last edited by Brother Oni; 2020-03-28 at 03:38 AM.

  15. - Top - End - #75
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    Default Re: How might we stop a pandemic in the future?

    Quote Originally Posted by Brother Oni View Post
    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?
    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...
    Last edited by NichG; 2020-03-28 at 05:28 AM.

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